Age-Related Macular Degeneration and Risk of Degenerative Dementia among the Elderly in Taiwan: A Population-Based Cohort Study.
OBJECTIVE
To investigate the relationship between age-related macular degeneration (AMD) and future development of Alzheimer's disease (AD) or senile dementia.


METHODS
A longitudinal case-control study using the Taiwan National Health Insurance Research Database.


METHODS
From 2001 to 2009, the newly diagnosed AMD cases aged ≥65 years in the database were recruited as the AMD cohort (n=4993). Of those, there were 540 with and 4453 without exudative AMD diagnoses. Subjects without any AMD, matched for age, gender, and time of enrollment, were randomly sampled as the control cohort (n=24,965) for comparison.


METHODS
Alzheimer's disease/senile dementia-free survival analysis was assessed using a Kaplan-Meier method. Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of AD or senile dementia for the 2 cohorts after adjusting for preexisting comorbidities and number of clinical visits.


METHODS
The first-ever diagnosis of AD or senile dementia during the observation period.


RESULTS
Of the 29 958 sampled subjects, 1589 (5.3%) were diagnosed with AD or senile dementia during a mean follow-up period of 4.4 years, including 294 (5.9%) from the AMD cohort and 1295 (5.2%) from the control cohort. The incidence of AD or senile dementia was higher in patients with AMD than in the controls (P=0.044), with an HR of 1.44 (95% confidence interval [CI], 1.26-1.64) after adjusting for covariates. The stratified analysis showed that the adjusted HR for AD or senile dementia was 1.35 (95% CI, 0.89-2.06) for exudative AMD versus the controls and 1.44 (95% CI, 1.26-1.65) for nonexudative AMD versus the controls.


CONCLUSIONS
This study provides large-scale, population-based evidence that AMD, especially nonexudative AMD, is independently associated with an increased risk of subsequent AD or senile dementia development.
Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan.
Der-Chong
DC
Tsai
National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Shih-Jen
SJ
Chen
National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
Chin-Chou
CC
Huang
National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Radiology, National Yang-Ming University Hospital, Yilan, Taiwan.
May-Kang
MK
Yuan
National Yang-Ming University School of Medicine, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: hbleu@vghtpe.gov.tw.
Hsin-Bang
HB
Leu
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D057092:Geographic Atrophy / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology*