Abstract
The eye is said to be the window into the brain. Alzheimer’s disease (AD) and glaucoma both being diseases of the elderly, have several epidemiological and histological overlaps in pathogenesis. Both these diseases are neurodegenerative conditions. Over the years, a consensus has developed that both may be two ends of a singular spectrum of diseases. Epidemiological studies have shown that more Alzheimer’s patients may be suffering from glaucoma than general healthy population. Retinal ganglion cell damage is a characteristic of both diseases, along with discovery of amyloid-β and tau protein deposition in the retina and aqueous humor of eye. The latter two proteins are known to be pathognomonic of AD. Other pathways such as the insulin receptor pathway also seem to be affected in both diseases similarly. In spite of these overlaps, there are few missing links which still need more evidence, namely, intraocular pressure mechanisms, cerebrospinal fluid pressure and trans-lamina cribrosa pressure gradients, vascular autoregulation factors, etc. Several factors point towards a common pathogenesis at some level for both diseases and prospective studies are necessary to study the natural course of both diseases.
摘要
眼睛是通往大脑的窗户。阿尔兹海默症 (Alzheimer’s disease, AD) 与青光眼均为老年性疾病, 在发病机制、流行病学以及组织病理学上有相同之处, 另外它们都是神经退行性疾病。多年来, 已经达成共识, 即这两者可能属于同一疾病谱。流行病学研究表明阿尔兹海默症患者青光眼的发病人数比一般健康人群多。视网膜神经节细胞损伤是这两种疾病的共同特征, 另外在视网膜和房水中发现β-淀粉样蛋白和tau蛋白沉积物, 后两种蛋白被认为是AD的病理学特征。其他通路如胰岛素受体通路在这两种疾病中均相似地受到影响。尽管两种疾病存在以上交叉, 但在球内压力机制、脑脊液压力和跨筛板压力梯度、血管自动调节因子等方面仍缺乏需要更多证据支持的关联。一些因素在一些程度上已经阐释了这两种疾病的共同发病机制, 前瞻性研究需要研究这两种疾病的自然病程.
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Sen, S., Saxena, R., Tripathi, M. et al. Neurodegeneration in Alzheimer’s disease and glaucoma: overlaps and missing links. Eye 34, 1546–1553 (2020). https://doi.org/10.1038/s41433-020-0836-x
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