{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:20:39Z","timestamp":1790266839514,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHMRC Scholarship"},{"name":"UTS Scholarship"},{"name":"NHMRC-ARC Dementia Research Fellowship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Glaucoma, the leading cause of irreversible blindness, is classified as a neurodegenerative disease, and its incidence increases with age. Pathophysiological changes, such as the deposition of amyloid-beta plaques in the retinal ganglion cell layer, as well as neuropsychological changes, including cognitive decline, have been reported in glaucoma. However, the association between cognitive ability and retinal functional and structural measures in glaucoma, particularly glaucoma subtypes, has not been studied. We studied the association between cognitive ability and the visual field reliability indices as well as the retinal ganglion cell (RGC) count estimates in a cohort of glaucoma patients. Methods: A total of 95 eyes from 61 glaucoma patients were included. From these, 20 were normal-tension glaucoma (NTG), 25 were primary open-angle glaucoma (POAG), and 16 were glaucoma suspects. All the participants had a computerised Humphrey visual field (HVF) assessment and optical coherence tomography (OCT) scan and were administered the written Montreal Cognitive Assessment (MoCA) test. RGC count estimates were derived based on established formulas using the HVF and OCT results. A MoCA cut-off score of 25 and less was designated as cognitive impairment. Student\u2019s t-test was used to assess differences between the groups. The Pearson correlation coefficient was used to assess the association between MoCA scores and retinal structural and functional measures. Results: Significant associations were found between MoCA scores and the false-negative and pattern standard deviation indices recorded on the HVF (r = \u22120.19, r = \u22120.22, p &lt; 0.05). The mean IOP was significantly lower in the cognitively impaired group (i.e., MOCA \u2264 25) (13.7 \u00b1 3.6 vs. 15.7 \u00b1 4.5, p &lt; 0.05). No significant association was found between RGC count estimates and MoCA scores. Analysis of these parameters in individual glaucoma subtypes did not reveal any group-specific significant associations either.<\/jats:p>","DOI":"10.3390\/jcm11175097","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T00:13:56Z","timestamp":1661904836000},"page":"5097","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Cognitive Performance on the Montreal Cognitive Assessment Test and Retinal Structural and Functional Measures in Glaucoma"],"prefix":"10.3390","volume":"11","author":[{"given":"Solmaz","family":"Bastani Viarsagh","sequence":"first","affiliation":[{"name":"Vision Science Group, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Er","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vision Science Group, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Shariflou","sequence":"additional","affiliation":[{"name":"Vision Science Group, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Agar","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Prince of Wales Hospital, University of New South Wales, Sydney 2031, Australia"},{"name":"Marsden Eye Specialists, Sydney 2150, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4479-3917","authenticated-orcid":false,"given":"S. Mojtaba","family":"Golzan","sequence":"additional","affiliation":[{"name":"Vision Science Group, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e4209","DOI":"10.1097\/MD.0000000000004209","article-title":"Estimating the rate of retinal ganglion cell loss to detect glaucoma progression an observational cohort study","volume":"95","author":"Hirooka","year":"2016","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1136\/bjophthalmol-2020-317461","article-title":"Normal-tension glaucoma is associated with cognitive impairment","volume":"106","author":"Mullany","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.ajo.2012.04.022","article-title":"Estimating the Rate of Retinal Ganglion Cell Loss in Glaucoma","volume":"154","author":"Medeiros","year":"2012","journal-title":"Am. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1159\/000496233","article-title":"Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment","volume":"18","author":"McCoskey","year":"2018","journal-title":"Neurodegener. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1016\/j.ophtha.2015.06.015","article-title":"Estimating Lead Time Gained by Optical Coherence Tomography in Detecting Glaucoma before Development of Visual Field Defects","volume":"122","author":"Kuang","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_6","first-page":"196","article-title":"Change in retinal structural anatomy during the preclinical stage of Alzheimer\u2019s disease","volume":"10","author":"Audia","year":"2018","journal-title":"Alzheimer\u2019s Dementia Diagn. Assess. Dis. Monit."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1093\/aje\/kwp453","article-title":"Original Contribution Untreated Poor Vision: A Contributing Factor to Late-Life Dementia","volume":"171","author":"Rogers","year":"2010","journal-title":"Am. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/j.ophtha.2014.06.047","article-title":"Relationship between Ganglion Cell Layer Thickness and Estimated Retinal Ganglion Cell Counts in the Glaucomatous Macula","volume":"121","author":"Zhang","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7095","DOI":"10.1038\/s41598-017-07714-7","article-title":"The association between structure-function relationships and cognitive impairment in elderly glaucoma patients","volume":"7","author":"Honjo","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/IJG.0000000000001269","article-title":"The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients","volume":"28","author":"Raman","year":"2019","journal-title":"J. Glaucoma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1212\/WNL.0b013e318230208a","article-title":"Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample","volume":"77","author":"Rossetti","year":"2011","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/aje\/kwh288","article-title":"Validity of the Clock-Drawing Test as a Screening Tool for Cognitive Impairment in the Elderly","volume":"160","author":"Nishiwaki","year":"2004","journal-title":"Am. J. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1001\/jamaophthalmol.2017.1279","article-title":"Association Between Neurocognitive Decline and Visual Field Variability in Glaucoma","volume":"135","author":"Daga","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1111\/jch.14391","article-title":"Impact of mean blood pressure and blood pressure variability after diagnosis of mild cognitive impairment and risk of dementia","volume":"23","author":"Muddasani","year":"2021","journal-title":"J. Clin. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.ajo.2004.04.054","article-title":"Risk assessment in the management of patients with ocular hypertension","volume":"138","author":"Weinreb","year":"2004","journal-title":"Am. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1442-9071.2012.02770.x","article-title":"\u2018Structure\u2013function relationship\u2019 in glaucoma: Past thinking and current concepts","volume":"40","author":"Malik","year":"2012","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1167\/iovs.10-5174","article-title":"A comparison of functional and structural measures for identifying progression of glaucoma","volume":"52","author":"Xin","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0002-9394(01)00964-3","article-title":"Risk factors for progression of visual field abnormalities in normal-tension glaucoma","volume":"131","author":"Drange","year":"2001","journal-title":"Am. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/S0161-6420(97)30173-0","article-title":"Analysis of Reliability Indices from Humphrey Visual Field Tests in an Urban Glaucoma Population","volume":"104","author":"Birt","year":"1997","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s10072-014-2055-3","article-title":"The relationship between the degree of cognitive impairment and retinal nerve fiber layer thickness","volume":"36","author":"Oktem","year":"2015","journal-title":"Neurol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.clineuro.2011.02.014","article-title":"Retinal thickness in patients with mild cognitive impairment and Alzheimer\u2019s disease","volume":"113","author":"Kesler","year":"2011","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000360279","article-title":"Comparison of the Diagnostic Accuracy of Neuropsychological Tests in Differentiating Alzheimer\u2019s Disease from Mild Cognitive Impairment: Can the Montreal Cognitive Assessment Be Better than the Cambridge Cognitive Examination?","volume":"4","author":"Martinelli","year":"2014","journal-title":"Dement. Geriatr. Cogn. Disord. Extra"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6939","DOI":"10.1167\/iovs.12-10345","article-title":"The Structure and Function Relationship in Glaucoma: Implications for Detection of Progression and Measurement of Rates of Change","volume":"53","author":"Medeiros","year":"2012","journal-title":"Investig. Opthalmology Vis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e914","DOI":"10.1111\/aos.14419","article-title":"Anatomical and functional changes in the retina in patients with Alzheimer\u2019s disease and mild cognitive impairment","volume":"98","author":"Szegedi","year":"2020","journal-title":"Acta Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/5097\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:20:30Z","timestamp":1760142030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/5097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,30]]},"references-count":25,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11175097"],"URL":"https:\/\/doi.org\/10.3390\/jcm11175097","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,30]]}}}