Cognitive impairment in glaucoma

Glaucoma, while regarded as an isolated ocular disorder, is now increasingly recognized as a component of a wider neurological spectrum. An accumulating body of neuroimaging-based studies have revealed structural and functional changes in the brain that are analogous to those observed in Parkinson's and Alzheimer's disease. These changes are further associated with systemic disturbances, including autonomic dysfunction, neuroinflammation, and elevated cortisol levels. This mounting evidence may elucidate the increased susceptibility of cognitive impairment and dementia observed in individuals with glaucoma. This article presents a narrative review of the existing literature. A thorough search was conducted across various databases, including PubMed, Scopus, and the Embase Library, without restriction on year of publication. This review consolidates various lines of evidence that underscore the common characteristic between glaucomatous optic neuropathy and neurodegenerative disorders. A range of pharmacological (anti-dementia medication, nootropic agent, cerebral metabolizers, and neutraceuticals) and nonpharmacological strategies (regular physical activity, meditation, sleep optimization, and dietary modification) and emerging modalities-including noninvasive brain stimulation, nanotechnology-based drug delivery systems, and artificial intelligence-guided therapeutic models-are broadening the scope of management beyond traditional approaches that not only target intraocular pressure reduction but also may support overall neuro-cognitive wellbeing. The establishment of a multidisciplinary framework is also vital, wherein an ophthalmologist works in collaboration with neurologists, psychologists, and rehabilitation specialists to facilitate thorough cognitive evaluation and timely treatment. This review underscores the need of safeguarding both visual and cognitive functions by recognizing glaucoma as an ocular disorder and neurodegenerative condition, aiming to improve long-term outcomes and quality of life.