Post-traumatic stress disorder and risk of dementia among U.S. veterans

CONTEXT Posttraumatic stress disorder (PTSD) is highly prevalent among US veterans because of combat and may impair cognition. OBJECTIVE To determine whether PTSD is associated with the risk of developing dementia among older US veterans receiving treatment in the Department of Veterans Affairs medical centers. DESIGN A stratified, retrospective cohort study conducted using the Department of Veterans Affairs National Patient Care Database. SETTING Department of Veterans Affairs medical centers in the United States. PARTICIPANTS A total of 181 093 veterans 55 years or older without dementia from fiscal years 1997 through 2000 (53 155 veterans with and 127 938 veterans without PTSD). MAIN OUTCOME MEASURES During the follow-up period between October 1, 2000, and December 31, 2007, 31 107 (17.2%) veterans were ascertained to have newly diagnosed dementia according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS The mean baseline age of the veterans was 68.8 years, and 174 806 (96.5%) were men. Veterans with PTSD had a 7-year cumulative incident dementia rate of 10.6%, whereas those without had a rate of 6.6% (P < .001). With age as the time scale, Cox proportional hazards models indicated that patients with PTSD were more than twice as likely to develop incident dementia compared with those without PTSD (hazard ratio, 2.31; 95% confidence interval, 2.24-2.39). After multivariable adjustment, patients with PTSD were still more likely to develop dementia (hazard ratio, 1.77; 95% confidence interval, 1.70-1.85). Results were similar when we excluded those with a history of head injury, substance abuse, or clinical depression. CONCLUSIONS In a predominantly male veteran cohort, those diagnosed as having PTSD were at a nearly 2-fold-higher risk of developing dementia compared with those without PTSD. Mechanisms linking these important disorders need to be identified with the hope of finding ways to reduce the increased risk of dementia associated with PTSD.

[1]  Henry Völzke,et al.  Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: evidence from the general population. , 2010, Journal of psychiatric research.

[2]  D. Kozaric-Kovacic,et al.  Homocysteine and serum lipids concentration in male war veterans with posttraumatic stress disorder , 2009, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[3]  Charles W Hoge,et al.  Mild traumatic brain injury in U.S. Soldiers returning from Iraq. , 2008, The New England journal of medicine.

[4]  C. Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. , 2004, U.S. Army Medical Department journal.

[5]  J. Talbott.  Neuropsychological Outcomes of Army Personnel Following Deployment to the Iraq War , 2008 .

[6]  Michael W Weiner,et al.  Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. , 2006, Neuropsychology.

[7]  Philip D. Harvey,et al.  Longitudinal Assessment of Cognitive Performance in Holocaust Survivors with and without PTSD , 2006, Biological Psychiatry.

[8]  B. Dohrenwend,et al.  The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods , 2006, Science.

[9]  S. Orr,et al.  Neurocognitive function in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder. , 2006, Journal of abnormal psychology.

[10]  B. Roozendaal,et al.  Do Corticosteroids Damage the Brain? , 2006, Journal of neuroendocrinology.

[11]  Y. Stern.  Cognitive Reserve and Alzheimer Disease , 2006, Alzheimer disease and associated disorders.

[12]  Philip D. Harvey,et al.  Relationship between cortisol and age-related memory impairments in Holocaust survivors with PTSD , 2005, Psychoneuroendocrinology.

[13]  Eirini Flouri,et al.  Post-Traumatic Stress Disorder (PTSD) , 2005, Journal of interpersonal violence.

[14]  Joseph A Boscarino,et al.  Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies , 2004, Annals of the New York Academy of Sciences.

[15]  D. Alexander,et al.  Disturbance of pro-inflammatory cytokines in post-traumatic psychopathology. , 2003, Cytokine.

[16]  C. Rosen,et al.  Causes of Death Among Male Veterans Who Received Residential Treatment for PTSD , 2003, Journal of traumatic stress.

[17]  Marylene Cloitre,et al.  Enhanced cellular immune response in women with PTSD related to childhood abuse. , 2003, The American journal of psychiatry.

[18]  Kurt J. Bauman,et al.  Educational Attainment: 2000. Census 2000 Brief. , 2003 .

[19]  S. Rubin,et al.  Inflammatory markers and cognition in well-functioning African-American and white elders , 2003, Neurology.

[20]  C. Jack,et al.  Brain MRI hippocampal volume and prediction of clinical status in a mild cognitive impairment trial , 2002, Journal of Molecular Neuroscience.

[21]  Sudha Seshadri,et al.  Plasma Homocysteine as a Risk Factor for Dementia and Alzheimer's Disease , 2002 .

[22]  N. Schuff,et al.  Decreased hippocampal N-acetylaspartate in the absence of atrophy in posttraumatic stress disorder , 2001, Biological Psychiatry.

[23]  D. Mittal,et al.  Worsening of Post-Traumatic Stress Disorder Symptoms with Cognitive Decline: Case Series , 2001, Journal of geriatric psychiatry and neurology.

[24]  R. Miller,et al.  C-reactive protein and interleukin 6 receptor in post-traumatic stress disorder: a pilot study. , 2001, Cytokine.

[25]  Deirdre D. Johnston.  A Series of Cases of Dementia Presenting with PTSD Symptoms in World War II Combat Veterans , 2000, Journal of the American Geriatrics Society.

[26]  Alison H. Paris,et al.  Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[27]  K Yaffe,et al.  Depressive symptoms and cognitive decline in nondemented elderly women: a prospective study. , 1999, Archives of general psychiatry.

[28]  J. D. Hamilton,et al.  Persistence of Combat-Related Posttraumatic Stress Symptoms for 75 Years , 1998, Journal of traumatic stress.

[29]  J M Golding,et al.  Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. , 1997, The American journal of psychiatry.

[30]  D. Kaloupek,et al.  Comorbid Psychiatric Disorders in PTSD , 1997, Annals of the New York Academy of Sciences.

[31]  S. Southwick,et al.  MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. , 1995, The American journal of psychiatry.

[32]  W. Kamphorst,et al.  Increased Cortisol Levels in Aging and Alzheimer's Disease in Postmortem Cerebrospinal Fluid , 1994, Journal of neuroendocrinology.

[33]  P. Schnurr,et al.  Combat-related posttraumatic stress disorder symptoms in older men. , 1994, Psychology and aging.

[34]  S. Southwick,et al.  Deficits in short-term memory in posttraumatic stress disorder. , 1993, The American journal of psychiatry.

[35]  Charles R. Marmar,et al.  Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjus , 1990 .

[36]  S. Hulley,et al.  Delayed effects of the military draft on mortality. A randomized natural experiment. , 1986, The New England journal of medicine.

[37]  R. Yehuda.  POST-TRAUMATIC STRESS DISORDER , 1985, The Lancet.

[38]  K. Kupka,et al.  International classification of diseases: ninth revision. , 1978, WHO chronicle.