Posttraumatic stress disorder and risk of dementia among US veterans.
BACKGROUND
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.


METHODS
A stratified, retrospective cohort study conducted using the Department of Veterans Affairs National Patient Care Database.


METHODS
Department of Veterans Affairs medical centers in the United States.


METHODS
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).


METHODS
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.
San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. kristine.yaffe@ucsf.edu
Kristine
K
Yaffe
Eric
E
Vittinghoff
Karla
K
Lindquist
Deborah
D
Barnes
Kenneth E
KE
Covinsky
Thomas
T
Neylan
Molly
M
Kluse
Charles
C
Marmar
D000368:Aged; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*