PTSD, Psychotropic Medication Use, and the Risk of Dementia Among US Veterans: A Retrospective Cohort Study.
OBJECTIVE
To determine the associations between PTSD, psychotropic medication use, and the risk for dementia.


METHODS
Retrospective cohort.


METHODS
Nationwide sample of US veterans (N = 417,172) aged ≥56 years during fiscal year (FY) 2003 without a diagnosis of dementia or mild cognitive impairment at baseline (FY02-03) and ≥1 clinical encounter every 2 years during follow-up (FY04-12).


METHODS
Demographic characteristics; diagnosis of PTSD, dementia, and medical and psychiatric comorbidity (defined by ICD-9 codes); and psychotropic medication use including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), novel antidepressants (NA), benzodiazepines (BZA), and atypical antipsychotics (AA). Cox proportional hazard models examined for associations between PTSD diagnosis, psychotropic medication use, and risk for a dementia diagnosis.


RESULTS
PTSD diagnosis significantly increased the risk for dementia diagnosis (HR = 1.35; [95% CI = 1.27-1.43]). However, there were significant interactions between PTSD diagnosis and use of SSRIs (P < .001), NAs (P = .014), and AAs (P < .001) on the risk for dementia diagnosis. HR for dementia diagnosis among veterans diagnosed with PTSD and not using psychotropic medications was 1.55 [1.45-1.67]. Among veterans diagnosed with PTSD prescribed SSRI, SNRI, or AA, HR for dementia diagnosis varied by drug class use ranging from 1.99 for SSRI to 4.21 for AA, relative to veterans without a PTSD diagnosis and no psychotropic medication receipt. BZAs or SNRIs use at baseline was associated with a significantly increased risk for dementia diagnosis independent of a PTSD diagnosis.


CONCLUSIONS
PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic medications. Further research would help to delineate if these findings are due to differences in PTSD severity, psychiatric comorbidity, or independent effects of psychotropic medications on cognitive decline.
Department of Epidemiology, University of Iowa, Iowa City, Iowa.
Francis
F
Mawanda
Department of Epidemiology, University of Iowa, Iowa City, Iowa.|Department of Medicine, University of Iowa, Iowa City, Iowa.
Robert B
RB
Wallace
Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa.
Kimberly
K
McCoy
Department of Epidemiology, University of Iowa, Iowa City, Iowa.|Department of Medicine, University of Iowa, Iowa City, Iowa.|Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa.
Thad E
TE
Abrams
D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy*; D014728:Veterans / Q000523:psychology*
D014150:Antipsychotic Agents; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors

PTSD
; dementia; psychotropic drugs; veterans