Dementia More Prevalent among Older Veterans with PTSD
FINDINGS:
- Older Veterans with PTSD had twice the incidence and prevalence of dementia diagnoses, even after accounting for confounding illnesses, combat-related trauma (measured by receipt of a Purple Heart), and number of primary care visits.
- Rates of TBI were highest in the group with PTSD and a Purple Heart, while rates of stroke were slightly higher among the groups with PTSD (regardless of Purple Heart receipt). The prevalence of drug dependence and abuse and the rates of alcohol dependence and abuse were highest in the group with PTSD, but without a Purple Heart.
- The mechanism for the observed increased incidence and prevalence of dementia among Veterans with PTSD is unknown. Possibilities include a common risk factor underlying PTSD and dementia, or PTSD being a risk factor for dementia. Regardless, the authors suggest that veterans over 65 years of age with PTSD be considered for dementia screening.
BACKGROUND:
As many as 22% of OEF/OIF Veterans who used VA healthcare between 2002 and 2008 were diagnosed with PTSD. PTSD can be a chronic illness, and studies suggest that it may cause changes in attention, learning, memory, and executive functioning. Further, many risk factors for PTSD are also risk factors for dementia. This study sought to determine the association between PTSD and dementia in 10,481 older Veterans. Investigators assessed VA data for Veterans older than age 65 years, who had been seen at the VA at least twice from 10/97 to 09/99, and who had a diagnosis of PTSD or were Purple Heart recipients (with or without PTSD). Four groups of Veterans were compared: 1) those with PTSD only and no Purple Heart, 2) those with Purple Heart only and no PTSD, 3) those with PTSD and Purple Heart, and 4) a comparison group with neither PTSD and nor a Purple Heart. Diagnoses of PTSD, dementia, and other physical co-morbidities with known associations with dementia (e.g. stroke, TBI, alcohol/drug use/dependence) were obtained from VA outpatient encounters from 10/97 to 09/08.
LIMITATIONS:
- Results must be interpreted cautiously, since the analyses were based on administrative data
- Some important variables that can affect cognition or dementia diagnosis could not be included in this study, such as duration, severity, and treatment of PTSD, as well as medication use.
- Investigators were unable to ascertain the type of dementia associated with PTSD.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Qureshi, Petersen, and Kunik are part of HSR&D’s Houston Center for Quality of Care & Utilization Studies. Drs. Kimbrell, Pyne, and Hudson are part of HSR&D’s Center for Mental Health and Outcomes Research in Little Rock, AR
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Qureshi S, Kimbrell T, Pyne J, Magruder K, Hudson T, Petersen N, Yu H-J, Schulz P, Kunik M. Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder. Journal of the American Geriatrics Society September 2010;58(9):1627-33.
