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Pivotal study finds link between PTSD and dementia

More study needed to determine why Veterans with PTSD are more at risk than others

September 2010--Results of a study reported in the September issue of the Journal of the American Geriatrics Society suggest that Veterans with post-traumatic stress disorder (PTSD) have a greater risk for dementia than Veterans without PTSD, even those who suffered traumatic injuries during combat.

Exposure to life threatening events, like war, can cause PTSD, and there are high rates among veterans. PSTD includes symptoms such as avoiding things or people that remind a person of the trauma, nightmares, difficulty with sleep, and mood problems.

"We found Veterans with PTSD had twice the chance for later being diagnosed with dementia than Veterans without PTSD," said Mark Kunik, M.D., M.P.H., a psychiatrist at the Michael E. DeBakey VA Medical Center, Texas, USA, and senior author of the article.

"Although we cannot at this time determine the cause for this increased risk, it is essential to determine whether the risk of dementia can be reduced by effectively treating PTSD. This could have enormous implications for Veterans now returning from Iraq and Afghanistan."

The study included 10,481 Veterans at least 65 years of age who had been seen at the VA Medical Centre at least twice between 1997 and 1999.

Outpatient data were gathered for all identified patients until 2008. Subjects who had been wounded during combat (with and without a PTSD diagnosis) were also identified to provide a group with confirmed injuries and combat experience.

A group with two visits, but no PTSD or combat related injuries, was identified for purposes of comparison.

36.4% of the Veterans in this study had PTSD. 11.1% of those with PTSD but not injured, and 7.2% of those with PTSD and injured, had dementia, compared to 4.5% and 5.9% respectively in the non-PTSD groups.

These results remained significant after other risk factors of dementia were taken into account like diabetes, hypertension, heart disease, stroke, etc.

"Despite the increased risk for those with PTSD, it is noteworthy that most Veterans with PTSD did not develop dementia during the period we studied," said Salah Qureshi, M.D., a staff psychiatrist and investigator with the Houston VA Center of Excellence and first author of the article.

"It will be important to determine which Veterans with PTSD are at greatest risk and to determine whether PTSD induced by situations other than war injury is also associated with greater risk."

The authors note there could be several explanations for their findings. It could be that cognitive impairment in PTSD is an early marker of dementia, having PTSD makes one more likely to get dementia, or PTSD and dementia have some characteristics in common.

They emphasize the need for further study with a broader sample in the civilian population.

In an editorial accompanying this paper, Dr. Soo Borson of the University of Washington Medical Centre, Washington, highlights the need for further research to explain the association and also the wider significance of these findings, "Confirmation of a causal link between PTSD and cognitive impairment in late life would have enormous global implications in a world facing a rising societal burden of dementia, a shrinking workforce to sustain its economies, and the difficulties of containing human violence. Soldiers and other U.S. war veterans are just one of many groups exposed to deeply traumatizing experiences with lifetime effect."