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Kristine Yaffe, MD; Eric Vittinghoff, PhD; Karla Lindquist, MS; Deborah Barnes, PhD; Kenneth E. Covinsky, MD, MPH; Thomas Neylan, MD; Molly Kluse, BA; Charles Marmar, MD

Arch Gen Psychiatry. 2010;67(6):608-613.

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.

Author Affiliations: Departments of Psychiatry (Drs Yaffe, Barnes, Neylan, and Marmar and Ms Kluse), Neurology (Dr Yaffe), Epidemiology and Biostatistics (Drs Yaffe and Vittinghoff), and Medicine (Ms Lindquist and Dr Covinsky), School of Medicine, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center (Drs Yaffe, Covinsky, Neylan, and Marmar).

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