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O5–05–06: War‐related risk factors for dementia in older veterans
Author(s) -
Barnes Deborah,
Byers Amy,
Williams Brie,
Kirby Katharine,
Yaffe Kristine
Publication year - 2013
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2013.04.498
Subject(s) - dementia , medicine , hazard ratio , cohort study , cohort , retrospective cohort study , medical record , psychiatry , gerontology , confidence interval , disease
Background: Prior studies have found that post-traumatic stress disorder (PTSD) is a risk factor for dementia in older veterans, but little is known about the long-term impact of other war-related exposures. The goal of our studywas to examine the association between exposure to Agent Orange (AO, a highly toxic chemical used in the Vietnam war),prisoner of war (POW) status and their interaction with PTSD on risk of dementia in older veterans.Methods:We performed a retrospective cohort study of a random sample of 200,000 US veterans age 55 years or older who received healthcare within the Veterans Health Administration system. 11,236 had prevalent dementia at baseline (10/1/2000-9/30/2003) and were excluded for a final sample size of 188,764. AO exposure, POW status and PTSD diagnoses at baseline and dementia diagnoses during follow-up (10/1/2003-3/ 31/2011) were determined from electronic medical records. Fine-Grey propotional hazards models (age as time-scale) were utilized to examine associations between AO exposure, POW status and their interactions with PTSD on risk of dementia while accounting for the competing risk of death. Results: The prevalence of AO exposure was3,710 (2.0%), and485 (0.3%) veterans had been POWs. Veterans with AO exposure were younger (mean age, 60 years) while POWs were older (76 years) than other veterans (68 years). During follow-up, the age-adjusted hazard of dementia accounting for the competing risk of death was significantly increased for both AO exposure (HR, 1.30; 95% confidence interval [CI]: 1.13, 1.51) and POW status (HR, 1.74; 95% CI, 1.48, 2.06). There also was evidence of interaction with PTSD such that risks were highest in veterans with both AO and PTSD (HR, 2.43; 95%CI: 1.85, 3.21) or POWand PTSD (HR, 2.42; 95%CI: 1.85, 3.16). Conclusions:War-related exposures such as Agent Orange, POW status and PTSD are associated with an increased risk of developing dementia, even after accounting for the competing risk of death. Veterans with PTSD in combination with other war-related exposures are at particularly high risk. Efforts should be made to ensure that these vulnerable veterans receive appropriate care for their war-related exposures in late life.