Yaffe Kristine, Vittinghoff Eric, Lindquist Karla, Barnes Deborah, Covinsky Kenneth E, Neylan Thomas, Kluse Molly, Marmar Charles
San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
Arch Gen Psychiatry. 2010 Jun;67(6):608-13. doi: 10.1001/archgenpsychiatry.2010.61.
Posttraumatic stress disorder (PTSD) is highly prevalent among US veterans because of combat and may impair cognition.
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.
A stratified, retrospective cohort study conducted using the Department of Veterans Affairs National Patient Care Database.
Department of Veterans Affairs medical centers in the United States.
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).
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.
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.
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.
由于战争经历，创伤后应激障碍（PTSD）在美国退伍军人中极为普遍，且可能损害认知功能。
确定在接受退伍军人事务部医疗中心治疗的美国老年退伍军人中，PTSD是否与患痴呆症的风险相关。
使用退伍军人事务部国家患者护理数据库进行的分层回顾性队列研究。
美国退伍军人事务部医疗中心。
共有181093名1997财年至2000财年55岁及以上无痴呆症的退伍军人（53155名患有PTSD的退伍军人和127938名未患PTSD的退伍军人）。
在2000年10月1日至2007年12月31日的随访期间，根据《国际疾病分类，第九版，临床修订本》编码，确定31107名（17.2%）退伍军人新诊断为痴呆症。
退伍军人的平均基线年龄为68.8岁，174806名（96.5%）为男性。患有PTSD的退伍军人7年累积痴呆症发病率为10.6%，而未患PTSD的退伍军人发病率为6.6%（P < 0.001）。以年龄为时间尺度，Cox比例风险模型表明，与未患PTSD的退伍军人相比，患PTSD的退伍军人发生痴呆症的可能性高出两倍多（风险比，2.31；95%置信区间，2.24 - 2.39）。经过多变量调整后，患PTSD的退伍军人仍更易患痴呆症（风险比，1.77；95%置信区间，1.70 - 1.85）。当排除有头部受伤、药物滥用或临床抑郁症病史的患者时，结果相似。
在以男性为主的退伍军人队列中，被诊断患有PTSD的退伍军人患痴呆症的风险比未患PTSD的退伍军人高近两倍。需要确定将这些重要疾病联系起来的机制，以期找到降低与PTSD相关的痴呆症风险增加的方法。
