Maccabitech, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Netw Open. 2022 Aug 1;5(8):e2225445. doi: 10.1001/jamanetworkopen.2022.25445.
Posttraumatic stress disorder (PTSD) in elderly men may be associated with increased risk of Parkinson disease (PD); thus, this group of patients needs to be monitored closely for timely, customized treatment.
To evaluate the risk of PD in patients with PTSD compared with patients without PTSD.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective, cohort study used data from Maccabi Health Care Services (MHS), the second largest health plan in Israel, spanning from 2000 to 2019. Participants included MHS members born before 1970 who received a diagnosis of PTSD in 2000 to 2015. Patients with PTSD who had PD before their first diagnosis were excluded. Data analysis was performed from February to June 2022.
Incident PTSD was denoted by at least 1 diagnosis (1) given by psychiatrists, psychologists, or neurologists; (2) hospital discharge diagnosis; or (3) registered as a chronic diagnosis (defined as such by the primary care physician). The index date was defined as first diagnosis for the patients with PTSD and for the corresponding patients without PTSD.
PD incident cases up to 2019 were ascertained by idiopathic PD diagnosis (1) given by a neurologist, (2) extracted from a hospital discharge report, or (3) registered as a chronic diagnosis. Patients with PD-like syndromes documentation after the last mention of PD were excluded.
Of 8342 eligible patients, 8336 (99.9%) were matched to nonexposed patients in a 1:1 ratio by birth year and sex; 4303 patients (51.6%) were male, and the mean (SD) age at index was 55.8 (13.2) years. Patients with PTSD had a 1.48-fold (95% CI, 1.10-1.99) excess risk for PD, compared with patients without PTSD. An elevated risk of PD (hazard ratio, 1.95; 95% CI, 1.16-3.28) was recorded among men receiving a diagnosis of PTSD at age 72 years or older.
These findings suggest that elderly men who receive a diagnosis of PTSD are at an increased risk of PD. Further studies are needed to corroborate these findings and to further assess the association of stress with PD risk.
老年男性创伤后应激障碍（PTSD）可能与帕金森病（PD）风险增加有关；因此，这群患者需要密切监测，以便及时进行定制化治疗。
评估 PTSD 患者与无 PTSD 患者相比患 PD 的风险。
设计、环境和参与者：这项基于人群的回顾性队列研究使用了以色列第二大健康计划 Maccabi 医疗保健服务（MHS）的数据，时间跨度为 2000 年至 2019 年。参与者包括在 2000 年至 2015 年期间被诊断为 PTSD 的 1970 年前出生的 MHS 成员。排除在首次诊断之前患有 PD 的 PTSD 患者。数据分析于 2022 年 2 月至 6 月进行。
至少有 1 次（1）由精神科医生、心理学家或神经科医生做出的诊断；（2）医院出院诊断；或（3）作为慢性诊断（由初级保健医生定义）记录，被认定为 PTSD 发作。指数日期被定义为 PTSD 患者和对应无 PTSD 患者的首次诊断日期。
通过神经科医生给出的特发性 PD 诊断（1）、从医院出院报告中提取的诊断（2）或作为慢性诊断（3）确定 2019 年之前的 PD 发病病例。排除 PD 后最后一次提及 PD 后有 PD 样综合征记录的患者。
在 8342 名符合条件的患者中，8336 名（99.9%）通过出生年份和性别与未暴露患者以 1:1 的比例匹配；4303 名（51.6%）为男性，指数年龄的平均（SD）为 55.8（13.2）岁。与无 PTSD 的患者相比，患有 PTSD 的患者患 PD 的风险增加了 1.48 倍（95%CI，1.10-1.99）。在 72 岁或以上被诊断为 PTSD 的男性中，PD 的风险升高（风险比，1.95；95%CI，1.16-3.28）。
这些发现表明，被诊断为 PTSD 的老年男性患 PD 的风险增加。需要进一步的研究来证实这些发现，并进一步评估压力与 PD 风险的关联。
