Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race

Bhattarai, Jackie; Oehlert, Mary E.; Multon, Karen D.; Sumerall, Scott W.

doi:10.1177/0898264318781131

Cited by 26 publications

(24 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings were consistent with those from a study of non-FDNY WTC responders, which reported that WTC exposure and PTSD symptoms were associated with worse performance on an objective cognitive measure [ 7 ]. They also accord with a large body of research showing PTSD symptoms and depressive symptoms to be risk factors for cognitive dysfunction, both in studies of veterans [ 8 , 9 , 10 ] and in general populations [ 11 , 12 , 13 ]. PTSD has been linked to reduced cognitive function even in studies of non-veteran trauma survivors in which trauma-exposed comparison groups without PTSD were used, such as natural disaster survivors or war victims [ 14 , 15 ].…”

Section: Introductionsupporting

confidence: 78%

“…Our results demonstrate that increased subjective cognitive concerns in the most highly WTC-exposed group vs. the lesser exposed group can be attributed to elevated levels of PTSD and depression, which are well-established risk factors for cognitive dysfunction [ 8 , 9 , 10 , 11 , 12 , 13 , 41 , 43 , 44 ]. In other words, mental health outcomes associated with greater WTC exposure, rather than WTC exposure alone, increase workers’ risk for subjective cognitive concerns.…”

Section: Discussionmentioning

confidence: 82%

“…In other words, mental health outcomes associated with greater WTC exposure, rather than WTC exposure alone, increase workers’ risk for subjective cognitive concerns. While many studies linking PTSD and/or depression to cognitive decline or dementia have been performed in older populations [ 11 , 12 , 41 , 42 , 43 ], there is some evidence of an association between these mental health conditions and cognition in younger age groups as well [ 8 , 9 , 10 , 13 , 45 ]; for example, PTSD and depression were associated with worse cognitive outcomes in middle-aged military veterans [ 8 , 9 ] and general populations [ 13 , 45 ]. Additionally, investigations that assessed self-perception of cognitive functioning in young and middle-aged veterans have similarly found associations between PTSD symptoms and/or depressive symptoms and self-perceived cognitive impairment, despite using different subjective cognitive measures than the current study—i.e., the Neurobehavioral Symptom Inventory and the Everyday Memory Scale [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

Singh

Zeig‐Owens

Schwartz

et al. 2020

IJERPH

View full text Add to dashboard Cite

We observed that World Trade Center (WTC) exposure, post-traumatic stress disorder (PTSD) symptoms and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers. This follow-up study examined whether PTSD symptoms and/or depressive symptoms mediate the observed association between WTC exposure and subjective cognitive concerns. We included WTC-exposed FDNY workers who completed the Cognitive Function Instrument (CFI), measuring self-perceived cognitive decline (N = 9516). PTSD symptoms and depressive symptoms were assessed using the PCL-S and CES-D, respectively. Multivariable linear regression estimated the association between WTC exposure and CFI score, adjusting for confounders. Mediation analyses followed the methods of Vanderweele (2014). Participants’ average age at CFI assessment was 56.6 ± 7.6 years. Higher-intensity WTC exposure was associated with worse CFI score, an effect that was entirely mediated by PTSD symptoms (%mediated: 110.9%; 95%CI: 83.1–138.9). When substituting depressive symptoms for PTSD symptoms, the WTC exposure–CFI association was largely mediated (%mediated: 82.1%; 95%CI: 60.6–103.7). Our findings that PTSD symptoms and depressive symptoms mediate the association between WTC exposure and subjective cognitive concerns indicate that in the absence of these symptoms, WTC exposure in rescue/recovery workers would not be associated with subjective cognition. Interventions targeting PTSD and depression may have additional value in mitigating cognitive decline in WTC-exposed populations.

show abstract

Section: Introductionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

Singh

Zeig‐Owens

Schwartz

et al. 2020

IJERPH

View full text Add to dashboard Cite

show abstract

“…Studies have reported racial disparities in self-reported health and prevalence of chronic disease among Veterans [17][18][19][20]. However, only a limited number of studies have investigated racial disparity of AD/ADRD in US Veterans [21,22]. The objective of our study was to determine the incidence of AD/ADRD among a national sample of African American and white Veterans, and to examine predictors of AD/ADRD overall as well as separately within these two populations.…”

Section: Introductionmentioning

confidence: 99%

Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in Older African American and White Veterans

Cheng

Ahmed

Zamrini

et al. 2020

JAD

View full text Add to dashboard Cite

Background: Racial disparity in the epidemiology of Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) has been reported. However, less is known about this disparity among Veterans. Objective: To estimate the racial disparity in AD/ADRD among the Veterans. Methods: Of the 5,413,418 Veterans ≥ 65 years receiving care at the Veterans Health Administration (1999-2016), 4,045,269 were free of prevalent AD/ADRD, schizophrenia, or bipolar disorder at baseline. Of these, 432,469 were African American. Race was self-identified and incident AD/ADRD during 20 (median 6.7) years of follow-up was ascertained using International Classification of Diseases codes. Results: Patients had a mean age of 70.4 (±6.6) years and 97.8% were men. Age-sex-adjusted incidence of AD/ADRD per 1,000 person-year was 19.3 and 10.8 for African American and white Veterans, respectively (age-sex-adjusted hazard ratio associated with African American race, 1.77; 95% confidence interval, 1.75-1.79; p < 0.0001). This association remained essentially unchanged after multivariable adjustment (hazard ratio, 1.67; 95% confidence interval, 1.65-1.69; p < 0.0001). Among the key baseline characteristics that were significant predictors of AD/ADRD in both races, stroke was a significantly stronger predictor among African Americans, and Hispanic ethnicity and depression among whites (p-value for all interaction,<0.0001). Conclusion: The findings of a higher incidence of AD/ADRD among African American Veterans is consistent with the findings in the general population reported in the literature, although the overall incidence appears to be lower than that in the general population. Future studies need to examine this disparity in incidence as well as the between-race heterogeneity in AD/ADRD risk.

show abstract

“…Many previous studies of PTSD and cognitive function were carried out in populations of military veterans (16,34,35); however, a connection between PTSD and cognitive impairment has also been observed in studies of individuals exposed to other types of trauma (12,13,36), as well as in one study involving a general population (14). In the previously noted cohort of non-FDNY WTC responders, PTSD symptoms were associated with an increased risk of cognitive impairment (15).…”

Section: Discussionmentioning

confidence: 95%

World Trade Center exposure, post‐traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

Singh

Zeig‐Owens

Hall

et al. 2019

Acta Psychiatr Scand

View full text Add to dashboard Cite

Objective To determine whether World Trade Center (WTC)‐exposure intensity and post‐traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. Method The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self‐perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top‐quartile (≥2) CFI score, and of early post‐9/11 PTSD with top‐quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. Results Mean age at CFI completion was 56.7 ± 7.7 (range: 36–81). Participants with high‐intensity WTC exposure had an increased likelihood of top‐quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07–1.64), controlling for covariates. Current and early PTSD were both associated with top‐quartile CFI (OR: 3.25, 95%CI: 2.53–4.19 and OR: 1.56, 95%CI: 1.26–1.93) respectively. Conclusions High‐intensity WTC exposure was associated with self‐reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC‐exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.

show abstract

Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race

Cited by 26 publications

References 60 publications

PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in Older African American and White Veterans

World Trade Center exposure, post‐traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

Contact Info

Product

Resources

About