Risk for developing dementia among patients with posttraumatic stress disorder: A nationwide longitudinal study

Wang, Tsung-Yang; Wei, Han Ting; Liou, Ying‐Jay; Su, Tung Ping; Bai, Ya Mei; Tsai, Shih Jen; Yang, Albert C.; Chen, Tzeng Ji; Tsai, Chia Fen; Chen, Mu Hong

doi:10.1016/j.jad.2016.08.013

Cited by 44 publications

(42 citation statements)

References 24 publications

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“…Nine studies scored in the higher range of methodological quality (supplementary material). Four studies [26][27][28] were judged to be of poor quality. Methodological domains where there was evidence of risk of bias included study design (i.e.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis

et al. 2020

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Background Post-traumatic stress disorder (PTSD) has been identified as a potential risk factor for developing dementia. There are currently, however, no meta-analyses quantifying this risk. Aims To systematically review and quantify the risk of future dementia associated with PTSD across populations. PROSPERO registration number CRD42019130392. Method We searched nine electronic databases up to 25 October 2019 for longitudinal studies assessing PTSD and risk of dementia. We used random- and fixed-effects meta-analyses to pool estimates across studies. Results PTSD was associated with a significant risk for all-cause dementia: pooled hazard ratio HR = 1.61 (95% CI 1.43–1.81, I2= 85.8%, P < 0.001; n = 1 693 678; 8 studies). Pooled HR was 1.61 (95% CI 1.46–1.78; I2= 80.9%, P < 0.001; n = 905 896; 5 studies) in veterans, and 2.11 (95% CI 1.03–4.33, I2= 91.2%, P < 0.001; n = 787 782; 3 studies) in the general population. The association between PTSD and dementia remained significant after excluding studies with high risk of bias (HR = 1.55, 95% CI 1.39–1.73, I2= 83.9%, P < 0.001; n = 1 684 928; 7 studies). Most studies included were retrospective and there was evidence of high heterogeneity. Conclusions This is the first meta-analysis quantifying the association of PTSD and risk of dementia showing that PTSD is a strong and potentially modifiable risk factor for all-cause dementia. Future studies investigating potential causal mechanisms, and the protective value of treating PTSD are needed.

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Section: Study Characteristicsmentioning

confidence: 99%

“…35,36 PTSD and dementia may also share common underlying genetic vulnerability, with pathways between the two being bidirectional. Wang 26 Roughead 24 Mawanda 38 Flatt 33 Gradus 37 Yaffe 25 I-V overall (I 2 = 85.8%, P = 0.000)…”

Section: Mechanismsmentioning

confidence: 99%

Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis

et al. 2020

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“…Our finding that individuals with a stress-related disorder were at an increased risk of developing a neurodegenerative disease gains support from previous studies. 95-102 104 However, most of the previous research has focused solely on PTSD 95-100 102 and dementia, [96][97][98][99][100][101] and were often derived from studies of male veterans, who differ significantly from the general population and in terms of trauma exposure. [95][96][97][98] For specific neurodegenerative diseases, we found a statistically significant association for AD but not for PD or ALS.…”

Section: Stress-related Disordersmentioning

confidence: 99%

Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases

et al. 2020

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The objective of this thesis was to investigate the relationship of personality and stress with subsequent risk of Parkinson's disease (PD). In Study I, we conducted a population-based cohort study using questionnaire data from the Swedish Twin Registry to explore whether the personality traits, neuroticism and introversion, were associated with later PD risk. We also explored the role of smoking as a mediator in the relationship between personality and PD. Both neuroticism and introversion were associated with an increased PD risk. Further, smoking was a significant mediator in the relationship between personality traits and PD that partly accounted for the effect of introversion, whereas it acted as a suppressor for the effect of neuroticism on PD risk. In Study II, we wanted to further explore the main findings from study I, with the aim to examine whether the observed associations between neuroticism, smoking and PD may be causal. We conducted a two-sample Mendelian randomization study in a network framework, consisting of three main analyses: (I) causal effect of neuroticism on PD, (II) causal effect of neuroticism on smoking initiation, (III) causal effect of smoking initiation on PD. We found no support for a causal association between neuroticism and PD risk. On the other hand, the results indicated that the association between neuroticism and smoking initiation is causal and that there is a strong causal effect of smoking initiation on a reduced PD risk.

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“…As noted in Section “Progress and Limits in the Homeostatic Understanding of PTSD,” it appears that non-physical factors such as cognitive appraisals may in some cases play a decisive role in the expression of behavioral pathology, raising the question that if free will is real, then what are its definable limits for producing top-down effects that recover “healthier” neural processes and their physical correlations? While the jury may still be out on this matter, meanwhile the multiple disturbances of subjective experience associated with clinical PTSD including negative cognitions, dysregulations of mood, and especially poor sleep, in conjunction with its risks for cardiovascular, metabolic, and other impairments such as age-related cognitive decline (e.g., Burri et al, 2013; Wang et al, 2016) should not be dismissed as probable statistical anomalies (and at an anecdotal level, the author of this article received an indelible imprint from an individual in her mid-50s with dementia, residing in an assisted living facility 15 years after being a responder to the 2001 terror attacks in New York City, where the author was also living at the time of the attacks; and see Clouston et al, 2016). Ramified effects from PTS are predicted by the PAO’s proposition that brain-body communication is the rule and not the exception.…”

Section: Selected Considerations and Summarymentioning

confidence: 99%

A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration

Lee

2019

Front. Hum. Neurosci.

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There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments . The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation , hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.

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Risk for developing dementia among patients with posttraumatic stress disorder: A nationwide longitudinal study

Cited by 44 publications

References 24 publications

Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis

Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis

Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases

A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration

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