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Subjective cognitive concerns, APOE [epsilon]4, PTSD symptoms, and risk for dementia among older veterans
Journal article   Open access   Peer reviewed

Subjective cognitive concerns, APOE [epsilon]4, PTSD symptoms, and risk for dementia among older veterans

Kristin Mattocks, Darshana Jhala, Saib Gappy, Kimberly Hammer, Emily Potter, Prakash Balasubramanian, Richard L Hauger, Luis E Selva, Lori Churby, Erika J Wolf, …
Alzheimer's research & therapy, Vol.16(1), 143
06/29/2024
DOI: 10.1186/s13195-024-01512-w
PMCID: PMC11218206
PMID: 38951900
url
https://doi.org/10.1186/s13195-024-01512-wView
Published (Version of record) Open Access

Abstract

Background Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with self-reported problems with cognition as well as risk for Alzheimer's disease and related dementias (ADRD). Overlapping symptom profiles observed in cognitive disorders, psychiatric disorders, and environmental exposures (e.g., head injury) can complicate the detection of early signs of ADRD. The interplay between PTSD, head injury, subjective (self-reported) cognitive concerns and genetic risk for ADRD is also not well understood, particularly in diverse ancestry groups. Methods Using data from the U.S. Department of Veterans Affairs (VA) Million Veteran Program (MVP), we examined the relationship between dementia risk factors (APOE [epsilon]4, PTSD, TBI) and subjective cognitive concerns (SCC) measured in individuals of European (n = 140,921), African (n = 15,788), and Hispanic (n = 8,064) ancestry (EA, AA, and HA, respectively). We then used data from the VA electronic medical record to perform a retrospective survival analysis evaluating PTSD, TBI, APOE [epsilon]4, and SCC and their associations with risk of conversion to ADRD in Veterans aged 65 and older. Results PTSD symptoms (B = 0.50-0.52, p < 1E-250) and probable TBI (B = 0.05-0.19, p = 1.51E-07 - 0.002) were positively associated with SCC across all three ancestry groups. APOE [epsilon]4 was associated with greater SCC in EA Veterans aged 65 and older (B = 0.037, p = 1.88E-12). Results of Cox models indicated that PTSD symptoms (hazard ratio [HR] = 1.13-1.21), APOE [epsilon]4 (HR = 1.73-2.05) and SCC (HR = 1.18-1.37) were positively associated with risk for ADRD across all three ancestry groups. In the EA group, probable TBI also contributed to increased risk of ADRD (HR = 1.18). Conclusions The findings underscore the value of SCC as an indicator of ADRD risk in Veterans 65 and older when considered in conjunction with other influential genetic, clinical, and demographic risk factors. Keywords: Dementia, APOE [epsilon]4, TBI, PTSD, Survival analysis
 Brain Alzheimer's disease Apolipoproteins Injuries Medical records Post-traumatic stress disorder Risk factors

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