Military-related risk factors in female veterans and risk of dementia

Neurology. 2019 Jan 15;92(3):e205-e211. doi: 10.1212/WNL.0000000000006778. Epub 2018 Dec 12.


Objective: To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans.

Methods: This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death.

Results: During follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01-2.20; PTSD adjusted sHR 1.78, 95% CI 1.34-2.36; and depression-adjusted sHR 1.67, 95% CI 1.55-1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84-2.51).

Conclusions: We found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Injuries / complications
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / epidemiology*
  • Cohort Studies
  • Dementia / epidemiology*
  • Dementia / etiology
  • Depression / complications
  • Depression / epidemiology*
  • Female
  • Humans
  • Middle Aged
  • Military Personnel*
  • Risk Factors
  • Stress Disorders, Post-Traumatic / complications
  • Stress Disorders, Post-Traumatic / epidemiology*
  • United States / epidemiology
  • Veterans