Abstract
Few studies have examined whether UK military veterans are at an increased risk of dementia. We explored the risk of dementia in Scottish military veterans aged up to 73 years in comparison with people who have never served. Retrospective cohort study of 78 000 veterans and 253 000 people with no record of service, matched for age, sex and area of residence, with up to 37 years follow-up, using Cox proportional hazard analysis to compare risk of dementia in veterans and non-veterans, overall and by subgroup. Dementia was recorded in 0.2% of both veterans and non-veterans overall, Cox proportional hazard ratio 0.98, 95% confidence interval (CI) 0.82-1.19, p = 0.879 (landmark age: 50 years), with no difference for men but increased risk in veteran women and Early Service Leavers. Post-traumatic stress disorder (PTSD) was associated with a higher risk of dementia in both veterans and non-veterans, although possibly to a lesser degree in veterans. A history of mood disorder was strongly associated with developing dementia, greater in veterans than in non-veterans, odds ratio 1.54, 95% CI 1.01-2.35, p = 0.045. There was no evidence to suggest that military service increased the risk of dementia, although this may change as the cohort ages. The well-documented association with PTSD shows no evidence of being stronger in veterans; by contrast, the association of mood disorder with dementia is much stronger in veterans. Healthcare providers should carefully assess the cognitive status of older veterans presenting with depressive illness in order to identify early dementia and ensure optimum management.
Highlights
The reduction in premature mortality in the latter half of the 21st century has paradoxically created a new challenge; more people than ever are living with dementia, creating a major burden on health and social care
There was no increase in risk in veterans among men, Hazard ratios (HRs) 0.93, 95% confidence interval (CI) 0.76–1.14, p = 0.481
There was an increased risk for veteran women which almost achieved statistical significance, HR 1.76, 95% CI 0.95–3.23, p = 0.070, the number of cases was small
Summary
The reduction in premature mortality in the latter half of the 21st century has paradoxically created a new challenge; more people than ever are living with dementia, creating a major burden on health and social care. Dementia shares many risk factors with cardiovascular disease, including hypertension, hypercholesterolaemia, obesity and diabetes (Kivipelto et al, 2006), together with poor educational attainment (Sharp & Gatz, 2011), while age-associated health decline and frailty increase risk (Song, Mitnitski, & Rockwood, 2011). It is unsurprising, in view of the association with cardiovascular risk factors, than a positive association with inflammatory cytokines has been described (Angelopoulos et al, 2008). Healthcare providers should carefully assess the cognitive status of older veterans presenting with depressive illness in order to identify early dementia and ensure optimum management
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