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. 2024 Jun 29;16(1):143.
doi: 10.1186/s13195-024-01512-w.

Subjective cognitive concerns, APOE ε4, PTSD symptoms, and risk for dementia among older veterans

Zoe E Neale  1   2   3 , Jennifer R Fonda  4   5   6 , Mark W Miller  1   4 , Erika J Wolf  1   4 , Rui Zhang  1 , Richard Sherva  7 , Kelly M Harrington  4   8 , Victoria Merritt  9   10 , Matthew S Panizzon  10   11 , Richard L Hauger  9   10   11 , J Michael Gaziano  8   12 ; VA Million Veteran Program; Mark W Logue  13   14   15   16
Collaborators, Affiliations

Subjective cognitive concerns, APOE ε4, PTSD symptoms, and risk for dementia among older veterans

Zoe E Neale et al. Alzheimers Res Ther. .

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 ε4, 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 ε4, 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 ε4 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 ε4 (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: APOE ε4; Dementia; PTSD; Survival analysis; TBI.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparisons of Main and Interaction Effects Predicting Subjective Cognitive Concerns. Filled point estimates indicate significant effects where p-values < 0.05. Open point estimates indicate non-significant effects. Sex was coded such that males = 0 and females = 1. TBI = traumatic brain injury, PTSD = posttraumatic stress disorder, SCC = subjective cognitive concerns
Fig. 2
Fig. 2
Comparison of ADRD Hazard Ratios in European, African, and Hispanic Ancestry Individuals Age 65 + . Filled point estimates indicate significant effects where p-values < 0.05. Open point estimates indicate non-significant effects. Sex was coded such that males = 0 and females = 1. TBI = traumatic brain injury, PTSD = Posttraumatic stress disorder, ADRD = Alzheimer’s Disease and related dementias, SCC = subjective cognitive concerns
Fig. 3
Fig. 3
a-d Survival Curves for Veterans of European Ancestry Age 65 and Older. Panels show Kaplan–Meier survival curves demonstrating the relationship between SCC, APOE ε4, PTSD symptoms, TBI, and incidence of ADRD in Veterans of European ancestry age 65 and older. TBI = traumatic brain injury, PTSD = posttraumatic stress disorder, ADRD = Alzheimer’s Disease and related dementias, SCC = subjective cognitive concerns
Fig. 4
Fig. 4
a-d Survival Curves for Veterans of African Ancestry Age 65 and Older. Panels show Kaplan–Meier survival curves demonstrating the relationship between SCC, APOE ε4, PTSD symptoms, TBI, and incidence of ADRD in Veterans of African ancestry age 65 and older. TBI = traumatic brain injury, PTSD = Posttraumatic stress disorder, ADRD = Alzheimer’s Disease and related dementias, SCC = Subjective Cognitive Concerns
Fig. 5
Fig. 5
a-d Survival Curves for Veterans of Hispanic Ancestry Age 65 and Older. Panels show Kaplan–Meier survival curves demonstrating the relationship between SCC, APOE ε4, PTSD symptoms, TBI, and incidence of ADRD in Veterans of Hispanic ancestry age 65 and older. TBI = traumatic brain injury, PTSD = Posttraumatic stress disorder, ADRD = Alzheimer’s Disease and related dementias, SCC = Subjective Cognitive Concerns
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