Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review

Abstract

Objectives Posttraumatic stress disorder (PTSD) is associated with neurocognitive and psychiatric comorbidities, and older adults experience comorbid illnesses disproportionately. Little is known about the comorbidities of PTSD among older veterans. This systematic review examines the prevalence, incidence, and patterns of neurocognitive and psychiatric comorbidities of PTSD among older veterans and explores the factors associated with these comorbidities. Methods A systematic literature review was performed using PubMed, CINAHL, and PsycINFO databases. The search was limited to peer‐reviewed articles published in English from January 1980 to October 2018. Eligible studies examined the comorbid neurocognitive and psychiatric disorders of PTSD among veterans aged 60 and older. Results Twenty‐four studies met the criteria for inclusion. The risk for dementia was higher in veterans with PTSD than those without PTSD; hazard ratios ranged from 1.21 to 1.77. Depressive disorder was the most prevalent psychiatric comorbidity with estimates ranging from 33% to 52.3%, followed by generalized anxiety disorder (14%‐15%) and substance use disorders (1.9%‐11.3%). Factors consistently associated with PTSD comorbidities included age, combat‐related exposures, clinical conditions, and health‐related and psychosocial outcomes. Conclusions Despite heterogeneity in research designs and methodological limitations, this review highlights the need to consider comorbid neurocognitive and psychiatric disorders among older veterans with PTSD in order to individualize care approaches. Future research should incorporate factors associated with neurocognitive and psychiatric comorbidities of PTSD into study designs that can help improve prediction of comorbidity and generate evidence for developing and implementing tailored treatments in older veterans.

Prevalence, injury-, and non-injury-related factors associated with anxiety and depression in polytrauma patients – A retrospective 20 year follow-up study

“…severe trauma are most commonly described in military setting. A recently published systematic review on psychiatric comorbidities among older veterans summarized a prevalence of depressive disorder of 33% to 52.3% and a generalized anxiety disorder of 14% to 15% [29]. These rates for depression are comparable to this study (48.2%), however, the percentage of patients with symptoms of anxiety in our cohort was lower (4.1%).…”

Long-Term Psychological Consequences of World War II Trauma Among Polish Survivors: A Mixed-Methods Study on the Role of Social Acknowledgment

“…Second, although we excluded participants with dementia, we did not screen for individual differences with respect to the cognitive abilities of the participants, which could be responsible for the relatively high level of missing data among our participants, who were then not included in the main analysis. This particular aspect is especially crucial taking into an account the fact that not all PTSD symptoms occurred to be significantly related with WWIIrelate traumatic events (e.g., lack of relationship between PTSD from E criterion representing hyperarousal and hyperactivity; Kang et al, 2018). Third, in our study, we concentrated on assessment of WWII traumatic events only, so we did not measure other traumatic events across the lifespan of participants.…”

“…To make matters more complicated, one should also bear in mind that for WWII survivors, aging may modify this potential comorbidity (Kang et al, 2018). Specifically, age−related factors such as a decline in cognitive functioning, other physical comorbidities, and retirement, sometimes associated with poor social support, may all exacerbate the PTSD-depression association among older adults (Osei-Boamah et al, 2013).…”

Cancer‐related cognitive impairment and associated factors in a sample of older male oral‐digestive cancer survivors

“…Cancer‐related PTSD (CR‐PTSD) and combat‐related PTSD were assessed for three reasons: cancer diagnosis and treatment can be distressing and traumatic for patients, participants were recruited from VAMCs, and some studies find that post‐traumatic stress is a risk factor for dementia . The 17‐item Posttraumatic Stress Disorder Check List‐Stressor‐Specific version (PCL‐S) measured CR‐PTSD in the past week (α = .95 in this sample).…”