Pharmacotherapy in posttraumatic stress disorder and the link to increased dementia risk

By: Michelle Huang, PharmD Candidate c/o 2021

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In the midst of countless chronic diseases that we face today, one that is usually overlooked is posttraumatic stress disorder (PTSD). On average it affects 5.2 million individuals per year and women are twice as likely to develop PTSD.¹ This overwhelming incidence is greatly attributed to the number of veterans who served during the Vietnam or Gulf Wars or faced other, similar life-threatening experiences. As a result, new studies suggest a correlation between PTSD and risk of developing cognitive decline and dementia.²

A recent study conducted at the University of Iowa elucidated the negative effects of psychoactive medications. At baseline, or initial reading, patients were assessed on their cognitive function after an adverse life event. In 2002 to 2003, researchers compared initial readings to follow-up data in order to determine the likelihood of developing dementia.² Scores were determined and adjusted according to sex and age as to minimize discrepancies. The researchers concluded that there was an additional risk for dementia among PTSD patients who took antipsychotic medications. Patients who did not use any medications did not develop dementia during the follow-up and those who took medications were at greater risk for developing the condition. Antipsychotics were also proven to speed up the process of developing dementia altogether.²

However, the correlation between PTSD and increased dementia risk could not be established because increased dementia risk could be due to numerous factors.³ Amongst the various factors, PTSD symptom severity has been shown to be highly confounding since severe PTSD usually means that the individual has received treatment with psychoactive medications.³ Furthermore, there are a lack of studies conducted that posed any association between PTSD and risk for dementia. Some even claim the medications themselves influenced the risk for dementia.

The topic of antipsychotics as a psychotherapy for PTSD is crucial because there is a direct correlation these medications and an increased risk of dementia that cause patients to sustain a higher extracellular activity of serotonin and noradrenaline.⁴ In doing so, the medications can impair cognitive function and increase the risk of dementia among PTSD patients.² Stress can also play a major role in dementia development since it damages the hippocampus, which is critical in memory and learning. Malfunctioning of the hippocampus leads to abnormalities in neurotransmitters and hormone levels, subsequently triggering dementia.⁴

There is still no substantial information to help us understand the relationship between antipsychotic medication use and dementia. We should continue to look for treatments that would ultimately reduce the risk of adverse health outcomes like dementia through advanced screening for cognitive impairment. Perhaps by finding appropriate and effective treatments for PTSD patients, we can start to eliminate the drugs that account for the development of dementia in old age. Ultimately, continued research on the effects of antipsychotic medications for PTSD and other related conditions can help determine ways to improve patient care and outcomes altogether.

SOURCES:

1. Post Traumatic Stress Disorder. http://www.ptsd.ne.gov/index.html. Accessed 09/14/2017.
2. Mawanda F, Wallace RB, McCoy K, Abrams TE. PTSD, psychotropic medication use, and the risk of dementia among US veterans: A retrospective cohort study. J Am Geriatr Soc. 2017;65(5):1043-50.
3. Greenberg MS, Tanev K, Marin MF, Pitman RK. Stress, PTSD, and dementia. Alzheimers Dement. 2014;10(3 Suppl):S155-65.
4. Yaffe K, Vittinghoff E, Lindquist K, et al. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry. 2010;67(6):608-613.