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Dementia in Scottish military veterans: early evidence from a retrospective cohort study

Published online by Cambridge University Press:  07 January 2022

Hui-Yuan Chen,
Renin ChangOpen the ORCID record for Renin Chang[Opens in a new window] and
James Cheng-Chung Wei
Hui-Yuan Chen*
Affiliation:
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Renin Chang
Affiliation:
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
James Cheng-Chung Wei*
Affiliation:
Institute of Medicine, Chung Shan Medical University, Taichung, TaiwanDepartment of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, TaiwanGraduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
*
Author for correspondence: James Cheng-Chung Wei, E-mail: wei3228@gmail.com
Author for correspondence: James Cheng-Chung Wei, E-mail: wei3228@gmail.com
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Type
Correspondence
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023, pp. 4820
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

To the Editor:

We read with great interest the paper by Bergman, Mackay, and Pell (Reference Bergman, Mackay and Pell2021) about dementia in veterans and non-veterans. Authors found that there was no evidence in the subsequent risk of dementia between veterans and non-veterans (Bergman et al., Reference Bergman, Mackay and Pell2021). This study has provided an excellent basis for a follow-up study of the association of veterans with dementia. However, there are some concerns we would like to discuss further.

First, we note that there's possibility of important residual confounders. We suggest further match or adjust known risk factors of dementia to rule out residual confounding bias, such as hypertension, diabetes, hypercholesterolemia, obesity, and cardiovascular diseases. Further subgroup analysis on these important covariates for clinical applications would be appreciated (Baumgart et al., Reference Baumgart, Snyder, Carrillo, Fazio, Kim and Johns2015; Shang et al., Reference Shang, Fratiglioni, Marseglia, Plym, Welmer, Wang and Xu2020). Additionally, it would be necessary for further matching or stratified analysis of periodontal disease and chronic inflammatory diseases (Lee et al., Reference Lee, Lee, Hu, Huang, Chao, Lin and Chen2016; Ma et al., Reference Ma, Hasturk, Carreras, Dedeoglu, Veeravalli, Huang and Wei2021).

Second, we also concern about the coding accuracy of ICD-9 and -10 for dementia, post-traumatic stress disorder, and mood disorder that may be underdiagnosed in many claim-based databases. We suggest that the authors to provide validation data or references for the definition of outcome to avoid information bias.

We are grateful for the work done by the authors and looking forward to their response.

Conflict of interest

None declared.

Footnotes

*

Hui-Yuan Chen and Renin Chang contributed equally.

References

Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer's & Dementia, 11(6), 718–726. https://doi.org/10.1016/j.jalz.2015.05.016.CrossRefGoogle ScholarPubMed
Bergman, B. P., Mackay, D. F., & Pell, J. P. (2021). Dementia in Scottish military veterans: Early evidence from a retrospective cohort study. Psychological Medicine, 1–6. https://doi.org/10.1017/s0033291721002440.Google ScholarPubMed
Lee, Y.-T., Lee, H.-C., Hu, C.-J., Huang, L.-K., Chao, S.-P., Lin, C.-P., … Chen, C.-C. (2016). Periodontitis as a modifiable risk factor for dementia: A nationwide population-based cohort study. Journal of the American Geriatrics Society, 65(2), 301–305. https://doi.org/10.1111/jgs.14449.CrossRefGoogle ScholarPubMed
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Shang, Y., Fratiglioni, L., Marseglia, A., Plym, A., Welmer, A., Wang, H., … Xu, W. (2020). Association of diabetes with stroke and post-stroke dementia: A population-based cohort study. Alzheimer's & Dementia, 16(7), 1003–1012. https://doi.org/10.1002/alz.12101.CrossRefGoogle ScholarPubMed