Cognitive Deficits in Veterans with Parkinson’s Disease: A National Database Analysis (P5.262)

Objective: To explore cognitive-related diagnoses and demographics of a large sample of Veterans with Parkinson’s disease over the last decade. Background: Although cognitive decline in Parkinson’s disease (PD) patients is well recognized, cognitive-related diagnostic codes and relationship to war-associated diagnoses are not well studied. US Veterans have a higher risk of brain injuries than the general population, including exposure to neurotoxins, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI), which necessitates an independent evaluation of this cohort for risks of cognitive impairment. Veterans administration (VA) databases are large, well organized and provide access to subject identification and health history in a unique way that is not otherwise available in other healthcare systems. Methods: We constructed a study cohort by extracting data for PD patients over the last decade, which included cognitive diagnoses (based on a list of all possible cognitive ICD-9 diagnosis) and select war-related exposures. Only subjects with more than two diagnostic codes of PD were included. Results: Of the 105,193 Veterans identified, 46.9% had a cognitive diagnosis. Average age was 74, 87.9% were Caucasian, and 98.4% were male. African Americans had a higher rate of cognitive diagnoses than whites (p=0.0001). ICD-9 diagnoses varied widely with non-specific "mental disorder NOS," Alzheimer’s disease, and senile dementia accounting for 60% of cases. Veterans with PD and PTSD, Agent Orange (AO) exposure or TBI history had a higher prevalence of cognitive diagnosis compared to those without a similar diagnosis (p=0.0001 in each case). Conclusions: This unique, large VA-based PD cohort documents the prevalence and subtypes of cognitive diagnoses in the US Veteran population. Factors associated with a higher rate of cognitive diagnoses include race and history of AO exposure, TBI, or PTSD. Future analysis of these and other comorbidities on cognitive symptoms and cognitive factors related to wartime exposures is warranted. Disclosure: Dr. Barton has received personal compensation for activities with Teva Neuroscience, Allergan Inc., Merz Pharma, Lundbeck Research USA, Inc., Merck & Co., Inc., Impax Pharmaceuticals, Parkinson9s Disease Foundation, Rush University Medical Center, and Jesse Brown VA Medical Center. Dr. Huo has nothing to disclose. Dr. Kletzel has nothing to disclose. Dr. Stroupe has nothing to disclose. Dr. Goetz has received personal compensation for activities with AOP Orphan, Addex Pharma, Advanced Studies of Medicine, Boston Scientific Corp., CHDI Foundation, Health Advances, ICON Clinical Research, Ingenix, and the National Institutes of Health. Dr. Goetz has received personal compensation in an editorial capacity for Oxford University Press, Elsevier Publishers, Wolters Kluwer Health-Lippincott, Wilkins and Williams, Movement Disorder, American Academy of Neurology, and the Unviersity of Pennsylvania. Dr. Goetz has received research support from the National Institutes of Health, the Michael J Fox Foundation, and The Parkinson9s Disease Foundation. Dr. Weaver has nothing to disclose.