Holocaust survivorship and late‐life cognitive performance in men with coronary heart disease

AbstractBackgroundHolocaust victims experienced extreme physical and mental stress that could lead to prolonged deficits in psychological and physiological well‐being. Indeed, some evidence demonstrates a link between Holocaust exposure and higher incidence of post‐traumatic disorder as well as for cardiovascular morbidity and its risk factors, which in turn are associated with increased brain aging. Recent evidence points to increased dementia risk among Holocaust survivors compared to the general population, however data are limited. We aimed to examine whether exposure to Holocaust conditions is associated with cognitive function and decline in old age.MethodThe study sample included 351 individuals (mean age at baseline 56.7±6.5y) with coronary heart disease (CHD) who participated in the secondary prevention Bezafibrate Infarction Prevention trial in 1990‐1997. During 2004‐2008, these participants underwent a computerized cognitive assessment (mean age 71.8±6.5y). A second cognitive assessment was performed during 2011‐2013 (mean age 77.1±6.4y). Exposure to Holocaust conditions was based on self‐report at the second assessment. Linear regression and mixed‐effect models were conducted to evaluate the associations between Holocaust survivorship and subsequent cognitive performance and rate of decline while adjusting for potential confounders.ResultOf the total sample, 45 (12.8%) survived concentration camp/ghettos, 70 (19.9%) were Holocaust survivors who escaped concentration camps/ghettos, and 236 (67.2%) were not Holocaust survivors. After adjustment for potential confounders, concentration camp/ghetto survivors had poorer global cognitive performance and poorer attention (β=‐3.90; 95% CI:‐7.11;‐0.68 and β=‐4.11; 95% CI:‐7.83;‐0.38, respectively) compared to individuals who were not exposed to Holocaust conditions. In the longitudinal analysis, participants who reported being at concentration camps/ghettoes had increased cognitive decline in global performance and executive function (β=‐0.19; 95% CI: ‐0.37;‐0.008 and β=‐0.29; 95% CI: ‐0.53;‐0.06, respectively) compared to participants who were not Holocaust survivors. Lastly, those who were Holocaust survivors but not in concentration camps/ghettos had greater decline in attention (β=‐0.11; 95% CI: ‐0.21;‐0.01). Results remained unchanged after excluding individuals with prevalent stroke and dementia and after utilizing Inverse Probability Weighting to adjust for potential selection bias.ConclusionExposure to Holocaust conditions in early‐life may be linked with poorer cognitive function and greater cognitive decline decades later in old‐adults with (CHD).