Exposure to the Holocaust and World War II Concentration Camps during Late Adolescence and Adulthood is not Associated with Increased Risk for Dementia at Old Age

Holocaust and Nazi concentration camp survivors were subjects to prolonged and multi-dimensional trauma and stress. The aim of the present study was to assess the association between exposure to such trauma during late adolescence and adulthood with dementia at old age. In 1963, approximately 10,000 male civil servants aged 40-71 participated in the Israel Ischemic Heart Disease (IIHD) study. Of them, 691 reported having survived Nazi concentration camps [concentration Camp Survivors (CCS)]. Additional 2316 participants were holocaust survivors but not concentration camp survivors (HSNCC) and 1688 were born in European countries but not exposed to the Holocaust (NH). Dementia was assessed in 1999-2000, over three decades later, in 1889 survivors of the original IIHD cohort; 139 of whom were CCS, 435 were HSNCC, and 236 were NH. Dementia prevalence was 11.5% in CCS, 12.6% in HSNCC, and 15.7% in NH. The odds ratio of dementia prevalence, estimated by age adjusted logistic regression, for CCS as compared to HSNCC was 0.97 (95% CI: 0.53-1.77), approximate Z=-0.10; p = 0.92. Further adjustment for socioeconomic status, diabetes mellitus, and other co-morbidity at midlife (coronary heart disease, lung, and kidney disease), and height did not change the results substantially. Thus, in subjects who survived until old age, late adolescence and adulthood exposure to extreme stress, as reflected by experiencing holocaust and Nazi concentration camps, was not associated with increased prevalence of dementia. Individuals who survived concentration camps and then lived into old age may carry survival advantages that are associated with protection from dementia and mortality.