My father was a proud World War II Army veteran. I have a nephew in his twenties who recently served in the Army in Iraq and Afghanistan. Another nephew is currently serving in the Marine Corps and intends to make it a career. I have often wondered about the likelihood of soldiers returning from their tours of duty, eventually developing Alzheimer’s or other forms of dementia. I came across some recent articles that gave me disturbing answers.
Veterans’ Unique Risk Factors
There are currently about thirteen million veterans over the age of 55. This represents two-thirds of the veteran population in our country. The Department of Veterans Affairs (VA) estimates that more than 770,000 older veterans have Alzheimer’s disease or associated dementias. The National Institute of Health published a study in which they estimate that 420,000 veterans will have developed Alzheimer’s between 2010 and 2020.
According to Dr. David X. Cifu, a researcher and traumatic brain injury specialist at the VA, veterans are at a higher risk for developing Alzheimer’s for several reasons. There is a higher prevalence of mental health disorders in the veterans’ community which creates more likelihood of developing dementia.
The unique risk factors include: post-traumatic stress, depression, traumatic brain injury, and blast-induced neurotrauma.
- Post-traumatic Stress Disorder and Depression
According to a study that appeared in the Journal of the American Geriatrics Society, the risk of Alzheimer’s doubles for veterans with post-traumatic stress disorder (PTSD). The VA estimates that thirty percent of Vietnam veterans suffer from post-traumatic stress. This is four times the rate of the general U.S. population. More than one-third of our Iraq veterans suffer from PTSD or depression. PTSD and depression are also associated with suicidal ideation and the rising rate of suicide among veterans.
Symptoms of PTSD may include:
Unwanted and repeated memories of the life-threatening event;
Flashbacks where the event is relived and person temporarily loses touch with reality;
Avoidance of people, places, sights, or sounds that are reminders;
Feelings of detachment from people, even family, and emotional numbness.
- Traumatic Brain Injury
Traumatic brain injury (TBI) also increases the risk of dementia. TBI is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Veterans with TBI are sixty percent more likely to develop dementia than other veterans, according to a 2014 study by the American Academy of Neurology.
Because of the prominent use of improvised explosive devices, blast exposure has been the most common cause of TBI. Iraq and Afghanistan veterans are at a higher risk to develop Alzheimer’s because they have sustained more brain injuries. If you were to count all combat wounds veterans suffered in the Iraq and Afghanistan conflicts, twenty-two percent were brain injuries. This is nearly double the brain injuries sustained by US soldiers during the Vietnam War.
There are physical, emotional-behavioral, and cognitive symptoms that are common consequences of TBI. Here are some of the symptoms:
Physical: fatigue, headaches, difficulty with speech, decreased muscle movement, and disruptions to sensory symptoms.
Emotional-behavioral: depression, irritability, anxiety, disturbed sleep, impulsivity.
Cognitive: word-finding problems, difficulty multi-tasking, difficulty remembering and concentrating.
- Blast-induced Neurotrauma
The use of body armor is allowing soldiers to survive blasts that would otherwise be fatal. Blast-induced traumatic brain injury (bTBI) is a major medical concern and has been called the “signature wound” of the Afghanistan and Iraq wars. During the Iraq conflict, nearly half of the soldiers who were injured experienced blast exposure resulting in neurotrauma.1
According to a variety of scientific studies, high rates of blast injuries and blast-induced neurotrauma are associated with irreversible, chronic brain tissue damage, including neurodegeneration, long-term neurological deficits, and memory loss.
- Successive Concussion Syndrome
The post-concussion syndrome (PCS), a common sequel of traumatic brain injury (TBI), is a symptom complex comprising of headache, sleep disturbance, neuropsychiatric symptoms, and cognitive impairment.
Mayo Clinic defines post-concussion syndrome as “a complex disorder in which various symptoms, such as headaches and dizziness, last for weeks and sometimes months after the injury that caused the concussion. Concussion is a mild traumatic brain injury that usually happens after a blow to the head. It can also occur with violent shaking and movement of the head or body. You don’t have to lose consciousness to get a concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury.”
Barriers to Effective Diagnosis, Treatment and Care
A timely and early diagnosis of Alzheimer’s is critical to care. Veterans may face several barriers to getting effective care. These include: a complex VA health system; a lack of understanding of available benefits; and a stigma related to brain and mental health problems.
Dr. Sandra Bond Chapman, Founder and Chief Director, Center for Brain Health at the University of Texas at Dallas, notes: “Stigma about the brain keeps them (veterans) from seeking the help they need causing the problems to worsen over time. We must get ahead of the growing risk of Alzheimer’s for the increasing number of veterans who served our country.”
Alzheimer’s disease can not only take a devastating toll on veterans, but also on family members who provide their care. Social isolation and depression are possible negative effects of caregiving, but support is available.
A New National Network
The advocacy group, USAgainst Alzheimer’s, recently launched a new network called “Veterans Against Alzheimer’s” to specifically spotlight the challenges faced by veterans and their families. It will focus on raising awareness, and advocating for increased resources, programs and funding for needed research. This group also hopes to increase veteran participation in clinical trials. They are working in collaboration with the VA, Veterans of Foreign Wars, and the Department of Defense funded Chronic Effects of Neurotrauma Consortium.
Help Is Available
If your loved one is a veteran experiencing difficulties concentrating, has recurring headaches, or any of the symptoms described above, make an appointment to see a primary care provider who can then recommend a neurologist for more in depth diagnosis if needed.
Caregivers play an important role in the health and well-being of veterans. The VA offers a free six-week online workshop, “Building Better Caregivers.” Check out the other resources available at the VA website: https://www.caregiver.va.gov/. The Veterans Crisis Line phone number is 1-800-273-8255.
The U.S. Department of Veteran Affairs has information on their website regarding Alzheimer’s and dementia care: https://www.va.gov/geriatrics/alzheimers_and_dementia_care.asp.
For more information and to become involved in Veterans Against Alzheimer’s, go to their website: http://www.usagainstalzheimers.org/veterans-network.
Brainline.org is a website that focuses on brain injuries and TBI. It has a section devoted to veterans and their caregivers: https://www.brainline.org/military-veterans. The website also has a resource directory where you can find help near where you live: https://www.brainline.org/military-resource-directory.
The ancient Greek physician Hippocrates is said to have remarked in 400 BC: “No head injury is too severe to despair of, nor too trivial to ignore.” As we approach the observance of Veterans Day, November 11, let us all join to help fight and win the battle against Alzheimer’s. We owe it to our veterans!
I wish you peace, love, compassion and joy in your caregiving today and every day!
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To read the brief, “Veterans and Alzheimer’s: Meeting the Crisis Head On,” published by Veterans Against Alzheimer’s, October 3, 2017, go to: http://www.usagainstalzheimers.org/sites/default/files/USA2_Veterans%20Issue%20Brief_October%2010%202017%20%282%29.pdf.
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Dr. David Cifu discusses brain trauma in this brief YouTube video: https://youtu.be/pXjmX1WKxRI.
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Patients are an integral part of the interdisciplinary polytrauma team at the Washington, D.C., VA Medical Center: https://youtu.be/PPD3KLc-q08.
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An Army veteran discusses his symptoms and treatment of PTSD and TBI in this brief YouTube video: https://youtu.be/mEVA0T7QR1E.