The worrying link between veterans and Alzheimer’s disease, and what Houston experts are doing to fix it Harry D. Gonzalez November 11, 2021 Link finder Mike Allen knew that his father had served two tours in the military in Vietnam. Other than that, Robert “Bobby” Allen didn’t mention it. “My dad didn’t talk a lot about his service, especially his time in Vietnam,” Allen remembers. “As an adult, I respected what he went through and the sacrifices he made for our country.” Allen decided not to bring up the subject. He didn’t want his father to have to relive a difficult past. His grandfather was a fighter pilot during WWII and his uncle was also a Vietnam veteran. He assumes they’ve all seen horrible things. And they were all part of a generation, explained Allen, who often didn’t speak about what they saw or how they felt. Still, there is one topic of conversation Allen wants to encourage: the risk of Alzheimer’s and dementia for veterans. Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) may be relatively new concepts to many people of his father’s age who served in combat. “They didn’t even use the term PTSD back then,” he said. “But the hits to the head, the mental stress, there is a lot of correlation.” Allen said his father’s battle with Alzheimer’s disease has become most visible over the past two years. “But you look back and the signs were there,” he said. Dementia, Alzheimer’s and risk for veterans A fact sheet released by the Alzheimer’s Association in March notes that nearly half a million U.S. veterans have Alzheimer’s disease. In addition, the annual number of veterans diagnosed with dementia has increased by more than 22% since 2008. And as the population ages, those numbers are expected to increase. There is some evidence that moderate and severe TBIs increase the risk of developing certain forms of dementia. More than one in five combat injuries caused by the wars in Afghanistan and Iraq involve brain damage, and more than 430,000 veterans have been diagnosed with TBI since 2000. PTSD, which may be two to five times more common in veterans, is also linked to a higher risk of dementia. In fact, it can double the risk. These findings come as no surprise to Dr. Robert H. Meaders, a retired sea captain with over 23 years of medical experience. He is certified in preventive medicine and ophthalmology and has practiced in private practice for 10 years. He has also worked with the World Health Organization and the International Eye Foundation. For years, from his home in Montgomery, he led the nonprofit Operation Helmet, which he launched in 2003. The organization’s mission was to modernize combat helmets with protective pads to reduce the risk of TBI. Meaders explained that between 2006 and 2009, 18 percent of all troops, even those not diagnosed, had some form of traumatic brain injury; 1.5 percent suffered such severe trauma that they were not fit to return to combat service. “And it’s not just direct trauma,” Meaders added. “It’s also the shock wave.” Blast waves – an area of pressure after an explosion – wave the helmet against the skull, which can strike the brain unless there is proper padding. This can lead to chronic traumatic encephalopathy (CTE), a progressive brain disease, Meaders said. He said the majority of non-fatal injuries among veterans are head trauma. “It’s no wonder we are seeing a high incidence of dementia, Alzheimer’s disease and chronic traumatic encephalopathy,” Meaders said. Operation Helmet sent 97,000 helmet upgrades before it closed recently. “The military is starting to change its styles of helmets,” Meaders added. “They’re lighter now, which encourages people to wear them. But even these do very little for shock wave protection. Identify modifiable risk factors Examining risk factors, like TBI and PTSD, is relatively new, explained Richard Elbein, CEO of the Alzheimer’s Association of Houston and Southeast Texas. “We are talking about harm reduction for the first time,” he said. For a long time, Elbein explained, science did not support the idea that preventive measures could be taken. “Now we know there are things we can do – diet, exercise, cognitive stimulation,” he said. A 2020 Lancet Commission study showed how lifestyle can affect dementia, explained Dr Mark Kunik, geriatric psychiatrist and professor at Baylor College of Medicine. Kunik is also the Behavioral Health and Implementation Program Manager at the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center, as well as the Director of the South Central Mental Illness Research, Education and Clinical Center. “We’re learning more and more that there are modifiable risk factors for dementia,” Kunik explained. Risk factors include high blood pressure, diabetes, smoking, obesity, and hearing loss. “All of these are often higher among veterans,” Kunik added. The good news, he explained, is that diet, exercise, and social stimulation can help prevent dementia. “You can do something,” Kunik said. “The enthusiasm is really about how we can move forward towards prevention, like we did with heart disease. Can we take the same approach to brain health? “ Finding New Ways to Help Veterans Scientific research on risk factors, prevention and early detection has prompted the Alzheimer’s Association to change course. “Our mission changed a little over a year ago,” Elbein said. “It has become more focused. We want to lead the way to end Alzheimer’s disease. It also means accelerating global research, he explained, and maximizing the quality of care for patients. Elbein explained that about 12 years ago, the Alzheimer’s Association funded a study to support the Department of Veterans Affairs standard of care for dementia. “The study was very successful,” he said. “It showed that caregivers who received extra support were much less stressed and used medical care less frequently. This has helped us as an organization to focus more on the social services that we provide. The study also strengthened the relationship between the Alzheimer’s Association and the Michael E. DeBakey VA Medical Center in Houston. Before COVID-19, staff at the Alzheimer’s Association in Houston set up a table twice a month at the VA to help people newly diagnosed with dementia. The organization is also working with the VA to achieve its Elder Friend designation, which means the facility is designed to treat older patients. The Alzheimer’s Association in Houston continues to look for ways to better serve veterans and recently hosted a community forum with the people last month. “It will open up avenues for us,” Elbein said. “It’s like raising the temperature. “ In the meantime, the Alzheimer’s Association is by your side, with an online community resource finder and telephone helpline. The organization offers care consultations to develop individualized plans based on specific needs. “We can get them to the most appropriate resources and create a plan to meet their needs in the future,” Elbein said. Contribute to scientific research Allen, a resident of Cypress, has also found a way to be proactive about his father’s diagnosis, which he often finds overwhelming. “I had this empty feeling of not knowing what to do,” Allen said. “I have Google searched for Alzheimer’s disease so many times. “ When the Alzheimer’s Association launched its Ride to End ALZ bike fundraising event in Texas, Allen signed up. The event was scheduled last month in Wimberley. Maybe it’s something I can do to help the cause, he thought. He has set himself a goal of raising $ 500. Then his wife reminded him of an obstacle: “Honey, you don’t have a bike. You don’t ride. Allen had eight weeks to train. He hoped his spin lessons would help him tackle two wheels. “If I want to ask for money, I have to work for it,” he said. Allen raised $ 650 on the first day. The next day, the number jumped to $ 950. He continued to increase his fundraising goal. In the end, he raised around $ 6,000 for Alzheimer’s disease research. Before the big day, Allen called his mom, who lives in Dallas, and asked her, “Is there a possibility that you’re knocking daddy down?” She said, “Absolutely. His parents, wife and two children cheered him on to the finish line, after covering 80 miles. Now Allen can’t wait to do the ride again next year. He wants to help raise awareness, especially for other veterans with dementia. He hopes to start the conversation. “And it doesn’t cost a dollar,” he said. Lindsay Peyton is a Houston-based freelance writer.