Blast Exposure May Increase Risk of Alzheimer’s in Veterans
What is Alzheimer’s Disease?
Alzheimer’s disease is a type of dementia that causes problems with memory, thinking, and behavior. Specifically, it is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out simple tasks and daily activities. Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s disease. Decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning and judgment may signal the early stages of Alzheimer’s disease as well. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but more recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.
About the Study
A new study from Boston University’s School of Medicine raises the possibility that close-range blast exposure among veterans with a genetically higher risk for Alzheimer’s disease may make them more susceptible to neurodegenerative conditions. Although there is evidence that genetic risk for Alzheimer’s disease may elevate the risk of neurodegeneration following traumatic brain injury (TBI), it has been unknown if blast exposure also interacts with Alzheimer’s disease risk to promote neurodegeneration.
Dementia and TBI
As mentioned above, prior research shows that there is a connection between TBI and dementia amongst veterans. Namely, a June 2019 study compared dementia diagnosis in veterans who had experienced TBI with or without a loss of consciousness and control participants without TBI exposure. The study found that a total of 4,698 veterans (2.6 percent) without TBI developed dementia compared with 10,835 (6.1 percent) of those with TBI. These results indicate that TBI with and without loss of consciousness are both associated with a heightened risk of developing dementia. Importantly, even mild TBI without loss of consciousness was associated with more than a twofold increase in the risk of a dementia diagnosis and long-term neurodegenerative consequences.
What the Researchers Examined: Close-Range Blast Exposure and Alzheimer’s Disease
The researchers at Boston University’s School of Medicine examined whether apolipoprotein (APOE)-4, a well-known genetic risk factor for Alzheimer’s disease, influenced the relationship between close-range blast exposure (approximately 10 yards) and white matter integrity (marker for neurodegeneration) in a group of 200 Iraq and Afghanistan War veterans.
Findings and Results
The study found that veterans who had close-range blast exposure and carried the genetic risk factor had more spatially diffused white matter abnormalities than those without the genetic risk factor. This interaction remained significant after controlling for TBI, pointing to the specificity of close-range blast exposure and genetic risk factors in white matter disruptions.
Implications of the Study
Researchers believe this study has implications for the long-term health effects of veterans returning from the Iraq and Afghanistan Wars. Those who experienced a blast exposure within close-range and have elevated genetic risk for neurodegenerative disease may be at a greater risk for neurodegeneration and subsequent presentation of neurodegenerative diseases such as Alzheimer’s disease.
VA Health Care for Dementia and Alzheimer’s Disease
Care for veterans with dementia or Alzheimer’s disease is provided throughout the full range of VA health care services. Depending on the veteran’s needs, services may include any of the following:
Home-Based Primary Care
The Home-Based Primary Care Program allows veterans to be seen by a medical professional, such as a physician, nurse practitioner, or nurse, in their own home. This program is intended for veterans who have complex healthcare needs, and for whom “routine clinic-based care is not effective.” Through this program, veterans are able to:
- Receive primary care visits from a physician, nurse practitioner, or physician’s assistant at home;
- Have their care managed by a nurse practitioner, physician’s assistant, or nurse at home;
- Have their services coordinated by a social worker;
- Receive occupational, physical, or speech therapy;
- Obtain mental health services;
- Get nutrition counseling from a dietician;
- Get help managing medications
The Veterans Health Administration’s (VHA) Standard Medical Benefits Package allows all enrolled veterans who meet clinical criteria to access Home-Based Primary Care services.
Homemaker and Home Health Aide Care
A Home Health Aid or Homemaker is a trained individual that travels to a veteran’s home in order to assist them with activities of daily living, including self-care. These professionals are not nurses and therefore do not provide the level of medical care that a Skilled Home Health Care professional can. This program can be used as an alternative to nursing home care and may offer respite care for veterans and their caregivers. These professionals can assist veterans in:
- Getting dressed
- Using the restroom
- Food shopping
- Doing laundry
- Taking medication
This program is also part of VHA’s Standard Medical Benefits Package, therefore all enrolled veterans who meet the program’s clinical criteria are eligible.
Adult Day Health Care
The Adult Day Health Care program gives elderly veterans a place to go during the day for social and recreational activities, to receive peer support and companionship, while also assisting with activities of daily living. This program can especially benefit veterans who are isolated or whose caregivers are “experiencing burden,” offering respite care for family caregivers. Health services from nurses, social workers, or therapists may be available to veterans in this program as well. Veterans can attend full or half-day sessions for up to five days per week based upon availability.
Veterans suffering from a terminal condition and no longer seeking treatment other than palliative care may be eligible for hospice care services from VA. Hospice care seeks to relieve suffering and help control symptoms near the end of a person’s life. Bereavement support is also available to the families of veterans.
Usually VA’s hospice program is reserved for veterans with less than six months to live and can be offered at home, in an outpatient clinic, or in an inpatient setting. All veterans enrolled in VA healthcare are eligible for hospice care if they meet clinical need.
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