Veterans with PTSD Nearly Twice as Likely to Develop Dementia

Recent findings have revealed that there may be a connection between post-traumatic stress disorder (PTSD) and dementia. First, let’s take a look at the two conditions individually.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that some individuals develop after experiencing or witnessing a life-threatening event, such as combat, a natural disaster, a car accident, or sexual assault.  According to the National Center for PTSD, it is normal to have upsetting memories, feel on edge, or have trouble sleeping after a traumatic event.  Such symptoms may contribute to difficulties with daily activities, including going to work, attending school, or spending time with loved ones.

For most individuals, these symptoms begin to subside within a few weeks or months following the traumatic event; however, for some, symptoms may persist.  In this case, a diagnosis of PTSD may be assigned by a health care provider, typically a therapist, psychologist, or psychiatrist.

Importantly, personal factors, like previous traumatic exposure, age, and gender, can affect whether an individual will develop PTSD.  Stress can make PTSD more likely, while social support can make it less likely.

Symptoms of PTSD

 Generally speaking, there are four main types of PTSD symptoms, including the following:

• Reliving the event– re-experiencing the trauma through intrusive, distressing recollections of the event, flashbacks, and nightmares
• Avoidance – avoiding places, people, and activities that are reminders of the traumatic event
• Increased arousal – difficulty sleeping and concentrating, feeling jumpy or on edge, and being easily irritated and angered
• Emotional numbness – not having positive or loving feelings towards other people, avoiding relationships and interactions, thinking the world is a dangerous place in which no one can be trusted

However, it should be noted that PTSD symptoms tend to vary amongst individuals and therefore, the list of symptoms outlined above is non-exhaustive.

Treatment for PTSD

There are two main types of treatment for PTSD: (1) psychotherapy (i.e., talk therapy) and (2) medication.  Oftentimes individuals combine psychotherapy and medication for the best possible outcome.  Research shows that trauma-focused psychotherapy (i.e., therapy that focuses on the memory of the traumatic event or its meaning) is the most effective treatment for PTSD.  Different types of trauma-focused psychotherapies include:

• Cognitive Processing Therapy (CPT) – involves learning skills to understand how trauma impacts thoughts and feelings and changing how individuals think about the trauma to change how they feel overall
• Prolonged Exposure (PE) – involves discussing trauma repeatedly until memories are no longer upsetting thereby giving the individual greater control over their trauma
• Eye Movement Desensitization and Reprocessing (EMDR) – involves focusing on sounds or hand movements while discussing trauma with the goal of helping the brain work through the traumatic memories

In terms of medications, many health care providers prescribe selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are also used to treat depression.  Examples of SSRIs and SNRIs used for PTSD include sertraline, paroxetine, fluoxetine, and venlafaxine.

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What is Dementia?

According to the National Institute on Aging, dementia is the loss of cognitive functioning (i.e., thinking, remembering, and reasoning) and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.  Oftentimes, these cognitive functions include memory, language skills, visual perception, problem-solving, self-management, and the ability to focus.

Typically, dementia ranges in severity from mild to severe.  In the mildest stage, individuals with dementia begin to notice difficulties with daily functioning whereas in the most severe stage, individuals must often depend on others for basic activities of living.  While dementia is more common as people grow older (i.e., up to 50 percent of all people ages 85 or older may have some form of dementia), it is not a normal part of aging.

Causes of dementia can vary, depending on the types of brain changes that may be taking place; however, Alzheimer’s disease is the most common cause of dementia in older adults.  An additional cause of dementia may include a traumatic brain injury (TBI).

Relationship Between PTSD and Dementia

In September 2020, the British Journal of Psychiatry published a study exploring the relationship between PTSD and dementia.  Researchers analyzed findings from 13 studies conducted on four continents, including data from nearly 1.7 million people, to determine whether a PTSD diagnosis was associated with an increased risk of dementia up to 17 years later.

Findings demonstrated that individuals with PTSD faced a nearly two times higher risk of developing dementia.  It remains unclear how PTSD raises dementia risk; however, researchers determined that it may be related to hypervigilance and recurrent re-experiencing of trauma, contributing to threat- and stress-related activity in the brain, while social isolation may reduce cognitive reserve and resilience.

Does This Finding Regarding PTSD and Dementia Affect Veterans?

Veterans are at high risk of developing both PTSD and oftentimes dementia.  However, this study found that dementia risk among people who are diagnosed with PTSD was higher in the general population as compared to veterans.  Specifically, people with PTSD within the general population were twice as likely to develop dementia as compared to veterans.

Researchers concluded that this discrepancy may reflect the fact that veterans are typically more likely to receive treatment for PTSD, which may suggest that treating PTSD reduces subsequent dementia risk.