Unexpected connections: veterans, PTSD and dementia

It’s funny how things unexpectedly connect.

I took part in a webinar on veterans’ health organised by the BMA last year. I suppose I booked it because, as an old age psychiatrist, I don’t remember seeing many veterans. The blurb for the webinar asserted that “most healthcare professionals don’t ask or know if their patient is a veteran, even though the average GP is likely to have 30 or 40 veterans on their list.” I suppose that made me curious – have I been missing something important over my years in old age psychiatry?

The webinar focused mainly on physical health and included veterans telling their stories. Mainly these were young veterans (by my standards!), and I wondered about the generation of older adults presenting to mental health services now, who are veterans of conflicts we might regard as historic.

Then, in connection with some work I’m doing, I came across the issue of veterans, PTSD and dementia. Did you know that there is literature suggesting the veterans with PTSD have an increased risk of developing dementia? (Twice the risk in the non veteran population). Interesting … Add to this, publications describing the (apparently new) onset of PTSD symptoms in veterans who are in the early stages of developing dementia. And there is also literature suggesting that delayed-onset PTSD in veterans who develop dementia might be misdiagnosed as behavioural and psychological symptoms.

So what do I take away from this? Well maybe we should ask people more often whether they are veterans. Martinez-Clavera and colleagues argue that information about veteran status and trauma should be gathered early, “before significant cognitive decline”, and that psychological treatments might be appropriate at this stage. In people with more advanced dementia conditions, they note that information will need to be obtained from relatives and it will be important to avoid environmental triggers.

I wonder whether other people working in older people’s mental health ask about veteran status…

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