VA and the Kristine Yaffe Lab at the University of California, San Francisco, have taken a new approach to understanding the association of mild traumatic brain injury (TBI) — with and without loss of consciousness (LOC) — with dementia among Veterans. Their recent study, one of the largest in the United States, included 178,779 Veterans in the VA health care system who were diagnosed with various levels of TBI severity.
The study found that TBI with and without LOC are both associated with a heightened risk of developing dementia. Even mild TBI without LOC was associated with more than a twofold increase in the risk of a dementia diagnosis.
The study was part of the Chronic Effects of Neurotrauma Consortium (CENC), a federally funded research project devised to address the long-term effects of mild TBI in military service members and Veterans. CENC is jointly funded by VA and the Department of Defense.
TBI is a complex physiological condition that can arise when a brain experiences trauma, either directly or indirectly, during any of a variety of moderate to catastrophic events. TBI has been researched and studied in-depth by some of the world’s leading neurologists, neuropsychologists, neuropsychiatrists and other leading mental health experts. Their goal is to develop treatments, tools and resources to help those affected by TBI return to their previous, or close to their previous, quality of life and cognitive ability. TBI among Veterans is a key focus area of VA physical and mental health care, and VA conducts research every day to help unravel the intricacies of TBI’s symptoms and effects.
In the past 10 years, researchers and clinicians have confirmed that TBI may be a risk factor for dementia, but they have yet to determine why. Some professionals think dementia may be related to the injury itself, while others believe that head trauma may cause toxic and abnormal proteins associated with dementia to build up over time.
Advice for Veterans experiencing symptoms of TBI
Evaluation by a physician is critical to help identify and address symptoms of TBI. TBI can be difficult to diagnose because it has many causes, such as motor vehicle collisions, sports-related injuries and falls. Among Veterans, TBI may be caused by a single event, such as an IED blast, but also may occur over time as a result of repetitive jolts to the head or neck. If you have had a recent head injury, or if you had a head injury in the past and are concerned about recent changes in your memory, consult your physician for a screening.
During a TBI evaluation, you and your doctor will discuss what caused your injury and ways to deal with any physical, cognitive and behavioral symptoms, such as difficulty concentrating and headaches. You also will explore how these symptoms affect your daily life. Your doctor may recommend counseling to help you learn ways to manage the effects of TBI. Because a TBI can affect the way the brain functions, medications may be needed or changed to assist in recovery and coping.
To learn more about TBI symptoms and treatment for Veterans, visit VA’s mental health page on TBI or go to MakeTheConnection.net, which features videos of Veterans talking about their experience with TBI.
Understanding dementia risk factors
Although there is a slightly elevated risk for dementia among those who have experienced TBI, that does not mean everyone with TBI is at risk. TBI is only one of many risk factors for dementia, including genetic markers, that are being studied. No matter what risk factors you may have, it’s important to maintain an overall healthy lifestyle, monitor your heart health and try to remain mentally and physically active.
The future of TBI and dementia research
The VA health care system recognizes that more research is needed to further understand and provide the best health care to Veterans with TBI. This study suggests that Veterans with TBI — in particular, older Veterans — should be monitored and screened at regular intervals for any signs of memory changes. Research collaboration among VA, universities and national organizations such as the National Institutes of Health will continue to expand our knowledge of TBI and related conditions and opportunities to prevent and treat them.
About the VISN 21 MIRECC
VA’s VISN 21 MIRECC is committed to improving the clinical care of Veterans with dementia and with post-traumatic stress disorder through the development of innovative clinical, research and educational programs. This center’s approach is to identify risk factors for cognitive decline in older Veterans and to develop and implement novel countermeasures to minimize this decline.
For more information on VISN 21, visit www.mirecc.va.gov/mirecc/visn21.
Dr. Yaffe received a bachelor’s degree from Yale University, earned her medical degree at the University of Pennsylvania and completed residencies in neurology and psychiatry at the University of California, San Francisco (UCSF). She is the Scola Endowed chair and vice chair, professor of psychiatry in neurology and epidemiology and co-director of the Clinical and Translational Science Training program at UCSF. She is also the chief of neuropsychiatry and director of the Memory Disorders Clinic at the San Francisco VA Medical Center.