PTSD & Agent Orange: The Risk for Dementia
By Kim Maryniak, PhDc, MSN, RNC-NIC, Contributor
Dementia is a general term. It describes a decline in mental capacity severe enough to interfere with the activities of daily life. More specifically, the term is used to describe the loss of cognitive functioning. While the normal process of aging can cause the loss of some neurons, those with dementia experience a far greater loss. Dementia patients can lose the ability to think, remember, or reason – even experience possible behavioral complications (NIH, 2013).
The prevalence of dementia can be difficult to ascertain, mainly due to the complexity of diagnosis. Symptoms can be attributed to the aging process rather than dementia, and many cases can go undiagnosed. An assessment conducted by the Organization for Economic Cooperation and Development (OECD) estimated that dementia affects about 10 million people in OECD member countries. More recent studies estimate the number of people living with dementia is between 27 million and 36 million, worldwide (NIA, 2015). There are some general risk factors which are indicated in the development of dementia. These include advancing age, alcohol use, atherosclerosis, diabetes, Down’s syndrome, hypertension, mental illness, smoking, and family history of dementia (NIH, 2013). Other risk factors recently considered, include post-traumatic stress disorder (PTSD) and exposure to the chemical, Agent Orange.
PTSD is a common psychiatric syndrome associated with high rates of morbidity and mortality, and is one of the most common findings in veterans returning from combat. While evidence shows that PTSD may impair cognitive performance and that older individuals with PTSD have a greater decline in cognitive performance, little was known about PTSD as a risk factor for developing dementia. A stratified, retrospective cohort study by Yaffe et al. (2010) included 181,093 veterans, 55 years and older, who originally did not have dementia. Follow-up after the study initiation identified 31,107 veterans who developed dementia within a seven year period. Of this group, veterans with PTSD had a 7-year cumulative incident dementia rate of 10.6%, whereas those without PTSD had a rate of 6.6% (Yaffe et al., 2010).
A follow-up study conducted by Pless Kaiser et al. (2012) also confirmed that older adults and veterans with dementia may display more PTSD symptoms. Additionally, the study confirmed that PTSD may be a risk factor for dementia; individuals diagnosed with PTSD were almost twice as likely to develop dementia, when compared to those without the PTSD diagnosis (Yaffe et al., 2010).
During military combat, some veterans have come into contact with chemical agents – most notably Agent Orange, a defoliant that was used to thin dense tropical foliage (1961-71) in Vietnam. A 2013 study by Veitch, Friedl, & Weiner examined risk factors for dementia and Alzheimer’s disease. They discovered chemical exposure to veterans, including Agent Orange, was associated with the development of type II diabetes, hypertension, heart disease and metabolic syndrome. Although they have found no definitive causation between exposure to the controversial herbicide and cognitive decline, each of the disorders is a risk factor for the development of dementia (Veitch et al., 2013).
For more information on Alzheimer’s disease and other dementias, please see, “Alzheimer’s and other Related Dementias: Addressing Individual and Family Needs,” “Dementia: An In-Depth Review,” and “Dementia: Awareness for CNAs” at RN.com.
National Institutes of Health. [NIH]. (2013). The dementias: Hope through research. Retrieved from here.
National Institute on Aging. [NIA]. (2015). Global health and aging: The burden of dementia. Retrieved from here.
Pless Kaiser, A., Schuster Wachen, J., Potter, C., Moye, J., Davison, E., with the Stress, Health, and Aging Research Program (SHARP). (2012). Posttraumatic stress symptoms among older adults: A review. Retrieved from here.
Veitch, D., Friedl, K., & Weiner, M. (2013). Military risk factors for cognitive decline, dementia and Alzheimer’s disease. Current Alzheimer Research, 10, 907-930.
Yaffe, K., Vittinghoff, E., Lindquist, K., Barnes, D., Covinsky, K. E., Neylan, T., … & Marmar, C. (2010). Post-traumatic stress disorder and risk of dementia among U.S. veterans. Archives of General Psychiatry, 67(6), 608–613.
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Kim Maryniak has over 26 years nursing experience in medical/surgical, psychiatry, pediatrics and neonatal intensive care nursing. She has been a staff nurse, charge nurse, educator, instructor, manager and nursing director. Kim is certified in Neonatal Intensive Care Nursing and has been active in both the National Association of Neonatal Nurses and American Nurses Association. Kim’s current and previous roles have included professional development and practice, research utilization, nursing peer review and advancement, education, infection control, nursing operations, quality and process improvement.