The U.S. Department of Veterans Affairs estimates that 23.2 million living veterans have served in the United States armed services in times of both war and peace.
As these men and women who served their country advance in age, there is concern about the known increased risk of potential cognitive impairment and neurodegenerative disease that exceeds that of the general population. Each conflict had risks for long-term health consequences, including chemical exposure, traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
In order to bring attention to this public health concern and to provide a forum for open discussion, Alzheimer's and Dementia — the professional journal of the Alzheimer's Association — has given open access to its June issue. The issue focuses on the overall problem of cognitive decline and dementia in soldiers and veterans.
The objective as described by the organization is twofold: "first, to provide, in one place, much of the currently available evidence concerning the various risk factors and exposures that are associated with cognitive decline, Alzheimer's disease and dementia in soldiers and military veterans and second, to give greater evidence and arouse interest in this issue."
Ara S. Khachaturian, Ph.D., the executive editor of the journal, provided the introductory comments: "Understanding the neurobiological mechanisms of TBI and PTSD with and increased risk of neurodegenerative disease has become a high priority for the U.S. Army.
"Focus on expanding ongoing collaborative effort and build upon the experiences gained from already-established, ongoing international collaborative efforts, such as the World Wide Alzheimer's Disease Neuroimaging Initiative (ADNI), the U.S. Department of Defense, the Alzheimer's Association Global Biomarker Standardization Consortium and the Global Alzheimer's Association Interactive Networks."
There are 24 peer-reviewed articles covering a diverse range of topics in addition to TBI and PTSD. Some of the topics addressed are chemical exposures, prisoners of war, depression, sleep pathology and smoking.
With 1.7 million living veterans of World War II and another 2.3 million Korean veterans already at the age of increased risk for cognitive dysfunction as well as 7.4 million Vietnam veterans approaching the age of risk, medical systems are likely ill-prepared to fully address the unique cognitive concerns of combat soldiers. Another 2.2 million veterans of Desert Storm will be adding to the numbers of older veterans.
Many of the veterans of 21st century warfare have experienced a unique form of functional issues, having survived traumas that in previous wars had resulted in death. It is estimated that there are 2.8 million veterans of Afghanistan and Iraq (IAVA), many of whom will need services.
Regarding the need for more concentrated efforts to better care for veterans, Michael W. Weiner, M.D., of the Department of Veterans Affairs Medical Center, San Francisco, points out in the journal issue's preface:
"The Department of Defense, Department of Veterans Affairs and the National Institutes of Health must work with industry, philanthropy and academe to develop a comprehensive approach for effective treatment and prevention of Alzheimer's disease and associated conditions, thus preventing functional disability due to cognitive impairment. We, as a society, owe this to 'those who served.'"
