My husband is a Nam vet, served 20 years in the USAF with multiple tours in Nam. After retiring the VA did not recognize PTSD as a legitimate condition. He managed to function enough to finish a degree and work in an engineering related field. Retired from that about 12 years ago. Not long after that he was diagnosed with severe cardiac issues that were rated at 100% disabled by the VA as well as a 70% disabled rated for PTSD along with 40% disabled due to Agent Orange related type ll diabetes.

We've been together almost 25 years and as is not unusual for those who have severe PTSD, one finds that their world begins to shrink, until in some cases, it becomes a circle of two. That is where we find ourselves. He is a very special man. I've always admired the way he never focused upon himself, was always willing to help anyone who needed help, despite the horrors he saw and lived through, had managed to keep his soul intact, still had compassion, was funny and if reserved in his interaction with others in general, was open and warm and loving with me.

As his health has changed, so has the scope of our world; for some time now it has consisted almost entirely of his numerous medical visits. Also, as his health has changed over the last decade I've slowly assumed the role of care giver. Not a comfortable situation for a man who is intelligent and had always been independent.

He's been in a weekly PTSD group with the local outpatient VA clinic. While he hasn't (by his own admission) been overly active in participating until rather recently; he seems to have become comfortable and secure in the company of the other men and the group leader. The group leader is very dedicated and supportive of the veterans in his group.

We're closer than many couples, partly due to the nature of his health issues and partly because I've (perhaps) been too inclined to forgo social interaction as to avoid him being in situations that were uncomfortable for him. I've learned to be very observant of subtle changes in his health, physical and mental, know what his personal 'triggers' are related to specific dates / seasons / sounds / smells / visual images, that can set off PTSD related episodes. And know to advise his caregivers when he has been in the hospital for surgeries, what certain things might cause him to react in a negative way (he cannot handle small or dark rooms or people blocking his path in front of him) and that is those things can be avoided, it is better, but if not, that they need to consider that some of the things he experienced in Nam have very, very deeply affected him. Along with this, and not uncommon for those with significant health problems, he has rather significant depression.

However, in the past two years or so, I've begun to notice cognitive issues that didn't seem related to any of his physical health issues: two successful carotid endarterectomy surgeries within that last three three years; significant, though not limb compromising blockages in his illiac arteries (monitored twice a year); a bi-vent pacer placement five years ago (original EF was 20, dropped to 12 and unable to induce VF in the lab, the choice was made for the pacer in combination with medication for treatment).... Well controlled diabetes with oral medications and diet, consistently good A1C numbers (monitored every 3 months).

About a year ago I said that I thought the time was coming when we'd need to have 'the talk' about when it was time to stop driving. I based this on his difficulty to maintain a consistent rate of speed within the posted limited, some confusion as to directions and periods of 'missing time', when he'd drive alone for a simple errand near our home and return a couple hours later with a totally unrelated item and no sense of how long he'd been gone. When he drove through the screen garage doors the second time, I said the time for talk had arrived and for his sake and the safety of others, he needed to stop driving.

As difficult on me as on him, this loss of independence was bound to have an effect upon him. However it came when I had begun to notice a pattern of misplacing things, losing things, personality changes, changes in his usual sleep patterns (always a bit off due to nightmares), agitation / nervous energy / lack of direction, usually beginning in the later part of the day or evenings; though not every day. It took three incidents that involved 9-1-1 and hospital admissions before I finally came to the conclusion that it was very likely he might have Alzheimers.

Long story short, in the last six months two of his physicians have independent of one another, come to the conclusion that it is very probable that he has mid-stage AD, his depression has greatly increased and he has been diagnosed with paranoia.

The last two months have been very challenging for both of us. He's had three inpatient stays for his AD and related psychotic behavior. Last month he was in a VA secure unit where, to the best of my knowledge, they simply followed the "Medicate - Sedate ' Isolate - Restraint" method of treatment. This only lead to increased agitation and a most unproductive cycle of inappropriate behavior / staff response.

Originally the unit social worker said he'd likely need either placement in an assisted living facility (at our expense) or placement in a VA long term care facility (their expense). Both I found disturbing as my committed to my husband was regardless, he would always remain in our home and with my care. However I also know that even if respite care came for short periods, that with his assorted issues, that might not be viable. As far as assisted living, I explained that even the best memory care unit would be highly unlikely to accept a resident with his numerous and significant health issues and his very significant mental health issues, which also include phases of wanting to 'fix things' which involve things being taken apart and now truly being in need of repair and bouts of verbal and physical violence (never at a person directly, currently limited to pounding on walls, doors, counters, etc.). Also, as a social worker, she must be aware that a person with combat related PTSD is very uncomfortable in groups of strangers and combined with his paranoia; is not likely to be able to maintain what control he still has, over his behavior.

Despite my concerns he was discharged, medicated ( I assumed based on his physical bearing and mental fog) just enough to almost get him home before he reverted back into his cycle of paranoia / anger / agitation/ confusion; refusing to take his medications or eat. Within 24 hours he was back in a hospital, this time under a Baker Act, due to his actions at both the local VA outpatient clinic and his private primary care doctor.

Currently, after much involvement and constant 'nudging' by myself and (I assume) the leader of the PTSD group, he has been transferred to another VA hospital within the region. He alternates between being seemingly lucid, but as soon as anyone disagrees with him, questions him or acts / says anything that he takes as being 'out to get him'; he becomes upset and while sometimes he can be 'redirected' in another direction, to avoid a complete melt down; he always returns to the topic / object of his most current fixation.

Have I worn you out yet? A few of his caregivers have mentioned that he is 'very energy intensive'....... And they are only dealing with him in 8 hour shifts; imagine it 24/7/365.

I came to this site by way of researching for any link between combat related / induced PTSD and dementia. Considering it took the VA 20 odd years to accept the cause and effect of Agent Orange exposure and numerous health issues; I do not doubt that they would be inclined to not to quickly accept any responsibility between combat PTSD and a greater likelihood of dementia.

However, as my husband is 100% service connected disabled and as I have thus far done all I can with regards to making our home safer for a person with AD and have and can cope with his physical health needs, the possibility that due to his extreme combat experiences, the nature of how Alzheimers might affect him, could be more than I alone can handle. As the potential (at least currently) for him to be physically aggressive, might negate the option of bringing in-home assistance into the plan; I am hoping that perhaps there are other studies which might help me build the case that the VA has a moral and legal obligation, to provide as is best, for the veteran.

When it comes to my husband, I am completely devoted and while beginning to feel the effects of both physical and emotional exhaustion because of the last year or so; I cannot just let this issue go. The clock is ticking, so to speak, while he is in a secure unit. I need to gather as much information, from as many sources, so to best make sure that my husband is not another veteran, lost in a system that is overwhelmed, underfunded and overtaxed by a growing need for their services.