Combat PTSD and Alzheimers?

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.

I was married to a nam vet also. he had severe ptsd and drank wayyyyyyyy too much.

maybe talk to his dr and get them to order home health care and go from there with getting you some help. don't feel guilty for asking for help either hon. make sure though whoever you can get that they know about combat ptsd and alzhiemers. they should be able to provide you with respite care too so you can have some ME time. keep us posted and welcome to the group. oh btw does the vet center he goes to have a spouse support group as well? Please get some kind of counseling for yourself too.

GulfGypsy, welcome to PC! I want to start off telling you that I kept thinking what a wonderful person your husband is from your description of him.

I don't know of any research linking combat PTSD with Alzheimer's. Have you tried a web search of the two?

Has your husband had a full work up by a neurologist? With all of his medical problems there needs to be work up to rule out dementia caused by a medical condition. Some docs are too quick to stick an Alzheimer's diagnosis on a patient without investigating other causes for the memory and behavior changes.

PC has a caregiver support forum you might find helpful.

GulfGypsy, I googled PTSD and Alzheimer's and came up with a ton of information. Two links I thought might be especially helpful were
http://www.webmd.com/mental-health/news/20100607/posttraumatic-stress-disorder-linked-to-dementia
June 7, 2010 -- Older veterans who suffer from posttraumatic stress disorder (PTSD) are almost twice as likely to develop Alzheimer's disease and other age-related dementias as veterans without PTSD, a study shows.
The study is among the first to link combat-related posttraumatic stress disorder to dementia later in life, but it is not clear if having PTSD increases the risk for late-life dementias or if recurring PTSD is an early symptom of dementia in older veterans, Deborah Barnes, PhD, of the University of California, San Francisco tells WebMD.
"We can't say from a study like this one that PTSD causes dementia," she says. "But if it does, one theory is that stress is to blame."
There is evidence that chronic stress may damage the hippocampus, which is the area of the brain that is critical for memory and learning.

http://blog.seattlepi.com/nowhearthis/archives/162933.asp
To learn how to participate in the study, contact NIA's Alzheimer's Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or by email to adear@nia.nih.gov.
Meanwhile, the PTSD study seeks volunteers who are veterans with a previous medical diagnosis of PTSD, though they don't have to be enrolled in the VA system for health care to participate.
The PTSD study involves a group psychological intervention called Mindfulness-Based Stress Reduction, or MBSR for short, which more scientific literature indicates could significantly reduce stress and provide relief for veterans with PTSD.

Something else to note.

Acetylcholine is a vital neurotransmitter that is synthesized in the body. Patients with Alzheimers typically have a lower level of Acetylcholine and part of the treatment is to increase it with medication. This often leads to a "higher than normal" level of acetylcholine in the body, which is a direct link to depression.

This could be further exacerbated by the existing depression caused by basic PTSD symptoms. I wish the best for you both. Good luck.

Lizardlady, I'd found the same / related links when I Googled the two conditions ......... The possible link between combat PTSD and Alzheimers, the preliminary findings was that it appeared that combat vets had a rate about twice that of general population, is what caught my attention. Though nothing definitive; which isn't surprising because I'd imagine that it will be a difficult cause and effect to prove to a high enough degree for the VA to step up to their responsibility to our vets. Not to mention that the first large group of combat vets now reaching / already in the age group most likely to be affected are Nam vets ......... The potential liability is staggering, if there is a link....... After all, look how long it took for PTSD to be recognized and how wide the affected group and related health issues for those exposed to Agent Orange?

We have private insurance, so he has all private doctors (who actually spend time with him and me, discussing each new health issues and treat him as a person not simply an ailment or medical condition.), using the VA only for his PTSD support group, dental and now, mental health, primarily because in our county there is only one 'receiving center' for those in mental health crisis and due to his physical health, it is not equipped to properly accept a patient with significant health conditions. He's had full work up from his neurologist, multiple CAT's within the last several months; all have come back clear of any problems. I'd even wondered if he'd been having TIA's which I was not catching. Between his neurologist, primary care doctor and his psychiatrist, we'd discussed then dismissed, the possibility of a PET scan, due to the pre scan zero carb diet for 24 and that we're having a difficult enough time getting to eat normally and wanting to get his blood glucose to '0'. A more recent fixation of his, as is his alternating between food not tasting good, him throwing out food when either I or staff at the hospital aren't looking or only wanting to eat ice cream, cookies and candy. Granted though, he has always been very fond of sweets and until he was diagnosed with diabetes, I baked several times a week, fresh bread, home made pasta, always had pies or cookies or other such items in our home.

bebop: In the last five years that my husband has been in the PTSD group, the idea of the group leader having a womens support group has been brought up many times. However the only one actually held was very poorly attended and even reaching out to several of the women about perhaps getting together informally, in a neutral setting even once a month or so, was not well met. Perhaps after decades of learning to cope with the level of social isolation which is not uncommon among those with PTSD, spouses tend to not want to 'rock the boat', as it were; perhaps out of concern that for some of the vets, might not be comfortable with this.

slinger .... True. And as the changes in personality, behavior, increasing depression and other changes have become so great, his doctors have run about every lab work up that can be imagined. And thus far nothing has come back which might indicate a 'simple fix' situation.

Today when I went for visiting with my husband, I was not aware we'd have a meeting with several of the doctors / the social worker / case manager, working with / for my husband. He began to get upset and left the room after a few minutes. After a couple decades I can read when he's about to lose control and was glad he choose to step away for a bit. I explained that his acts / dispalys of violence are increasing and it doesn't require a 'trigger' related to his PTSD; when I walk away, when he's home, he'll follow me because he gets angry when myself or another person does not engage with him, when he's upset. Also explained why this as well as his extreme PTSD and inability to interact or even tolerate others around him, make an ALF, even with a 'memory unit', not a viable option. Only, IMO, a secure VA long term facility specific to his mental health needs, is going to be appropriate.

As this is a teaching facility and as they are and will be, dealing with vets who have been in the Gulf War and now the sandbox, I offered this simple insight:

After these decades of living with and loving and sharing all the good and bad days and crisis that make up a shared life; I know the man my husband is: Good, strong, intelligent with a very deep sense of right and wrong. Specifically that he knows he does not want to hit me or hurt me; but it's as if there's a veil between what the 'real man' knows and his ability to not act out directly, on the impulse to hit, beat, pound, destroy. But that I am very concerned that at some point he'll not be able to take this anger our on 'things'. His drawing his fist on me last week is one step closer to his not being able to control those impulses.

Something he later admitted to the social worker and says he doesn't know why, as well as saying that when people say he's said he wants to kill himself; they don't understand: He's said he'd rather kill himself than hurt me. When asked why he wants to hurt me, he says he doesn't know why, only that he feels this way.

When I called after diner, he seemed to be in good spirits, not overly aggressive or paranoid. However a couple hours later the unit called to say he'd gotten upset over not getting what he wanted and first threw his walker at a doctor then, from the best I could understand, attacked them. The Nurse who called me to explain this, sounded a bit shaken by what had happened. Despite his health problems, when he is angry, he can muster a great deal of strength.

My first concern was that he was ok, then that the doctor was not hurt. It's breaking my heart to see this happening to such a wonderful man. I've been trying to explain to his doctors that this was my fear, for both my husband and myself: that at some point, he would not be able to control his impulses to act on his anger in a very physical manner. Things can be fixed;they're just things..... But people.......... Not always.

In each case when he has been hospitalized in the past year, the various medical care givers have all shared two common observations: He is very 'draining' to work with and he gets very angry whenever he is told he can't do something or is told he needs to wait. Even a few nurses who worked with him in years past, when he's had surgeries, have been saddened to see the change in him from four or five years ago, to now.

Now perhaps they understand why bringing in either a VA worker for two 6 hour days of respite, per month, or hiring a private respite worker, is also, not a viable option, as the potential for physical violence from my husband, is very much a part of our new / current, reality.

I loathe the idea that it has comes down to 'medicate - isolate - sedate - restraint' as a course of dealing with him, when his anger / rage reaching the point of physical violence.......... But I can also understand why this is sometimes the only / last option available. However, those options aren't ones that are possible in an ALF or here in our home.

I understand the isolation. I did that because no one understood why I stayed with him. I did end up leaving but it was due to his drinking. I could handle everything else but that. I am here if you want to chat further. my pm box is always open!

I know I am getting to this post about a month after Bebop last posted. I just read through all that you are experiencing with your husband. Want to say how much I feel for what you are experiencing.

What a wonderful husband your husband has been & what wonderful good memories you have with & of his good times.

I can also completely understand your frustration with the alzheimers. I went through it with my grandmother. If you can imagine a little woman only 4'10" tall, striking my grandfather with her cane & breaking everything in the house with it......that was my grandma. We were lucky enough to get her into the hospital to have her hip replacement replaced & from there, we got her settled into a good convalescent home where they would give her meds when she got violent (any time someone crossed her or did something she didn't like). I remember the times when the food didn't taste good & all she wanted were sweets.....but then I have seen several reports saying that even normal people's taste buds crave sweets as they get older....the one thing that always tastes good....have noticed it even with myself.

I am so sorry that you are having to go through this most difficult experiences with your husband at this point in life when one should be enjoying the finer times of life together. My heart goes out to you & to your husband. It is wonderful that you are working so hard to make sure he is provided for in the best way possible.....you are truly a wonderful wife & both you & your husband have my deepest respect.

After reading your post I feel like you somehow came into my life and posted about it as it is almost a mirror image of what my husband and I are dealing with. I commend you for your never ending love, support and patience that you have given him. I feel and act the same way as you and just wanted to send you an electronic hug. It is overwhelming at times and even though I have always been a positive person I find myself crying all the time. Whenever I had a question or needed something, my husband was the one that provided that and now I can't even ask him for help with this insidious disease that is stealing him away from me. I am sending my thoughts and prayers to you and your husband.