Jan. 14, 2000 WINSTON-SALEM, N.C. - For World War II and Korean War veterans who develop dementia as they age, there's a risk that painful war memories may be unlocked, triggering violent episodes of post-traumatic stress disorder (PTSD), reports Dr. Deirdre Johnston of Wake Forest University Baptist Medical Center in January's issue of the Journal of the American Geriatrics Society. "In appears that some veterans are able to suppress their war memories and function quite normally for most of their lives," said Johnston, assistant professor of psychiatry. "But, with the onset of dementia, the ability to manage the traumatic memories can be lost, which can give rise to violent outbursts that can threaten spouses or caregivers."
Johnston said PTSD symptoms can appear for the first time with the onset of dementia or re-appear after years of "managing" the memories. Johnston - the first to report the possible link - said more research is needed because of the large number of war veterans who are at risk of developing dementia.
"There are about 600,000 war veterans older than 65 who are at risk of developing dementia," said Johnston. "We need to learn how frequently dementia and PTSD occur together and find out how the ability to manage these distant memories breaks down as dementia develops."
Johnston, who has seen numerous examples of the phenomenon in Veterans Administration treatment centers and other settings, reported on three cases in the article. In one, a 78-year-old combat veteran attempted to strangle his wife in her sleep. On an earlier occasion, she was awakened by him shooting at the bedroom drapes, which he believed were assailants. Another veteran, 77-years-old, without any prior history of aggression towards his wife, piled furniture in the living room to create a fort and ambushed her when she returned from the grocery store. He shot her five times with a .22 caliber rifle.
The third veteran, 68-years-old, would call out in his sleep, "We're under attack." At times, we would wake his wife by calling out from behind the bed, "Get down, get down, we're under fire." He began to keep a loaded gun under the bed. In each case, the veterans showed no signs of violence until they developed dementia.
PTSD has been recognized in combat veterans, ex-prisoners of war, disaster survivors and survivors of sexual and physical abuse. It can occur when someone experiences or witnesses a life-threatening or dangerous situation and feels intense horror, fear or helplessness. People with PTSD avoid things that remind them of the trauma. Their symptoms can include anxiety, restlessness, disturbed sleep, nightmares, irritability, outbursts of anger and hostile behavior. Though PTSD has been studied extensively in Vietnam War veterans, there is evidence it is under-diagnosed in WWII veterans. One study indicates that serving in combat increases the likelihood of PTSD; veterans exposed to heavy combat were found to have a 13 times greater risk of having PTSD than non-combat veterans after 45 years.
"The evidence suggests that many of the individuals who served in combat are likely to have dormant or partially controlled PTSD," said Johnston. "It is of pressing importance to explore the relationship between PTSD and dementia in this aging population."
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