More Inclusive Research Key to Understanding Prevalence of Dementia

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12/7/2022 By: Claudia Sanchez-Bustamante, MHS Communications

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Rather than being considered a specific disease, the National Institute on Aging defines dementia as a general term for a range of neurological conditions that affect the brain and get worse over time. It includes losing the ability to remember, think, and reason to levels that affect your everyday life and activities.

Though dementia affects over six million people in the United States, the Centers for Disease Control and Prevention states that women are at higher risk—nearly twice that of men—of developing Alzheimer’s disease, one of several progressive cognitive disorders common in older adults.

According to the NIA, there are several types of dementia:

Alzheimer's disease: Caused by changes in the brain, including abnormal buildups of proteins, it's the most common dementia diagnosis among older adults. According to the National Plan to Address Alzheimer's Disease , "It is a major public health issue and will increasingly affect the health and well-being of the population."
Frontotemporal dementia: Rare and tends to occur in people younger than 60, who have abnormal amounts or forms of certain proteins.
Lewy body dementia: Caused by abnormal deposits of a protein called Lewy bodies.
Vascular dementia: Caused by conditions that damage blood vessels in the brain or interrupt the flow of blood and oxygen to the brain.
Mixed dementia: A combination of two or more types of dementia

Risk Factors for the Military

Military service members "may be at greater risk for developing dementia due to a higher prevalence of traumatic brain injury, posttraumatic stress disorder, and depression," according to a 2019 National Institutes of Health study the Department of Defense supported.

The study included a cohort of female veterans aged 55 and older and concluded that women with TBI, depression, and post-traumatic stress disorder had an increased risk of developing dementia than women without those diagnoses. It also found that female veterans with multiple risk factors had more than twice the risk of developing the condition than those who did not have those conditions.

This and other studies like it help explain why "veterans are at increased risk of dementia due to some risk factors associated with being in the military," said U.S. Air Force Maj. Elizabeth Trahan, a clinical neuropsychologist and mental health flight commander with the 96th Medical Group at Eglin Air Force Base, in Florida.

Deployed service members "probably aren't sleeping as well," Trahan continued. "And they may be at increased risk to trauma exposure if they're in a combat zone or if they're exposed to a lot of explosives."

"But those risks don't only happen in a deployed environment," said Trahan.

"We have a lot of service members who have trauma and TBI from training exercises or non military related activities, but deployments make service members more prone to be exposed to those conditions which could potentially increase their risk," she said.

Although there were more than 458,000 reported traumatic brain injuries in the DOD between 2000-2022, "most TBIs occur in noncombat settings," according to the Defense Health Agency's Traumatic Brain Injury Center of Excellence.

"For example, service members can sustain a TBI during day-to-day activities, such as while playing sports or participating in recreational events, military training, and military deployment," according to the TBICoE.

Reasons Behind the Inequity

There are several reasons for the inequity, said Trahan.

"For a long time, the argument was that women live longer than men," she said. "So, of course, we were going to have higher numbers of women with dementia simply because they were outliving men."

But experts know now that that's not the only reason and that doesn't solely explain why that happens, she added.

"It's a complex issue that involves hormones, inflammatory markers, different risk factors that women might be prone to that men might not, but also probably to some stereotypes and biases against women that have resulted in less access to education and health care in some cases."

Genetics and reproduction could also play a role, said U.S. Air Force Col. (Dr.) Mary Anne Kiel, a pediatrician and chair of the Defense Health Agency's Primary Care Clinical Community.

Yet, for both men and women, there are ways to prevent dementia.

"Research shows that up to 60% of dementia may be preventable with a healthier lifestyle", said Kiel. "Other leading research in this area estimates that optimizing one's lifestyle may reduce the risk of dementia by as much as 90%."

Female veterans with diagnoses of post-traumatic stress disorder, traumatic brain injury, and depression may be at increased risk of developing dementia than women without those diagnoses. Photo credit: U.S. Army Spc. Joseph Black

Impacts on Readiness

“It’s key to focus on preventative efforts, preventative medicine, those self-help things that people can do to try to get ahead of it before it becomes an issue, impacts readiness, and so that it has less of an impact on the strain on our health care resources available to veterans and military members,” Trahan said.

“Recommended preventative strategies include a healthy diet, exercise, routine health care, those kinds of things,” she added, emphasizing they’re the same for men and women.

“Honestly, if it's good for your body, it's good for your brain,” she said.

For Kiel, a healthy diet implies changing to a predominantly whole plant foods diet more vegetables, fruits, whole grains, legumes, nuts, and seeds, while minimizing processed foods and eliminating red and processed meats.

She agreed that preventive strategies, “can not only improve our individual readiness but also significantly protect us from negative effects of stressors—such as injury and illness—and aid in recovery as well as minimize the risk of developing future chronic diseases, including Alzheimer’s disease.”

Promoting Brain Health

Trahan explained improving your sleep is key to brain health.

She noted additional research shows “that people who have prolonged sleep problems are also at higher risk for developing dementia.”

Kiel explained that during sleep, “our brains use that time to clean up the trash that has accumulated while we’re awake. If we don’t get adequate restful sleep, those harmful toxins remain and accumulate over time in the brain. The buildup of toxic proteins has been linked to Alzheimer’s and dementia.”

Since “sleep is a challenge in the military, just due to the nature of our job and deployments, practicing healthy sleep habits and trying to get an adequate amount of sleep is something else that people can do,” to promote brain health, said Trahan.

She added it’s important to take on activities that activate the brain. “Make sure you do things that are cognitively stimulating,” she said, like staying engaged in social or academic activities with a goal of learning something new.

“Constantly doing something that keeps your brain active helps keep your brain young,” she said.

Some of these activities can include crossword puzzles, playing a musical instrument, or learning a new language to keep your brain active, challenged, and engaged. However, if you’re already good at those things, it’s time to challenge yourself to do something new, say experts.

More Diverse and Inclusive Research

“There are lots of different correlations to the development of dementia,” said Trahan. “We need to do more research; we need to learn more about those. And as part of that research, it’s really important to make sure we are including women.”

She said that some of the limitations and the reasons there are so many unknowns is because the research is not including diverse populations.

In the case of women, “we just don't know enough about why women are at increased risk,” yet much of the available research shows “some pretty big discrepancies in terms of the sample population, or that the study population is conducted primarily on men,” Trahan said.

As such, recruiting women to be a part of the research is especially important.

DOD Efforts

The DOD has a variety of resources on TBIs, including fact sheets, podcasts, and more.

In June 2022, DOD put in place the Warfighter Brain Health Initiative, a joint effort between operational and medical communities to better address the brain health needs of service members, their families, line leaders, commanders, and their communities at large.

“The strategy and action plan addresses brain exposures, to include blast exposures, TBl, and long term or late effects of TBl, with the goal of optimizing brain health and countering TBI,” said the memorandum Deputy Secretary of Defense Kathleen Hicks and Vice Chairman of the Joint Chiefs of Staff Christopher W. Grady signed to implement the initiative.

“Our goal must be to ensure our warfighters are performing at optimized capacity and if exposed or injured by a known or emerging hazard, we return our warfighters to full health to include their brain health to maximize each individual's quality of life,” they said in the strategy and action plan.

The initiative aims to:

Optimize cognitive and physical performance
Identify, monitor, and mitigate brain exposures
Prevent, recognize, and minimize the effects of TBI
Reduce or eliminate long-term and late effects
Advance warfighter brain health science

It also emphasizes good sleep as a critical health element.

“We are emphasizing sleep quite a bit in the Comprehensive Strategy and Action Plan for Warfighter Brain Health,” said Dr. David Brody, chief science and innovation officer at the Center for Neuroscience and Regenerative Medicine of the Uniformed Services University of the Health Sciences, in Bethesda, Maryland.