Planning Ahead for Dementia

VA and DoD, however, are partnering to change that situation and funding research that would allow for a clearer picture of the relationship between brain injury and development of dementia.

“It’s a very important issue that needs the right kind of research and the funding for it,” Cifu said. “The VA and military are leading the charge on this. We really want to figure this out.”

Suggestions that brain injury could lead to dementia have been in the medical literature since the 1970s.

In the meantime, the philosophy of VA as it plans ahead for dementia services is to assume a high likelihood that a link will be conclusively proven and plan accordingly.

For the first time since 2004, VA is updating its projections for how many veterans will develop dementia in the next 20 years.

“We have a lot more information to enter into our equations now,” Cooley said.

Much of that equation is based on the national prevalence rate, which has changed since 2004. According to the Alzheimer’s Association, one in eight people 65 years of age and older has Alzheimer’s disease, and 43% of those older than 85 have the disease. By 2030, an estimated 7.7 million Americans will have Alzheimer’s, with the growth curve steadily rising every decade.

“A lot of things have changed in the world of projections in dementia, and we’ll be applying those to the updated VA projections,” Cooley said. “That includes factoring in things like TBI, even though it’s not clear yet whether there is a connection between TBI and later development of dementia or exactly what the connection is.”

Those projections will include sensitivity analyses involving TBI. “If ‘X’ proportion of people with TBI are expected to develop dementia, how would that affect our basic projections into the future?” Cooley said.

Those projection models will help determine what funding VA will require, the number of clinicians it will need to hire and what kind of long-term care VA will have to offer in the coming decades.

The projections are expected to be completed sometime this year. The basic numbers will be available within the next six months, with more detailed analyses to come later, Cooley said.

Cognitive Rehabilitation

Planning ahead also includes developing treatment options for patients with TBI. If there is a correlation between TBI and dementia, swift and effective treatment might lower the risk.

“We’re doing lots of research into cognitive rehabilitation,” Cifu said, noting that the emerging field of research could have a critical effect for patients with head injuries. “What can we do to ameliorate and reduce the impact of that injury?"

The history of cognitive-rehabilitation research has been on nonblast-related TBI among civilian patients. Whether blast-related TBI victims will respond the same way is unproven, though numerous VA studies are targeting that question.

VA research is under way to look at the impact of structured cognitive-rehabilitation therapy on cognitive function, daily functioning and psychiatric symptoms of blast-related TBI patients.

“That’s one of our questions. If these methods are developed, would that reduce the risk of later development of dementia,” Cooley said. “because there are a lot of  [treatments] that can be done between the occurrence of TBI and the eventual development of dementia.”

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