Introduction
Veterans frequently present to general practitioners and non-GP medical specialists with concerns regarding mood, thinking, memory, cognition concerns and in some cases even self-diagnosed dementia Often, the underlying cause is unclear The differential diagnosis might include an undiagnosed mental health condition, a sleep disorder, impacts from alcohol or drug use, dementia, a degenerative neurological condition or even just normal forgetfulness.
There are a number of DVA supports available to differentiate and manage cognitive concerns such as access to funded assessment, treatment and mental health services Understanding what support veterans can access, as well as the intersection between cognitive concerns and military service can help providers ensure veterans receive the right care at the right time.
Dementia in the Australian contex
Dementia is often the number one concern of veterans presenting with cognitive issues Dementia is defined as a syndrome characterised by cognitive decline impacting a range of daily functions While there are a number of causes of dementia, the most common cause in Australia is Alzheimer’s Disease.
In 2024, dementia overtook cardiovascular disease and cancer to be the biggest cause of death in Australia, accounting for over 17,500 deaths Dementia deaths have increased by 39 per cent in the last decade; this is partially due to reduced deaths from other causes and the fact that more Australians are now likely to live to an age where they have a higher risk of developing dementia Dementia is more common in women, and changes in ADF recruiting and the workforce means there are greater numbers of female veterans than ever before.
Age is the main risk factor for dementia, while other risk factors include physical inactivity, hypertension, diabetes, alcohol use, tobacco use, hypercholesteremia and severe head trauma Hearing loss and vision loss, educational attainment, job complexity and social status all play a role, as do mental health comorbidities Genetics play a role in a number of types of dementia; however, direct inheritability is only relevant for rarer types (e g Huntington’s disease).
Cognitive issues and veterans
While dementia remains an important differential diagnosis for veterans with cognitive concerns, many veterans symptoms stem from other treatable causes Co-morbid mental health conditions including post traumatic stress disorder, anxiety, depression and substance use can all mimic or worsen cognitive symptoms, while pain and sleep disruption, which are both highly prevalent in the veteran population, can also impact cognition Changes in identity and difficulty navigating the health system, as well as social isolation, can delay help-seeking or exacerbate symptoms for some veterans.
Work up and management
Management aims at arriving at a diagnosis and treating the treatable such as optimising diet, sleep, alcohol and drug intake and linking to appropriate clinical and support services.
As with most conditions a thorough physical examination and comprehensive social and medical history are the foundation of diagnosis For veterans this should include targeted questions on military service including details of any head injuries Elapsed time since injury, and serial review is often used to aid diagnosis Longitudinal relationships with family, carers and clinicians can help detect and monitor cognitive changes before testing Cognitive deficits can be subtle and sometimes require comprehensive neuropsychological review.
Rationalising medications (including alternative therapies) can often improve cognition Polypharmacy, especially of psychotropic and sedative medications can cause impaired cognition and balance, with an increased risk of falls Regardless of the level of cognitive impairment improved control of risk factors such as alcohol intake, smoking, glucose levels, blood pressure and lipids is important Minimising further brain insults can alter the overall trajectory After all, we have only one brain.
Low level blast exposure
Some veterans may raise concerns about exposure to repetitive low level blast exposure The impacts of repetitive low level blast exposures on the brain is an area of emerging understanding and is an area of active global research DVA has commissioned the University of New South Wales to conduct a rolling literature review of the evidence on the neurocognitive effects of low-level blast exposure as part of our commitment to monitor current and emerging evidence.
Recommendation 61 of the 2024 Royal Commission into Defence and Veteran Suicide was that a brain injury program be created to better understand and mitigate the impact of repetitive low-level blast exposure on brain processes and to assess and treat neurocognitive issues, whatever their cause The Government agreed to this recommendation in principle and referred it to the Royal Commission Taskforce for further consideration Government is currently considering the Taskforce’s report To inform DVA and Defence’s response to Recommendation 61, a joint Brain Injury Expert Advisory Panel has been established that brings together medical and scientific experts who research, diagnose and treat brain injuries and other neurocognitive conditions The EAP is meeting biannually to consider topics relevant to DVA and Defence’s work on brain injury prevention and program development and provide advice.
Veteran Brain Bank
For veterans and clinicians who wish to contribute to anatomical and pathological research, the Australian Veterans Brain Bank is seeking postmortem tissue donations.
This effort mirrors those of Five Eyes partners to create a mass of histopathological material to scientifically study and better understand neurological conditions and exposures affecting Australian veterans Enrolled veterans complete lifestyle questionnaires, medical imaging and exposures and history to support future f indings being linked to known risks.
Summary
Overall brain health is affected by the lifelong accumulation of past environments and exposures When veterans and their families present with cognitive concerns providers can access DVA funded comprehensive supports and services to support assessment, investigation, referral and management, ultimately improving outcomes for veterans.
DVA supports
DVA funds a wide range of interventions that can be used in the assessment and management of cognitive concerns These include:
- funded medical consultations
- access to funded psychology and allied health supports
- specific item numbers (VC40 and VC41) for neurocognitive testing for veterans (Prior Financial Approval is not required for these)
- medications (via the RPBS)
- relevant home supports and aids and appliances (RAP), and
- counselling and support services offered through Open Arms (1800 011 046) – 24 hour a day, 7 days a week
Providers should note that all veterans with a White Card are eligible for mental health treatment (including cognitive assessment) under Non-Liability Health Care, Mental Health.
Dr Dan Corkery, Senior Medical Officer – Health, DVA
Please specify the URL of your file
