The VA is facing a changing population of Veterans and has to be ready to serve them. There is an increase in the number of aging Veterans with and without a host of chronic conditions that were deployed to Vietnam, Korea, and the first Gulf War. With increase in age comes an increase in the occurrence of dementia. Primary care providers are usually the first to identify if the Veteran has a cognitive impairment, which is a possible precursor to Alzheimer’s dementia. Veterans that were deployed after 2001 are returning with complicated health issues. The VA’s primary care providers are required to screen for a possible history of traumatic brain injury, post-traumatic stress disorder, and alcohol or legal substance misuse.
However, the front-line observer and the persons that can best attest to a Veteran’s mental health problems are the family members and close friends. Family and friends need to be perceptive to symptoms such as poor attention and slowed information processing that could affect important everyday function. Impairment in the Veteran’s decision-making and multitasking abilities may also be initially identified by an employer. For instance, a Veteran who has been efficient in his job says that he’s recently been missing deadlines or missing steps, or misplacing tools.
Early detection of a memory or concentration impairment might allow for the Veteran to receive early intervention or rehabilitation.
As a family member or concerned employer of a Veteran that is exhibiting deficits in cognitive function, you can make your observations or concerns known to the Veteran’s medical provider with a written statement. After you have discussed your observations and concerns with the Veteran, and if the Veteran agrees, you may write a statement addressing your concerns and observations that can be given to the primary care provider or that the Veteran can submit to the VA in support of their claim. Your input may trigger the Veteran’s primary care provider to request a neuropsychological evaluation. Often times the VA initially will administer the Mini-Cog which is an efficient cognitive screen that only takes a few minutes to complete.
Particularly with the younger Veterans, it may take a lot more prompting for a primary care provider to take the Veteran’s complaints seriously to initiate closer investigation of the alleged symptoms. For younger Veterans, the treating physician’s may look for changes in physical status, psychosocial status, and changes in mood to determine whether there is a need for cognitive evaluation. Therefore, the more information the care-giver can provide regarding the Veteran’s progression of symptoms over time and perhaps, if possible, a brief account of the Veteran’s former level of functioning, may help the clinician determine if further testing is warranted.
These are a few behaviors that a family member, care-giver, or friend should observe and report on:
- Does the Veteran maintain eye contact?
- Are his/her hygiene appropriate? For example, are the clothes disheveled, dirty, or not appropriate for the weather?
- Is the Veteran able to follow the conversation with you? Does the Veteran have difficulties maintaining focus during a conversation?
- When you’re giving instructions, does he ask you to repeat them a few minutes later? Does he make a comment that he has not understood how to take his medication or the need for follow-up care?
- Has there been a pattern of missed appointments or deadlines, especially without good reason?
In the VA population, hypertension and diabetes are significant risk factors especially for the development of memory disorders. These disorders can cause microvascular angiopathy which is associated with slowed thinking and decreased spontaneous recall.
For the younger Veterans, those that served during Operation Enduring Freedom, and Operation Iraqi Freedom, experience many physical and cognitive complaints and commonly report becoming aware of deficits particularly in short-term memory after the end of their deployments.
When a cognitive impairment is present, it can unsettle the normal rhythms of family life. It can possibly cause a sense of confusion or emotional turmoil within a family. This is especially so when the Veteran does not acknowledge any issues and believes family members are acting in a controlling manner. As a family member, friend, or care-giver, be patient and seek professional advice if necessary, but do not forsake the Veteran that has sacrificed to serve our country.