Why psychologists are investigating dementia symptoms in Vietnamese American refugees

A decade ago, Oanh Meyer was studying the experiences of caregivers for people with dementia when she noticed a troubling trend among Vietnamese elders.

First, her mother, who fled Vietnam as a refugee in 1975, began experiencing bouts of paranoia, a symptom of dementia, associated with her memories of the Vietnam War. Convinced that Communist soldiers were hiding outside her house and plotting to kill her family, she was constantly closing blinds and locking doors, Meyer recalled. She also suspected that visiting relatives and friends were leaders of the Communist Party.

Soon after, Meyer’s uncle and aunt, also war refugees, began showing similar symptoms.

Now an associate adjunct professor at the Alzheimer’s Disease Center at the University of California, Davis, Meyer is leading the country’s first longitudinal study into links between wartime trauma and dementia in the Vietnamese American community. The investigation comes at a crucial moment, as many refugees who fled Saigon in the mid-1970s are reaching ages at which people with dementia begin showing symptoms.

“I hope it’ll provide a voice to the community about what they’re going through,” Meyer, 45, told NBC Asian America. “And hopefully we can find intervention and services that can help them and their adult children, as well.”

In her 2015 research on caregivers, Meyer found that Vietnamese Americans, the fourth-largest Asian origin group in the U.S., appeared to be at critical risk for poor physical and mental health, due to low educational attainment, household income and English language proficiency. A significant portion of the population lives with depression due to experiences of war trauma and resettlement challenges.

Early stage dementia and Alzheimer’s disease affects short-term memory but leaves long-term memory mostly intact, Meyer said, so it’s not uncommon for people to relive indelible moments from decades earlier. For refugees like her mother, those core memories are often tied to their experiences during the war.

These indicators for mental and cardiovascular health, Meyer said, make aging Vietnamese Americans a demographic at high risk for Alzheimer’s and dementia. But no one has yet published a study on the roots and prevalence of the disease — and how it might be tied to early life adversity — in the Vietnamese diaspora.

“The goal is to raise awareness about dementia, not just in the academic sphere,” Meyer said. “If we know about certain risk factors — not only trauma but also cardiovascular factors like smoking, blood pressure — that are related to dementia, we can target them for intervention early on in future generations.”

Meyer’s five-year investigation, which is supported by a $7.2 million grant from the National Institute on Aging, will track the cognitive health of more than 500 Vietnamese elders in Northern California, which has a sizable Vietnamese population and a strong network of social services groups. California is home to 40 percent of the country’s 1.4 million Vietnamese residents, and greater Los Angeles boasts the largest Vietnamese population in a U.S. city.

San Jose boasts the largest Vietnamese community in a U.S. city.)

Meyer’s team, which began interviewing participants earlier this month, worked with Bay Area nonprofit organizations like Asian Resources and International Children Assistance Network to recruit volunteers and host outreach events. Though she doesn’t have the resources at the moment, she said she hopes to eventually recruit participants from Vietnamese enclaves in Southern California and Houston.

While the study focuses on older Vietnamese Americans, experts say it could also provide valuable guidance for community organizers working with other refugee groups, such as the more than 75,000 Afghans who have relocated to the U.S. through Operation Allies Welcome.

Since the fall of Saigon in 1975, more than 1.2 million Southeast Asian refugees have resettled in the U.S., making them the largest refugee group in the country. Some 70 percent of Southeast Asian refugees who receive mental health care were diagnosed with post-traumatic stress disorder, according to a 2006 study from the National Institute of Diabetes and Digestive and Kidney Diseases.

The study will look into intergenerational transmission of trauma — the idea that elders who have dementia may pass on their wartime memories and trauma to children and relatives who are caring for them.

“That caring piece starts when we’re translating for our parents or taking them to doctor’s appointments,” Meyer said. “So I think about my generation: Are we at increased risk for dementia later on? If so, how do we target early intervention and prevention?”

Vietnamese Americans, however, face a number of barriers to seeking treatment for trauma and dementia. The community stigma against mental illness, Meyer said, is a strong deterrent, as is a lack of culturally and linguistically appropriate care.

While conducting her research on Vietnamese American caregivers, Meyer found that family members of people with dementia often refused to believe their loved ones were experiencing a mental or neurological illness. Rather, they thought memory loss and psychiatric symptoms of the disease — such as paranoia, anxiety and depression — were simply a natural process of aging.

Educating the community about risk factors for dementia, she said, will be crucial in developing effective prevention measures and treatments.

“It’s been harder to have people share their stories,” Meyer said. “It was hard for me to even talk about my mom, but there needs to be more awareness and knowledge.”