Combat Dementia in Military Personnel: A Novel Neurocognitive Profile of Relentless War

We introduce the term combat dementia as a novel neurocognitive phenotype emerging in military personnel due to prolonged continuous exposure to combat environments. In a prospective cohort (2014–2025; n = 297), multimodal assessment included neuropsychological testing (MoCA, MMSE), cognitive event-related potentials, quantitative EEG, and multidisciplinary clinical evaluation. Three clinical phenotypes of cognitive impairment were identified: (A) post-traumatic brain injury with MRI/CT-verified macrostructural changes (classical organic variant); (B) without TBI and PTSD, lacking macrostructural lesions on MRI/CT but showing persistent network-level microstructural pathology verified by neurophysiological markers (combat dementia); (C) associated with PTSD/cumulative psychotrauma, with predominantly functional alterations and potentially reversible dynamics (transitional/borderline variant). These phenotypes delineate three distinct trajectories of cognitive decline: macrostructural organic (A), microstructural persistent (B), and transitional/borderline (C). Phenotype C illustrates a possible progression from functional alterations to stable microstructural pathology, explaining the elevated dementia risk in chronic PTSD. Continuous frontline exposure exceeding 14 months was a key predictor, tripling the risk of progression to more severe impairment. Longitudinal observations (6/12 months; subgroups followed up to 10 years) confirm the persistence of phenotype B and its distinction from A and C. Recognition of combat dementia as an independent clinical entity is crucial for screening, rehabilitation strategies, and nosological classification of cognitive disorders in military populations. These findings open a new domain in neuropsychiatry with significant implications for Ukraine and the global community in shaping rehabilitation systems, humanitarian policy, and military medical expertise.