Treatment of post-traumatic stress disorder in people with dementia: a structured literature review.

Post-traumatic stress disorder (PTSD) is associated with cognitive dysfunctions and is an independent risk factor for dementia. A recent study has found the prevalence of PTSD in people with dementia is 4.7%-7.8%. However, little is known about the effectiveness of PTSD treatment for people with dementia. The primary aim of the current study is to review previous studies on the treatment of PTSD in people with dementia. A structured literature review was performed using a 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' analysis in PubMed, Embase, PsycINFO and CINAHL. Two independent researchers screened titles and abstracts. The inclusion criteria were: PTSD symptoms present, diagnosis of dementia, PTSD treatment form described and effects of the treatment mentioned. Articles that matched these criteria were included and content and quality were analyzed. We included nine articles, all case reports, with a total of 11 cases. The discussed treatment options are eye movement desensitisation and reprocessing (EMDR) (n = 3), prolonged exposure (n = 1), cognitive behavioural therapy (n = 1) and pharmacological treatment (n = 4). All articles reported a positive effect of the intervention on several monitored symptoms. Evidence for positive effects and feasibility of EMDR were most reliable, and it was applied in two articles of sufficient quality published in 2018 and 2019. EMDR 'on-the-spot' was described with positive effect in one article in which three cases were discussed. The quality of included papers ranged from insufficient to sufficient. This review shows that people with PTSD and dementia can benefit from PTSD treatment. EMDR, prolonged exposure, acceptance and commitment therapy and pharmacological treatment are applicable in this population. EMDR treatment is most described in this population (n = 5) and shows positive results, and the studies are of sufficient quality (n = 3). Further research in the form of a randomised controlled trial is required to study the effectivity of different treatment interventions in this population.

[Visual pattern analysis and reasoning: Ravens' Coloured Progressive Matrices in old-age and very-old-age adults]. / Visuele patroonanalyse en redeneren: Ravens Coloured Progressive Matrices bij volwassenen van hoge tot zeer hoge leeftijd.

Sixty-five non-demented elderly adults, born between 1895 and 1918 (mean age +/- sd: 80.0 +/- 5.4) were tested with Raven's Coloured Progressive Matrices (CPM). Subjects were recruited from homes for the aged and were rated by the staff as free from any symptoms of dementia or other psychiatric disease. Mean number of years of education was 8.2 (range 5 to 18). CPM scores ranged from 9 to 35 with mean +/- sd of 25.9 +/- 5.9. Subjects who had received more formal education performed better on the CPM (Pearson's r: 0.49). When education was controlled for in the analysis, the correlation between age and performance was attenuated and did not reach statistical significance (Pearson's r: -0.24). Test results appeared to be specific for generations, regardless of age. Mean performance in this sample was significantly higher than less recently published norms suggest. Analysis of item content revealed that the CPM consists of three main types of problems: two of a predominantly visuospatial type (12 items of simple continuous pattern-completion and 15 concrete items showing progressive changes in one or two directions) and 9 items of an abstract reasoning type. The concrete visuospatial items appear very useful in the assessment of visuoperceptive dysfunction, as for example in visual apperceptive agnosia. The abstract matrices were very difficult for most of our elderly subjects, so that these items cannot be used to detect deviations from normal old age.

[Psychometric study of the vocabulary of older and very old adults]. / Psychometrisch onderzoek van de woordenschat bij volwassenen van hoge tot zeer hoge leeftijd.

Sixty-five non-demented elderly adults, born between 1895 and 1918 (mean age +/- SD: 80.0 +/- 5.4) were tested with the Vocabulary Test of the 1970 Dutch revision (30-item form) of Wechsler's Adult Intelligence Scale. Subjects were recruited from homes for the aged and were rated by the staff as free from any symptoms of dementia or other psychiatric disease. Vocabulary scores ranged from 11 to 53 (maximum score would be 60) with mean +/- SD of 31.3 +/- 10.2 Subjects who had received more formal education performed better on this test (Pearson's r = 0.59). When education was controlled for in the analysis, the correlation between age and performance was attenuated and did not reach statistical significance (Pearson's r = -0.16). Data are presented for two levels of education that can be used to put clinical data in perspective. The level of difficulty of each item of the Vocabulary scale was calculated for this sample. Twelve per cent of the subjects recorded correct answers beyond the official criterion of five consecutive failures for discontinuing the test. The effect of differences in item difficulty could be minimized by using a criterion of six consecutive failures to determine the point at which the test should be discontinued.

[Behavior problems at homes for the aged. An inventory of 6 homes for the aged and a comparison with various nursing homes]. / Gedragsproblemen in verzorgingstehuizen. Een inventarisatie in zes verzorgingstehuizen en een vergelijking met enkele verpleeghuizen.

An inventory of behavioural problems by means of the 'Beoordelingsschaal voor Oudere Patiënten' (BOP, Behaviour Rating Scale for Elderly Patients), was made in six residential homes. About half of the 673 residents made little social contact and showed depressive behaviour. Apathy and difficulties spending their time were found in 30% of the residents. Behaviour associated with cognitive dysfunctions was observed in 14%. Approximately 5% of the residents had very severe physical disabilities. Thus, in the residential homes we found a wide range of behavioural problems. These place high demands on the organisation and quality of the care. The BOP-scores of the subjects in the residential homes were compared with those sampled in the same period in a nursing home for patients suffering from physical disabilities (N = 152) and a psychogeriatric nursing home (N = 169). Highly significant differences between the inhabitants of the residential homes on the one hand and the nursing homes on the other, were found for the subscales dependency, social disturbance, physical disability, orientation/communication and apathy. Only depression-scores were the same in the three types of institutions. These results contradict the often-heard opinion that the problems of care and assistance in residential homes increasingly resemble those of nursing homes.