Comorbidity rates of Posttraumatic Stress Disorder in dementia: a systematic literature review.

Background: Post Traumatic Stress Disorder (PTSD) has been described as an independent risk factor for cognitive decline and dementia. At the same time, cognitive deterioration and increased loss experiences in dementia may increase liability for the reactivation of traumatic memories and thereby PTSD symptoms. Objective: In order to investigate co-occurrence of PTSD in dementia this systematic literature review summarizes all the available evidence on reported comorbidity rates of PTSD in patients with dementia. Method: PubMed, Embase, PsycINFO and CINAHL were searched for potential publications investigating the co-occurrence of PTSD in dementia until 25 November 2019. Cohort and cross-sectional studies were included. To assure current comorbidity of PTSD in dementia, only publications with a recent PTSD diagnosis (<2 years before onset of dementia) were selected. Results: Of the 860 identified abstracts, three studies (0.35%) met the eligibility criteria and were included. These three studies concerned only military veteran populations, and they comprised two cross-sectional cohort studies and one prospective cohort study. The estimated comorbidity rate of PTSD in veterans with dementia varied between 4.7% and 7.8%. Conclusions: The limited research available shows comorbidity rates only in military veterans, which were possibly dependent on investigated population with respect to dementia severity and possibly associated behavioural and psychiatric symptoms of dementia (BPSD). In dementia patients the comorbidity with PTSD may be high and we suggest that worldwide the impact of PTSD in dementia is high and probably underestimated. Research and care on this topic should improve urgently with the current expanding prevalence of dementia. A first step to improve quality of dementia research and care would be to develop a structured tool to diagnose PTSD in these patients.

Antecedentes: El trastorno de estrés postraumático (TEPT) ha sido descrito como un factor de riesgo independiente para el deterioro cognitivo y la demencia. De manera concurrente, el deterioro cognitivo y el incremento en la pérdida de experiencias en la demencia pueden incrementar la vulnerabilidad para la reactivación de recuerdos traumáticos y, por tanto, de síntomas del TEPT.Objetivo: Para investigar la comorbilidad del TEPT en la demencia, esta revisión sistemática resume toda la evidencia disponible de los índices de comorbilidad del TEPT en pacientes con demencia.Métodos: Se realizó una búsqueda de potenciales publicaciones investigando la comorbilidad del TEPT en demencia en PubMed, Embase, PsycINFO y CINAHL hasta el 25 de noviembre del 2019. Se incluyeron estudios de cohorte y estudios transversales. Para asegurar que la comorbilidad del TEPT en demencia sea actual, solo se seleccionaron publicaciones que incluyeran un diagnóstico reciente del TEPT (de menos de dos años desde el inicio de la demencia).Resultados: De los 860 resúmenes identificados, tres estudios (0,35%) cumplieron los criterios de inclusión y fueron seleccionados. Estos tres estudios incluyeron únicamente a poblaciones de militares veteranos. Dos de estos estudios eran de cohortes transversales y uno era un estudio de cohorte prospectiva. La comorbilidad estimada del TEPT en veteranos con demencia osciló entre un 4,7% y un 7,8%.Conclusiones: La escasa investigación disponible muestra índices de comorbilidad solo en militares veteranos, los cuales fueron posiblemente dependientes de la población investigada en relación con la severidad de la demencia y posiblemente asociados con síntomas conductuales y psiquiátricos de la demencia (BPSD por sus siglas en ingles). En los pacientes con demencia, la comorbilidad con el TEPT puede ser alta y sugerimos que, universalmente, el impacto del TEPT sobre la demencia es alto y probablemente subestimado. La investigación y la atención a este tema deberían mejorar urgentemente dado el incremento en la prevalencia de la demencia. Un primer paso para mejorar la calidad de la investigación y la atención del tema sería el desarrollar un instrumento estructurado para diagnosticar el TEPT en estos pacientes.

Trajectories of Behavioural Disturbances Across Dementia Types.

OBJECTIVE: To replicate a previous finding that the trajectory of the Neuropsychiatric Inventory (NPI) shifts in the sixth year of behavioural variant frontotemporal dementia (bvFTD). We evaluated longitudinal tracking with both the Frontal Behavioural Inventory (FBI) and NPI, comparing bvFTD against other dementias. METHODS: Chart reviews over two to five years for patients with bvFTD (n=30), primary progressive aphasia (PPA, n=13) and Alzheimer's disease (AD, n=118) at an urban Canadian tertiary clinic specializing in dementia. Linear regressions of the longitudinal data tested predictors of annualized rates of change (ROC) in NPI and FBI total and subscales for apathy and disinhibition among dementia groups. RESULTS: The mode of the overall sample for the most advanced duration of illness observed was 5 years, with the median at 7 years. We did not find a crescendo-decrescendo pattern in scores although, for bvFTD and AD, high initial scores correlated with ensuing downward ROCs on the NPI and FBI. Educational level showed an influence on disinhibition ROCs. The FBI was no more revealing than the NPI for apathy and disinhibition scores in these dementias. CONCLUSIONS: A cognitive reserve effect on behavioural disturbance was supported but it may take longer than our 4 years of observing the clinical sample to record inflection points in the behavioural and psychiatric symptoms seen in bvFTD. The current data only imply that both apathy and disinhibition will diminish over the course of dementia.