This weekend, as we honor the sacrifices of the thousands of soldiers killed in wars fought on behalf of our country, we are also reminded of the living soldiers who must still deal with the aftermath of battle, many of whom suffer from post-traumatic stress disorder, or PTSD.
In a review published a few years ago by Progress in Neurology and Psychiatry (http://www.progressnp.com/article/delayed-onset-post-traumatic-stress-disorder-symptoms-dementia/), authors Clara Martinez-Clavera, Sarah James, Eva Bowditch and Tarun Kuruvilla discuss delayed-onset PTSD in older adults, and how the symptoms can be mistaken for behavioral and psychological symptoms of dementia (BPSD) commonly seen in people living with dementia. According to the review, “published cases of WWII veterans in the early stages dementia describe the onset of PTSD after decades of living without symptoms.” War experiences are not the only cause of PTSD. The International Classification of Diseases, 10th Revision, defines PTSD as a condition that follows exposure to a stressful event or situation of exceptionally threatening or catastrophic nature, which may cause pervasive distress.
Dr. Kuruvilla says is important to recognize PTSD in people with dementia so that caregivers and family can understand better the origin of their distress and manage it most effectively. Getting a person’s detailed trauma history during the memory assessment can help caregivers identify residents who may be at risk for delayed onset PTSD, though the authors note that this can be challenging due to lack of valid assessment tools and a reluctance to upset those involved by asking for details of past trauma. However, the authors stress that it is essential to obtain this information before significant cognitive decline occurs.
According to the article, non-pharmacological management for some cases of PTSD could include avoiding noisy environments, one-on-one support with caregivers, reassurance at times of distress, reminiscence therapy and emphasis on positive life events. More research is needed on this. First-line pharmacological management of PTSD symptoms include SSRI’s and SNRI’s, and may include these in combination with anti-dementia medication. There is little evidence supporting the use of antipsychotics or hypnotics for delayed-onset PTSD.
Have a safe holiday weekend!