Although the relation of PTSD and vulnerability to
dementia has been well established, it is unknown how
the presence of PTSD symptomatology impacts dementia symptoms or how the presence of dementia impacts
PTSD symptoms. Posttraumatic stress disorder and dementia share similar risks like traumatic brain injury,
low IQ, poor education, substance abuse, precipitated
by stressful life events and impairment of coping, physical health and related risk factors. Unmasking PTSD
symptoms resulting from dementia is a well-known phenomenon described in recent studies on late-onset stress
Since PTSD is a major risk factor that doubles the
chance of developing dementia, mandatory screening for dementia in older patients along with assessment of other risk factors as a standard of care may
help physicians in the early detection and initiation of
care. Recognition of LOSS may be an important milestone in the treatment of delayed onset PTSD, which
is considered a normal aging process and a premorbid
stage of PTSD.10,40
Although there is no established treatment, early
psychotherapeutic approaches like reminiscent therapy
along with psychoeducation may be beneficial in patients
with LOSS.40-42 Effective treatments for PTSD with patients with dementia may be challenging, though dementia was not found to be a barrier to implement prolonged
exposure therapy in patients with mild cognitive impairment.43 Patient aligned care teams can be an ideal approach for the care of these veterans.
Posttraumatic stress disorder and dementia are well studied and documented disorders, although PTSD has been
studied far more extensively in younger populations. Accounts of comorbidity of the 2 disorders are limited in
the literature. Individuals may exhibit PTSD symptoms
prior to the onset of dementia. They also may develop
or uncover long quiescent symptoms of the disease. The
populations of patients with PTSD and dementia are recognized, but their characteristics are largely unstudied
and thus unknown.
Although the authors believe this to be a phenomenon
of unrecognized coexistence of the 2 disorders, a disproportionate number of patients may be found in certain
populations, especially among veterans. There is good evidence to expect increased numbers of these patients in
the VA system, especially given the relative frequency of
PTSD symptoms in aging cohorts of VA patients. l
The authors report no actual or potential conflicts of interest with regard to this article.
The opinions expressed herein are those of the authors and
do not necessarily reflect those of Federal Practitioner,
Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review
complete prescribing information for specific drugs or drug
combinations—including indications, contraindications,
warnings, and adverse effects—before administering pharmacologic therapy to patients.
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