Dementia is a general term describing the loss of memory, language, problem-solving, and other cognitive abilities that is severe enough to interfere with daily life.  Dementia has varying causes and clinical presentations.

Post-traumatic Stress Disorder (PTSD) is a psychiatric condition which may develop in individuals who have experienced emotionally or physically threatening traumatic events.

Although the association is poorly understood, individuals with mental health disorders, including PTSD, are considered high risk for developing dementia (1).

It is unclear if psychiatric disorders are a causal risk factor for dementia, however, there is some evidence to suggest that psychiatric disorders may represent a prodrome of dementia in some patients (1).  The shared risk factors between PTSD and dementia suggest a potential link between the etiologies of these disorders (2).  Understanding this association can help providers understand how a patient’s trauma and mental health history might affect their dementia course, behaviors, and treatment.

Clinically validated screening tools include:

• Dementia:

 MiniCog quick screen, Montreal Cognitive Assessment (MoCA), the Mini Mental Status Exam (MMSE), and the St. Louis University Mental Status exam (SLUMS).

Please see GFF #95 for more information on these assessments.

•  PTSD:

 Startle, Physiological arousal, Anger, and Numbness (SPAN) tool and the Trauma Screening Questionnaire (TSQ) (3).

Gather a comprehensive biopsychosocial history and assess patients for risk factors related to both PTSD and dementia (e.g., substance use, hypertension, hyperlipidemia). Patients with PTSD are at higher risk of these conditions which can contribute to an increased risk of certain types of dementia. Strong social support is a protective factor for patients with both dementia and PTSD (2).

While no set guidelines exist for the treatment of comorbid PTSD and dementia, general concepts regarding the medical and non-pharmacologic management of both conditions in older adults apply.

Some common treatments for PTSD, including SSRIs, novel antidepressants, and atypical antipsychotics have been associated with increased incidence of dementia when compared to patients with PTSD who did not receive these medications. This could represent either an effect of more severe PTSD or a neurotoxic effect of some antipsychotic medications (4,5).

There is some overlap in medications used to treat PTSD and those used to treat behavior changes in dementia. In dementia patients with a history of PTSD, it is important to consider whether their PTSD may be influencing their behaviors and to assess if any modifiable factors could be addressed to mitigate behaviors in lieu of starting medications. If medications are necessary for symptom management, best practice strategies include using Beers’ Criteria to guide prescribing.  Additional care should be taken in the medical management of new behaviors in dementia patients who have PTSD and are already taking an antipsychotic, as these medications could both be contributing to their behaviors and put them at risk of adverse effects from drug interactions if additional antipsychotics are prescribed. Please see GFF #38, 40, 53, and 63 for further recommendations on the management of behaviors in dementia.