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

Figures & data

Figure 1. PRISMA flow chart documenting the search and screening process

Table 1. Studies (n = 3) in which comorbidity rates of PTSD in dementia patients have been described or can be calculated based on reported findings. Variables to describe the population with respect to setting, age, cognition, PTSD and other psychiatric symptoms or behavioural and psychological symptoms of dementia (BPSD) are shown

Study	Subjects	N (sample sepcification)	Setting	Mean age (Y, of total population)	Dementia measure	Neuropsychological scales
Verma (2001)	Veterans with dementia and BPSD	252 (100% male; race- 77% white, 16% black, 7% other)	Medical Center geropsychiatric inpatient unit	73.4 (Range: 70-78, SE unknown)	DSM-III-R/ DSMIV	Clinical assessment MMSE
Pinciotti (2017)	Veterans with dementia	486 (gender, race unknown; stated lack of variance in population)	Veterans community sample (2 years): Partners in Dementia Care	79 (Range, SE unknown)	ICD-9	No information
Ball (2009)	Veterans with new onset dementia without aggression (<1 year)	215 (95.4% male; race- 76% white, 20% black, 4% other))	Michael E. DeBakey Veterans Affairs Medical Center, 2 years follow-up	76 (Range: 60-84, SE: 2.21)	ICD-9	DemRS2

PTSD measure	PTSD scales	Comorbidity of PTSD in dementia %	Psychiatric scales and / or BPSD	Adjustment for confounders	Study quality (Total score NOS)	Main objectives and findings
Cross-sectional studies
DSM-III-R/ DSM-IV	None (Clinical assessment)	16/252=6.3 %	CMAI CIRS BPRS PANNS	Matching: age, MMSE scores	6	Objective: Investigate the contribution of PTSD to behavioral disturbances in dementia. Finding: There were no differences between patients with and without PTSD in behavioral disturbances.
ICD-9	No information	38/486=7.8%	Hetero anamnestic (caregivers): perception of cognitive impairment, behavior problems questionnaires	None	7	Objective: Investigate similarities and differences in psychosocial, health, and service use outcomes among caregivers of veterans with dementia with and without PTSD. Finding: Patients with dementia and comorbid PTSD exhibited more difficult behavior symptoms than without PTSD, which also increased burden on caregivers.
Prospective studies
ICD-9 (2 years pre and post study)	No information	10/215= 4.7%	RAS CMAI	antipsychotics	6	Objective: Investigate the potential of increased aggression in patients with dementia and PTSD compared those without PTSD. Finding: No increased risk of aggression in patients with dementia and comorbid PTSD was found.

BPRS = Brief Psychiatric Rating Scale; BPSD = Behavioural and Psychological Symptoms of Dementia; CIRS = Cumulative Illness Rating Scale; CMAI = Cohen-Mansfield Agitation Inventory; DemRS2 = Dementia Rating Scale-2; DSM (-III-R/IV) = Diagnostic and Statistical Manual of Mental Disorders; ICD (−9) = International Classification of Diseases; MMSE = Mini Mental State Examination; NOS = Newcastle-Ottawa Scale; PANNS = Positive and Negative Syndrome Scale for Schizophrenia; PTSD = Post Traumatic Stress Disorder; RAS = Ryden Aggression Scale; SE = Standard Error.

Verma, S., Orengo, C. A., Maxwell, R., Kunik, M. E., Molinari, V. A., Vasterling, J. J., & Hale, D. D. (2001). Contribution of PTSD/POW history to behavioral disturbances in dementia. International Journal of Geriatric Psychiatry, 16(4), 356–360. doi:10.1002/gps.333.

 PubMed Web of Science ®Google Scholar

Pinciotti, C. M., Bass, D. M., McCarthy, C. A., Judge, K. S., Wilson, N. L., Morgan, R. O., … Kunik, M. E. (2017). Negative consequences of family caregiving for veterans with PTSD and dementia. Journal of Nervous and Mental Disease, 205(2), 106–111. doi:10.1097/NMD.0000000000000560.

 PubMed Web of Science ®Google Scholar

Ball, V. L., Hudson, S., Davila, J., Morgan, R., Walder, A., Graham, D. P., … Kunik, M. E. (2009). Post-traumatic stress disorder and prediction of aggression in persons with dementia. International Journal of Geriatric Psychiatry, 24(11), 1285–1290. doi:10.1002/gps.2258.

 PubMed Web of Science ®Google Scholar

Data availability statements

The authors confirm that there are no data used in this study.