Department of clinical geriatrics, Zuyderland Medical Hospital, Sittard-Heerlen, The Netherlands.
Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands.
Psychogeriatrics. 2022 Jul;22(4):509-520. doi: 10.1111/psyg.12830. Epub 2022 Apr 26.
Posttraumatic stress disorder (PTSD) is a prevalent disorder worldwide and often co-occurs in dementia. Both have a major impact on disease burden and quality of life. PTSD may be difficult to recognize in dementia and a structured diagnostic method is lacking. In order to get insight into the clinical diagnostics of PTSD in dementia, this systematic literature review evaluates the clinical presentation of PTSD and other relevant symptoms in people with dementia. PubMed, PsycINFO, Embase, and CINAHL were searched for all publications through 30 December 2021. Articles were included which met the following criteria: (i) description of at least one case with a current diagnosis of dementia and co-morbid PTSD; (ii) clinical presentation of symptoms being adequately described; (iii) no difference being made between chronic PTSD, PTSD with re-activation, and delayed onset PTSD. Of the 947 identified abstracts, 13 papers met the inclusion criteria and were included (describing 30 cases). Based on our rating, only one case completely fulfilled the DSM-5 criteria of PTSD. Avoidance was only described in three cases. Most commonly described symptoms were irritability and anger (E1, 9%), persistent negative emotional state (D4, 9%), and sleep disturbances (E6, 8%). In 93% of the case reports, other symptoms were also described, i.e. memory problems (58%), screaming (33.3%), and wandering (22.2%). People with dementia who have experienced a traumatic event seem to present, based on our rating method, with insufficient symptoms to meet all criteria for a PTSD DSM-5 diagnosis. The DSM-5 core symptom of avoidance was absent in most of the cases. Clinical presentation consists mainly of symptoms of irritability, anger, persistent negative emotional state, and sleep disturbances, often accompanied by other symptoms. These findings suggest that older people with dementia may have other symptom presentations than people without dementia.
创伤后应激障碍（PTSD）是一种全球范围内普遍存在的疾病，常与痴呆同时发生。这两种疾病都对疾病负担和生活质量有重大影响。PTSD 在痴呆症中可能难以识别，并且缺乏结构化的诊断方法。为了深入了解痴呆症中 PTSD 的临床诊断，本系统文献综述评估了痴呆症患者 PTSD 及其他相关症状的临床表现。通过 2021 年 12 月 30 日检索 PubMed、PsycINFO、Embase 和 CINAHL，搜索了所有相关出版物。纳入了符合以下标准的文章：（i）描述了至少 1 例当前诊断为痴呆症和共病 PTSD 的病例；（ii）症状的临床表现得到充分描述；（iii）未对慢性 PTSD、再激活 PTSD 和延迟发作 PTSD 进行区分。在 947 篇摘要中，有 13 篇文章符合纳入标准并被纳入（描述了 30 例病例）。根据我们的评分，只有 1 例完全符合 PTSD 的 DSM-5 诊断标准。只有 3 例描述了回避症状。最常见的描述症状为易激惹和愤怒（E1，9%）、持续的负面情绪状态（D4，9%）和睡眠障碍（E6，8%）。在 93%的病例报告中，还描述了其他症状，即记忆问题（58%）、尖叫（33.3%）和徘徊（22.2%）。根据我们的评分方法，经历过创伤事件的痴呆症患者似乎表现出的症状不足以为 PTSD DSM-5 诊断的所有标准。回避是 DSM-5 的核心症状，在大多数病例中都没有出现。临床表现主要包括易激惹、愤怒、持续的负面情绪状态和睡眠障碍等症状，通常伴有其他症状。这些发现表明，痴呆症老年人的症状表现可能与非痴呆症患者不同。
