Highlights
- •We examined the current evidence for a bidirectional relationship between post-traumatic stress disorder and dementia, where 1) post-traumatic stress disorder is a risk factor for the development of dementia and 2) onset of dementia is a risk factor for the delayed emergence of post-traumatic stress disorder manifestations.
- •Our systematic review identified 25 articles pertaining to both dementia and post-traumatic stress disorder. Post-traumatic stress disorder in mid-life was reported to increase the risk for late-life dementia of all types while late-onset Alzheimer's disease and vascular dementia were reported to increase the risk for the delayed emergence, the re-emergence, or the worsening of post-traumatic stress disorder.
- •More rigorous longitudinal studies that include neuroimaging and biomarkers are needed to corroborate the association between the two conditions as well as to better understand the underlying pathological mechanisms.
ABSTRACT
Background
Post-traumatic stress disorder (PTSD) has been reported to increase the risk for dementia
in veterans and civilians. Conversely, case reports have described the delayed onset
of PTSD in individuals developing dementia, suggesting a complex relationship between
these two conditions.
Objectives
To critically review studies investigating the association between PTSD and dementia
and to assess the evidence for a bidirectional relationship between the two conditions.
Methods
A systematic review of Web of Science Core databases was carried out from inception
of databases up to November 2018 to identify observational studies pertaining to both
PTSD and dementia. Populations enrolled, stressors and neuropathologies, and main
outcomes of studies were extracted, in addition to age at trauma and at onset of PTSD
and dementia. The different temporal relationships between trauma and onset of the
conditions were characterized.
Results
Twenty-five articles were included in the review; 14 articles assessed the association
of PTSD with subsequent dementia and 11 articles reported the delayed onset of PTSD
with the onset of dementia. Most reported traumas occurred in early-life (<40 years)
and were related to war combat experiences. PTSD in mid-life (between 40 and 60 years
of age) was associated with an increased risk of late-onset dementia. Numerous case
series reported the delayed onset of PTSD in Alzheimer's disease and vascular dementia.
Conclusion
Current evidence suggests that PTSD and dementia have a bidirectional relationship:
PTSD increases the risk for late-onset dementia and dementia increases the risk for
delayed-onset PTSD in those who experienced a significant trauma earlier in life.
Key Words
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Article info
Publication history
Published online: August 09, 2019
Accepted:
August 5,
2019
Received in revised form:
August 2,
2019
Received:
June 4,
2019
Identification
Copyright
© 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
