Challenges in diagnosing Posttraumatic stress disorder in dementia: A case report

Background

Assessment of Posttraumatic Stress Disorder (PTSD) symptoms in individuals with dementia is difficult due to diagnostic challenges like an incomplete self-report, interference of neuropsychiatric symptoms and overlapping comorbid psychiatric symptoms.

Objective

These diagnostic challenges are articulated here and an in-depth evaluation of assessment of PTSD in dementia is given.

Method

A qualitative case design was used including an 88 years old woman, living in a nursing home, with moderate-severe dementia and suspected PTSD. The TRAuma and DEmentia(TRADE)-interview, a semi-structured tool to diagnose PTSD in dementia, was assessed independently by two psychologists, followed by a debriefing in which the outcomes were discussed with the use of informant measures (Neuropsychiatric Inventory-Nursing Home (NPI-NH), the Gerontological Personality Disorders Scale (GPS), Levels of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) and Personality Inventory DSM-5-Brief Form (PID5-BF).

Results

TRADE-interview indicated PTSD triggered by a cycling accident with agitation as a neuropsychiatric symptom. Personality assessment indicated features of a cluster C personality disorder (PD) with core features of negative affectivity and detachment. In the debriefing psychologists reported three challenges: attributing symptoms to the past traumatic event, interference of neuropsychiatric symptoms and overlap in symptoms between PTSD and PDs.

Conclusions

Distinguishing PTSD symptoms in those with dementia from neuropsychiatric and PD symptoms requires careful evaluation of all symptoms present. The TRADE-interview can be helpful, but sometimes additional resourcefulness and good clinical considerations are advised.