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.