EUGMS Congress 2017 Nice FRANCE Trauma resurgence and impact on a - PowerPoint PPT Presentation

September 21, 2017 EUGMS Congress 2017 Nice – FRANCE Trauma resurgence and impact on a dementia process. Detection and treatment. Nicolas Delrue, Université Paris 8 (France), Laboratoire de Psychopathologie et Neuropsychologie Arnaud Plagnol, Université Paris 8 (France), Laboratoire de Psychopathologie et Neuropsychologie

E U G M S C o n g r PTSD in the elderly  Post Traumatic Stress Disorder (PTSD) is an anxiety disorder.  It can remain silent for years and can be reactivated after years as delayed PTSD . Dallam, D. L., et al . (2011).  Delayed PTSD would be the most common and characteristic in the elderly. Charles, E., et al . (2005).  20 % of those who experienced wars might have a PTSD. Walser, R., et al . (2012).  Significant life changes, such as entry in a nursing home, could result in a delayed PTSD. Schnurr, P. P., et al . (2005).

E U G M S C o n g r Links between PTSD and dementia  Relationships seem to exist between PTSD and dementia. Dallam, D. L., et al . (2011). => PTSD could constitute a risk factor for developing dementia. For example : veterans with PTSD are twice as likely to develop demantia. Yaffe, K. (2010).  PTSD and Alzheimer’s Disease (AD ) are associated with cognitive disorders : attention and memory systems. Roncone, R., et al . (2013).  There is an implication of identical brain structures such as the hippocampus . Samuelson, K. W. (2011).

E U G M S C o n g r Links between PTSD and episodic memory  The episodic memory is linked to hippocampal structures.  The episodic memory is the first memory system affected AD.  The episodic memory is also affected by PTSD. Stress treatment can improve memory. Spedding, M., & Lestage, P. (2005).

E U G M S C o n g r Objectives No longitudinal study seems to exist about the impact of delayed PTSD on the evolution of Alzheimer's disease (AD). Our objective is to check if a specific treatment of a resurgent PTSD can improve the evolution of AD.

E U G M S C o n g r Design  A longitudinal study (3 years).  3 nursing homes.  A target population (n=20) with AD and PTSD A control population (n=20) with AD but no PTSD.  Repeated quantitative and qualitative measures for the two populations (MMSE, ADAS-Cog, MIS-D, TEMPau, ADRQL).  The measures target the episodic memory as an indicator of the AD’s seriousness.

E U G M S C o n g r Process - PTSD treatment for the target T1 (after 6 T2 (after 6 T0. group; months). months). Follow-up . - follow-up for Evaluations Evaluations . Evaluations . the control group .

E U G M S C o n g r PTSD treatment PTSD treatment with Cognitive behavioral therapy (CBT) for subjects with PTSD :  20 therapy sessions  written guide for therapy. Session Objectives 1 Therapeutic alliance 2 à 4 Relaxation learning 5 à 8 Life review 9 Hierarchical list 10 à 15 Exposition 16 Evaluation 17 à 19 Cognitive restructuring 20 Evaluation.

E U G M S C o n g r First results for PTSD treatment  The main cause of delayed PTSD is war (X8), then death (of spouse X6), disease/medical error (X3) and natural disaster (X2) .  After treatment (20 therapy sessions with CBT), disappearance of PTSD symptoms ( p <0.01). 30 25 20 Symptômes de reviviscence 15 Symptômes d'évitement 10 Symptômes Limit for PTSD d'hyperéveil 5 0 Score moyen avant Score moyen après Score moyen après traitement traitement (T1 à six follow-up (T2 à 12 mois) mois)

E U G M S C o n g r Results for verbal episodic memory (1/4)  For the target group, the average number of errors in words recall decreases by 1.67 ( p <0.01).  For the control group, the average number of errors in words recall increases by 1.40 ( p =0.05). 10 9 8 7 6 5 Control group Groupe témoin 4 Target group Groupe cible 3 2 1 0 Score moyen "Rappel Score moyen "Rappel Score moyen "Rappel de mots". Première de mots". Deuxième de mots" après follow- passation (T0) /10 passation (T1 à six up (T2 à 12 mois) /10 mois) /10

E U G M S C o n g r Results for verbal episodic memory (2/4)  For the target group, the average number of false recognitions decreases by 1.17 ( p <0.01).  For the control group, the average number of false recognitions increases by 1.50 ( p <0.01). 12 10 8 6 Control group Groupe témoin 4 Groupe cible Target group 2 0 Score moyen Score moyen Score moyen "Reconnaissance de "Reconnaissance de "Reconnaissance de mots". Première mots". Deuxième mots" après follow-up passation (T0) /12 passation (T1 à six (T2 à 12 mois) /12 mois) /12

E U G M S C o n g r Results for verbal episodic memory (3/4)  For the target group, the average score in immediate recall increases by 1.47 ( p <0.01).  For the control group, the average score in immediate recall decreases by 2.07 ( p <0.01). 8 7 6 5 4 Control group Groupe témoin 3 Target group Groupe cible 2 1 0 Score moyen "Rappel Score moyen "Rappel Score moyen "Rappel immédiat". Première immédiat". Deuxième immédiat" après follow- passation (T0) /8 passation (T1 à six up (T2 à 12 mois) /8 mois) /8

E U G M S C o n g r Results for verbal episodic memory (4/4)  For the target group, the average score in delayed recall increases by 2.47 ( p <0.01).  For the control group, the average score in delayed recall decreases by 2.26 ( p <0.01). 8 7 6 5 4 Control group Groupe témoin 3 Groupe cible Target group 2 1 0 Score moyen "Rappel Score moyen "Rappel Score moyen "Rappel différé". Première différé". Deuxième différé" après follow-up passation (T0) /8 passation (T1 à six (T2 à 12 mois) /8 mois) /8

E U G M S C o n g r Results for autobiographical episodic memory (1/2)  For the target group, the average number of recent memories increases by 6.44 ( p <0.01).  For the control group, the average number of recent memories decreases by 3.84 ( p <0.01). 16 14 12 10 Scores globaux du groupe Control group 8 témoin /16 6 4 Target group Scores globaux du groupe cible /16 2 0 Score moyen global Score moyen global Score moyen global pour la période des pour la période des pour la période des "12 derniers mois". "12 derniers mois". "12 derniers mois". Première passation Deuxième passation à Après six mois de /16 cinq mois /16 suivi /16

E U G M S C o n g r Results for autobiographical episodic memory (2/2)  For the target group, the average number of life time memories increases by 8.84 ( p <0.01).  For the control group, the average number of life time memories decreases by 1.8 ( p <0.01). Life time memories score. Life time memories score. Target population (PTSD + AD) Control population (AD only) 14 9 8 12 7 10 6 8 5 4 6 3 4 2 2 1 0 0 First passation (average) After PTSD treatment First passation (average) Second passation (average) (average)

E U G M S C o n g r Results for dementia (stage)  For the target group, the average MMSE score increases by 1.14 ( p <0.01).  For the control group, the average MMSE score decreases by 2.0 ( p <0.01). 30 28 26 24 22 20 18 16 14 Control group Groupe témoin 12 Groupe cible Target group 10 8 6 4 2 0 Fonctionnement Fonctionnement Fonctionnement cognitif global (MMSE). cognitif global (MMSE). cognitif global (MMSE) Première passation Deuxième passation après follow-up (T2 à (T0) /30 (T1 à six mois) /30 12 mois) /30

E U G M S C o n g r Conclusion  For verbal episodic and autobiographical memory, the target population (AD + PTSD diagnosed and treated) shows a positive evolution in comparison to the control population (AD only).  These results show that with a PTSD treatment, there may be an improvement of : • traumatic symptoms, • but also memory disorders • and dementia evolution . These results show that it is relevant to detect and treat PTSD in the elderly with AD to limit cognitive decline . No conflict of interest. Thank you for your attention…