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

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

EUGMS Congress 2017

Nice – FRANCE

September 21, 2017

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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).

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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).

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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).

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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.

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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.

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Process

T0. Evaluations

• PTSD treatment

for the target group;

• follow-up for

the control group. T1 (after 6 months). Evaluations. Follow-up. T2 (after 6 months). Evaluations.

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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.

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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).

5 10 15 20 25 30 Score moyen avant traitement Score moyen après traitement (T1 à six mois) Score moyen après follow-up (T2 à 12 mois) Symptômes de reviviscence Symptômes d'évitement Symptômes d'hyperéveil

Limit for PTSD

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 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).

Results for verbal episodic memory (1/4)

1 2 3 4 5 6 7 8 9 10 Score moyen "Rappel de mots". Première passation (T0) /10 Score moyen "Rappel de mots". Deuxième passation (T1 à six mois) /10 Score moyen "Rappel de mots" après follow- up (T2 à 12 mois) /10 Groupe témoin Groupe cible

Control group Target group

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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).

2 4 6 8 10 12 Score moyen "Reconnaissance de mots". Première passation (T0) /12 Score moyen "Reconnaissance de mots". Deuxième passation (T1 à six mois) /12 Score moyen "Reconnaissance de mots" après follow-up (T2 à 12 mois) /12 Groupe témoin Groupe cible

Control group Target group

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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).

1 2 3 4 5 6 7 8 Score moyen "Rappel immédiat". Première passation (T0) /8 Score moyen "Rappel immédiat". Deuxième passation (T1 à six mois) /8 Score moyen "Rappel immédiat" après follow- up (T2 à 12 mois) /8 Groupe témoin Groupe cible

Control group Target group

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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).

1 2 3 4 5 6 7 8 Score moyen "Rappel différé". Première passation (T0) /8 Score moyen "Rappel différé". Deuxième passation (T1 à six mois) /8 Score moyen "Rappel différé" après follow-up (T2 à 12 mois) /8 Groupe témoin Groupe cible

Control group Target group

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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).

2 4 6 8 10 12 14 16 Score moyen global pour la période des "12 derniers mois". Première passation /16 Score moyen global pour la période des "12 derniers mois". Deuxième passation à cinq mois /16 Score moyen global pour la période des "12 derniers mois". Après six mois de suivi /16 Scores globaux du groupe témoin /16 Scores globaux du groupe cible /16

Control group Target group

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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).

2 4 6 8 10 12 14 First passation (average) After PTSD treatment (average)

Life time memories score. Target population (PTSD + AD)

1 2 3 4 5 6 7 8 9 First passation (average) Second passation (average)

Life time memories score. Control population (AD only)

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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).

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 Fonctionnement cognitif global (MMSE). Première passation (T0) /30 Fonctionnement cognitif global (MMSE). Deuxième passation (T1 à six mois) /30 Fonctionnement cognitif global (MMSE) après follow-up (T2 à 12 mois) /30 Groupe témoin Groupe cible

Control group Target group

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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…