Emergence of PTSD in Trauma Survivors With Dementia

Letter to the Editor

Sir: Posttraumatic stress disorder (PTSD), a syndrome marked by reexperiencing, arousal, and avoidance symptoms, typically emerges soon after a traumatic event. However, some trauma survivors may experience the full-blown syndrome for the first time as they age. Several published cases involving World War II veterans describe the onset of PTSD after decades of living without symptoms. Explanations have included job retirement with loss of daily structure and social contact increased exposure to death or other losses reminiscent of past trauma and age-related weakening of psychological defenses. In a recent case series, Johnson described 3 World War II veterans in whom onset of dementia was heralded by an exacerbation of PTSD symptoms. In the present report, we extend this work and describe 3 additional patients who also experienced a marked increase in PTSD symptoms after onset of dementia. However, only 1 of these patients was a war veteran; one was a Holocaust survivor, and another, a passenger on the Titanic. Thus, the relationship between PTSD and dementia appears to extend beyond the trauma of combat and include a much larger group of elderly individuals who have been traumatized in the past.