Neuropsychiatric symptoms of dementia in those with and without a recorded history of psychological trauma: A comparative study from an Australian dementia support service

ObjectiveTo compare the number and severity of neuropsychiatric symptoms (NPS) and associated caregiver distress between those with and without a noted history of psychological trauma among those referred to a specialised national dementia NPS support service.MethodsThis was a 5-year retrospective observational study of records from the Dementia Support Australia NPS support service. NPS were reported by formal or informal caregivers at service entry using the Neuropsychiatric Inventory Nursing Home version or Questionnaire version. A history of psychological trauma was recorded in the person's social or medical history and/or endorsed as a contributor to NPS by a trained dementia consultant after a comprehensive clinical review. Regression was used to examine the impact of a recorded history of psychological trauma on NPS severity and associated caregiver distress, controlling for age and sex.ResultsAmong 41,876 eligible referrals with dementia, 6% (n = 2529) had some reference in their records to a history of psychological trauma. Referrals with a recorded history of psychological trauma were rated with a higher rate of both NPS severity (mean = 12.0) and associated caregiver distress (mean = 16.5) at service entry than those without a recorded history of psychological trauma (means = 10.7 and 14.5, respectively). A recorded history of psychological trauma was associated with higher odds of psychotic symptoms, agitation/aggression, irritability, disinhibition, affective symptoms and night-time behaviours.ConclusionsTraumatic stress symptoms may represent a neglected target for intervention to reduce the impact of NPS in people with dementia. Psychological trauma is a putative risk factor for dementia, and dementia onset can also trigger the re-emergence or exacerbation of traumatic stress. However, little is known about how trauma contributes to neuropsychiatric symptoms (NPS) in dementia.People with dementia and a recorded history of psychological trauma were rated as having more frequent, more severe, and more distressing NPS than people without a recorded history of psychological trauma.Traumatic stress symptoms are modifiable and therefore may represent a neglected target for intervention to reduce the impact of NPS in people with dementia.