Journal of Clinical and Experimental Neuropsychology

2004, Vol. 26, No. 5, pp. 698–705

PTSD Symptoms and Onset of Neurologic Disease

in Elderly Trauma Survivors
A.B. Grossman1, B.E. Levin1,3, H.L. Katzen2,
, and S. Lechner3
1
Department of Neurology, University of Miami School of Medicine, Miami, FL, USA,
2
Department of Neurology, Weill Medical College of Cornell University, New York, NY, USA,
and 3Department of Psychology, University of Miami, Miami, FL, USA

ABSTRACT

In this case study, we present two Holocaust survivors who appeared to have adapted well post-trauma, but
developed severe PTSD symptomatology following the onset of neurologic illness in later life. These
individuals were referred for neuropsychological evaluations by their treating neurologists to assess their
levels of cognitive functioning. We present the neuropsychological findings, and discuss possible
mechanisms for the emergence of PTSD symptoms. These case studies demonstrate the need for systematic
research to further investigate the potential relationship between aging, degenerative disease, and PTSD
symptoms in elderly trauma survivors.

INTRODUCTION 2001) described exacerbations of PTSD symp-

There is relatively little known about symptoms
of post-traumatic stress in advanced age. It has
been reported that some elderly individuals who
were exposed to trauma but appear to have
adapted well during their early and middle adult-
hood, experience either the development or re-
emergence of persistent intrusive memories,
disturbances in sleep and dreaming, avoidance
of stressors, and an increased vulnerability to age-
appropriate losses (Sadavoy, 1997). There have
also been published reports of World War II
(WWII) combat veterans who develop Post-
Traumatic Stress Disorder (PTSD) for the first
time in their later years (Brockaway, 1988;
Hamilton, 1982; Johnson, 2000; van Dyke,
Zilberg, & McKinnon, 1985). A recent case
study (van Achterberg, Rohrbaugh, & Southwick,
toms in three trauma survivors with dementia; a
combat veteran, a Holocaust survivor, and a
survivor of the Titanic. These individuals initially
showed only mild post-traumatic stress symptom-
atology during their younger years, but the
development of a neurologic illness increased
their vulnerability to the re-emergence of these
symptoms.
In light of the recent exposure to acts and
threats of terrorism, increasing numbers of com-
bat veterans, and increasing survivors of disasters
who will reach old age in the years to come, the
issue of PTSD and its effect on the aging
population is relevant and timely, and warrants
careful attention. It is not yet understood how
trauma-related symptoms acquired at an early age
evolve over time. This issue is further complicated
by the fact that changes in cognitive functioning

Dr. Katzen is currently affiliated with Ortho-McNeil Pharmaceuticals, Inc., Miami, FL, USA.
Address correspondence to: Bonnie Levin, Ph.D., Department of Neurology, Division of Neuropsychology, 1150 NW
14th Street, Miami, FL 33136, USA. Tel.: þ1-305-243-7529. Fax: þ1-305-243-7218. E-mail: Bonnld@aol.com
Accepted for publication: October 21, 2003.

10.1080/13803390490504362$16.00 # Taylor & Francis Ltd.

 ELDERLY TRAUMA SURVIVORS
are associated with the normal aging process.
Further, it is estimated that approximately 5% of
individuals over the age of 65 and over 20% of
those over 80 suffer from a dementing illness
(Caine & Lyness, 2000). For these individuals, it
would be important to clarify the interrelationships
between effects of neurologic illness, advancing
age, and past exposure to trauma. To date, there are
no neuropsychological studies examining the
neurologic factors that impact PTSD in the elderly.
We present two cases of Holocaust survivors
who developed neurologic illnesses in later life.
They were referred for neuropsychological evalua-
tions by their treating neurologists to assess in-
tellectual and cognitive functioning, and were
seen in the Division of Neuropsychology at the
University of Miami School of Medicine. The sur-
vivors underwent comprehensive neuropsycholo-
gical assessment including a clinical interview and
a 3-hr cognitive battery examining: general intelli-
gence, language, visuospatial skills, judgment and
reasoning, attention and memory, executive func-
tioning, motor skills, and psychological well-being.
Both individuals exhibited significant emotional
distress during their evaluation. They were tearful
throughout the examination and reported height-
ened levels of depressive and anxious symp-
tomatology. Although they were reluctant to fully
discuss the details of the traumatic events, clinical
interviews revealed frequent highly distressing
intrusive thoughts involving the Holocaust begin-
ning after their neurologic symptoms began.
Case 1
Mr. A is a 74-year-old, right-handed male
who suffered a cerebrovascular accident (CVA)
approximately 2 years prior to his having been
referred for neuropsychological assessment. The
patient apparently was taken to the hospital after
he passed out in the elevator of his apartment
building. According to medical records, Mr. A
presented with right-sided weakness and dyspha-
gia. Hospital progress notes indicated a ‘‘com-
pleted left hemisphere stroke and bilateral
internal carotid artery stenosis.’’ An MRA
revealed critical stenosis of the right internal
carotid artery and severe to critical stenosis at
the origin of the left internal carotid artery. A
cranial CT scan indicated focus of non-specific
699
white matter disease adjacent to the left ventricle,
with no acute intracranial abnormality. A follow-
up cranial CT scan several days later was normal.
Mr. A was discharged with a diagnosis of cere-
brovascular accident and was transferred to a
rehabilitation unit.
Mr. A was born and raised in Hungary. He is a
concentration camp survivor whose entire family
perished in the War. Mr. A met his wife in
Hungary, and they have been married for 51 years.
The couple had two of their three children before
immigrating to the United States in 1957. Mr. A’s
educational background includes high school in
Hungary and trade school for electrical contract-
ing. He owned and operated his own electrical
business for over 30 years, and retired with his
wife in South Florida at the age of 67. His
children now run the family business. Mr. A was
always socially active. He served as the president
of his condominium for many years. He denied
any significant past medical or psychiatric history
including the range of PTSD symptoms. During
an interview with the patient’s wife, she denied
that her husband exhibited evidence of PTSD
symptomatology prior to the onset of his illness.
At the time of testing, Mr. A complained of
right-sided weakness and cognitive changes in-
cluding forgetfulness, problems sustaining atten-
tion, impaired judgment and slurred speech. He
required assistance with activities of daily living
such as bathing, dressing, and feeding. Mr. A and
his wife reported dramatic changes in his mood
following the vascular event. He reportedly suf-
fered from severe depression. Mr. A also met
formal criteria for a diagnosis of PTSD, having
experienced a traumatic event that involved actual
or threatened death, which in turn, caused a
substantial amount of fear. Mr. A re-experiences
his memories of WWII repeatedly due to uncon-
trollable and recurrent, distressing thoughts. He is
woken up two to three times a night and has
difficulty falling back asleep. Mr. A also exhibits
a low frustration tolerance with decreased anger
control. He is often irritable, socially withdrawn,
and has stopped participating in the condominium
activities that he was so active in before. Mr. A
also exhibited an intense fear of being left alone.
His wife stated that he would cry and panic if he
thought she was leaving him alone, even for a
700 A.B. GROSSMAN ET AL.

short while. Mr. A had attempted suicide Table 1.

approximately 6 months before the evaluation.
Mental status
He was prescribed Paxil (30 mg) and had begun Folstein MMSE 21/30
psychological counseling.
Neuropsychological testing revealed that at the Language
WAIS-III Information SS ¼ 7
time of the evaluation, Mr. A was alert and ori- WAIS-III Vocabulary SS ¼ 4
ented to person and place. He knew the day of the Phonemic Fluency (CFL) 5
week and the year, but was disoriented to month Animal Fluency 10
or date. Mr. A’s premorbid level of intelligence Boston Naming Test 19/60,
was estimated to be in the Average to High Abstract reasoning
Average range based on educational and employ- WAIS-III Similarities SS ¼ 6
ment histories. His current overall level of intel- WAIS-III Comprehension SS ¼ 8
lectual functioning was estimated to be in the WAIS-III Picture Arrangement SS ¼ 8
Borderline Impaired range. Although he exhibited Visuospatial skills
strengths in certain cognitive domains such as WAIS-III Picture Completion SS ¼ 7
reasoning and auditory and visual memory, most WAIS-III Block Design SS ¼ 5
areas assessed were impaired. Mr. A exhibited an Judgment of Line Orientation 4/15
expressive aphasia (confrontational naming, repe- Executive functions
tition, oral comprehension, and phonemic and Wisconsin Card Sorting Test 0/6 categories
semantic fluency). His performance was impaired Number of Perseverative Errors 87, <1st percentile
on tests assessing visuospatial and constructive Attention and memory
skills, reflecting poor planning and organization WAIS-III Arithmetic SS ¼ 8
(Table 1). His performance on the Wisconsin Card WAIS-III Digit Span SS ¼ 8; 5F, 4B
Sorting Test, a measure of complex problem WMS-III Logical SS ¼ 10, SS ¼ 10
solving abilities and mental flexibility, was also in Memory I & II
the impaired range. An examination of his WMS-III Verbal Paired SS ¼ 10, SS ¼ 14
Associates I & II
performance revealed a significantly high number WMS-III Faces I & II SS ¼ 9, SS ¼ 6
of perseverative errors (1st percentile). Mr. A’s WMS-III Family SS ¼ 6, SS ¼ 9
pattern of errors was not random, as evidenced by Pictures I & II
a tendency to become stuck in set, despite being
Motor
able to demonstrate an understanding of the task WAIS-III Digit Symbol SS ¼ 4
demands. A psychological screening consisting of
clinical interview, behavioral observations, and Psychological screen
Beck Depression Inventory 31
self report inventories indicated severe levels of Geriatric Depression Scale 27
depression and feelings of hopelessness about his Beck Hopelessness Scale 12
future. The results of the evaluation were indicative
of a significant decline in cognitive functioning
from estimated premorbid levels, which was disturbing memories. His tendency to get stuck in
believed to be attributed to a vascular dementia. set causes the thoughts to get repeated over and
Mr. A’s emergence of PTSD symptoms can be over, without any meaningful organization or
related to neuropsychological test results. Perfor- temporal perspective. This causes him to experi-
mance deficits were noted on tasks assessing ence anxiety.
language skills, visuospatial abilities, and tasks
requiring organizational skills and problem solv- Case 2
ing. His performance was also characterized by Ms. B is an 80-year-old, right-handed female who
frequent perseverative errors. It can be argued that was referred for neuropsychological assessment
Mr. A’s inability to organize and inhibit intrusive by her treating neurologist in order to rule out
thoughts may have been compromised by his Dementia of the Alzheimer’s Type. One year and
tendency to perseverate on these traumatic and a half prior, Ms. B fell and broke her right hip and
 ELDERLY TRAUMA SURVIVORS 701

wrist. She did not sustain a head injury at that time.
Following the surgery on her hip and wrist, Ms. B
suffered from post-operative confusion lasting 2.5
days. Her daughter reported that since the opera-
tion Ms. B’s memory has progressively worsened.
A CT scan of the brain performed 1 month prior
to the current neuropsychological evaluation re-
vealed age appropriate cerebral atrophy, bilateral
mild atrophy of both temporal lobes, and scattered
foci of abnormal high T2 signal in the subcortical
and deep paraventricular of both hemispheres
likely related to small vessel disease.
Ms. B was born and raised in Lithuania. She
has a high school education. She served as a nurse
in WWII in the Russian army caring for wounded
soldiers. During that time she was repeatedly
exposed to individuals with severe war related
injuries and death. Her entire family died in the
camps. Ms. B married at age 24 and moved to
Poland with her husband. They moved to
Australia in 1956 and worked together to build a
successful apparel company. A few years later,
her husband died in a swimming accident. Ms. B
ran the company and raised her daughter alone.

Table 2.

Mental status
Folstein MMSE 16/30

Language
Boston Naming Test 20/60
Animal Fluency 6
Automatized Series Months F ¼ 12/12; serial 3’s ¼ 12/12; Alphabet ¼ 4/26; Months B ¼ 3/12

Abstract reasoning
WAIS-III Similarities SS ¼ 10

Visuospatial skills
Judgment of Line Orientation 2/10
Hooper Visual Organization Test 10/15

Executive functions
Trails A
Trails B
Design Fluency (fixed condition)
WISC-III Mazes
Clock Drawing (copy)
Clock Drawing (spontaneous)
263 s
Discontinued at 2 min due to patient’s confusion with the task
Five novel designs in 4 min
Inefficient strategizing, inability to learn from mistakes
Poor planning in number placement
Numbers placed in reverse sequence, incorrect placement of hands

Attention and memory

WAIS-III Digit Span SS ¼ 9; 6F, 3B
Rey 15-Item Test one row (three items)
WMS-III Faces I SS ¼ 8
WMS-III Faces II SS ¼ 11

Motor
Grooved Pegboard
Dominant (right) 128 s (3rd percentile)
Non-dominant (left) 134 s (7th percentile)

Psychological screen
Beck Depression Inventory II 23
Beck Anxiety Inventory 9
702 A.B. GROSSMAN ET AL.
Ms. B has been living in the United States for the
past 20 years. She reported being very close with
her daughter, son-in-law, and granddaughter. She
developed a large social network and has regularly
participated in card games. Her past medical
history is significant for hypertension. Psychiatric
history indicates she had received short-term
outpatient treatment for depression following her
husband’s death in the late 1950s. However, the
patient’s daughter denied that her mother exhibited
overt PTSD-related symptoms through the years.
At the time of the evaluation, Ms. B acknowl-
edged that she had been experiencing some short-
term memory difficulties. For example, she
described instances when she forgot to turn off
the stove. Ms. B also reported experiencing severe
levels of depression and anxiety. She met formal
criteria for a diagnosis of PTSD. Her symptoms
included a pronounced perseveration of intrusive
memories of frightening experiences during
WWII. Her daughter reported that at times, her
mother exhibited confusion, stating she was still
in Europe. During these times she became
reclusive. Socially, she had become withdrawn,
refusing to participate in her usual card games and
social activities, and avoiding her friends. She
also exhibited signs of hypervigilance with an
increased startle response. Eventually, Ms. B
became intensely fearful of being alone and
moved in with her daughter’s family. Ms. B was
treated with Zoloft and Zyprexa after her fall, and
at the time of the current evaluation, was being
weaned off the Zyprexa by her primary physician.
The results of neuropsychological testing
revealed that Ms. B was oriented to person and
place, but not to time. Her premorbid intellectual
functioning was estimated to be in the Average to
High Average range. Her current neuropsycholog-
ical profile was consistent with a dementing
illness, characterized by impaired performance on
tests assessing language skills, memory, executive
functioning, visuospatial skills, and fine motor
coordination (Table 2). Current relative strengths
for Ms. B were simple auditory attention and
verbal abstract reasoning. Psychological screen-
ing indicated that Ms. B was suffering from a
great deal of emotional distress.
A close examination of Ms. B’s neuropsycho-
logical profile indicates that her errors on
visuospatial tasks were more characteristic of
poor planning and organizational skills, rather
than primary visuospatial deficits. For example,
on spontaneous drawing of a clock, the numbers
were written in backward order, and the hands
were incorrectly placed. There was no evidence
of spatial planning deficits. She had difficulty
initiating and maintaining mental sets, as well.
Affect was characterized by extreme anxiety. In
fact, she was unable to complete memory tests,
giving up easily and asking to leave the room. Her
inability to understand her symptoms, as demon-
strated by a notable lack of insight, brought on
increasing levels of anxiety.
DISCUSSION
It is not possible to know with certainty whether
the PTSD symptoms experienced by these two
individuals were a re-emergence of prior sympto-
matology or if the neurologic illness served as a
catalyst for late PTSD onset. It is possible that
stress-related symptoms were present but not
evident to family members. What is significant
is that in each case, their symptoms became
uncontrollable and highly disruptive following
the onset of a neurologic illness. During WWII,
both individuals experienced and/or witnessed
traumatic events involving serious threats to
their physical safety and that of others. Each
presumably led productive lives following the
War. Both individuals married, raised children,
and had active social lives. Each patient and their
caregivers denied the presence of PTSD-like
symptoms interfering with their quality of life
predating the onset of their neurologic symptoms.
We believe, in each case, these individuals
most likely experienced some degree of post-
traumatic stress, but may have been able to
regulate their emotions and utilize adaptive
coping responses (i.e., distraction, suppression)
to prevent the symptoms from interfering with
their lifestyles. Cognitive decline added a layer
of complexity, in that it diminished the capacity
to inhibit the intrusive traumatic memories of
their pasts, resulting in a re-emergence of PTSD
symptoms accompanied by intense feelings of
anxiety and depression.
 ELDERLY TRAUMA SURVIVORS
Normative aging research indicates that
declines in fluid intelligence (Backman, Small,
Wahlin, & Larsson, 2000), attention (Vanneste
& Pouthas, 1999), secondary memory (Prull,
Gabrieli, & Bunge, 2000), some aspects of
language (Kemper, Kynette, Rash, O’Brien, &
Sprott, 1989), visuoperceptual and motor skills
(Albert, 1988; Lezak, 1995), and executive
functioning (Keys & White, 2000) are frequently
reported. These changes usually appear gradually,
allowing the individual to derive strategies to
compensate for the declines (Backman et al.,
2000). Dementia, on the other hand, is marked by
a persistent decline in cognitive functioning,
severe enough to interfere with activities of daily
living (Lezak, 1995). In light of the existing
geriatric population of Holocaust survivors, a
dementing condition will put these individuals at
further risk for disabling psychological symp-
toms.
A possible explanation for the relationship
between dementia and PTSD symptoms in pa-
tients with prior trauma may lie in the underlying
pathophysiology of the dementing illnesses and
the functional disconnections between the pre-
frontal cortex and other areas of the brain. The
prefrontal cortex has been shown to have an
inhibitory effect on regulating thoughts and
emotions (Miller & Cohen, 2001). Damage to
the prefrontal cortex is associated with disinhibi-
tion and perseveration of thoughts and responses.
In patients with a dementing illness, a decline in
the integrated activities of the prefrontal cortex
and the hippocampus results in impaired short-
term memory (Grady, Furey, Pietrini, Horwitz, &
Rapoport, 2001) with the preservation of long-
term memories. In the case of a trauma survivor,
the reliance on long-term memories would be
especially distressing, especially when one is not
able to inhibit these disturbing recollections.
In the case of Mr. A, the onset of his emotional
disturbance resulted from a left hemispheric
stroke. Although it is not possible to disentangle
the complex interrelationship between depression
and stroke, it is well known that depression is
commonly associated with vascular events, re-
gardless of lesion side (Nelson et al., 1993).
However, patients with left hemispheric involve-
ment tend to experience more catastrophic
703
reactions, whereas right-sided infarcts often
produce indifference (Starkstein & Robinson,
1992). This difference is likely due to the fact
that a right-sided infarct results in a diminished
capacity for insight and awareness. Mr. A’s level
of self-awareness was likely preserved following
the CVA, thereby increasing his focus on his
current condition and concerns.
Another explanation for the emergence of
PTSD symptoms accompanying decreased cog-
nitive functioning involves a diminished capacity
to utilize long-standing adaptive coping mecha-
nisms. Strategies used to inhibit or avoid unpleas-
ant thoughts or to compartmentalize experiences
are no longer able to be relied on. According to
cognitive-behavioral theory (Beck, 1961), these
distressing, intrusive thoughts may cause negative
emotional states. It should be emphasized that we
are not asserting that either Mr. A or Ms. B did not
experience PTSD symptoms prior to the onset of
their neurologic illnesses. However, based on
patient and caregiver reports, both individuals
were able to effectively manage these symptoms
by utilizing adaptive coping strategies. This
allowed them to lead productive lives in spite of
their symptoms. Following the onset of their
respective diseases, both patients were unable to
use these coping skills to inhibit or suppress the
troubling symptoms.
An alternative hypothesis for the phenomenon
described in this case study is that the PTSD
symptoms observed were triggered by stress
associated with illness and disability. Current
research indicates that elderly patients with
chronic medical problems frequently experience
symptoms of anxiety (Kim, Seung, Braun, &
Kunik, 2001; Kvaal, Macijauskiene, Engedal, &
Laake, 2001). The anxiety symptoms can present
as either aspects of a primarily psychiatric
diagnosis, or as physiologic sequelae of illness
and medical treatments. There have also been
reports of a relationship between PTSD symptom-
atology and various medical conditions and
treatments. This type of reaction has been as-
sociated with the trauma of receiving a life-
threatening diagnosis, as well as with undergoing
prolonged and uncomfortable medical proce-
dures. The occurrence of PTSD symptoms has
been documented in patients with HIV infection,
704 A.B. GROSSMAN ET AL.
cardiac disease, stroke, childbirth, miscarriage,
abortion, gynecological procedures, and cancer.
Only a minority of patients with primary med-
ical conditions experience PTSD symptoms.
Although it is possible that other non-neurologic
factors may have been operating, both patients
described in this case study had clear evidence of
cognitive decline and neurologic illness. Their
PTSD symptoms primarily reflected their experi-
ences during WWII, rather than their current
medical diagnoses.
These case studies demonstrate the need for
systematic research to further investigate the po-
tential relationship between dementia and PTSD
symptoms in elderly trauma survivors. One study
might compare two groups of patients with
dementia, one group having had experienced past
trauma and the other group not. The frequency of
psychological and behavioral symptoms could
then be examined. Another study could compare
cognitively intact trauma survivors who have
serious medical conditions with trauma survivors
who have dementia, in order to investigate
whether there are any differences in the occur-
rence of PTSD symptoms. Research in this area is
important because newer treatment strategies are
needed that incorporate age and disease relevant
variables. Given the current domestic and inter-
national political climate, it is even more pressing
that health providers become cognizant of the fact
that elderly patients suffering from dementia may
undergo particularly painful intrusive memories,
but may no longer have the insight or capacity to
understand their symptoms and seek help.
REFERENCES
Albert, M.S. (1988). Cognitive function. In M.S. Albert
& M.B. Moss (Eds.), Geriatric Neuropsychology
(pp. 33–56). New York: Guilford.
Backman, L., Small, B.J., Wahlin, A., & Larsson, M.
(2000). Cognitive functioning in very old age. In
F.I.M. Craik & T.A. Salthouse (Eds.), The handbook of
aging and cognition: Second edition (pp. 91–153).
New Jersey: Lawrence Erlbaum Associates.
Beck, A.T. (1961). A systematic investigation of
depression. Comprehensive Psychiatry, 2, 163–170.
Brockaway, S. (1988). Case report: Flashback as a
post-traumatic stress disorder symptom in a
World War II veteran. Military Medicine, 153,
372–373.
Caine, E.D., & Lyness, J.M. (2000). Delirium, de-
mentia, and amnestic and other cognitive disorders.
In H.I. Kaplan & B.J. Sadock (Eds.), Comprehen-
sive textbook of psychiatry (7th ed., p. 894).
New York, NY: Lippincott, Williams, & Wilkins.
Grady, C.L., Furey, M.L., Pietrini, P., Horwitz, B., &
Rapoport, S.I. (2001). Altered brain connectivity
and impaired short-term memory in Alzheimer’s
disease. Brain, 124, 739–756.
Hamilton, J.W. (1982). Unusual long-term sequelae of
a traumatic war experience. Bulletin of Menninger
Clinic, 46, 539–541.
Johnson, D. (2000). A series of cases of dementia
presenting with PTSD symptoms in World War II
combat veterans. Journal of the American Geriatric
Society, 48, 70–72.
Kemper, S., Kynette, D., Rash, S., O’Brien, K., &
Sprott, R. (1989). Life-span changes to adults’
language: Effects of memory and genre. Applied
Psycholinguistics, 10, 49–66.
Keys, B.A., & White, D.A. (2000). Exploring the
relationship between age, executive abilities, and
psychomotor speed. Journal of the International
Neuropsychological Society, 6, 76–82.
Kim, H., Seung, F., Braun, U., & Kunik, M.E. (2001).
Anxiety and depression in medically ill older adults.
Journal of Clinical Geropsychology, 7, 117–130.
Kvall, K., Macijauskiene, J., Engedal, K., & Laake, K.
(2001). High prevalence of anxiety symptoms in
hospitalized geriatric patients. International Journal
of Geriatric Psychiatry, 16, 690–693.
Lezak, M. (1995). Neuropsychological assessment (3rd
ed.). New York: Oxford University Press.
Miller, E.K., & Cohen, J.D. (2001). An integrative
theory of prefrontal cortex function. Annual Review
of Neuroscience, 24, 167–202.
Nelson, L.D., Cicchetti, D., Satz, P., Stern, S., Sowa,
M., Cohen, S., Mitrashina, M., & van Gorp, W.
(1993). Emotional sequelae of stroke. Neuropsy-
chology, 7, 553–560.
Prull, M.W., Gabrieli, J.D.E., & Bunge, S.A. (2000).
Age-related changes in memory: A cognitive neu-
roscience perspective. In F.I.M. Craik & T.A.
Salthouse (Eds.), The handbook of aging and
cognition: Second edition (pp. 91–153). New
Jersey: Lawrence Erlbaum Associates.
Sadavoy, J. (1997). A review of the late-life effects of
prior psychological trauma. The Journal of Ger-
iatric Psychiatry, 5, 287–301.
Starkstein, S.E., & Robinson, R.G. (1992). Neuropsy-
chiatric aspects of cerebral vascular disorders. In
S.C. Yudofsky & R.E. Hales (Eds.), Textbook of
neuropsychiatry: Second edition. Washington, DC:
American Psychiatric Press.
 ELDERLY TRAUMA SURVIVORS 705

van Achterberg, M.E., Rohrbaugh, R.M., & Southwick,
S.M. (2001). Emergence of PTSD in trauma
survivors with dementia. Journal of Clinical
Psychiatry, 62, 206–207.
van Dyke, C., Zilberg, N.J., & McKinnon, J.A.
(1985). Posttraumatic stress disorder: A thirty-
year delay in a World War II veteran.
American Journal of Psychiatry, 142, 1070–
1073.
Vanneste, S., & Pouthas, V. (1999). Timing in aging:
The role of attention. Experimental Aging Research,
25, 49–67.