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de Souza NL, Lindsey HM, Dorman K, Dennis EL, Kennedy E, Menefee DS, Parrott JS, Jia Y, Pugh MJV, Walker WC, Tate DF, Cifu DX, Bailie JM, Davenport ND, Martindale SL, O'Neil M, Rowland JA, Scheibel RS, Sponheim SR, Troyanskaya M, Wilde EA, Esopenko C. Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Neurology 2024; 102:e209417. [PMID: 38833650 PMCID: PMC11226312 DOI: 10.1212/wnl.0000000000209417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. METHODS We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. RESULTS The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. DISCUSSION Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.
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Affiliation(s)
- Nicola L de Souza
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Hannah M Lindsey
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Katherine Dorman
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Emily L Dennis
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Eamonn Kennedy
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Deleene S Menefee
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - J Scott Parrott
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Yuane Jia
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Mary Jo V Pugh
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - William C Walker
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - David F Tate
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - David X Cifu
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Jason M Bailie
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Nicholas D Davenport
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Sarah L Martindale
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Maya O'Neil
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Jared A Rowland
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Randall S Scheibel
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Scott R Sponheim
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Maya Troyanskaya
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Elisabeth A Wilde
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Carrie Esopenko
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
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2
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Biscoe N, New E, Murphy D. Complex PTSD symptom clusters and executive function in UK Armed Forces veterans: a cross-sectional study. BMC Psychol 2024; 12:209. [PMID: 38622745 PMCID: PMC11020799 DOI: 10.1186/s40359-024-01713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Less is known about complex posttraumatic stress disorder (CPTSD) than postrraumatic stress disorder (PTSD) in military veterans, yet this population may be at greater risk of the former diagnosis. Executive function impairment has been linked to PTSD treatment outcomes. The current study therefore aimed to explore possible associations between each CPTSD symptom cluster and executive function to understand if similar treatment trajectories might be observed with the disorder. METHODS A total of 428 veterans from a national charity responded to a self-report questionnaire which measured CPTSD symptom clusters using the International Trauma Questionnaire, and executive function using the Adult Executive Function Inventory. Single and multiple linear regression models were used to analyse the relationship between CPTSD symptom clusters and executive function, including working memory and inhibition. RESULTS Each CPTSD symptom cluster was significantly associated with higher executive function impairment, even after controlling for possible mental health confounding variables. Emotion dysregulation was the CPTSD symptom cluster most strongly associated with executive function impairment. CONCLUSIONS This is the first study to explore the relationship between executive function and CPTSD symptom clusters. The study builds on previous findings and suggests that executive function could be relevant to CPTSD treatment trajectories, as is the case with PTSD alone. Future research should further explore such clinical implications.
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Affiliation(s)
| | - Emma New
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, KT22 0BX, UK
- King's Centre for Military Health Research, King's College London, London, SE5 9PR, UK
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3
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Cohn-Schwartz E, Hoffman Y, Shrira A. Reciprocal associations of posttraumatic stress symptoms and cognitive decline in community-dwelling older adults: The mediating role of depression. Int Psychogeriatr 2024; 36:119-129. [PMID: 35543414 DOI: 10.1017/s1041610222000357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal. OBJECTIVE This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms. METHOD The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis. RESULTS Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures. CONCLUSIONS This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.
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Affiliation(s)
- E Cohn-Schwartz
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Y Hoffman
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - A Shrira
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
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4
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Mollusky A, Reynolds-Lallement N, Lee D, Zhong JY, Magnusson KR. Investigating the effects of age and prior military service on fluid and crystallized cognitive functions using virtual morris water maze (vMWM) and NIH Toolbox tasks. Arch Gerontol Geriatr 2024; 116:105156. [PMID: 37604015 DOI: 10.1016/j.archger.2023.105156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
Much of current knowledge of aging involves war veterans and research about age-related cognitive changes in veterans involves generalized or single function tests or health or neurological disorders. The current study examined military service within the context of comparisons of young and old humans involving generally healthy individuals to address normal age-associated cognitive changes. Adult participants included 11 young females (8 non-veterans; 3 veterans; 21-31 years), 5 young males (non-veterans, 21-24 years), 9 older females (non-veterans, 62-80 years), and 21 older males (11 non-veterans; 10 veterans; 60-86 years). They were tested in virtual Morris water maze (vMWM) tasks, which were designed to test spatial learning, cognitive flexibility and working memory, similar to rodent studies, and were validated by correlations with specific NIH Toolbox (NIH-TB) Cognitive Battery or Wechsler Memory Scale (WMS) Logical Memory I and II tests. Significant age-related deficits were seen on multiple vMWM tasks and NIH-TB fluid cognition tasks. Among older males, vMWM tasks appeared to be more sensitive, based on finding statistical differences, to prior military service than NIH Toolbox tasks. Compared with male non-veterans of comparable age and younger, older male veterans exhibited significant deficits in spatial learning, cognitive flexibility, and working memory on vMWM tasks. Our findings support continued development and characterization of vMWM tasks that are comparable between rodents and humans for translating aging interventions between species, and provide impetus for larger investigations examining the extent to which prior military service can serve as a "hidden" variable in normal biological declines of cognitive functions.
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Affiliation(s)
- Adina Mollusky
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Nadjalisse Reynolds-Lallement
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Dylan Lee
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Jimmy Y Zhong
- Department of Psychology, School of Social and Health Sciences, James Cook University, Australia (Singapore campus), Singapore 387380, Singapore; College of Healthcare Sciences, James Cook University, Australia (Singapore campus), Singapore 387380, Singapore; Georgia State/Georgia Tech Center for Advanced Brain Imaging (CABI), Georgia Institute of Technology, Atlanta, GA 30318, United States
| | - Kathy R Magnusson
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States.
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5
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Günak MM, Ebrahimi OV, Pietrzak RH, Fried EI. Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning. J Anxiety Disord 2023; 99:102768. [PMID: 37716026 DOI: 10.1016/j.janxdis.2023.102768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/24/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
Several studies have identified relationships between posttraumatic stress disorder (PTSD) and cognitive functioning. Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains 'marked alterations in arousal and reactivity' and 'negative alterations in cognitions and mood', and showed robust relations with the specific symptoms 'having difficulty concentrating' and 'trouble experiencing positive feelings'. Results largely replicated at the 3-year follow-up, suggesting that some PTSD symptoms both temporally precede and are statistically associated with the development or maintenance of reduced SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF-relations obfuscated by focusing on PTSD diagnoses or sum scores-as well as investigating mechanisms underlying these relations. Registration Number: 37069 (https://aspredicted.org/n5sw7.pdf).
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Affiliation(s)
- Mia Maria Günak
- Department of Clinical Psychology, Leiden University, Pieter de la Court Building, Wassernaarseweg 52, 2333 AK Leiden, the Netherlands; Department of Psychology, LMU Munich, Leopoldstr. 13, 80802 Munich, Germany
| | - Omid V Ebrahimi
- Department of Clinical Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; Department of Psychology, University of Amsterdam, Roeterseiland Campus, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, the Netherlands
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, Pieter de la Court Building, Wassernaarseweg 52, 2333 AK Leiden, the Netherlands.
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6
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Houghton DC, Spratt HM, Keyser-Marcus L, Bjork JM, Neigh GN, Cunningham KA, Ramey T, Moeller FG. Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders. Transl Psychiatry 2023; 13:296. [PMID: 37709748 PMCID: PMC10502088 DOI: 10.1038/s41398-023-02591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Significant trauma histories and post-traumatic stress disorder (PTSD) are common in persons with substance use disorders (SUD) and often associate with increased SUD severity and poorer response to SUD treatment. As such, this sub-population has been associated with unique risk factors and treatment needs. Understanding the distinct etiological profile of persons with co-occurring SUD and PTSD is therefore crucial for advancing our knowledge of underlying mechanisms and the development of precision treatments. To this end, we employed supervised machine learning algorithms to interrogate the responses of 160 participants with SUD on the multidimensional NIDA Phenotyping Assessment Battery. Significant PTSD symptomatology was correctly predicted in 75% of participants (sensitivity: 80%; specificity: 72.22%) using a classification-based model based on anxiety and depressive symptoms, perseverative thinking styles, and interoceptive awareness. A regression-based machine learning model also utilized similar predictors, but failed to accurately predict severity of PTSD symptoms. These data indicate that even in a population already characterized by elevated negative affect (individuals with SUD), especially severe negative affect was predictive of PTSD symptomatology. In a follow-up analysis of a subset of 102 participants who also completed neurocognitive tasks, comorbidity status was correctly predicted in 86.67% of participants (sensitivity: 91.67%; specificity: 66.67%) based on depressive symptoms and fear-related attentional bias. However, a regression-based analysis did not identify fear-related attentional bias as a splitting factor, but instead split and categorized the sample based on indices of aggression, metacognition, distress tolerance, and interoceptive awareness. These data indicate that within a population of individuals with SUD, aberrations in tolerating and regulating aversive internal experiences may also characterize those with significant trauma histories, akin to findings in persons with anxiety without SUD. The results also highlight the need for further research on PTSD-SUD comorbidity that includes additional comparison groups (i.e., persons with only PTSD), captures additional comorbid diagnoses that may influence the PTSD-SUD relationship, examines additional types of SUDs (e.g., alcohol use disorder), and differentiates between subtypes of PTSD.
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Affiliation(s)
- David C Houghton
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Heidi M Spratt
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Lori Keyser-Marcus
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - James M Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kathryn A Cunningham
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute of Drug Abuse, National Institutes of Health, Rockville, MD, USA
| | - F Gerard Moeller
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
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7
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Eisenberg ML, Rodebaugh TL, Flores S, Zacks JM. Impaired prediction of ongoing events in posttraumatic stress disorder. Neuropsychologia 2023; 188:108636. [PMID: 37437653 DOI: 10.1016/j.neuropsychologia.2023.108636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
The ability to make accurate predictions about what is going to happen in the near future is critical for comprehension of everyday activity. However, predictive processing may be disrupted in Posttraumatic Stress Disorder (PTSD). Hypervigilance may lead people with PTSD to make inaccurate predictions about the likelihood of future danger. This disruption in predictive processing may occur not only in response to threatening stimuli, but also during processing of neutral stimuli. Therefore, the current study investigated whether PTSD was associated with difficulty making predictions about near-future neutral activity. Sixty-three participants with PTSD and 63 trauma controls completed two tasks, one testing explicit prediction and the other testing implicit prediction. Higher PTSD severity was associated with greater difficulty with predictive processing on both of these tasks. These results suggest that effective treatments to improve functional outcomes for people with PTSD may work, in part, by improving predictive processing.
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Affiliation(s)
- Michelle L Eisenberg
- Department of Psychology, Box 1125, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Thomas L Rodebaugh
- Department of Psychology, Box 1125, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Shaney Flores
- Department of Psychology, Box 1125, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Jeffrey M Zacks
- Department of Psychology, Box 1125, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.
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8
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de Souza N, Esopenko C, Jia Y, Parrott JS, Merkley T, Dennis E, Hillary F, Velez C, Cooper D, Kennedy J, Lewis J, York G, Menefee D, McCauley S, Bowles AO, Wilde E, Tate DF. Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and Neuropsychological Profiles in Active-Duty Military Service Members. J Head Trauma Rehabil 2023; 38:E254-E266. [PMID: 36602276 PMCID: PMC10264548 DOI: 10.1097/htr.0000000000000848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD. METHODS Active-Duty US Service Members ( n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals. RESULTS For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified. CONCLUSIONS The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.
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Affiliation(s)
- N.L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - C. Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Y. Jia
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - J. S. Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - T.L. Merkley
- Department of Psychology & Neuroscience Center, Brigham Young University, Provo, UT, USA
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E.L. Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT
| | - F.G. Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA 16802, United States
- Social Life and Engineering Sciences Imaging Center, University Park, PA 16802, United States
| | - C. Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - D.B. Cooper
- San Antonio VA Polytrauma Rehabilitation Center, San Antonio, TX
- Departments of Rehabilitation Medicine and Psychiatry, UT Health San Antonio, TX
| | - J. Kennedy
- General Dynamics Information Technology (GDIT) contractor for the Traumatic Brain Injury Center of Excellence (TBICoE), Neurology Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
| | - J. Lewis
- Neurology Clinic, Wright Patterson Air Force Base, Wright Patterson AFB, Ohio
| | - G. York
- Alaska Radiology Associates, Anchorage, AK
| | - D.S. Menefee
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - S.R. McCauley
- Department of Neurology, Baylor College of Medicine, Houston, TX USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - A. O. Bowles
- Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, US
| | - E.A. Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX USA
| | - D. F. Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT
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Raise-Abdullahi P, Meamar M, Vafaei AA, Alizadeh M, Dadkhah M, Shafia S, Ghalandari-Shamami M, Naderian R, Afshin Samaei S, Rashidy-Pour A. Hypothalamus and Post-Traumatic Stress Disorder: A Review. Brain Sci 2023; 13:1010. [PMID: 37508942 PMCID: PMC10377115 DOI: 10.3390/brainsci13071010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Humans have lived in a dynamic environment fraught with potential dangers for thousands of years. While fear and stress were crucial for the survival of our ancestors, today, they are mostly considered harmful factors, threatening both our physical and mental health. Trauma is a highly stressful, often life-threatening event or a series of events, such as sexual assault, war, natural disasters, burns, and car accidents. Trauma can cause pathological metaplasticity, leading to long-lasting behavioral changes and impairing an individual's ability to cope with future challenges. If an individual is vulnerable, a tremendously traumatic event may result in post-traumatic stress disorder (PTSD). The hypothalamus is critical in initiating hormonal responses to stressful stimuli via the hypothalamic-pituitary-adrenal (HPA) axis. Linked to the prefrontal cortex and limbic structures, especially the amygdala and hippocampus, the hypothalamus acts as a central hub, integrating physiological aspects of the stress response. Consequently, the hypothalamic functions have been attributed to the pathophysiology of PTSD. However, apart from the well-known role of the HPA axis, the hypothalamus may also play different roles in the development of PTSD through other pathways, including the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) axes, as well as by secreting growth hormone, prolactin, dopamine, and oxytocin. This review aims to summarize the current evidence regarding the neuroendocrine functions of the hypothalamus, which are correlated with the development of PTSD. A better understanding of the role of the hypothalamus in PTSD could help develop better treatments for this debilitating condition.
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Affiliation(s)
| | - Morvarid Meamar
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ali Vafaei
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Alizadeh
- Department of Basic Medical Sciences, Faculty of Medicine, Qom Medical Sciences, Islamic Azad University, Qom, Iran
| | - Masoomeh Dadkhah
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sakineh Shafia
- Immunogenetics Research Center, Department of Physiology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Ramtin Naderian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed Afshin Samaei
- Department of Neurology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Alves de Araujo Junior D, Sair HI, Peters ME, Carvalho AF, Yedavalli V, Solnes LB, Luna LP. The association between post-traumatic stress disorder (PTSD) and cognitive impairment: A systematic review of neuroimaging findings. J Psychiatr Res 2023; 164:259-269. [PMID: 37390621 DOI: 10.1016/j.jpsychires.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Accumulating evidence suggests that post-traumatic stress disorder (PTSD) may increase the risk of various types of dementia. Despite the large number of studies linking these critical conditions, the underlying mechanisms remain unclear. The past decade has witnessed an exponential increase in interest on brain imaging research to assess the neuroanatomical underpinnings of PTSD. This systematic review provides a critical assessment of available evidence of neuroimaging correlates linking PTSD to a higher risk of dementia. METHODS The EMBASE, PubMed/MEDLINE, and SCOPUS electronic databases were systematically searched from 1980 to May 22, 2021 for original references on neuroimaging correlates of PTSD and risk of dementia. Literature search, screening of references, methodological quality appraisal of included articles as well as data extractions were independently conducted by at least two investigators. Eligibility criteria included: 1) a clear PTSD definition; 2) a subset of included participants must have developed dementia or cognitive impairment at any time point after the diagnosis of PTSD through any diagnostic criteria; and 3) brain imaging protocols [structural, molecular or functional], including whole-brain morphologic and functional MRI, and PET imaging studies linking PTSD to a higher risk of cognitive impairment/dementia. RESULTS Overall, seven articles met eligibility criteria, comprising findings from 366 participants with PTSD. Spatially convergent structural abnormalities in individuals with PTSD and co-occurring cognitive dysfunction involved primarily the bilateral frontal (e.g., prefrontal, orbitofrontal, cingulate cortices), temporal (particularly in those with damage to the hippocampi), and parietal (e.g., superior and precuneus) regions. LIMITATIONS A meta-analysis could not be performed due to heterogeneity and paucity of measurable data in the eligible studies. CONCLUSIONS Our systematic review provides putative neuroimaging correlates associated with PTSD and co-occurring dementia/cognitive impairment particularly involving the hippocampi. Further research examining neuroimaging features linking PTSD to dementia are clearly an unmet need of the field. Future imaging studies should provide a better control for relevant confounders, such as the selection of more homogeneous samples (e.g., age, race, education), a proper control for co-occurring disorders (e.g., co-occurring major depressive and anxiety disorders) as well as the putative effects of psychotropic medication use. Furthermore, prospective studies examining imaging biomarkers associated with a higher rate of conversion from PTSD to dementia could aid in the stratification of people with PTSD at higher risk for developing dementia for whom putative preventative interventions could be especially beneficial.
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Affiliation(s)
| | - Haris I Sair
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA
| | - Matthew E Peters
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - André F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Vivek Yedavalli
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA
| | - Lilja B Solnes
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA
| | - Licia P Luna
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA.
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11
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Chaposhloo M, Nicholson AA, Becker S, McKinnon MC, Lanius R, Shaw SB. Altered Resting-State functional connectivity in the anterior and posterior hippocampus in Post-traumatic stress disorder: The central role of the anterior hippocampus. Neuroimage Clin 2023; 38:103417. [PMID: 37148709 PMCID: PMC10193024 DOI: 10.1016/j.nicl.2023.103417] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/11/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Post-traumatic stress disorder can be viewed as a memory disorder, with trauma-related flashbacks being a core symptom. Given the central role of the hippocampus in autobiographical memory, surprisingly, there is mixed evidence concerning altered hippocampal functional connectivity in PTSD. We shed light on this discrepancy by considering the distinct roles of the anterior versus posterior hippocampus and examine how this distinction may map onto whole-brain resting-state functional connectivity patterns among those with and without PTSD. METHODS We first assessed whole-brain between-group differences in the functional connectivity profiles of the anterior and posterior hippocampus within a publicly available data set of resting-state fMRI data from 31 male Vietnam war veterans diagnosed with PTSD (mean age = 67.6 years, sd = 2.3) and 29 age-matched combat-exposed male controls (age = 69.1 years, sd = 3.5). Next, the connectivity patterns of each subject within the PTSD group were correlated with their PTSD symptom scores. Finally, the between-group differences in whole-brain functional connectivity profiles discovered for the anterior and posterior hippocampal seeds were used to prescribe post-hoc ROIs, which were then used to perform ROI-to-ROI functional connectivity and graph-theoretic analyses. RESULTS The PTSD group showed increased functional connectivity of the anterior hippocampus with affective brain regions (anterior/posterior insula, orbitofrontal cortex, temporal pole) and decreased functional connectivity of the anterior/posterior hippocampus with regions involved in processing bodily self-consciousness (supramarginal gyrus). Notably, decreased anterior hippocampus connectivity with the posterior cingulate cortex/precuneus was associated with increased PTSD symptom severity. The left anterior hippocampus also emerged as a central locus of abnormal functional connectivity, with graph-theoretic measures suggestive of a more central hub-like role for this region in those with PTSD compared to trauma-exposed controls. CONCLUSIONS Our results highlight that the anterior hippocampus plays a critical role in the neurocircuitry underlying PTSD and underscore the importance of the differential roles of hippocampal sub-regions in serving as biomarkers of PTSD. Future studies should investigate whether the differential patterns of functional connectivity stemming from hippocampal sub-regions is observed in PTSD populations other than older war veterans.
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Affiliation(s)
- Mohammad Chaposhloo
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Atlas Institute for Veterans and Families, Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ottawa, Ontario, Canada; School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Suzanna Becker
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Homewood Research Institute, Guelph, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Ruth Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada; Department of Neuroscience, Western University, London, Ontario, Canada; Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Saurabh Bhaskar Shaw
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada; Homewood Research Institute, Guelph, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada.
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12
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Reduced working memory performance in PTSD and suicide among veterans presenting for treatment. J Psychiatr Res 2022; 156:299-307. [PMID: 36283133 DOI: 10.1016/j.jpsychires.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Abstract
Suicide is among the leading causes of death in the United States, underscoring the continued need to understand the mechanisms underlying suicide risk. A growing body of research has examined the role of working memory deficits in suicidal thoughts and behaviors (STBs), yet little research has evaluated putative pathways via which working memory impairments may heighten suicide risk. Elevated posttraumatic stress symptoms (PTSS) represent one plausible mechanism through which poor working memory performance may increase STBs. The present study utilized data from 140 treatment-seeking veterans who presented for an intake evaluation in the PTSD Clinical Team of a large VA Medical Center. Veterans completed self-report measures, a semi-structured PTSD evaluation, and a digit span working memory test. In addition to concurrent suicidal ideation assessed during the intake, additional information regarding past suicide attempts, presence of a safety plan, documentation of past suicidal behaviors, and engagement with suicide crisis lines were collected via electronic medical records. Consistent with hypotheses, a significant indirect path emerged such that poor working memory performance predicted greater suicidal ideation, greater likelihood of a past suicide attempt, and greater latent suicide risk via increased PTSS. However, no direct effect of working memory on STBs or indirect paths of PTSS on STBs via working memory emerged. These findings suggest that the relation between working memory and STBs may be explained by PTSS severity.
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13
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Aloni R, Ginzburg K, Solomon Z. Trajectories analysis of comorbid depression and anxiety among Israeli veterans: The implications on cognitive performance. J Psychiatr Res 2022; 156:55-61. [PMID: 36242944 DOI: 10.1016/j.jpsychires.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among war veterans, research has indicated high rates of depression, anxiety, and comorbidity of these disorders, with even higher rates among prisoners-of-war. However, little is known about the longitudinal effects of comorbidity profiles on cognitive performance, particularly in the case of aging war veterans. METHOD This longitudinal study focuses on Israeli veterans from the 1973 Yom Kippur War, with assessments at four time-points: 1991 (T1), 2003 (T2), 2008 (T3), and 2015 (T4). Two groups were included: veterans who were held captive (ex-POWs; n = 196), and veterans who were not (war veterans; n = 159). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). RESULTS Three distinct profiles of comorbidity were identified: resiliency (57.5%, n = 204); delayed-onset (29.6%, n = 105), and chronic (13.00%, n = 46). The chronic profile identified mostly among ex-POW (91.3%, n = 42), veterans with lower education at T1, and with more cognitively impaired compared to the other profiles (p < .0001). No differences were found between the profiles in age and family status at T1. CONCLUSIONS The findings highlight the importance of viewing aging veterans as a high-risk population for cognitive impairments, particularly those suffering from chronic comorbidity of depression and anxiety. Therefore, the appropriate diagnosis and cognitive treatment are required to preserve cognitive abilities and prevent decline.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Kiryat HaMada 3, Ariel, Israel.
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv, Israel.
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv, Israel.
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14
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Kaufmann E, Rojczyk P, Sydnor VJ, Guenette JP, Tripodis Y, Kaufmann D, Umminger L, Seitz-Holland J, Sollmann N, Rathi Y, Bouix S, Fortier CB, Salat D, Pasternak O, Hinds SR, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Association of War Zone-Related Stress With Alterations in Limbic Gray Matter Microstructure. JAMA Netw Open 2022; 5:e2231891. [PMID: 36112375 PMCID: PMC9482063 DOI: 10.1001/jamanetworkopen.2022.31891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Military service members returning from theaters of war are at increased risk for mental illness, but despite high prevalence and substantial individual and societal burden, the underlying pathomechanisms remain largely unknown. Exposure to high levels of emotional stress in theaters of war and mild traumatic brain injury (mTBI) are presumed factors associated with risk for the development of mental disorders. OBJECTIVE To investigate (1) whether war zone-related stress is associated with microstructural alterations in limbic gray matter (GM) independent of mental disorders common in this population, (2) whether associations between war zone-related stress and limbic GM microstructure are modulated by a history of mTBI, and (3) whether alterations in limbic GM microstructure are associated with neuropsychological functioning. DESIGN, SETTING, AND PARTICIPANTS This cohort study was part of the TRACTS (Translational Research Center for TBI and Stress Disorders) study, which took place in 2010 to 2014 at the Veterans Affair Rehabilitation Research and Development TBI National Network Research Center. Participants included male veterans (aged 18-65 years) with available diffusion tensor imaging data enrolled in the TRACTS study. Data analysis was performed between December 2017 to September 2021. EXPOSURES The Deployment Risk and Resilience Inventory (DRRI) was used to measure exposure to war zone-related stress. The Boston Assessment of TBI-Lifetime was used to assess history of mTBI. Stroop Inhibition (Stroop-IN) and Inhibition/Switching (Stroop-IS) Total Error Scaled Scores were used to assess executive or attentional control functions. MAIN OUTCOMES AND MEASURES Diffusion characteristics (fractional anisotropy of tissue [FAT]) of 16 limbic and paralimbic GM regions and measures of functional outcome. RESULTS Among 384 male veterans recruited, 168 (mean [SD] age, 31.4 [7.4] years) were analyzed. Greater war zone-related stress was associated with lower FAT in the cingulate (DRRI-combat left: P = .002, partial r = -0.289; DRRI-combat right: P = .02, partial r = -0.216; DRRI-aftermath left: P = .004, partial r = -0.281; DRRI-aftermath right: P = .02, partial r = -0.219), orbitofrontal (DRRI-combat left medial orbitofrontal cortex: P = .02, partial r = -0.222; DRRI-combat right medial orbitofrontal cortex: P = .005, partial r = -0.256; DRRI-aftermath left medial orbitofrontal cortex: P = .02, partial r = -0.214; DRRI-aftermath right medial orbitofrontal cortex: P = .005, partial r = -0.260; DRRI-aftermath right lateral orbitofrontal cortex: P = .03, partial r = -0.196), and parahippocampal (DRRI-aftermath right: P = .03, partial r = -0.191) gyrus, as well as with higher FAT in the amygdala-hippocampus complex (DRRI-combat: P = .005, partial r = 0.254; DRRI-aftermath: P = .02, partial r = 0.223). Lower FAT in the cingulate-orbitofrontal gyri was associated with impaired response inhibition (Stroop-IS left cingulate: P < .001, partial r = -0.440; Stroop-IS right cingulate: P < .001, partial r = -0.372; Stroop-IS left medial orbitofrontal cortex: P < .001, partial r = -0.304; Stroop-IS right medial orbitofrontal cortex: P < .001, partial r = -0.340; Stroop-IN left cingulate: P < .001, partial r = -0.421; Stroop-IN right cingulate: P < .001, partial r = -0.300; Stroop-IN left medial orbitofrontal cortex: P = .01, partial r = -0.223; Stroop-IN right medial orbitofrontal cortex: P < .001, partial r = -0.343), whereas higher FAT in the mesial temporal regions was associated with improved short-term memory and processing speed (left amygdala-hippocampus complex: P < .001, partial r = -0.574; right amygdala-hippocampus complex: P < .001, partial r = 0.645; short-term memory left amygdala-hippocampus complex: P < .001, partial r = 0.570; short-term memory right amygdala-hippocampus complex: P < .001, partial r = 0.633). A history of mTBI did not modulate the association between war zone-related stress and GM diffusion. CONCLUSIONS AND RELEVANCE This study revealed an association between war zone-related stress and alteration of limbic GM microstructure, which was associated with cognitive functioning. These results suggest that altered limbic GM microstructure may underlie the deleterious outcomes of war zone-related stress on brain health. Military service members may benefit from early therapeutic interventions after deployment to a war zone.
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Affiliation(s)
- Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Valerie J. Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Augsburg, Germany
| | - Lisa Umminger
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Salat
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sidney R. Hinds
- Department of Neurology, Uniformed Services University of the Health Science, Bethesda, Maryland
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Lee S, Jung D. How does malingered PTSD affects continuous performance task performance? APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36027606 DOI: 10.1080/23279095.2022.2115370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to determine how malingered PTSD behavior affects the performance of a continuous performance task (CPT). An analog trauma group, two malingering groups (with or without educational intervention), and a control group were organized according to simulation design. During the CPT, the numbers of errors and response time indicators along with post-error slowing (PES) and recovery (PER) process were measured. Results are as follows: First, the analog trauma group showed deficits of response inhibition and a higher level of PES compared to the control group. Second, malingered PTSD caused a significant number of errors, inconsistent performance, and no PES. Third, there was a significantly more impaired and inconsistent performance in the low level of knowledge of disability. Finally, a discriminant accuracy of more than 90% appeared in the discriminant analysis of all group comparison conditions. Taken together, the results of this study show that post-error behavior indicators are affected by malingered PTSD, and differences according to the degree of knowledge of PTSD can also be confirmed. These results are expected to be used as basic data for the development of tasks for the detection of malingerers in clinical scenes in the future.
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Affiliation(s)
- Sangil Lee
- Graduate School of Artificial Intelligence, Ulsan National Institute of Science and Technology,Ulsan, Republic of Korea
| | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
- Healthcare Center, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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16
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Evans TC, Alonso MR, Jagger-Rickels A, Rothlein D, Zuberer A, Bernstein J, Fortier CB, Fonda JR, Villalon A, Jorge R, Milberg W, McGlinchey R, DeGutis J, Esterman M. PTSD symptomatology is selectively associated with impaired sustained attention ability and dorsal attention network synchronization. Neuroimage Clin 2022; 36:103146. [PMID: 36055063 PMCID: PMC9437905 DOI: 10.1016/j.nicl.2022.103146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) symptomatology is associated with dysregulated sustained attention, which produces functional impairments. Performance on sustained attention paradigms such as continuous performance tasks are influenced by both the ability to sustain attention and response strategy. However, previous studies have not dissociated PTSD-related associations with sustained attention ability and strategy, which limits characterization of neural circuitry underlying PTSD-related attentional impairments. Therefore, we characterized and replicated PTSD-related associations with sustained attention ability and response strategy in trauma-exposed Veterans, which guided characterization of PTSD-related differences in neural circuit function. In Study 1, PTSD symptoms were selectively associated with reduced sustained attention ability, but not more impulsive response strategies. In Study 2, we utilized task and resting-state fMRI to characterize neural circuitry underlying PTSD-related differences in sustained attention ability. Both PTSD symptomatology and sustained attention ability exhibited converging associations with reduced dorsal attention network (DAN) synchronization to endogeneous attentional fluctuations. Post-hoc time course analyses demonstrated that PTSD symptoms were most accurately characterized by delayed, rather than globally reduced, DAN synchronization to endogenous attentional fluctuations. Together, these findings suggest that PTSD symptomatology may selectively impair sustained attention ability by disrupting proactive engagement of attentional control circuitry.
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Affiliation(s)
- Travis C. Evans
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,Corresponding author at: VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA.
| | | | - Audreyana Jagger-Rickels
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - David Rothlein
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - Agnieszka Zuberer
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany,Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - John Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Jennifer R. Fonda
- Department of Psychiatry, Boston University School of Medicine, USA,Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Audri Villalon
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - Ricardo Jorge
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Joseph DeGutis
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Michael Esterman
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,National Center for PTSD, VA Boston Healthcare System, USA,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, USA
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17
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Interactive effects of the BDNF Val66Met polymorphism and posttraumatic stress disorder on cognition in U.S. military veterans. Psychoneuroendocrinology 2022; 142:105820. [PMID: 35679772 DOI: 10.1016/j.psyneuen.2022.105820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with mild-to-moderate deficits in cognition. The Met allele of the brain-derived neurotrophic factor (BDNF) Val66Met gene may also be associated with deficits in cognition. However, findings are inconsistent and may be sensitive to moderating variables such as psychopathology. While emerging research suggests that PTSD and the Met allele may interact, few studies have replicated this effect or examined the interactive effect of PTSD and the Met allele on subjective cognition. To address this gap, the current study analyzed data from European-American (EA) U.S. military veterans (n = 1244) who participated in the National Health and Resilience in Veterans Study (NHRVS) to examine the main and interactive effects of BDNF Val66Met genotype and probable PTSD on objective and subjective cognition. Results revealed significant (p's < 0.001) interactions between Met allele carrier status and probable PTSD in objective and subjective cognition. Among individuals with probable PTSD (n = 131), the Met allele was associated with poorer objective (p < .001, d = 0.62) and subjective cognition (p = .001, d = 0.53). Among individuals without PTSD (n = 1113), the Met allele was not significantly associated with objective or subjective cognition. These findings suggest that PTSD may moderate the association between Met allele carrier status and cognition. Implications of these results for the mitigation of cognitive dysfunction in older veterans are discussed.
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Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members. J Head Trauma Rehabil 2022; 37:E438-E448. [PMID: 35452025 PMCID: PMC9585096 DOI: 10.1097/htr.0000000000000779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether cognitive and psychological symptom profiles differentiate clinical diagnostic classifications (eg, history of mild traumatic brain injury [mTBI] and posttraumatic stress disorder [PTSD]) in military personnel. METHODS US Active-Duty Service Members (N = 209, 89% male) with a history of mTBI (n = 56), current PTSD (n = 23), combined mTBI + PTSD (n = 70), or orthopedic injury controls (n = 60) completed a neuropsychological battery assessing cognitive and psychological functioning. Latent profile analysis was performed to determine how neuropsychological outcomes of individuals clustered together. Diagnostic classifications (ie, mTBI, PTSD, mTBI + PTSD, and orthopedic injury controls) within each symptom profile were examined. RESULTS A 5-profile model had the best fit. The profiles differentiated subgroups with high (34.0%) or normal (21.5%) cognitive and psychological functioning, cognitive symptoms (19.1%), psychological symptoms (15.3%), and combined cognitive and psychological symptoms (10.0%). The symptom profiles differentiated participants as would generally be expected. Participants with PTSD were mainly represented in the psychological symptom subgroup, while orthopedic injury controls were mainly represented in the high-functioning subgroup. Further, approximately 79% of participants with comorbid mTBI and PTSD were represented in a symptomatic group (∼24% = cognitive symptoms, ∼29% = psychological symptoms, and 26% = combined cognitive/psychological symptoms). Our results also showed that approximately 70% of military personnel with a history of mTBI were represented in the high- and normal-functioning groups. CONCLUSIONS These results demonstrate both overlapping and heterogeneous symptom and performance profiles in military personnel with a history of mTBI, PTSD, and/or mTBI + PTSD. The overlapping profiles may underscore why these diagnoses are often difficult to diagnose and treat, but suggest that advanced statistical models may aid in identifying profiles representing symptom and cognitive performance impairments within patient groups and enable identification of more effective treatment targets.
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Bardeen JR, Gorday JY, Weathers FW. Executive functioning deficits exacerbate posttraumatic stress symptoms: A longitudinal mediation model. J Anxiety Disord 2022; 87:102556. [PMID: 35276509 PMCID: PMC8996315 DOI: 10.1016/j.janxdis.2022.102556] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Executive functioning (EF) consists of a set of related, but distinct, higher-level cognitive abilities that are used to organize and integrate lower-level processes in the service of engaging in goal-direct behavior. Evidence suggests that deficits in EF are a vulnerability factor for the development of posttraumatic stress (PTS) symptoms. Less understood, however, is the role that EF plays in symptom maintenance and exacerbation following trauma exposure. As such, the primary purpose of the present study was to determine whether EF deficits exacerbate PTS symptoms over the course of one year. A secondary aim of this study was to use a cross-lagged design to determine the directional relations among EF deficits and PTS. Trauma-exposed adults (N = 98) completed a clinical interview and self-report measures at an initial assessment session (Time 1 [T1]). Participants also completed self-report measures at 6- (Time 2 [T2]; n = 92) and 12-month (Time 3 [T3]; n = 91) follow-up sessions. As predicted, EF deficits at T2 mediated the relationship between PTS symptoms from T1 to T3, thus suggesting that EF deficits exacerbate PTS symptoms following trauma exposure. Results from a cross-lagged path analysis from T2 to T3 suggest that deficits in EF exert a stronger influence on the maintenance of PTS symptoms than vice versa. These results have implications for (a) identifying individuals that are at elevated risk for developing PTS symptoms, (b) developing precision medicine-based approaches for alleviating PTS symptoms, and (c) improving well-established PTSD treatments for those with relative deficits in EF.
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Wang Z, Hui Q, Goldberg J, Smith N, Kaseer B, Murrah N, Levantsevych OM, Shallenberger L, Diggers E, Bremner JD, Vaccarino V, Sun YV. Association Between Posttraumatic Stress Disorder and Epigenetic Age Acceleration in a Sample of Twins. Psychosom Med 2022; 84:151-158. [PMID: 34629427 PMCID: PMC8831461 DOI: 10.1097/psy.0000000000001028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) has been related to accelerated biological aging processes, but objective evidence for this association is limited. DNA methylation (DNAm) age acceleration is a novel measure of biological aging that may help clarify if PTSD is related to biological aging processes. We aim to examine whether PTSD is associated with biological aging using a comprehensive set of DNAm age acceleration markers and to what extent the unshared environment contributes to the association. METHODS Using a cross-sectional co-twin control study design, we investigated the association of the clinical diagnosis and symptom severity of PTSD with six measurements of DNAm age acceleration based on epigenome-wide data derived from peripheral blood lymphocytes of 296 male twins from the Vietnam Era Twin Registry. RESULTS Twins with current PTSD had significantly advanced DNAm age acceleration compared with twins without PTSD for five of six measures of DNAm age acceleration. Across almost all measures of DNAm age acceleration, twins with current PTSD were "epigenetically older" than their twin brothers without PTSD: estimated differences ranged between 1.6 (95% confidence interval = 0.0-3.1) and 2.7 (95% confidence interval = 0.5-4.8) biological age year-equivalents. A higher Clinician-Administered PTSD Scale score was also associated with a higher within-pair DNAm age acceleration. Results remained consistent after adjustment for behavioral and cardiovascular risk factors. CONCLUSIONS PTSD is associated with epigenetic age acceleration, primarily through unshared environmental mechanisms as opposed to genetic or familial factors. These results suggest that PTSD is related to systemic processes relevant to biological aging.
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Affiliation(s)
- Zeyuan Wang
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA
| | - Nicholas Smith
- Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA
| | - Belal Kaseer
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Nancy Murrah
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Oleksiy M. Levantsevych
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Lucy Shallenberger
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Emily Diggers
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences and Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
| | - Yan V. Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA 30033, USA
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21
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Walters J, Beidel D. Getting Real about Post-Traumatic Stress Disorder in the Department of Defense: Augmenting Exposure Therapy through Virtual Reality. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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22
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Meeres J, Hariz M. Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature. Stereotact Funct Neurosurg 2022; 100:143-155. [PMID: 34979516 DOI: 10.1159/000521130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Up to 30% of patients with post-traumatic stress disorder (PTSD), especially combat veterans, remain refractory to conventional treatment. For them, deep brain stimulation (DBS) has been suggested. Here, we review the literature on animal models of PTSD in which DBS has been used to treat PTSD-type behavior, and we review and discuss patient reports of DBS for PTSD. METHODS A broad search was performed to find experimental animal articles and clinical reports on PubMed, Ovid MEDLINE, Cochrane Library, and PsycINFO, using combinations and variations of search words pertinent to DBS and PTSD. RESULTS The search yielded 30 articles, 24 on DBS in rat models of PTSD, and 6 publications between 2016 and 2020 reporting on a total of 3 patients. DBS in rat models targeted 4 brain areas: medial prefrontal cortex (mPFC), ventral striatum, amygdala, and hippocampus. Clinical publications reported on 2 male combat veterans who received DBS in basolateral amygdala, and 1 female with PTSD due to domestic abuse, who received DBS of mPFC. All 3 patients benefitted to various extents from DBS, at follow-ups of 4 years, 6 months, and 7 months, respectively. CONCLUSIONS PTSD is the only potential clinical indication for DBS that shows extensive animal research prior to human applications. Nevertheless, DBS for PTSD remains highly investigational. Despite several years of government funding of DBS research in view of treating severe PTSD in combat veterans, ethical dilemmas, recruitment difficulties, and issues related to use of DBS in such a complex and heterogenous disorder remain prevalent.
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Affiliation(s)
- Jennifer Meeres
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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Evans TC, DeGutis J, Rothlein D, Jagger-Rickels A, Yamashita A, Fortier CB, Fonda JR, Milberg W, McGlinchey R, Esterman M. Punishment and reward normalize error-related cognitive control in PTSD by modulating salience network activation and connectivity. Cortex 2021; 145:295-314. [PMID: 34775266 DOI: 10.1016/j.cortex.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/03/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) symptomatology disrupts inhibitory control during sustained attention. However, PTSD-related inhibitory control deficits are partially ameliorated when punishments and rewards are administered based on task performance, which suggests motivational processes contribute to these deficits. Additionally, PTSD may also impair error-related cognitive control following inhibitory control failures as measured by post-error slowing (PES). However, it remains unclear if motivational processes also contribute to impaired error-related cognitive control in PTSD. Using an incentivized sustained attention paradigm in two independent samples of post-9/11 veterans, we characterized PTSD-related differences in PES during both non-motivated conditions (no task-based incentives) and motivated conditions (task-based rewards and punishments). In Study 1 (n = 139), PTSD symptom severity was modestly associated with smaller PES in the non-motivated condition, whereas no PTSD-related association was observed in the motivated condition. In Study 2 (n = 35), we replicated and extended these results by using fMRI to characterize modulation of the triple network system comprised of the Salience Network (SN), Frontoparietal Control Network (FPCN), and Default Mode Network (DMN). In the non-motivated condition, PTSD symptom severity was associated with non-specific SN and FPCN hyperactivation during both failed and successful inhibitory control. In the motivated condition, PTSD symptom severity was associated with greater focal activation of both the SN and Superior Parietal Lobule cluster (an FPCN node) during punished inhibitory control failures and weaker SN-FPCN connectivity during rewarded inhibitory control successes. Together, these results suggest that dysregulated motivational processes in PTSD may contribute to impaired error-related cognitive control.
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Affiliation(s)
- Travis C Evans
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA.
| | - Joseph DeGutis
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA
| | - David Rothlein
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA
| | - Audreyana Jagger-Rickels
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA
| | - Ayumu Yamashita
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Jennifer R Fonda
- Department of Psychiatry, Boston University School of Medicine, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA; Department of Psychiatry, Harvard Medical School, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Michael Esterman
- Boston Attention and Learning Lab, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, USA
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Reavis KM, Snowden JM, Henry JA, Gallun FJ, Lewis MS, Carlson KF. Blast Exposure and Self-Reported Hearing Difficulty in Service Members and Veterans Who Have Normal Pure-Tone Hearing Sensitivity: The Mediating Role of Posttraumatic Stress Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4458-4467. [PMID: 34582257 DOI: 10.1044/2021_jslhr-20-00687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Evidence suggests that military blast exposure may lead to self-reported hearing difficulties despite audiometrically normal hearing. Research identifying potential mechanisms of this association remains limited. The purpose of this article is to evaluate the associations between blast, posttraumatic stress disorder (PTSD), and self-reported hearing difficulty, and to examine PTSD as a possible mediator of the association between blast exposure and hearing difficulty. Method We used baseline data from the Noise Outcomes in Service members Epidemiology (NOISE) study (n = 477). Participants in this study undergo a comprehensive hearing, and tinnitus if applicable, evaluation and complete a large number of surveys. Pertinent data extracted from these surveys included information on participant's demographics, military service history, including exposure to blast, and health conditions such as symptoms of PTSD. Using regression models and following a formal causal mediation framework, we estimated total associations, natural direct and indirect associations, and percent mediated. Results We found that individuals with blast exposure had higher prevalence of both probable PTSD and self-reported hearing difficulty than individuals who were not blast exposed. Compared with participants without blast exposure, those with blast exposure had twice the prevalence of self-reported hearing difficulty, with 41% of the association mediated through probable PTSD. Conclusion As PTSD is a possible mediator of the association between blast exposure and hearing difficulty, Service members and Veterans with normal pure-tone hearing sensitivity who report hearing difficulties and a history of blast exposure may benefit from evaluation for PTSD symptoms. Supplemental Material https://doi.org/10.23641/asha.16674247.
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Affiliation(s)
- Kelly M Reavis
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Jonathan M Snowden
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - James A Henry
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Frederick J Gallun
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - M Samantha Lewis
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology, Oregon Health & Science University, Portland
- School of Audiology, Pacific University, Hillsboro, OR
| | - Kathleen F Carlson
- VA Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
- VA Rehabilitation Research and Development, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR
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25
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Abstract
Several studies have investigated the risk of dementia in posttraumatic stress disorder (PTSD) using a varying methodology. Epidemiological studies have found an increased risk of dementia with PTSD in Vietnam veterans as well as the general population. Laboratory studies reported the accelerated formation of β-amyloid and tau, which represent the primary pathology of Alzheimer's dementia in animal models of PTSD. These investigations were conducted against a background of cognitive impairment and atrophy of the hippocampus and certain cortical areas in patients with PTSD. Very few studies have investigated the pathological basis in humans for the reported association of PTSD with dementia. This important gap in the literature has recently been partly addressed by very few studies that estimated the burden of β-amyloid and tau. The PET studies did not show an association between PTSD and the specific pathology of Alzheimer's disease or signs of neurodegenerative diseases underlying other dementia syndromes. Another study demonstrated decreased plasma β-amyloid load and increased plasma β-amyloid 42/40 ratio in PTSD without PET evaluation. While PTSD is associated with an increased risk of dementia syndrome in general, there is no convincing evidence that it causes or accelerates the pathology of Alzheimer's disease, which causes the most common type of dementia. Factors that may account for the association between PTSD and a clinical diagnosis of dementia are discussed in this review.
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Affiliation(s)
- Alby Elias
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
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Clouston SAP, Muñiz Terrera G, Rodgers JL, O'Keefe P, Mann F, Lewis NA, Wänström L, Kaye J, Hofer SM. Cohort and Period Effects as Explanations for Declining Dementia Trends and Cognitive Aging. POPULATION AND DEVELOPMENT REVIEW 2021; 47:611-637. [PMID: 36937313 PMCID: PMC10021404 DOI: 10.1111/padr.12409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Studies have reported that the age-adjusted incidence of cognitive impairment and dementia may have decreased over the past two decades. Aging is the predominant risk factor for Alzheimer's disease and related dementias and for neurocognitive decline. However, aging cannot explain changes in overall age-adjusted incidence of dementia. The objective of this position paper was to describe the potential for cohort and period effects in cognitive decline and incidence of dementia. Cohort effects have long been reported in demographic literature, but starting in the early 1980s, researchers began reporting cohort trends in cognitive function. At the same time, period effects have emerged in economic factors and stressors in early and midlife that may result in reduced cognitive dysfunction. Recognizing that aging individuals today were once children and adolescents, and that research has clearly noted that childhood cognitive performance is a primary determinant of old-age cognitive performance, this is the first study that proposes the need to connect known cohort effects in childhood cognition with differences in late-life functioning.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Graciela Muñiz Terrera
- Biostatistics and Epidemiology, Center for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Joseph Lee Rodgers
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Frank Mann
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Nathan A Lewis
- Department of Psychology, University of Victoria, Victoria, BC
| | - Linda Wänström
- Department of Computer and Informational Science, Linköping University, Linköping, Sweden
| | - Jeffrey Kaye
- Oregon Center for Aging and Technology, Oregon Health and Sciences University, and NIA-Layton Aging & Alzheimer's Disease Center, Portland, OR, USA
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, BC
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27
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The cost of being absent: Is meta-awareness of mind-wandering related to depression symptom severity, rumination tendencies and trauma intrusions? J Affect Disord 2021; 292:131-138. [PMID: 34119868 DOI: 10.1016/j.jad.2021.05.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Deng, Li and Tang (2014) reported that depression symptom severity is negatively associated with dispositional mindfulness and importantly, positively associated with zone-outs (mind-wandering without meta-awareness). We replicated and extended their study by exploring possible explanations for these relationships, and by also investigating whether mind-wandering is related to (1) trait rumination subtype-brooding, depressive or reflective, and (2) trauma intrusions-a hallmark PTSD symptom, since both rumination and trauma intrusions strongly correlate with depression. We also explored if dispositional mindfulness-the opposing construct of mind-wandering-mediated these relationships. METHOD Two hundred participants completed mindfulness tendency and depression severity measures, counterbalanced with the Sustained Attention to Response Task (SART)-including thought probes to index behavioral mind-wandering (target-error frequency), subjective mind-wandering and meta-awareness-then the rumination style and trauma intrusion frequency measures. RESULTS Depression scores positively correlated with mind-wandering with and without meta-awareness and with SART target-error rates, and negatively correlated with dispositional mindfulness. Further, trait brooding positively correlated with mind-wandering without meta-awareness. Dispositional mindfulness mediated the relationships between brooding and depression, and depression and mind-wandering, and also negatively correlated with trauma intrusion frequency. LIMITATIONS Limitations include measurement and mind-wandering definitions, and an inability to make causal claims. CONCLUSIONS People experiencing greater depression symptomology, and/or who have a greater tendency to brood, mind-wandered more often. Further, people who experience more trauma intrusions tend to be less mindful. These results point to potential harmful effects of mind-wandering through people's reduced propensity to be mindful, facilitating a negative self-referenced cognitive loop that may maintain or increase depression.
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Stein CR, Cooney ML, Frank B, Bender HA, Winkel G, Lucchini RG. Mental health mediators of subjective cognitive concerns among World Trade Center responders. J Psychiatr Res 2021; 140:187-196. [PMID: 34118636 DOI: 10.1016/j.jpsychires.2021.05.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Decline in cognitive functioning among rescue and recovery workers who responded in the aftermath of the September 11, 2001, World Trade Center (WTC) attacks is of emerging interest. Responders are vulnerable to cognitive decline from exposure to airborne toxins present at the WTC site, as well as from WTC-related mental and physical health conditions. To better understand the relationship between occupational WTC exposure, mental health, physical health and subjective cognitive functioning, we examined the mediating role of health status in the association between exposure and subjective cognitive concerns in a multi-site, longitudinal investigation of the WTC General Responder cohort (n = 16,380 responders; n = 58,575 visits) for the period 2002-2015. Through latent class analyses, we identified a four-level marker of cognitive concerns based on information from a Self-Administered Mental Health Questionnaire. Using generalized linear mixed models with random intercepts, we observed that a higher intensity WTC exposure composite was associated with greater cognitive concerns, and that this association was operating almost entirely through mental health comorbidities, not physical health comorbidities. In fully adjusted models, the inclusion of probable depression, anxiety, PTSD and use of psychotropic medications attenuated the association between highest WTC exposure and greatest cognitive concerns. Physical health did not appear to be on the pathway between WTC exposure and cognitive concerns. Understanding the underlying sources of cognitive concerns may help identify vulnerable members of the General Responder cohort and potentially aid clinical decision-making, such as treatment choice and enhanced screening options. Earlier diagnosis and symptom treatment may help preserve functional independence.
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Affiliation(s)
- Cheryl R Stein
- Hassenfeld Children's Hospital at NYU Langone, Department of Child and Adolescent Psychiatry, Child Study Center, One Park Avenue 7th Floor, New York, NY, 10016, USA.
| | - Michael L Cooney
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Brandon Frank
- Clinical and Health Psychology, University of Florida, 1225 Center Dr, Gainesville, FL, 32603, USA
| | - Heidi A Bender
- Weill Cornell Medicine/New York Presbyterian, Weill Cornell Brain and Spine, 525 East 68 Street, Box 99, New York, NY, 10028, USA
| | - Gary Winkel
- Icahn School of Medicine at Mount Sinai, Population Health Science and Policy, 1425 Madison Avenue, 3rd Floor, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Roberto G Lucchini
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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29
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Effects of Vortioxetine Versus Placebo on Cognition and Functional Capacity in Adults With Posttraumatic Stress Disorder. J Clin Psychopharmacol 2021; 41:501-503. [PMID: 34145182 DOI: 10.1097/jcp.0000000000001414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Gabrielian S, Hellemann G, Koosis ER, Green MF, Young AS. Do cognition and other person-level characteristics determine housing outcomes among homeless-experienced adults with serious mental illness? Psychiatr Rehabil J 2021; 44:176-185. [PMID: 33048564 PMCID: PMC8435461 DOI: 10.1037/prj0000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Many persons with serious mental illness (SMI) who have experienced homelessness struggle to sustain stable and independent housing. We know little about determinants of this population's housing status. This study aimed to identify person-level determinants of housing status among homeless-experienced veterans with SMI, focused primarily on cognition. Method: We administered cross-sectional surveys and detailed cognitive assessments on a convenience sample of homeless-experienced veterans with SMI (n = 90); we also reviewed these participants' medical records. We captured person-level potential predictors of housing status (demographics, cognition, diagnoses, symptoms, and service utilization) and 2 years of retrospective housing history. Participants' housing status was conceptualized as the setting (stable housing, other sheltered settings, and streets) they lived in for >50% of the past 2 years. We used the chi-square test and analysis of variance to determine how potential predictors differed by housing status. We used recursive partitioning to identify the combination of potential predictors and corresponding scores that best-differentiated participants by housing status. Results: No between-groups differences (p < .05) in cognition, symptoms, or other person-level factors were found among participants grouped by housing status. Recursive partitioning did not yield a stable model to predict housing status from the potential predictor variables. Conclusions and Implications for Practice: These data suggest that clinical interventions addressing studied person-level factors (e.g., cognitive rehabilitation) may not affect housing status for homeless-experienced veterans. As housing is highly influenced by social determinants of health, policies, and practices that affect contextual factors (e.g., affordable housing supply) may be more likely to improve housing status. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Sonya Gabrielian
- Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles
| | - Gerhard Hellemann
- Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles
| | - Ella R Koosis
- Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles
| | - Michael F Green
- Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles
| | - Alexander S Young
- Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles
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Bremner JD, Hoffman M, Afzal N, Cheema FA, Novik O, Ashraf A, Brummer M, Nazeer A, Goldberg J, Vaccarino V. The environment contributes more than genetics to smaller hippocampal volume in Posttraumatic Stress Disorder (PTSD). J Psychiatr Res 2021; 137:579-588. [PMID: 33168198 PMCID: PMC8345282 DOI: 10.1016/j.jpsychires.2020.10.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies using structural magnetic resonance imaging (MRI) volumetrics showed smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD). These studies were cross-sectional and did not address whether smaller volume is secondary to stress-induced damage, or whether pre-existing factors account for the findings. The purpose of this study was to use a co-twin case control design to assess the relative contribution of genetic and environmental factors to hippocampal volume in PTSD. METHODS Monozygotic (N = 13 pairs) and dizygotic (N = 21 pairs) twins with a history of Vietnam Era military service, where one brother went to Vietnam and developed PTSD, while his brother did not go to Vietnam or develop PTSD, underwent MR imaging of the brain. Structural MRI scans were used to manually outline the left and right hippocampus on multiple coronal slices, add the areas and adjust for slice thickness to determine hippocampal volume. RESULTS Twins with Vietnam combat-related PTSD had a mean 11% smaller right hippocampal volume in comparison to their twin brothers without combat exposure or PTSD (p < .05). There was no significant interaction by zygosity, suggesting that this was not a predisposing risk factor or genetic effect. CONCLUSIONS These findings are consistent with smaller hippocampal volume in PTSD, and suggest that the effects are primarily due to environmental effects such as the stress of combat.
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Affiliation(s)
- J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences, USA, Radiology, and Medicine (Cardiology), USA, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA, Corresponding author. Dept of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE, USA. (J.D. Bremner)
| | | | - Nadeem Afzal
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Faiz A. Cheema
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Olga Novik
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Ali Ashraf
- Departments of Psychiatry and Behavioral Sciences, USA
| | | | - Ahsan Nazeer
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Jack Goldberg
- Information Center and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Viola Vaccarino
- Emory University School of Medicine, Atlanta GA; Atlanta VAMC, Decatur, GA, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
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Jagger-Rickels A, Stumps A, Rothlein D, Park H, Fortenbaugh F, Zuberer A, Fonda JR, Fortier CB, DeGutis J, Milberg W, McGlinchey R, Esterman M. Impaired executive function exacerbates neural markers of posttraumatic stress disorder. Psychol Med 2021; 52:1-14. [PMID: 33879272 PMCID: PMC10202148 DOI: 10.1017/s0033291721000842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A major obstacle in understanding and treating posttraumatic stress disorder (PTSD) is its clinical and neurobiological heterogeneity. To address this barrier, the field has become increasingly interested in identifying subtypes of PTSD based on dysfunction in neural networks alongside cognitive impairments that may underlie the development and maintenance of symptoms. The current study aimed to determine if subtypes of PTSD, based on normative-based cognitive dysfunction across multiple domains, have unique neural network signatures. METHODS In a sample of 271 veterans (90% male) that completed both neuropsychological testing and resting-state fMRI, two complementary, whole-brain functional connectivity analyses explored the link between brain functioning, PTSD symptoms, and cognition. RESULTS At the network level, PTSD symptom severity was associated with reduced negative coupling between the limbic network (LN) and frontal-parietal control network (FPCN), driven specifically by the dorsolateral prefrontal cortex and amygdala Hubs of Dysfunction. Further, this relationship was uniquely moderated by executive function (EF). Specifically, those with PTSD and impaired EF had the strongest marker of LN-FPCN dysregulation, while those with above-average EF did not exhibit PTSD-related dysregulation of these networks. CONCLUSION These results suggest that poor executive functioning, alongside LN-FPCN dysregulation, may represent a neurocognitive subtype of PTSD.
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Affiliation(s)
- Audreyana Jagger-Rickels
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Anna Stumps
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - David Rothlein
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
| | - Hannah Park
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
| | - Francesca Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Agnieszka Zuberer
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Jennifer R. Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
| | - Joseph DeGutis
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center (GRECC), VABoston Healthcare System, Boston, Massachusetts, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center (GRECC), VABoston Healthcare System, Boston, Massachusetts, USA
| | - Michael Esterman
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston Attention and Learning Lab (BALAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
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Dietary Habit Is Associated with Depression and Intelligence: An Observational and Genome-Wide Environmental Interaction Analysis in the UK Biobank Cohort. Nutrients 2021; 13:nu13041150. [PMID: 33807197 PMCID: PMC8067152 DOI: 10.3390/nu13041150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022] Open
Abstract
Dietary habits have considerable impact on brain development and mental health. Despite long-standing interest in the association of dietary habits with mental health, few population-based studies of dietary habits have assessed depression and fluid intelligence. Our aim is to investigate the association of dietary habits with depression and fluid intelligence. In total, 814 independent loci were utilized to calculate the individual polygenic risk score (PRS) for 143 dietary habit-related traits. The individual genotype data were obtained from the UK Biobank cohort. Regression analyses were then conducted to evaluate the association of dietary habits with depression and fluid intelligence, respectively. PLINK 2.0 was utilized to detect the single nucleotide polymorphism (SNP) × dietary habit interaction effect on the risks of depression and fluid intelligence. We detected 22 common dietary habit-related traits shared by depression and fluid intelligence, such as red wine glasses per month, and overall alcohol intake. For interaction analysis, we detected that OLFM1 interacted with champagne/white wine in depression, while SYNPO2 interacted with coffee type in fluid intelligence. Our study results provide novel useful information for understanding how eating habits affect the fluid intelligence and depression.
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Cenkner DP, Asnaani A, DiChiara C, Harb GC, Lynch KG, Greene J, Scott JC. Neurocognitive Predictors of Treatment Outcomes in Cognitive Processing Therapy for Post-traumatic Stress Disorder: Study Protocol. Front Psychol 2021; 12:625669. [PMID: 33574791 PMCID: PMC7870481 DOI: 10.3389/fpsyg.2021.625669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy (CPT), are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in CPT in some individuals with PTSD. Methods and Analysis Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD (CPTPTSD) study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD (NCT# 03641924). The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: (1) examining the specificity of memory effects on treatment response; (2) exploring how baseline cognitive functioning impacts functional outcomes; and (3) examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD.
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Affiliation(s)
- David P Cenkner
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Christina DiChiara
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Gerlinde C Harb
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Kevin G Lynch
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Greene
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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35
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Morissette SB, Ryan-Gonzalez C, Yufik T, DeBeer BB, Kimbrel NA, Sorrells AM, Holleran-Steiker L, Penk WE, Gulliver SB, Meyer EC. The effects of posttraumatic stress disorder symptoms on educational functioning in student veterans. Psychol Serv 2021; 18:124-133. [PMID: 31192672 PMCID: PMC7003209 DOI: 10.1037/ser0000356] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) occurs at high rates among student veterans and is known to negatively impact educational functioning; however, the unique effects of PTSD are less clear, given that PTSD is highly comorbid with many other conditions that could potentially affect educational functioning. The present study had two objectives: (a) to determine the impact of PTSD symptom severity on educational functioning after accounting for demographic variables, traumatic brain injury, and commonly co-occurring mental health conditions; and (b) to identify which symptom clusters of PTSD have the greatest impact on educational functioning. Educational functioning and other commonly occurring mental health conditions were assessed cross-sectionally among 90 student veterans. Traumatic brain injury and major depressive disorder (MDD) were initially associated with impaired educational functioning; however, after adding PTSD into the final model, only PTSD (β = .44, p < .001) and MDD (β = .31, p = .001) remained associated with educational impairment. Follow-up analyses indicated that the reexperiencing symptom cluster was most strongly associated with impaired educational functioning (β = .28, p = .031). Overall, these results suggest that PTSD symptoms-especially reexperiencing symptoms-may be a driving force behind impaired educational impairment, even after accounting for other commonly co-occurring mental health conditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Bryann B DeBeer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans
| | - Nathan A Kimbrel
- Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center
| | | | | | | | | | - Eric C Meyer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans
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36
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LaGoy AD, Kaskie R, Connaboy C, Germain A, Ferrarelli F. Overnight Sleep Parameter Increases in Frontoparietal Areas Predict Working Memory Improvements in Healthy Participants But Not in Individuals With Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1110-1117. [PMID: 33757792 DOI: 10.1016/j.bpsc.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary evidence indicates that non-rapid eye movement (NREM) sleep is implicated in enhancing working memory (WM) performance across days in healthy individuals. While REM sleep has been implicated in other forms of memory, its role in WM remains unclear. Further, the relationship between sleep changes and WM improvement is largely unknown in posttraumatic stress disorder (PTSD). Examining the relationship between changes in sleep and WM improvement in healthy participants and participants with PTSD may inform cognitive enhancement strategies and intervention targets. METHODS Repeated assessments of WM and overnight measurement of NREM and REM sleep parameters were performed in 79 participants (participants with PTSD: n = 33) during a 48-hour laboratory stay. Relationships between sleep parameter changes, WM performance changes, and clinical characteristics were analyzed in PTSD and healthy groups. RESULTS A between-night enhancement in both NREM and REM sleep parameters in frontoparietal areas predicted across-day better WM performance in healthy participants, particularly in those with improved performance. In contrast, in participants with PTSD, an enhancement of these sleep parameters predicted a worse WM performance and was also associated with more PTSD-related sleep disturbances. CONCLUSIONS This study shows that higher sleep activity in frontoparietal areas leads to enhanced WM performance in healthy individuals, whereas in individuals with PTSD, it likely reflects the presence of sleep disturbances that interfere with WM improvement. Interventions focused on addressing sleep disturbances could therefore ameliorate cognitive impairments in individuals with PTSD.
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Affiliation(s)
- Alice D LaGoy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachel Kaskie
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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37
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Bisson Desrochers A, Rouleau I, Angehrn A, Vasiliadis HM, Saumier D, Brunet A. Trauma on duty: cognitive functioning in police officers with and without posttraumatic stress disorder (PTSD). Eur J Psychotraumatol 2021; 12:1959117. [PMID: 34721819 PMCID: PMC8555514 DOI: 10.1080/20008198.2021.1959117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuropsychological alterations co-occur with Posttraumatic Stress Disorder (PTSD); yet, the nature and magnitude of such alterations in police officers remains unknown despite their high level of trauma exposure. OBJECTIVE The current research sought to examine (1) cognitive functioning among police officers with and without PTSD; (2) the clinical significance of their cognitive performance; and (3) the relationship between PTSD symptoms and cognition. METHOD Thirty-one police officers with PTSD were compared to thirty age- and sex-matched trauma-exposed officers without PTSD. Clinical assessment and self-report questionnaires established PTSD status. All participants underwent a neuropsychological evaluation. RESULTS Police officers with PTSD displayed lower cognitive performance across several domains, notably executive functioning, verbal learning and memory, and lexical access, compared to controls. The neuropsychological decrements in the PTSD group were mild compared to normative data, with average performances falling within normal limits. Among officers with PTSD, higher levels of intrusion symptoms were associated with reduced efficacy in executive functioning, as well as attention and working memory. Moreover, increased intrusion and avoidance symptoms were associated with slower information processing speed. CONCLUSION Considering that even mild subclinical cognitive difficulties may affect their social and occupational functioning, it appears important to integrate neuropsychological assessments in the clinical management of police officers diagnosed with PTSD.
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Affiliation(s)
- Alexandra Bisson Desrochers
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada.,Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Andréanne Angehrn
- Department of Psychology, Université du Québec àTrois-Rivières, Trois-Rivières, QC, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Daniel Saumier
- Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - Alain Brunet
- Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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38
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Rehman Y, Zhang C, Ye H, Fernandes L, Marek M, Cretu A, Parkinson W. The extent of the neurocognitive impairment in elderly survivors of war suffering from PTSD: meta-analysis and literature review. AIMS Neurosci 2020; 8:47-73. [PMID: 33490372 PMCID: PMC7815483 DOI: 10.3934/neuroscience.2021003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives We performed a meta-analysis and systematic review on elderly survivors of war suffering from PTSD to estimate the variability in their cognitive impairment based on individual neuropsychological tests. Methods We included case control studies that explored the association of cognitive deficits in elderly PTSD civilian survivor of wars (age >60 years), using MEDLINE, Embase and PsycINFO from the inception to January 2018. We compared the cognitive performances in three comparisons i) PTSD+ vs. PTSD− civilian survivors of war; ii) PTSD+ vs. Control and iii) PTSD− vs. Control. The risk of bias was assessed using the Newcastle-Ottawa Scale for case-control studies. Results Out of 2939 titles and abstracts, 13 studies were eligible for data extraction. As compared to PTSD− civilian survivors of war, PTSD+ civilian survivors of war demonstrated significant deficits on TMT-A, TMT-B, Digit span backward, explicit memory low pair associate, CVLT recognition, WAIS-verbal and non-verbal tests. As compared to health controls, PTSD+ survivors demonstrated significantly lower performance on explicit memory low pair and high associate, RAVLT immediate and delayed recall, CVLT delayed and short cued recall. Performance on the neuropsychological test between PTSD− survivors of war and controls was not significant for all tests. Conclusion The pattern suggests that PTSD+ survivors of war had poorer performance in tasks requiring processing speed, executive function, attention, working memory and learning. The magnitude of the cognitive deficits in our pooled analysis was small to moderate depending on the neuropsychological test. Most of our pooled analysis suffered from a high risk of bias, which lowered the confidence in our results.
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Affiliation(s)
- Yasir Rehman
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Cindy Zhang
- Faculty of Health Sciences, McMaster University, Hamilton ON, Canada
| | - Haolin Ye
- Faculty of Life Sciences, McMaster University, Hamilton ON, Canada
| | - Lionel Fernandes
- Faculty of Life Sciences, McMaster University, Hamilton ON, Canada
| | - Mathieu Marek
- Faculty of Life Sciences, McMaster University, Hamilton ON, Canada
| | - Andrada Cretu
- Faculty of Life Sciences, McMaster University, Hamilton ON, Canada
| | - William Parkinson
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
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Miskey HM, Martindale SL, Shura RD, Taber KH. Distress Tolerance and Symptom Severity as Mediators of Symptom Validity Failure in Veterans With PTSD. J Neuropsychiatry Clin Neurosci 2020; 32:161-167. [PMID: 31266409 DOI: 10.1176/appi.neuropsych.17110340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Performance validity tests (PVTs) and symptom validity tests (SVTs) are necessary in clinical and research contexts. The extent to which psychiatric distress contributes to failure on these tests is unclear. The authors hypothesized that the relation between posttraumatic stress disorder (PTSD) and validity would be serially mediated by distress tolerance and symptom severity. METHODS Participants included 306 veterans, 110 of whom met full criteria for current PTSD. PVTs included the Medical Symptom Validity Test (MSVT) and b Test. The Structured Inventory of Malingered Symptomatology (SIMS) was used to measure symptom validity. RESULTS MSVT failure was significantly and directly associated with PTSD severity (B=0.05, CI=0.01, 0.08) but not distress tolerance or PTSD diagnosis. b Test performance was not significantly related to any variable. SIMS failure was significantly associated with PTSD diagnosis (B=0.71, CI=0.05, 1.37), distress tolerance (B=-0.04, CI=-0.07, -0.01), and symptom severity (B=0.07, CI=0.04, 0.09). The serial mediation model significantly predicted all SIMS subscales. CONCLUSIONS PTSD severity was associated with failing a memory-based PVT but not an attention-based PVT. Neither PVT was associated with distress tolerance or PTSD diagnosis. SVT failure was associated with PTSD diagnosis, poor distress tolerance, and high symptomatology. For veterans with PTSD, difficulty managing negative emotional states may contribute to symptom overreporting. This may reflect exaggeration or an inability to tolerate stronger negative affect, rather than a "cry for help."
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Affiliation(s)
- Holly M Miskey
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Sarah L Martindale
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Robert D Shura
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Katherine H Taber
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
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40
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Esterman M, Stumps A, Jagger-Rickels A, Rothlein D, DeGutis J, Fortenbaugh F, Romer A, Milberg W, Marx BP, McGlinchey R. Evaluating the evidence for a neuroimaging subtype of posttraumatic stress disorder. Sci Transl Med 2020; 12:12/568/eaaz9343. [DOI: 10.1126/scitranslmed.aaz9343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Michael Esterman
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Anna Stumps
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Audreyana Jagger-Rickels
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Rothlein
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Francesca Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Adrienne Romer
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - William Milberg
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Regina McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
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41
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Subbie-Saenz de Viteri S, Pandey A, Pandey G, Kamarajan C, Smith R, Anokhin A, Bauer L, Bender A, Chan G, Dick D, Edenberg H, Kinreich S, Kramer J, Schuckit M, Zang Y, McCutcheon V, Bucholz K, Porjesz B, Meyers JL. Pathways to post-traumatic stress disorder and alcohol dependence: Trauma, executive functioning, and family history of alcoholism in adolescents and young adults. Brain Behav 2020; 10:e01789. [PMID: 32990406 PMCID: PMC7667345 DOI: 10.1002/brb3.1789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Family history (FH) of alcohol dependence is likely to increase the risk of trauma exposure, post-traumatic stress disorder (PTSD), and alcohol dependence. FH of alcohol dependence and trauma has been separately shown to adversely affect planning/problem-solving aspects of executive function. However, few studies have examined these risk factors in an integrated model. METHODS Using data from trauma-exposed individuals from the Collaborative Study on the Genetics of Alcoholism prospective cohort (N = 1,860), comprising offspring from alcohol-dependent high-risk and comparison families (mean age [SE] = 21.9 [4.2]), we investigated associations of trauma (nonsexual assaultive, nonassaultive, sexual assaultive) with DSM-IV PTSD and alcohol dependence symptom counts, and planning/problem-solving abilities assessed using the Tower of London Test (TOLT). Moderating effects of family history density of alcohol use disorder (FHD) on these associations and sex differences were explored. RESULTS Family history density was positively associated with PTSD in female participants who endorsed a sexual assaultive trauma. Exposure to nonsexual assaultive trauma was associated with more excess moves made on the TOLT. CONCLUSION Findings from this study demonstrate associations with PTSD and alcohol dependence symptom counts, as well as poor problem-solving ability in trauma-exposed individuals from families densely affected with alcohol dependence, depending on trauma type, FHD, and sex. This suggests that having a FH of alcohol dependence and exposure to trauma during adolescence may be associated with more PTSD and alcohol dependence symptoms, and poor problem-solving abilities in adulthood.
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Affiliation(s)
| | - Ashwini Pandey
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Gayathri Pandey
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Chella Kamarajan
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Rebecca Smith
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrey Anokhin
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lance Bauer
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Annah Bender
- University of Missouri, St. Louis, Missouri, USA
| | - Grace Chan
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Danielle Dick
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Howard Edenberg
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sivan Kinreich
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | | | | | - Yong Zang
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vivia McCutcheon
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen Bucholz
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bernice Porjesz
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jacquelyn L Meyers
- State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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42
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Boersma-van Dam E, van de Schoot R, Hofland HWC, Engelhard IM, Van Loey NEE. Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study. Qual Life Res 2020; 30:737-749. [PMID: 33090372 PMCID: PMC7952339 DOI: 10.1007/s11136-020-02678-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with burns in a multicenter study. Patients completed the EQ-5D-3L questionnaire with a Cognition bolt-on shortly after hospital admission, which included a recalled pre-injury measure, and, again, at 3, 6, 12 and 18 months post-burn. Burn severity was indicated by the number of surgeries, and PTSD symptoms were assessed with the IES-R at three months post-burn. Pre- and post-injury HRQL were compared to norm populations. Results Recalled pre-injury HRQL was higher than population norms and HRQL at 18 months post-burn was comparable to population norms. Compared to the pre-injury level of functioning, four HRQL patterns of change over time were established: Stable, Recovery, Deterioration, and Growth. In each HRQL domain, a subset of patients did not return to their recalled pre-injury levels, especially with regard to Pain, Anxiety/Depression, and Cognition. Patients with more severe burns or PTSD symptoms were less likely to return to pre-injury level of functioning within 18 months post-burn. Conclusion This study identified four patterns of individual change. Patients with more severe injuries and PTSD symptoms were more at risk of not returning to their recalled pre-injury HRQL. This study supports the face validity of using a recalled pre-burn HRQL score as a reference point to monitor HRQL after burns. Electronic supplementary material The online version of this article (10.1007/s11136-020-02678-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elise Boersma-van Dam
- Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA, Beverwijk, The Netherlands. .,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.,Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | | | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA, Beverwijk, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
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43
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Miyagi T, Oishi N, Kobayashi K, Ueno T, Yoshimura S, Murai T, Fujiwara H. Psychological resilience is correlated with dynamic changes in functional connectivity within the default mode network during a cognitive task. Sci Rep 2020; 10:17760. [PMID: 33082442 PMCID: PMC7576164 DOI: 10.1038/s41598-020-74283-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
Resilience is a dynamic process that enables organisms to cope with demanding environments. Resting-state functional MRI (fMRI) studies have demonstrated a negative correlation between resilience and functional connectivities (FCs) within the default mode network (DMN). Considering the on-demand recruitment process of resilience, dynamic changes in FCs during cognitive load increases may reflect essential aspects of resilience. We compared DMN FC changes in resting and task states and their association with resilience. Eighty-nine healthy volunteers completed the Connor–Davidson Resilience Scale (CD-RISC) and an fMRI with an auditory oddball task. The fMRI time series was divided into resting and task periods. We focused on FC changes between the latter half of the resting period and the former half of the task phase (switching), and between the former and latter half of the task phase (sustaining). FCs within the ventral DMN significantly increased during “switching” and decreased during “sustaining”. For FCs between the retrosplenial/posterior cingulate and the parahippocampal cortex, increased FC during switching was negatively correlated with CD-RISC scores. In individuals with higher resilience, ventral DMN connectivities were more stable and homeostatic in the face of cognitive demand. The dynamic profile of DMN FCs may represent a novel biomarker of resilience.
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Affiliation(s)
- Takashi Miyagi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Oishi
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kei Kobayashi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsukasa Ueno
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan
| | - Sayaka Yoshimura
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironobu Fujiwara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Artificial Intelligence Ethics and Society Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
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44
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Rodriguez G, Moore SJ, Neff RC, Glass ED, Stevenson TK, Stinnett GS, Seasholtz AF, Murphy GG, Cazares VA. Deficits across multiple behavioral domains align with susceptibility to stress in 129S1/SvImJ mice. Neurobiol Stress 2020; 13:100262. [PMID: 33344715 PMCID: PMC7739066 DOI: 10.1016/j.ynstr.2020.100262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/07/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Acute physical or psychological stress can elicit adaptive behaviors that allow an organism maintain homeostasis. However, intense and/or prolonged stressors often have the opposite effect, resulting in maladaptive behaviors and curbing goal-directed action; in the extreme, this may contribute to the development of psychiatric conditions like generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. While treatment of these disorders generally focuses on reducing reactivity to potentially threatening stimuli, there are in fact impairments across multiple domains including valence, arousal, and cognition. Here, we use the genetically stress-susceptible 129S1 mouse strain to explore the effects of stress across multiple domains. We find that 129S1 mice exhibit a potentiated neuroendocrine response across many environments and paradigms, and that this is associated with reduced exploration, neophobia, decreased novelty- and reward-seeking, and spatial learning and memory impairments. Taken together, our results suggest that the 129S1 strain may provide a useful model for elucidating mechanisms underlying myriad aspects of stress-linked psychiatric disorders as well as potential treatments that may ameliorate symptoms.
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Affiliation(s)
- G Rodriguez
- Michigan Neuroscience Institute, USA.,Neuroscience Graduate Program, USA
| | - S J Moore
- Department of Molecular and Integrative Physiology, USA.,Michigan Neuroscience Institute, USA
| | - R C Neff
- Department of Molecular and Integrative Physiology, USA
| | - E D Glass
- Department of Molecular and Integrative Physiology, USA.,Michigan Neuroscience Institute, USA
| | | | | | - A F Seasholtz
- Michigan Neuroscience Institute, USA.,Neuroscience Graduate Program, USA.,Department of Biological Chemistry University of Michigan, Ann Arbor, MI, USA
| | - G G Murphy
- Department of Molecular and Integrative Physiology, USA.,Michigan Neuroscience Institute, USA.,Neuroscience Graduate Program, USA
| | - V A Cazares
- Department of Molecular and Integrative Physiology, USA.,Michigan Neuroscience Institute, USA.,Department of Psychology, Williams College, MA, USA
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45
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Alper HE, Tuly RA, Seil K, Brite J. Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197330. [PMID: 33049920 PMCID: PMC7579594 DOI: 10.3390/ijerph17197330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.
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Affiliation(s)
- Howard E. Alper
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
- Correspondence: ; Tel.: +1-718-786-4387; Fax: +1-718-786-4006
| | - Rifat A. Tuly
- School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Kacie Seil
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
| | - Jennifer Brite
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
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46
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Relationship between intelligence and posttraumatic stress disorder in veterans. INTELLIGENCE 2020. [DOI: 10.1016/j.intell.2020.101472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Kaseda ET, Levine AJ. Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivors. Clin Neuropsychol 2020; 34:1498-1514. [PMID: 32847484 DOI: 10.1080/13854046.2020.1811894] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: SARS-CoV-2 infection and its oft-associated illness COVID-19 may lead to neuropsychological deficits, either through direct mechanisms (i.e., neurovirulance) or indirect mechanisms, most notably complications caused by the virus (e.g., stroke) or medical procedures (e.g., intubation). The history of past human coronavirus outbreaks resulting in similar health emergencies suggests there will be a substantial prevalence of post-traumatic stress disorder (PTSD) among COVID-19 survivors. To prepare neuropsychologists for the difficult task of differentiating PTSD-related from neuropathology-related deficits in the oncoming wave of COVID-19 survivors, we integrate research across a spectrum of related areas.Methods: Several areas of literature were reviewed: psychiatric, neurologic, and neuropathological outcomes of SARS and MERS patients; neurological outcomes in COVID-19 survivors; PTSD associated with procedures common to COVID-19 patients; and differentiating neuropsychological deficits due to PTSD from those due to acquired brain injuries in other patient groups.Conclusions: Heightened risk of PTSD occurred in MERS and SARS survivors. While data concerning COVID-19 is lacking, PTSD is known to occur in patient groups who undergo similar hospital courses, including ICU survivors, patients who are intubated and mechanically ventilated, and those that experience delirium. Research with patients who develop PTSD in the context of mild traumatic brain injury further suggests that PTSD may account for some or all of a patient's subjective cognitive complaints and neuropsychological test performance. Recommendations are provided for assessing PTSD in the context of COVID-19.
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Affiliation(s)
- Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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48
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Schindler L, Stalder T, Kirschbaum C, Plessow F, Schönfeld S, Hoyer J, Trautmann S, Steudte-Schmiedgen S. Cognitive functioning in posttraumatic stress disorder before and after cognitive-behavioral therapy. J Anxiety Disord 2020; 74:102265. [PMID: 32623282 DOI: 10.1016/j.janxdis.2020.102265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
Although substantial evidence suggests altered executive functioning and autobiographical memory in posttraumatic stress disorder (PTSD), the clinical significance of these findings remains unclear. Here, we investigated the effects of cognitive-behavioral therapy (CBT) on different aspects of cognitive functioning (working memory, interference susceptibility, conflict adaptation, autobiographical memory) in PTSD patients in a pre-post control group design with a nested cross-sectional element. Cross-sectional analyses at baseline were conducted on 58 PTSD patients, 39 traumatized (TC), and 45 non-traumatized controls (NTC). Intervention effects were investigated before and after 25 CBT sessions in 25 PTSD and 34 untreated NTC individuals assessed in parallel. At baseline, PTSD patients showed higher conflict adaptation than the NTC group and less autobiographical memory specificity than both control groups, suggesting particularly the latter to be a correlate of PTSD. No consistent evidence for treatment-induced improvements in cognitive functioning emerged on the group level or from associations between intra-individual clinical and cognitive changes. Analyses on the role of cognitive functioning on subsequent treatment effects revealed a predictive effect of backward digit span on CBT-induced reductions of depressiveness, but no other significant effects. Our findings highlight the need for further research to identify more relevant predictors of differential treatment response.
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Affiliation(s)
- Lena Schindler
- Faculty of Psychology, Technische Universität Dresden, Germany.
| | - Tobias Stalder
- Department Erziehungswissenschaften und Psychologie, Universität Siegen, Germany.
| | | | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sabine Schönfeld
- Faculty of Psychology, Technische Universität Dresden, Germany; Department of Psychology, Lund University, Sweden.
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Sebastian Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Psychology, Medical School Hamburg, Germany.
| | - Susann Steudte-Schmiedgen
- Faculty of Psychology, Technische Universität Dresden, Germany; Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany.
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49
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Weaver SS, Birn RM, Cisler JM. A Pilot Adaptive Neurofeedback Investigation of the Neural Mechanisms of Implicit Emotion Regulation Among Women With PTSD. Front Syst Neurosci 2020; 14:40. [PMID: 32719590 PMCID: PMC7347986 DOI: 10.3389/fnsys.2020.00040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is widely associated with deficits in implicit emotion regulation. Recently, adaptive fMRI neurofeedback (A-NF) has been developed as a methodology that offers a unique probe of brain networks that mediate implicit emotion regulation and their impairment in PTSD. We designed an A-NF paradigm in which difficulty of an emotional conflict task (i.e., embedding trauma distractors onto a neutral target stimulus) was controlled by a whole-brain classifier trained to differentiate attention to the trauma distractor vs. target. We exploited this methodology to test whether PTSD was associated with: (1) an altered brain state that differentiates attention towards vs. away from trauma cues; and (2) an altered ability to use concurrent feedback about brain states during an implicit emotion regulation task. Adult women with a current diagnosis of PTSD (n = 10) and healthy control (n = 9) women participated in this task during 3T fMRI. During two initial non-feedback runs used to train a whole-brain classifier, we observed: (1) poorer attention performance in PTSD; and (2) a linear relationship between brain state discrimination and attention performance, which was significantly attenuated among the PTSD group when the task contained trauma cues. During the A-NF phase, the PTSD group demonstrated poorer ability to regulate brain states as per attention instructions, and this poorer ability was related to PTSD symptom severity. Further, PTSD was associated with the heightened encoding of feedback in the insula and hippocampus. These results suggest a novel understanding of whole-brain states and their regulation that underlie emotion regulation deficits in PTSD.
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Affiliation(s)
- Shelby S Weaver
- Department of Psychiatry, The University of Wisconsin-Madison, Madison, WI, United States
| | - Rasmus M Birn
- Department of Psychiatry, The University of Wisconsin-Madison, Madison, WI, United States
| | - Josh M Cisler
- Department of Psychiatry, The University of Wisconsin-Madison, Madison, WI, United States
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50
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Adams Z, Adams T, Stauffacher-Gros K, Mandel H, Wang Z. The Effects of Inattentiveness and Hyperactivity on Posttraumatic Stress Symptoms: Does a Diagnosis of Posttraumatic Stress Disorder Matter? J Atten Disord 2020; 24:1246-1254. [PMID: 25882836 PMCID: PMC4608860 DOI: 10.1177/1087054715580846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To address the nature of associations between ADHD symptoms and posttraumatic stress disorder (PTSD) psychopathology in adult military veterans. Method: Ninety-five combat veterans, with PTSD (n = 63) and without PTSD (n = 32), were recruited for this study. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS) and ADHD was assessed with Connors' Adult ADHD Rating Scale-Self-Report: Short Version (CAARS-S:S). Results: PTSD participants endorsed greater hyperactivity or restlessness, inattention or memory problems, and impulsivity or emotional lability scores than participants without PTSD. Among PTSD participants, inattention or memory problems and impulsivity or emotional lability were significant predictors of total PTSD symptoms, but only inattention or memory problems significantly predicted PTSD symptoms when other ADHD symptom clusters were considered simultaneously. Conclusion: Our data suggest that inattention may serve as a risk factor for posttraumatic stress symptoms following combat exposure.
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Affiliation(s)
| | | | | | | | - Zhewu Wang
- Medical University of South Carolina,Ralph H. Johnson VA Medical Center,Please send correspondence to: Zhewu Wang, MD, Ralph H. Johnson VA Medical Center/Medical University of South Carolina, 109 Bee Street, Charleston, SC. USA. Phone: 843-789-7949; Fax: 843-792-3195
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