A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder

Assessing neurocognitive outcomes in PTSD: a multilevel meta-analytical approach

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge's g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events. Currently, there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder. In addition, the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment. Evidence suggests that this condition is a multisystem disorder that affects many biological systems, raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder. We performed a PubMed search for microRNAs (miRNAs) in post-traumatic stress disorder (PTSD) that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023. These included four studies with whole blood, seven with peripheral blood mononuclear cells, four with plasma extracellular vesicles/exosomes, and one with serum exosomes. One of these studies had also used whole plasma. Two studies were excluded as they did not involve microRNA biomarkers. Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat, and only two were from recently traumatized adult subjects. In measuring miRNA expression levels, many of the studies had used microarray miRNA analysis, miRNA Seq analysis, or NanoString panels. Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls. The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood; miR-193a-5p, -7113-5p, -125a, -181c, and -671-5p in peripheral blood mononuclear cells; miR-10b-5p, -203a-3p, -4488, -502-3p, -874-3p, -5100, and -7641 in plasma extracellular vesicles/exosomes; and miR-18a-3p and -7-1-5p in blood plasma. Several important limitations identified in the studies need to be taken into account in future studies. Further studies are warranted with war veterans and recently traumatized children, adolescents, and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Associations between physiological indicators of cochlear deafferentation and listening effort in military Veterans with normal audiograms

Cochlear synaptopathy, a type of cochlear deafferentation that impacts the synapses between the inner hair cells and the afferent auditory nerve fibers, is predicted to result in speech perception in noise difficulty. However, this has been difficult to confirm due to mixed findings in human studies of the relationship between speech perception in noise and physiological indicators of deafferentation (auditory brainstem response [ABR] wave I amplitude, envelope following response [EFR] magnitude, and middle ear muscle reflex [MEMR] magnitude). One possible explanation for the mixed findings is that some listeners with cochlear deafferentation can increase their cognitive effort to compensate for the degraded speech signal so that their speech-in-noise performance is relatively unaffected, obscuring the relationship between deafferentation and speech-in-noise scores. In a population at high risk for noise-induced cochlear deafferentation (military Veterans with normal audiograms), this study evaluated the relationship between physiological indicators of deafferentation (ABR, EFR, and MEMR) and listening effort, as indicated by pupil dilation during a speech-in-noise task. Mean reductions in ABR, EFR, and MEMR magnitude were associated with greater task-related pupil dilation, but not with reduced speech-in-noise performance, although only the ABR was statistically significant after accounting for sex and outer hair cell function. This suggests that cochlear deafferentation may result in increased listening effort during speech-in-noise perception, even if performance on the task is not negatively impacted. The observed relationship between EFR magnitude and pupil dilation was non-linear, suggesting that increased listening effort may only occur after a particular threshold level of deafferentation is reached.

Traumatic Brain Injury in US Veterans: Prevalence and Associations With Physical, Mental, and Cognitive Health

OBJECTIVE

To examine the prevalence of traumatic brain injury (TBI) in the US veteran population, and physical, mental, and cognitive health conditions associated with TBI.

DESIGN

Retrospective cohort study.

SETTING

A nationally representative sample of US military veterans surveyed in 2019-2020.

PARTICIPANTS

Veterans with probable TBI (n=943; M=58.8 years, SD=16.4; 75.9% non-Hispanic White) and without probable TBI (n=3,033; M=63.3 years, SD=15.3; 78.6% non-Hispanic White) were categorized based on a 2-item modified Veterans Health Administration TBI screen or self-reported health professional diagnoses of concussion/TBI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Self-reported health professional-diagnosed physical and cognitive health conditions, disability with basic and instrumental activities of daily living (ADLs), positive screens for posttraumatic stress disorder (PTSD), major depressive disorder, anxiety disorder, alcohol use disorder, or drug use disorder, and current suicidal ideation or prior suicide attempts.

RESULTS

Among the full sample, 24.5% (95% confidence interval: 22.7, 26.3) had probable TBI. In adjusted analyses, probable TBI was independently associated with greater odds of rheumatoid arthritis (odds ratio [OR]=2.06), chronic pain (OR=1.87), kidney disease (OR=1.81), pulmonary disease (OR=1.74), arthritis (OR=1.65), migraine (OR=1.59), sleep disorders (OR=1.57), and osteoporosis or osteopenia (OR=1.51). Veterans with probable TBI also had higher odds of mild cognitive impairment (OR=4.53) and disability with ADLs (OR=2.18) and instrumental ADLs (OR=1.98), although ADL disability was explained by other physical health conditions. Probable TBI was associated with higher odds of probable current anxiety disorder (OR=2.82), major depressive disorder (OR=2.17), suicidal ideation (OR=1.78), PTSD (OR=1.72), drug use disorder (OR=1.54), and alcohol use disorder (OR=1.47).

CONCLUSIONS

Nearly 1-in-4 US veterans screen positive for probable TBI, which was associated with several physical and mental health conditions that adversely affect health and functioning. Results underscore the importance of multidisciplinary interventions that concurrently target the unique physical, mental, cognitive, and functional health needs of this population.

Brain Fog and Cognitive Dysfunction in Posttraumatic Stress Disorder: An Evidence-Based Review

The term "brain fog" has long been used both colloquially and in research literature in reference to various neurocognitive phenomenon that detract from cognitive efficiency. We define "brain fog" as the subjective experience of cognitive difficulties, in keeping with the most common colloquial and research use of the term. While a recent increase in use of this term has largely been in the context of the post-coronavirus-19 condition known as long COVID, "brain fog" has also been discussed in relation to several other conditions including mental health conditions such as post-traumatic stress disorder (PTSD). PTSD is associated with both subjective cognitive complaints and relative deficits on cognitive testing, but the phenomenology and mechanisms contributing to "brain fog" in this population are poorly understood. PTSD psychopathology across cognitive, affective and physiological symptom domains have been tied to "brain fog". Furthermore, dissociative symptoms common in PTSD also contribute to the experience of "brain fog". Comorbid physical and mental health conditions may also increase the risk of experiencing "brain fog" among individuals with PTSD. Considerations for the assessment of "brain fog" in PTSD as part of psychodiagnostic assessment are discussed. While standard psychological intervention for PTSD is associated with a reduction in subjective cognitive deficits, other cognitive interventions may be valuable when "brain fog" persists following PTSD remission or when "brain fog" interferes with treatment. Limitations of current research on "brain fog" in PTSD include a lack of consistent definition and operationalization of "brain fog" in the literature, as well as limited tools for measurement. Future research should address these limitations, as well as further evaluate the use of cognitive remediation as an intervention for "brain fog".

Concurrent impact of PTSD symptoms and alcohol use on working memory and executive functioning in a U.S. adult sample

Despite high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) and well-documented independent impacts of each condition on cognitive functioning, few studies have explored the concurrent effects of PTSD and AUD on cognitive control. Recent intervention studies have explored working memory (WM) and executive functioning (EF) as potential treatment targets to improve outcomes for both PTSD and AUD, but there is a need to elucidate concurrent impacts of each condition to inform intervention development. The present study examined WM and EF performance in a sample of U.S. adults in relation to current PTSD symptom and alcohol use (AU) severity. We hypothesized that there would be main effects of both PTSD symptoms and AU severity on WM and EF outcomes, with an exploration of interaction effects. A sample of 112 participants (79% white, 61% female) recruited from a larger survey study also completed follow-up WM and EF tasks. Results did not support our hypotheses regarding main effects of PTSD and AU severity on WM and EF outcomes. Significant age effects were observed on WM measures such that higher age was associated with reduced performance. An interaction effect was detected for one EF measure (decision-making), such that decision-making performances were relatively stable at low to subthreshold PTSD symptoms regardless of AU severity but declined with increasing AU at clinically elevated PTSD symptoms. Findings reflect new information regarding the impact of concurrent PTSD and AU severity on EF, and implications for future research and intervention development are discussed.

Neurocognitive difficulties in trauma-exposed adults with metabolic syndrome: no influence of PTSD status or PTSD and metabolic syndrome comorbidity

BACKGROUND

Metabolic syndrome (MetS) and posttraumatic stress disorder (PTSD) often co-occur and both may compromise cognition, owing in part to common underlying mechanisms. Few studies have investigated the additive effects of these disorders on cognitive performance. Our aims were to compare cognitive performance between patients with PTSD and trauma-exposed controls (TEC) and investigate the additive effects of MetS factors on cognition.

METHODS

In this case-control study, we included 474 adult participants, 236 with PTSD and 238 TEC. Demographic, neuropsychiatric, metabolic-related, and neurocognitive assessments were undertaken and MANCOVAs performed controlling for age. Cognitive domains (immediate and delayed memory, attention, language, visuospatial performance, working memory and global cognition) were the dependent variables in the analysis. Patient status and presence/absence of MetS or MetS components were independent variables, in each model.

RESULTS

Patients with PTSD did not demonstrate worse cognitive performance than TEC on the neurocognitive domains assessed, and the presence of MetS in patients with PTSD did not alter this finding. Individuals with MetS also did not demonstrate worse cognition when compared to those without MetS. When we looked at individual MetS features, higher BMI was associated with poorer visuospatial performance, CONCLUSIONS: These findings contrast with many previous studies showing worse neurocognitive performance related to both PTSD and MetS. Further investigation is required to establish the contribution of MetS to cognitive deficits in those with PTSD. Generalisability and inferences regarding the directionality of associations are limited.

Symptoms of depression, but not PTSD, influence cognitive performance in healthy Army National Guard Soldiers

INTRODUCTION

Research suggests that comorbid depression and PTSD may contribute to cognitive impairment. However, few studies have explored this dynamic in military personnel who report only subclinical symptoms of PTSD and depression.

METHODS

Army National Guard Soldiers (ARNG; N = 1415) completed the Automated Neuropsychological Assessment Metrics (ANAM), the PTSD Checklist (PCL), and the Center for Epidemiological Studies Depression Scale (CES-D). The effects of PTSD and depression symptoms on ANAM performance were examined using multiple linear regression analyses. Exploratory factor analysis and regression models examined the relationship between symptom clusters and ANAM performance.

RESULTS

Six factors were identified: avoidance/flashbacks, cognitive/social difficulty, depressed mood, positive mood, sleep difficulty, and hypervigilance. Elevated symptoms of depression (measured using factor scores) were associated with poorer attention (β range -0.19-0.18, p range < 0.01-0.04, f2 effect size range 0.02-0.94).

CONCLUSION

Depression symptoms were associated with diminished attentional performance in a large sample of ARNG Soldiers who reported no clinical diagnosis. This study was limited in that unmeasured factors other than depression, PTSD, or demographics may explain much of the variance in cognitive performance. These findings highlight the importance of careful mental health screening and strategies to heighten awareness of the potential detrimental effects of depression and PTSD on health and performance.

Neuropsychological review of records in forensic cases: An AACN best practices paper with international perspectives

Objective: The purpose of this American Academy of Clinical Neuropsychology (AACN) best practices paper is to provide the neuropsychological community with the fundamentals of a competent forensic review of records. Method: Narrative review addressing fundamental factors related to review of records. Examples highlighted information necessary for a forensic determination of traumatic brain injury (TBI), and the data from records that can be used to address questions regarding validity of presentation. International and intra-jurisdictional perspectives within the US were used to illustrate the necessity of adhering the review to the rules. Results: Factors identified involve ethical responsibilities, completeness in obtaining and reviewing relevant records, evaluation of credibility of the records, considerations regarding examinee self-reporting, grounding of opinions within peer-reviewed science, determination of causation in the context of litigation, and avoiding bias in reporting, as well as consideration of cultural and language factors. Different jurisdictional rules require close attention. Conclusions: Neuropsychologists need to be aware of the need for a competent review of records to obtain basic facts, maintain objectivity, and provide a context for conclusions in a neuropsychological examination report. In litigation cases, opinions based solely on review of records may be challenged for reasons that might include not having personally evaluated the plaintiff, and whether opinions meet Daubert criteria pertaining to sufficient scientific bases and facts. A thorough review in the context of examination helps deal with litigant/claimant subjectivity and malleability of self-report, and it can provide critical reasoning about other factors relevant to causation.

Social Reactions to Disclosures of Intimate Partner Stalking and Unwanted Pursuit Behaviors: Associations With PTSD, Academic Outcomes, and Empowerment

Among college survivors of unwanted pursuit behaviors (UPBs; 40.1%, n = 189) or intimate partner stalking (IPS, i.e., UPBs causing emotional distress; 32.1%, n = 151), the present study examined effects of social reactions to disclosures on post-traumatic stress disorder (PTSD) symptomatology, academic outcomes, and personal empowerment. Compared to UPB survivors, IPS survivors were more likely to disclose and reported higher positive and negative reactions to disclosure as well as greater frequency of UPBs/IPS, IPV, and PTSD symptoms. Among both groups, only negative social reactions were positively associated with PTSD symptoms. However, among IPS (but not UPB) survivors, only positive social reactions were related to academic outcomes and empowerment when controlling for PTSD and IPS frequency. Implications for research and practice are discussed.

Physiology mechanisms of exercise for PTSD: a narrative review

In at-risk societies, the population of post-traumatic stress disorder (PTSD) incidence is gradually expanding from veterans to the general public. In the face of the high incidence of PTSD, exercise therapy, as an economical and maneuverable treatment, has not received the attention it deserves. In this paper, the literature on PTSD symptom improvement through comb-climbing exercise interventions found that performing long-term exercise can achieve significant improvement in PTSD symptoms by modulating the central nervous system, autonomic nervous system, and immune system at the physiological level. Aerobic exercise (running, walking) is beneficial to the central nervous system and immune system; anaerobic exercise positively affects the autonomic nervous system, including resistance or strength endurance training; yoga, which focuses on flexibility and balance training, has a positive effect on the immune system. Future research should explore the neutral and negative effects and mechanisms of exercise on PTSD interventions. Expand more empirical studies in special occupational populations. And implement longitudinal intervention studies with PTSD patients to gain an in-depth understanding of PTSD intervention effects.

Time-dependent fear memory generalization triggered by phosphodiesterase 5 inhibition during reconsolidation

Fear generalization, a lack of discrimination between safe and unsafe cues, is a hallmark of posttraumatic stress disorder. The phosphodiesterase 5 (PDE5) regulates the cyclic guanosine monophosphate (cGMP) pathway, which has been proposed to be involved in fear memory generalization. However, whether PDE5 activity underlies fear memory generalization remains unexplored. Considering the importance of retrieval-induced reconsolidation in memory maintenance, we aimed to investigate whether PDE5 inhibition during reconsolidation of recent fear memory affects generalization over time in adult male Wistar rats submitted to contextual fear conditioning. The PDE5 inhibition with vardenafil (VAR) 1 mg/kg i.p. during reconsolidation triggered a time-dependent fear generalization without affecting fear memory in the paired context. Fear generalization and impaired pattern separation appear to be interlinked. Likewise, an impairment of object pattern separation was observed in the VAR-treated group at the remote time point. These effects depended on memory retrieval and were restricted to the reconsolidation time window. A chemogenetic inhibition of the anterior cingulate cortex (ACC), a region involved in allocating remote memories and generalization, prevented the effects of VAR. Moreover, VAR infusion into the ACC (6 μg/0.2 μL) after retrieval also promoted fear generalization and impaired OPS in remote time point, suggesting that ACC underlies the behavioral outcomes of the treatment with VAR. In conclusion, our results suggest that inhibiting PDE5 during the reconsolidation of a recent fear memory recruits the activity of the ACC, triggering fear memory generalization and impairing object pattern separation over time.

On-TRACC Pilot Study: A Novel Intervention for Persistent Post-Concussive Cognitive Symptoms

OBJECTIVE

To present the results of a pilot study of On-TRACC (Tools for Recovery and Clinical Care), a novel intervention for individuals experiencing persistent cognitive difficulties after mild traumatic brain injury (mTBI). On-TRACC is a 5-session, 1:1 manualized treatment that integrates psychoeducation, cognitive rehabilitation strategies, and self-management skills to target symptoms and increase understanding of the interaction between cognitive difficulties, injury history, and comorbid medical and psychological conditions. The primary study goals were to evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC.

SETTING

Veterans Affairs medical center and an academic medical center.

PARTICIPANTS

Veterans and civilian adults (n = 28) >3 months post-mTBI with current self-reported cognitive difficulties.

DESIGN

In this single-group, open-label pilot study, all participants received On-TRACC (5 sessions) via video-based telehealth.

MAIN MEASURES

Primary measures were feasibility (eg, session attendance and homework completion rate, dropout rate, and treatment fidelity) and acceptability (treatment satisfaction/helpfulness ratings). Preliminary effectiveness was explored by measuring pre- to post-intervention change in cognitive symptom level and attribution, perceived self-efficacy, use of compensatory strategies, daily functioning, quality of life, and planned future engagement in health care.

RESULTS

The On-TRACC completion rate for all enrolled participants was 79% (with 88% treatment completion rate for participants who started On-TRACC); homework was fully or partially completed for 98% of attended sessions. Treatment satisfaction ratings were high, with 95% satisfied with the information and skills learned. There were no adverse events. Positive pre- to posttreatment changes were seen in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned engagement in care for comorbid conditions.

CONCLUSION

On-TRACC was a feasible and acceptable intervention for individuals with chronic cognitive difficulties following mTBI. Additional research, including a randomized clinical trial, is needed to evaluate the efficacy of this intervention and its long-term impact on outcomes in this clinical population.

Characterization of cognitive functioning in complex PTSD compared to non-complex PTSD

Background

Previous research has indicated cognitive impairments in patients with post-traumatic stress disorder (PTSD), specifically in attention, memory, and executive functioning. However, there is limited knowledge about the cognitive profile of individuals with complex PTSD (cPTSD), a new diagnosis in ICD-11. Moreover, predictors of cognitive impairment remain unclear. The present study aims to enhance understanding of cognitive functioning and its predictors in cPTSD compared with non-complex PTSD (ncPTSD).

Methods

N = 64 participants (n = 34 cPTSD, n = 30 ncPTSD) completed psychometric questionnaires and the neuropsychological test set Cognitive Basic Assessment (COGBAT) assessing a general cognitive index, attention, visual memory, and executive functioning. First, the test results of both groups were compared to the COGBAT norm sample. Secondly, group differences in cognitive domains were analyzed using student t-tests with independent samples (cPTSD vs. ncPTSD). Thirdly, bivariate and multivariate regressions examined influencing factors of cognitive impairment.

Results

Both groups showed cognitive impairments in comparison to the COGBAT norm group. Significant differences between cPTSD and ncPTSD were found in visual memory (p = .003) and selective attention (p = .004). In multivariate regression, type of PTSD and age were found to significantly impact visual memory, while type of PTSD, age, and psychotropic medication showed significant effects on selective attention.

Conclusions

Given higher symptom severity and cognitive deficits in cPTSD, more intensive and diverse interventions should be considered in comprehensive treatment plans, for instance, cognitive training.

Natural polyphenols as therapeutic candidates for mitigating neuropsychiatric symptoms in post-traumatic stress disorder: Evidence from preclinical studies

Post-traumatic stress disorder (PTSD) is a challenging mental health condition that affects millions of people worldwide after they experience traumatic events. The current medications often do not fully address the wide range of PTSD symptoms or the underlying brain mechanisms, prompting the need to explore new treatments. Polyphenols, which are natural compounds found in many plant-based foods, have gained interest due to their brain-protective, anti-inflammatory, and antioxidant benefits. This review looks at how polyphenols might help treat PTSD by influencing important brain pathways related to the disorder. We explored how polyphenols affect the stress-response system, fear-related memories, brain chemicals, and inflammation. Specifically, we discuss how compounds like resveratrol, curcumin, green tea extract, and quercetin can balance stress hormones, help reduce fear memories, regulate brain chemicals, and decrease brain inflammation. Studies with animals have provided insights into how these compounds might work to ease PTSD symptoms. Based on the preclinical studies, the present review suggests that polyphenols could be a valuable addition or alternative to current PTSD treatments. However, more research is needed to confirm these findings and to determine the best ways to use polyphenols in treating PTSD.

Randomized controlled trial of computerized working memory training for Veterans with PTSD

Posttraumatic stress disorder (PTSD) is a common psychiatric condition among Veterans that is associated with deficits across a range of neuropsychological domains including working memory. While gold-standard psychosocial treatments are highly effective, there still remains a high rate of individuals who do not engage with or fully benefit from them. Cognitive training targeting specific working memory deficits in PTSD presents an alternative treatment approach that has shown promise for reducing re-experiencing symptoms. The current study evaluated a 16-session working memory training (WMT) program in Veterans with PTSD, focusing on two levels of interference control training. Feasibility, acceptability, and clinical efficacy were assessed. Results indicated that the intervention was generally feasible and acceptable to Veterans and revealed similar effects between groups in the intent to treat analyses; however, the high interference control training group yielded greater re-experiencing symptom reductions than the low interference control training group among individuals who were protocol adherent (Hedges' g = 0.57). There were significant reductions in overall PTSD severity across groups. Results are broadly consistent with theoretical models and prior clinical trials linking working memory task improvement to re-experiencing symptom reductions. These results point to the potential for working memory training to be a viable intervention for PTSD in Veterans, though further research is necessary for validation and exploration of broader clinical outcomes.

The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial

BACKGROUND

There is robust evidence that posttraumatic stress disorder (PTSD) is associated with neurocognitive deficits, such as executive dysfunction or memory dysfunction. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD, in which eye movements (EMs) are performed during traumatic memory retrieval. We examined whether Eye Movement Desensitization (EMD) improves neurocognitive functioning in PTSD patients, in comparison with a retrieval-only control condition without EMs.

METHODS

Adult patients with PTSD (N = 91) were randomized into EMD (N = 47) or retrieval-only (N = 44). Data were collected at baseline (T0), one-week post-treatment (T1), one-month follow-up (T2), and at three-month follow-up (T3). Outcome measures were the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), and the Digit Span Subtest of the Wechsler Adult Intelligence Scale fourth edition (WAIS-IV). We conducted linear mixed model to analyse the main outcomes.

RESULTS

There was a main effect of time, indicating improvements for both the EMD and retrieval-only groups in CVLT scores, TMT A, TMT B and Digit Span score of WAIS-IV (Bonferroni-adjusted p's < 0.001) from T0 to T3. There were no effects of group (p = .64) or group by time on CVLT total trial A (T3; p = .34), delay A (T3; p = .76), TMT A (T3; p = .61), TMT B (T3: p = .58), and Digit Span scores (T3; p = .78) of the WAIS-IV, indicating no significant differences between groups on any of the outcomes.

CONCLUSION

Comparing EMD and retrieval-only did not show evidence for additive effects of EMs on the treatment of PTSD in terms of improvements in neurocognitive functioning. Thus, treatments based on retrieval of traumatic memories may be used to improve neurocognitive functioning in patients with PTSD.

CLINICAL TRIAL REGISTRATION

The trial was registered 19/12/2017 at ClinicalTrials.gov, identifier [ISRCTN55239132].

Heart rate variability wrist-wearable biomarkers identify adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure

Adverse posttraumatic neuropsychiatric sequelae (APNS) are common after traumatic events. We examined whether wrist-wearable devices could provide heart rate variability (HRV) biomarkers for recovery after traumatic stress exposure in a large socioeconomically disadvantaged cohort. Participants were enrolled in the emergency department within 72 hours after a traumatic event as part of the AURORA (Advancing Understanding of RecOvery afteR traumA) multicenter prospective observational cohort study and followed over 6 months. HRV biomarkers were derived and validated for associations with specific APNS symptoms at a point in time and changes in symptom severity over time. Sixty-four HRV characteristics were derived and validated as cross-sectional biomarkers of APNS symptoms, including pain (26), re-experiencing (8), somatic (7), avoidance (7), concentration difficulty (6), hyperarousal (5), nightmares (1), anxiety (1), and sleep disturbance (3). Changes in 22 HRV characteristics were derived and validated as biomarkers identifying changes in APNS symptoms, including reexperiencing (11), somatic (3), avoidance (2), concentration difficulty (1), hyperarousal (1), and sleep disturbance (4). Changes in HRV variables over time predicted symptom improvement (PPV 0.68-0.87) and symptom worsening (NPV 0.71-0.90). HRV biomarkers collected from wrist-wearable devices may have utility as screening tools for APNS symptoms that occur after traumatic stress exposure in high-risk populations.

Conceptualizing impulsivity as a construct in relation to posttraumatic stress disorder symptom severity among women

Despite the established association between posttraumatic stress disorder (PTSD) and impulsivity, the literature is limited regarding impulsivity as a multifaceted construct. That is, the field's understanding of how PTSD symptoms may increase particular impulsive tendencies and behaviors is constrained by examining impulsivity solely as an umbrella term. The aim of the present study was to determine if there are differential associations between PTSD symptom severity and various components of impulsivity across multiple self-report measures. A sample of 215 undergraduate women (M age = 19.77 years, SD = 1.91, Range: 18-39 years) completed the PTSD Checklist for DSM-5 (PCL-5), Barratt Impulsiveness Scale (BIS-11), short version of the UPPS-P Impulsive Behavior Scale (SUPPS-P), and Delaying Gratification Inventory (DGI). Structural equation modeling was used to examine associations between PTSD symptoms and each measure's subscales. The findings included significant predictions from PTSD symptoms to the BIS-11 Attentional Impulsiveness subscale, β = .23, SE = .07, 95% CI [.09, .37]; DGI Physical Pleasures, β = -.24, SE = .07, 95% CI [-.38, -.11], and Achievement subscales, β = -.19, SE = .08, 95% CI [-.34, -.04]; and the SUPPS-P Positive Urgency, β = .22, SE = .08, 95% CI [.07, .37], and Negative Urgency subscales, β = .32, SE = .07, 95% CI [.19, .46]. These results have implications for precision medicine approaches that emphasize targeting these specific facets of impulsivity, with likely downstream effects on health risk behaviors for emerging adult women.

Resolving Heterogeneity in Posttraumatic Stress Disorder Using Individualized Structural Covariance Network Analysis

The heterogeneity of posttraumatic stress disorder (PTSD) is an obstacle to both understanding and therapy, and this has prompted a search for internally homogeneous neuroradiological subgroups within the broad clinical diagnosis. We set out to do this using the individual differential structural covariance network (IDSCN). We constructed cortical thickness-based IDSCN using T1-weighted images of 89 individuals with PTSD (mean age 42.8 years, 60 female) and 89 demographically matched trauma-exposed non-PTSD (TENP) controls (mean age 43.1 years, 63 female). The IDSCN metric quantifies how the structural covariance edges in a patient differ from those in the controls. We examined the structural diversity of PTSD and variation among subtypes using a hierarchical clustering analysis. PTSD patients exhibited notable diversity in distinct structural covariance edges but mainly affecting three networks: default mode, ventral attention, and sensorimotor. These changes predicted individual PTSD symptom severity. We identified two neuroanatomical subtypes: the one with higher PTSD symptom severity showed lower structural covariance edges in the frontal cortex and between frontal, parietal, and occipital cortex-regions that are functionally implicated in selective attention, response selection, and learning tasks. Thus, deviations in structural covariance in large-scale networks are common in PTSD but fall into two subtypes. This work sheds light on the neurobiological mechanisms underlying the clinical heterogeneity and may aid in personalized diagnosis and therapeutic interventions.

Mental Health and Cognition in Women Veterans Enrolled in the Health of Vietnam Era Veteran Women's Study (HealthViEWS)

Objective: This analysis explored relationships between mental health symptoms and conditions and cognitive function in a cohort of Vietnam-era women veterans from the Health of Vietnam Era Veteran Women's Study (HealthViEWS). Methods: Vietnam-era women veterans completed a mail survey assessing self-reported symptom severity of posttraumatic stress disorder (PTSD) and depression. A telephone-based structured interview assessed mental health conditions and cognitive function (telephone interview for cognitive status [TICS]). Participants were categorized using a TICS threshold of ≤29 to designate possible cognitive impairment versus nonimpaired. Separate logistic regression models were used to determine associations between possible cognitive impairment and each self-reported and interviewer-rated assessment of PTSD and depression while adjusting for age, education, race, marital status, and wartime service location. Results: The sample consisted of 4,077 women veterans who were ≥60 years old and completed the TICS. Of these women, 7.20% were categorized with possible cognitive impairment. Logistic regression models indicated that self-reported PTSD and depression symptom severity were each significantly associated with higher odds of possible cognitive impairment (adjusted odds ratios [aOR]: 1.03 [95% confidence interval [CI]: 1.02-1.04] and 1.07 [95% CI: 1.04-1.09], respectively). Women veterans with a probable diagnosis of depression had higher odds of possible cognitive impairment compared to those without depression (aOR: 1.61 [95% CI: 1.07-2.42]). No association was found for probable diagnosis of PTSD. Conclusions: Although further examination remains necessary, results suggest that Vietnam-era women veterans with self-reported PTSD and depression symptom severity or a probable diagnosis of depression may benefit from screening of cognitive function to inform clinical care.

Neurocognitive Intraindividual Variability in Veterans with Mild Traumatic Brain Injury History and Posttraumatic Stress Disorder

OBJECTIVE

Veterans with a history of blast-related mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) may be at risk for greater cognitive concerns and worse functional outcomes compared to those with either condition in isolation. However, traditional neuropsychological assessment approaches have yielded equivocal results in these populations. The present study examined an alternative method for detecting subtle cognitive inefficiencies: neurocognitive intraindividual variability (IIV), a measure of within-person performance consistency.

METHOD

Participants were 79 male Veterans with a history of blast-related mTBI and current PTSD (mTBI/PTSD group; n = 54) or neither diagnosis (controls; n = 25). Mean T-scores and IIV scores were calculated from neuropsychological measures of attention and speed of information processing (A/SoP) as well as executive functioning (EF).

RESULTS

Global IIV was significantly higher in the mTBI/PTSD group compared to controls (p = .047, Cohen's d = 0.49). At the domain level, larger effect sizes were observed for EF IIV (Cohen's d = 0.46) compared to A/SoP IIV (d = 0.32), although neither were statistically significant. Within the mTBI/PTSD group, higher Global IIV was associated with worse self-reported executive dysfunction, psychological quality of life, and cognitive post-concussive symptoms; at the domain level, these clinical outcomes were generally associated with greater A/SoP IIV (but not EF IIV).

CONCLUSION

Findings extend previous investigations of neurocognitive IIV in individuals with a history of mTBI across PTSD status. Among Veterans with a history of mTBI and comorbid PTSD, neurocognitive variability may be a better indicator of self-reported cognitive inefficiencies and Veteran experience of daily cognitive functioning than mean neuropsychological performances.

Disentangling subjective symptom complaints and objective cognitive performance in veterans: Impact of posttraumatic stress disorder and lifetime traumatic brain injury burden

Self-reported histories of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) symptoms are prevalent among post-9/11 veterans. Both are associated with subjective and often overlapping symptom complaints, but variably with objective neuropsychological test performances. These outcomes are seldom explored in relation to lifetime mTBI burden. This cross-sectional study examined associations of PTSD and lifetime mTBI with subjective (persistent symptoms after concussion and cognitive complaints) and objective (performances across five cognitive domains) measures among 46 veterans. Within this sample, 20 veterans had Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) confirmed PTSD (PTSD+), whereas 26 demographically-similar participants did not meet criteria (PTSD-). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) yielded total mTBI scores ranging from 0 to 8. Regressions showed PTSD was associated with increased subjective symptoms/cognitive complaints, along with reduced verbal fluency, visuospatial memory, and processing speed performances. Lifetime mTBI burden was associated with subjective symptoms, but not with objective cognitive test performance, after controlling for PTSD. No significant interactions were observed. Exploratory correlations suggested that all PTSD symptom clusters were generally associated with the subjective and objective measures. However, fewer significant associations emerged within the PTSD+/- groups separately, with each group yielding somewhat different patterns of relationships. PTSD and increasing mTBI burden are consistently associated with negative subjective symptoms, including cognitive complaints. Each condition likely explains some degree of unique variance in symptom reporting. PTSD is associated with poorer objective cognition on some tasks, including processing speed, executive functioning, and learning/memory. Implications are explored.

Objective and subjective experiences of childhood maltreatment and their relationships with cognitive deficits: a cohort study in the USA

BACKGROUND

Cognitive deficits might contribute to the elevated risk of life-course psychopathology observed in maltreated children. Leading theories about the links between childhood maltreatment and cognitive deficits focus on documented exposures (objective experience), but empirical research has largely relied on retrospective self-reports of these experiences (subjective experience), and the two measures identify largely non-overlapping groups. We aimed to test the associations of objective and subjective measures of maltreatment with cognitive abilities within the same individuals.

METHODS

We studied a cohort of individuals from the US Midwest with both objective, court-documented evidence of childhood maltreatment and subjective self-reports of individuals' histories at age 29 years. Between the ages of 29 years and 41 years, participants were assessed with a comprehensive set of cognitive tests, including tests of general verbal intelligence (Quick Test and Wide Range Achievement Test-Revised [WRAT]), non-verbal intelligence (Matrix Reasoning Test [MRT]), executive function (Stroop Test and Trail Making Test Part B [TMT-B]), and processing speed (Trail Making Test Part A [TMT-A]). Participants were also assessed for psychopathology (Center for Epidemiologic Studies Depression Scale and Beck Anxiety Inventory). We tested the associations between objective or subjective measures of childhood maltreatment with cognitive functions using ordinary least squares regression. To test whether cognitive deficits could explain previously described associations between different measures of maltreatment and subsequent psychopathology, we re-ran the analyses accounting for group differences in the Quick Test. People with lived experience were not involved in the research or writing process.

FINDINGS

The cohort included 1196 individuals (582 [48·7%] female, 614 [51·3%] male; 752 [62·9%] White, 417 [34·9%] Black, 36 [3·8%] Hispanic) who were assessed between 1989 and 2005. Of the 1179 participants with available data, 173 had objective-only measures of childhood maltreatment, 492 had objective and subjective measures, 252 had subjective-only measures, and 262 had no measures of childhood maltreatment. Participants with objective measures of childhood maltreatment showed pervasive cognitive deficits compared with those without objective measures (Quick Test: β=-7·97 [95% CI -9·63 to -6·30]; WRAT: β=-7·41 [-9·09 to -5·74]; MRT: β=-3·86 [-5·86 to -1·87]; Stroop Test: β=-1·69 [-3·57 to 0·20]; TMT-B: β=3·66 [1·67 to 5·66]; TMT-A: β=2·92 [0·86 to 4·98]). The associations with cognitive deficits were specific to objective measures of neglect. In contrast, participants with subjective measures of childhood maltreatment did not differ from those without subjective measures (Quick Test: β=1·73 [95% CI -0·05 to 3·50]; WRAT: β=1·62 [-0·17 to 3·40]; MRT: β=0·19 [-1·87 to 2·24]; Stroop Test: β=-1·41 [-3·35 to 0·52]; TMT-B: β=-0·57 [-2·69 to 1·55]; TMT-A: β=-0·36 [-2·38 to 1·67]). Furthermore, cognitive deficits did not explain associations between different measures of maltreatment and subsequent psychopathology.

INTERPRETATION

Previous studies based on retrospective reports of childhood maltreatment have probably grossly underestimated the extent of cognitive deficits in individuals with documented experiences of childhood maltreatment, particularly neglect. Psychopathology associated with maltreatment is unlikely to emerge because of cognitive deficits, but might instead be driven by individual appraisals, autobiographical memories, and associated schemas.

FUNDING

National Institute of Justice, National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Aging, Doris Duke Charitable Foundation, and National Institute for Health and Care Research.

Executive functioning in posttraumatic stress disorder: Understanding how inhibition, switching, and test modality affect reaction times

OBJECTIVE

Posttraumatic stress disorder (PTSD) has been linked to deficits in executive functioning, but the literature suggests these associations are inconsistent. Results vary depending on the task used, test modality, and the specific subdomain being measured, such as inhibitory control (interference resolution, response inhibition) or set shifting (task switching, rule switching). Notably, deficits are more consistently observed in computerized tasks that measure precise reaction times (RTs) than in classic paper-and-pencil measures, but few studies have parsed specific executive functioning deficits in PTSD using detailed analyses of RT data.

METHOD

The present study used a cued-switching Stroop Task to examine both interference resolution and task switching in 28 veterans with PTSD and 28 age-matched controls. Each trial required attending to a randomly presented cue and responding to the specified target while ignoring irrelevant or opposing information. Analyses of RT distributions estimated both Gaussian (normal) and ex-Gaussian (exponential) parameters.

RESULTS

Veterans with PTSD had slower and more variable RTs than the controls on trials that required ignoring conflicting information (interference resolution, d' = .68). These effects were confined to the normal distribution, not to excessively slow responses (as estimated by ex-Gaussian parameters). Veterans with PTSD also showed modestly slower RTs on trials that required switching between cues, but Bayesian evidence for this was weak, and measures by ex-Gaussian parameters were not significant.

CONCLUSIONS

These results highlight the importance of examining executive functioning in PTSD with a more nuanced approach, as clarity around these deficits may have important implications for future intervention and rehabilitation strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Domain-specific associations between psychopathology and neurocognitive functioning

BACKGROUND

Neurocognitive dysfunction is a transdiagnostic finding in psychopathology, but relationships among cognitive domains and general and specific psychopathology dimensions remain unclear. This study aimed to examine associations between cognition and psychopathology dimensions in a large youth cohort.

METHOD

The sample (N = 9350; age 8-21 years) was drawn from the Philadelphia Neurodevelopmental Cohort. Data from structured clinical interviews were modeled using bifactor confirmatory factor analysis (CFA), resulting in an overall psychopathology ('p') factor score and six orthogonal psychopathology dimensions: dysphoria/distress, obsessive-compulsive, behavioral/externalizing, attention-deficit/hyperactivity, phobias, and psychosis. Neurocognitive data were aggregated using correlated-traits CFA into five factors: executive functioning, memory, complex cognition, social cognition, and sensorimotor speed. We examined relationships among specific and general psychopathology dimensions and neurocognitive factors.

RESULTS

The final model showed both overall and specific associations between cognitive functioning and psychopathology, with acceptable fit (CFI = 0.91; TLI = 0.90; RMSEA = 0.024; SRMR = 0.054). Overall psychopathology and most psychopathology dimensions were negatively associated with neurocognitive functioning (phobias [p < 0.0005], behavioral/externalizing [p < 0.0005], attention-deficit/hyperactivity [p < 0.0005], psychosis [p < 0.0005 to p < 0.05]), except for dysphoria/distress and obsessive-compulsive symptoms, which were positively associated with complex cognition (p < 0.05 and p < 0.01, respectively).

CONCLUSION

By modeling a broad range of cognitive and psychopathology domains in a large, diverse sample of youth, we found aspects of neurocognitive functioning shared across clinical phenotypes, as well as domain-specific patterns. Findings support transdiagnostic examination of cognitive performance to parse variability in the link between neurocognitive functioning and clinical phenotypes.

Daily life participation in PTSD: pilot study on patterns and correlators

Introduction

Participation in daily life activities with both the personal and community meaning is an important component of health and well-being. Even though there are mounting reports on the challenges in various aspects of daily-life functioning among individuals with post-traumatic stress disorder (PTSD), to date little research has been conducted on their comprehensive patterns of participation. The study aimed to describe objective and subjective participation dimensions in PTSD compared to healthy controls and investigate the association between personal and environmental factors and participation.

Methods

Sixty-one individuals were enrolled in two groups: PTSD (N=31; age: M=34.3; women:77.4%) and healthy controls matched by age and gender. The PTSD group completed standard assessments for symptom severity, general cognition, executive function (EF), sensory processing, self-efficacy, functional capacity, and environmental properties. Both groups completed a participation questionnaire.

Results

Individuals with PTSD participated with low intensity and diversity, more occupations were abandoned (-4.73

Discussion

The study demonstrates profound restrictions in participation in PTSD raising serious concerns. There are unique patterns of association between objective participation dimensions, subjective cognitive indices, sensory modulation, and environmental factors, suggesting a need for PTSD feature-specific intervention approaches to advance the participation of those with PTSD as a means of promoting health and well-being.

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Key Words

• environmental impacts
• functional capacity
• neurocognition
• objective participation
• subjective participation

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Affiliation(s)

Ruth Shapira Day care ward, School of Occupational Therapy, Faculty of Medicine, the Hebrew University, Jerusalem, Israel The Jerusalem Mental Health Center, Jerusalem, Israel
Yisca Jessica Baris Ginat The Jerusalem Mental Health Center, Jerusalem, Israel
Lena Lipskaya-Velikovsky Day care ward, School of Occupational Therapy, Faculty of Medicine, the Hebrew University, Jerusalem, Israel

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Prefrontal metabolite alterations in individuals with posttraumatic stress disorder: a 7T magnetic resonance spectroscopy study

Background

Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms.

Methods

Individuals with PTSD (n=27), trauma-exposed individuals without PTSD (n=27), and individuals without trauma exposure (n=26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed.

Results

We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity.

Conclusion

In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

Altered long-range functional connectivity in PTSD: Role of the infraslow oscillations of cortical activity amplitude envelopes

OBJECTIVE

Coupling between the amplitude envelopes (AEs) of regional cortical activity reflects mechanisms that coordinate the excitability of large-scale cortical networks. We used resting-state MEG recordings to investigate the association between alterations in the coupling of cortical AEs and symptoms of post-traumatic stress disorder (PTSD).

METHODS

Participants (n = 96) were service members with combat exposure and various levels of post-traumatic stress severity (PTSS). We assessed the correlation between PTSS and (1) coupling of broadband cortical AEs of beta band activity, (2) coupling of the low- (<0.5 Hz) and high-frequency (>0.5 Hz) components of the AEs, and (3) their time-varying patterns.

RESULTS

PTSS was associated with widespread hypoconnectivity assessed from the broadband AE fluctuations, which correlated with subscores for the negative thoughts and feelings/emotional numbing (NTF/EN) and hyperarousal clusters of symptoms. Higher NTF/EN scores were also associated with smaller increases in resting-state functional connectivity (rsFC) with time during the recordings. The distinct patterns of rsFC in PTSD were primarily due to differences in the coupling of low-frequency (infraslow) fluctuations of the AEs of beta band activity.

CONCLUSIONS

Our findings implicate the mechanisms underlying the regulation/coupling of infraslow oscillations in the alterations of rsFC assessed from broadband AEs and in PTSD symptomatology.

SIGNIFICANCE

Altered coordination of infraslow amplitude fluctuations across large-scale cortical networks can contribute to network dysfunction and may provide a target for treatment in PTSD.

A retrospective chart review to assess the impact of alpha-guided transcranial magnetic stimulation on symptoms of PTSD and depression in active-duty special operations service members

Introduction

Special Operations Forces service members (SOF) are regularly exposed to traumatic and concussive events, increasing the prevalence of symptoms of post-traumatic stress disorder (PTSD) and depression, shortening potential years of service.

Methods

This retrospective chart review presents preliminary data on a Human Performance Optimization (HPO) program that provided an average of 30 sessions of individualized alpha frequency repetitive transcranial magnetic stimulation (α-rTMS) to active-duty SOF as to reduce symptoms of PTSD and depression following traumatic brain injury. Scores from the PTSD Checklist for DSM-5, PROMIS Depression short form and Perceived Deficits Questionnaire (PDQ) were reviewed.

Results

Significant reductions were noted after the HPO program in all clinical scales with an average 37% decrease in PCL-5 (p<.01), 11.3% reduction in PROMIS depression T-scores (p<.01), and 45.5% reduction in PDQ scales by session 30 (p<.01), with side effects matching those commonly reported in rTMS. Importantly, the average PCL-5 score decreased from 42.9 to 27 by end of the treatment program, which is below the clinical threshold of 33 for presence of PTSD. For those with depression symptoms scores greater than cut off clinical thresholds at baseline, 46% resolved following treatment.

Conclusion

This data provides preliminary support for safe application of α-rTMS for symptom reduction in active-duty special operations military personnel.

Temporal-Posterior Alpha Power in Resting-State Electroencephalography as a Potential Marker of Complex Childhood Trauma in Institutionalized Adolescents

The present study explored whether, given the association of temporal alpha with fear circuitry (learning and conditioning), exposure to complex childhood trauma (CCT) is reflected in the temporal-posterior alpha power in resting-state electroencephalography (EEG) in complex trauma-exposed adolescents in a sample of 25 adolescents and similar controls aged 12-17 years. Both trauma and psychopathology were screened or assessed, and resting-state EEG was recorded following a preregistered protocol for data collection. Temporal-posterior alpha power, corresponding to the T5 and T6 electrode locations (international 10-20 system), was extracted from resting-state EEG in both eyes-open and eyes-closed conditions. We found that in the eyes-open condition, temporal-posterior alpha was significantly lower in adolescents exposed to CCT relative to healthy controls, suggesting that childhood trauma exposure may have a measurable impact on alpha oscillatory patterns. Our study highlights the importance of considering potential neural markers, such as temporal-posterior alpha power, to understanding the long-term consequences of CCT exposure in developmental samples, with possible important clinical implications in guiding neuroregulation interventions.

Comparing neuropsychological, typical, and ADNI criteria for the diagnosis of mild cognitive impairment in Vietnam-era veterans

OBJECTIVE

Neuropsychological criteria for mild cognitive impairment (MCI) more accurately predict progression to Alzheimer's disease (AD) and are more strongly associated with AD biomarkers and neuroimaging profiles than ADNI criteria. However, research to date has been conducted in relatively healthy samples with few comorbidities. Given that history of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for AD and common in Veterans, we compared neuropsychological, typical (Petersen/Winblad), and ADNI criteria for MCI in Vietnam-era Veterans with histories of TBI or PTSD.

METHOD

267 Veterans (mean age = 69.8) from the DOD-ADNI study were evaluated for MCI using neuropsychological, typical, and ADNI criteria. Linear regressions adjusting for age and education assessed associations between MCI status and AD biomarker levels (cerebrospinal fluid [CSF] p-tau181, t-tau, and Aβ42) by diagnostic criteria. Logistic regressions adjusting for age and education assessed the effects of TBI severity and PTSD symptom severity simultaneously on MCI classification by each criteria.

RESULTS

Agreement between criteria was poor. Neuropsychological criteria identified more Veterans with MCI than typical or ADNI criteria, and were associated with higher CSF p-tau181 and t-tau. Typical and ADNI criteria were not associated with CSF biomarkers. PTSD symptom severity predicted MCI diagnosis by neuropsychological and ADNI criteria. History of moderate/severe TBI predicted MCI by typical and ADNI criteria.

CONCLUSIONS

MCI diagnosis using sensitive neuropsychological criteria is more strongly associated with AD biomarkers than conventional diagnostic methods. MCI diagnostics in Veterans would benefit from incorporation of comprehensive neuropsychological methods and consideration of the impact of PTSD.

Understanding the association between fatigue and neurocognitive functioning in patients with glioma: A cross-sectional multinational study

Background

Fatigue and neurocognitive impairment are highly prevalent in patients with glioma, significantly impacting health-related quality of life. Despite the presumed association between these two factors, evidence remains sparse. Therefore, we aimed to investigate this relationship using multinational data.

Methods

We analyzed data on self-reported fatigue and neurocognitive outcomes from postoperative patients with glioma from the University of California San Francisco (n = 100, UCSF) and Amsterdam University Medical Center (n = 127, Amsterdam UMC). We used multiple linear regression models to assess associations between fatigue and seven (sub)domains of neurocognitive functioning and latent profile analysis to identify distinct patterns of fatigue and neurocognitive functioning.

Results

UCSF patients were older (median age 49 vs. 43 years, P = .002), had a higher proportion of grade 4 tumors (32% vs. 18%, P = .03), and had more neurocognitive deficits (P = .01). While the number of clinically fatigued patients was similar between sites (64% vs. 58%, P = .12), fatigue and the number of impaired neurocognitive domains were not correlated (P = .16-.72). At UCSF, neurocognitive domains were not related to fatigue, and at Amsterdam UMC attention and semantic fluency explained only 4-7% of variance in fatigue. Across institutions, we identified four distinct patterns of neurocognitive functioning, which were not consistently associated with fatigue.

Conclusions

Although individual patients might experience both fatigue and neurocognitive impairment, the relationship between the two is weak. Consequently, both fatigue and neurocognitive functioning should be independently assessed and treated with targeted therapies.

A First Exploration: Can Eye Movement Desensitization and Reprocessing Improve Cognition in Older Adults With Posttraumatic Stress Disorder?

OBJECTIVES

In older adults, PTSD is associated with decreased verbal learning and executive dysfunction. Therefore, feasibility of EMDR-treatment to improve cognitive performance in older adults with PTSD was examined. Additionally, we investigated pre-treatment correlation with often co-occurring risk factors for cognitive decline (sleep problems, depressive disorder, physical inactivity, childhood traumatic events).

DESIGN

Multicenter design with pre-post measurements.

SETTING

Psychiatric Dutch hospitals Mondriaan Mental Health Center and Altrecht.

PARTICIPANTS

22 treatment-seeking PTSD-outpatients (60-84 years).

INTERVENTION

Weekly one-hour EMDR session during 3, 6, or 9 months.

MEASUREMENTS

PTSD was assessed with Clinician-Administered PTSD-scale for DSM-5 (CAPS-5). Verbal learning memory was measured with Auditory Verbal Learning Test (RAVLT), interference with Stroop Colour-Word Test (SCWT) and working memory with Wechsler Adult Intelligence Scale-Digit Span (WAIS-IV-DS).

RESULTS

A Linear mixed-model showed significant improvement on RAVLT immediate-recall (F (1, 21) = 15.928, P = .001, 95% CI -6.98-2.20), delayed-recall (F (1, 21) = 7.095, P = .015, 95% CI -2.43-.30), recognition (F (21) = 8.885, P = .007, 95% CI -1.70- -.30), and SCWT (F (1 ,21) = 5.504, P = .029, 95% CI 4.38-72.78) but not on WAIS-IV-DS (F (20) = -1.237, P = .230, 95% CI -3.07-.78). There was no significant influence of therapy duration and CAPS-5 pre-treatment scores. There were small-medium nonsignificant correlations between CAPS-5 and cognitive performance pre-post differences, and between most cognitive measures and sleep problems, depressive disorder, and physical inactivity.

CONCLUSIONS

Cognitive functioning on memory and attention possible increased in older adults with PTSD after EMDR treatment. Further research is needed with a larger sample and a control condition to corroborate these findings and to identify the possible mediating role of modifiable risk factors.

Complex PTSD symptom clusters and executive function in UK Armed Forces veterans: a cross-sectional study

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.

Biomarkers associated with cognitive impairment in post-traumatic stress disorder: A systematic review of current evidence

OBJECTIVE

This systematic review aimed at synthesizing current evidence on biomarkers associated with cognitive impairment (CI) in Post-Traumatic Stress Disorder (PTSD).

METHODS

A systematic literature search was conducted for studies assessing biomarkers associated with CI in PTSD.

RESULTS

Of the 10,149 titles screened, 8 studies met our inclusion criteria. In a single longitudinal study, MRI volumes, Aβ and tau accumulation were not associated with CI in PTSD. Studies on structural imaging reported no significant association between morphological changes and CI. Two studies on diffusion neuroimaging showed abnormalities in white matter tracts which were cross-sectionally associated with CI in PTSD. Similarly, lower resting-state functional connectivity in neocortical networks, and elevated tau in the neocortex were also cross sectionally associated with CI. Two single studies on biochemical biomarkers showed that sixteen novel plasma proteins and lower BDNF, indicative of genetic vulnerabilities associated with neural and synaptic dysfunctions commonly observed in neurodegeneration, were cross-sectionally associated with CI in PTSD. Overall, evidence is of low quality.

CONCLUSIONS

Longitudinal research utilizing large representative samples of trauma exposed populations are needed to establish the utility of specific biomarkers in monitoring cognitive decline in PTSD.

Specific emotion regulation difficulties and executive function explain the link between worry and subsequent stress: A prospective moderated mediation study

BACKGROUND

Worry is a transdiagnostic risk factor for stress-related mental health complaints such as anxiety, depression, and insomnia. Although worry may function as a form of avoidance of unwanted emotions and accordingly interfere with adaptive emotion regulation, the specific domains of emotion regulation that are perturbed by excessive worry to confer risk for stress-related symptoms are unclear. Further, it is unknown if cognitive control mechanisms that underlie successful emotion regulation influence the effect of worry on stress. The present study addressed these gaps in the literature by examining specific emotion regulation difficulties as mediators of the relationship between worry and subsequent stress, as well as executive function as a moderator of the mediated effects.

METHOD

656 community adults were assessed for trait worry, emotion dysregulation, stress, and executive dysfunction once per month for three months (time 1 - time 3).

RESULTS

The effect of worry (time 1) on subsequent stress (time 3) was partially mediated by difficulties with emotional clarity and difficulty engaging in goal-directed behavior when upset (time 2) after controlling for age, gender, and baseline stress. Moderated mediation models revealed that the indirect effect of worry on stress via difficulty with goal-directed behavior was significantly moderated by executive dysfunction, such that fewer executive function difficulties acted as a buffer against the harmful effects of worry.

LIMITATIONS

Limitations include reliance on self-report measures, lack of experimental manipulation, and a nonclinical sample.

CONCLUSIONS

Findings point to specific domains of emotion regulation as treatment targets for individuals with high worry proneness.

Frontal cortical volume deficits as enduring evidence of childhood abuse in community adults with AUD and HIV infection comorbidity

Background

Childhood abuse is an underappreciated source of stress, associated with adverse mental and physical health consequences. Childhood abuse has been directly associated with risky behavior thereby increasing the likelihood of alcohol misuse and risk of HIV infection, conditions associated with brain structural and functional deficits. Here, we examined the neural and behavioral correlates of childhood trauma history in alcohol use disorder (AUD), HIV infection (HIV), and their comorbidity (AUD+HIV).

Methods

Occurrence of childhood trauma was evaluated by retrospective interview. Cortical (frontal, temporal, parietal, and occipital), subcortical (hippocampus, amygdala), and regional frontal volumes were derived from structural MRI, adjusted for intracranial volume and age. Test scores of executive functioning, attention/working memory, verbal/visual learning, verbal/visual memory, and motor speed functional domains were standardized on age and education of a laboratory control group.

Results

History of childhood abuse was associated with smaller frontal lobe volumes regardless of diagnosis. For frontal subregional volumes, history of childhood abuse was selectively associated with smaller orbitofrontal and supplementary motor volumes. In participants with a child abuse history, poorer verbal/visual memory performance was associated with smaller orbitofrontal and frontal middle volumes, whereas in those without childhood abuse, poorer verbal/visual memory performance was associated with smaller orbitofrontal, frontal superior, and supplemental motor volumes.

Conclusions

Taken together, these results comport with and extend the findings that childhood abuse is associated with brain and behavioral sequelae in AUD, HIV, and AUD+HIV comorbidity. Further, these findings suggest that sequelae of abuse in childhood may be best conceptualized as a spectrum disorder as significant deficits may be present in those who may not meet criteria for a formal trauma-related diagnosis yet may be suffering enduring stress effects on brain structural and functional health.

Ketamine alleviates fear memory and spatial cognition deficits in a PTSD rat model via the BDNF signaling pathway of the hippocampus and amygdala

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with traumatic stress experiences. This condition can be accompanied by learning and cognitive deficits. Studies have demonstrated that ketamine can rapidly and significantly alleviate symptoms in patients with chronic PTSD. Nonetheless, the effects of ketamine on neurocognitive impairment and its mechanism of action in PTSD remain unclear.

METHODS

In this study, different concentrations of ketamine (5, 10, 15, and 20 mg/kg, i.p.) were evaluated in rat models of single prolonged stress and electrophonic shock (SPS&S). Expression levels of brain-derived neurotrophic factor (BDNF) and post-synaptic density-95 (PSD-95) in the hippocampus (HIP) and amygdala (AMG) were determined by Western blot analysis and immunohistochemistry.

RESULTS

The data showed that rats subjected to SPS&S exhibited significant PTSD-like cognitive impairment. The effect of ketamine on SPS&S-induced neurocognitive function showed a U-shaped dose effect in rats. A single administration of ketamine at a dosage of 10-15 mg/kg resulted in significant changes in behavioral outcomes. These manifestations of improvement in cognitive function and molecular changes were reversed at high doses (15-20 mg/kg).

CONCLUSION

Overall, ketamine reversed SPS&S-induced fear and spatial memory impairment and the down-regulation of BDNF and BDNF-related PSD-95 signaling in the HIP and AMG. A dose equal to 15 mg/kg rapidly reversed the behavioral and molecular changes and promoted the amelioration of cognitive dysfunction. The enhanced association of BDNF signaling with PSD-95 effects could be involved in the therapeutic efficiency of ketamine for PTSD.

Vulnerability of the Hippocampus to Insults: Links to Blood-Brain Barrier Dysfunction

The hippocampus is a critical brain substrate for learning and memory; events that harm the hippocampus can seriously impair mental and behavioral functioning. Hippocampal pathophysiologies have been identified as potential causes and effects of a remarkably diverse array of medical diseases, psychological disorders, and environmental sources of damage. It may be that the hippocampus is more vulnerable than other brain areas to insults that are related to these conditions. One purpose of this review is to assess the vulnerability of the hippocampus to the most prevalent types of insults in multiple biomedical domains (i.e., neuroactive pathogens, neurotoxins, neurological conditions, trauma, aging, neurodegenerative disease, acquired brain injury, mental health conditions, endocrine disorders, developmental disabilities, nutrition) and to evaluate whether these insults affect the hippocampus first and more prominently compared to other brain loci. A second purpose is to consider the role of hippocampal blood-brain barrier (BBB) breakdown in either causing or worsening the harmful effects of each insult. Recent research suggests that the hippocampal BBB is more fragile compared to other brain areas and may also be more prone to the disruption of the transport mechanisms that act to maintain the internal milieu. Moreover, a compromised BBB could be a factor that is common to many different types of insults. Our analysis indicates that the hippocampus is more vulnerable to insults compared to other parts of the brain, and that developing interventions that protect the hippocampal BBB may help to prevent or ameliorate the harmful effects of many insults on memory and cognition.

Reciprocal associations of posttraumatic stress symptoms and cognitive decline in community-dwelling older adults: The mediating role of depression

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.

Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder

Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to play a role in GWI symptoms. The present study examined the association between self-reported military exposures and GWI, stratified by PTSD status, in veterans from the Gulf War Era Cohort and Biorepository who were deployed to the Persian Gulf during the war. Participants self-reported current GWI and PTSD symptoms as well as military exposures (e.g., pyridostigmine [PB] pills, pesticides/insecticides, combat, chemical attacks, and oil well fires) experienced during the Gulf War. Deployed veterans' (N = 921) GWI status was ascertained using the Centers for Disease Control and Prevention definition. Individuals who met the GWI criteria were stratified by PTSD status, yielding three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression, adjusted for covariates, was used to examine associations between GWI/PTSD groups and military exposures. Apart from insect bait use, the GWI+/PTSD+ group had higher odds of reporting military exposures than the GWI+/PTSD- group, adjusted odds ratio (aOR) = 2.15, 95% CI [1.30, 3.56]-aOR = 6.91, 95% CI [3.39, 14.08]. Except for PB pills, the GWI+/PTSD- group had a higher likelihood of reporting military exposures than the GWI- group, aOR = 2.03, 95% CI [1.26, 3.26]-aOR = 4.01, 95% CI [1.57, 10.25]. These findings are consistent with roles for both PTSD and military exposures in the etiology of GWI.

An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters

OBJECTIVE

Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans.

METHOD

Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model.

RESULTS

After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters.

CONCLUSIONS

Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.

Experiential Avoidance, Post-Traumatic Stress Symptoms, and Academic Impairment

The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants (N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.

Post-traumatic stress disorder symptom remission and cognition in a large cohort of civilian women

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit.

METHODS

Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively.

RESULTS

Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression.

CONCLUSION

Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.

Unraveling the relations between post-traumatic stress symptoms, neurocognitive functioning, and limbic white matter in pediatric brain tumor patients

Background

Pediatric brain tumor patients are at risk of developing neurocognitive impairments and associated white matter alterations. In other populations, post-traumatic stress symptoms (PTSS) impact cognition and white matter. This study aims to investigate the effect of PTSS on neurocognitive functioning and limbic white matter in pediatric brain tumor patients.

Methods

Sixty-six patients (6-16 years) completed neuropsychological assessment and brain MRI (1-year post-diagnosis) and parents completed PTSS proxy questionnaires (CRIES-13; 1-3 months and 1-year post-diagnosis). Mean Z-scores and percentage impaired (>1SD) for attention, processing speed, executive functioning, and memory were compared to normscores (t-tests, chi-square tests). Multi-shell diffusion MRI data were analyzed for white matter tractography (fractional anisotropy/axial diffusivity). Effects of PTSS on neurocognition and white matter were explored with linear regression models (FDR correction for multiple testing), including age at diagnosis, treatment intensity, and tumor location as covariates. Neurocognition and limbic white matter associations were explored with correlations.

Results

Attention (M = -0.49, 33% impaired; P < .05) and processing speed (M = -0.57, 34% impaired; P < .05) were significantly lower than healthy peers. PTSS was associated with poorer processing speed (β = -0.64, P < .01). Treatment intensity, age at diagnosis, and tumor location, but not PTSS, were associated with limbic white matter metrics. Neurocognition and white matter metrics were not associated.

Conclusions

Higher PTSS was associated with poorer processing speed, highlighting the need for monitoring, and timely referrals to optimize psychological well-being and neurocognitive functioning. Future research should focus on longitudinal follow-up and explore the impact of PTSS interventions on neurocognitive performance.

Prefrontal Metabolite Alterations in Individuals with Posttraumatic Stress Disorder: A 7T Magnetic Resonance Spectroscopy Study

Background

Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms.

Methods

Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed.

Results

We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity.

Conclusion

In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

[Cognitive impairment in post-traumatic stress disorder]

Post-traumatic stress disorder (PTSD) is a common mental health disorder, with an incidence of up to 12.5% among primary care patients. Most often, PTSD is detected in combat veterans, victims of terrorist attacks and terror, but it can also be a consequence of traumatic brain injury and medical interventions. Impaired cognitive functioning is a key feature of PTSD, including attention deficits and reduced processing speed, executive dysfunction, and impairments in verbal learning and memory. Cognitive impairments in PTSD are significantly persistent and are largely similar in nature to neuropsychological impairments in neurodegenerative pathology. Possible pathogenetic mechanisms underlying PTSD are the development of neuroinflammation, oxidative stress and decreased production of neurotrophic factors. One of the promising areas of treatment is the use of Cerebrolysin, which has powerful neurotrophic and anti-inflammatory activity.

Impaired learning, memory, and extinction in posttraumatic stress disorder: translational meta-analysis of clinical and preclinical studies

Current evidence-based treatments for post-traumatic stress disorder (PTSD) are efficacious in only part of PTSD patients. Therefore, novel neurobiologically informed approaches are urgently needed. Clinical and translational neuroscience point to altered learning and memory processes as key in (models of) PTSD psychopathology. We extended this notion by clarifying at a meta-level (i) the role of information valence, i.e. neutral versus emotional/fearful, and (ii) comparability, as far as applicable, between clinical and preclinical phenotypes. We hypothesized that cross-species, neutral versus emotional/fearful information processing is, respectively, impaired and enhanced in PTSD. This preregistered meta-analysis involved a literature search on PTSD+Learning/Memory+Behavior, performed in PubMed. First, the effect of information valence was estimated with a random-effects meta-regression. The sources of variation were explored with a random forest-based analysis. The analyses included 92 clinical (N = 6732 humans) and 182 preclinical (N = 6834 animals) studies. A general impairment of learning, memory and extinction processes was observed in PTSD patients, regardless of information valence. Impaired neutral learning/memory and fear extinction were also present in animal models of PTSD. Yet, PTSD models enhanced fear/trauma memory in preclinical studies and PTSD impaired emotional memory in patients. Clinical data on fear/trauma memory was limited. Mnemonic phase and valence explained most variation in rodents but not humans. Impaired neutral learning/memory and fear extinction show stable cross-species PTSD phenotypes. These could be targeted for novel PTSD treatments, using information gained from neurobiological animal studies. We argue that apparent cross-species discrepancies in emotional/fearful memory deserve further in-depth study; until then, animal models targeting this phenotype should be applied with utmost care.

Neuropsychological Consequences of Massive Trauma: Implications and Clinical Interventions

Traumatic events, especially massive trauma resulting from catastrophic incidents, wars, or severe abuse can elicit significant neuropsychological alterations, with profound implications for cognitive, emotional, and behavioral functioning. This mini-review delineates the primary neural changes post-trauma and underscores the importance of timely neuropsychological and clinical interventions. Specific brain regions, including the amygdala and prefrontal cortex, undergo physiological changes that can lead to memory impairments, attention deficits, and emotional disturbances. PTSD, a commonly diagnosed condition post-trauma, exemplifies the intricate relationship between trauma and memory processing. Furthermore, the concept of neuroplasticity, the brain's inherent ability to adapt and rewire, offers hope for recovery. Current clinical interventions, such as cognitive behavioral therapy, mindfulness practices, and biofeedback, leverage this neuroplastic potential to foster healing. The review underscores the vital importance of early intervention to mitigate long-term neuropsychological impacts, emphasizing the role of timely and targeted clinical interventions. The synthesis of this knowledge is crucial for clinicians, allowing for informed therapeutic approaches that holistically address both the physiological and psychological dimensions of trauma.