Association of Posttraumatic Stress Disorder With Accelerated Cognitive Decline in Middle-aged Women

Roberts, Andrea L.; Liu, Jiaxuan; Lawn, Rebecca B; Jha, Shaili C.; Sumner, Jennifer A.; Kang, Jae H.; Rimm, Eric B.; Grodstein, Francine; Kubzansky, Laura D.; Chibnik, Lori B.; Koenen, Karestan C.

doi:10.1001/jamanetworkopen.2022.17698

Cited by 17 publications

(12 citation statements)

References 79 publications

(153 reference statements)

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“…Some studies have indicated associations of PTSD symptoms with WMH and cognition, yet these studies relied on data from males, veterans, and/or individuals undergoing PTSD treatment. The NHS II of midlife women found that women with histories of trauma exposure and more PTSD symptoms had greater declines in cognitive performance over approximately 1 year compared with women without PTSD symptoms . However, in the NHS II study, cognitive performance was assessed via a brief online battery assessing 2 domains: learning and working memory and psychomotor speed and attention.…”

Section: Discussionmentioning

confidence: 75%

“…The NHS II of midlife women found that women with histories of trauma exposure and more PTSD symptoms had greater declines in cognitive performance over approximately 1 year compared with women without PTSD symptoms. 10 However, in the NHS II study, cognitive performance was assessed via a brief online battery assessing 2…”

Section: Discussionmentioning

confidence: 99%

“…An exception is the Nurses' Health Study II (NHS II) of midlife women, which found associations between increased PTSD symptoms and worse cognitive function assessed via a self-administered online cognitive battery. [9][10][11] However, NHS II lacked vascular and brain health measures. Midlife is a critical time for women's cardiovascular and brain health, as it occurs directly before the onset of clinical CVD 12 and is when initial hallmarks of AD and related disorders (eg, amyloid β, hyperphosphorylated tau) begin.…”

Section: Introductionmentioning

confidence: 99%

“…First, the existing literature relies on male samples, with few studies in women and even fewer among midlife women. An exception is the Nurses’ Health Study II (NHS II) of midlife women, which found associations between increased PTSD symptoms and worse cognitive function assessed via a self-administered online cognitive battery . However, NHS II lacked vascular and brain health measures.…”

Section: Introductionmentioning

confidence: 99%

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Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women

Thurston,

Jakubowski,

Chang

et al. 2023

JAMA Netw Open

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ImportancePosttraumatic stress disorder (PTSD), cardiovascular disease (CVD), and Alzheimer disease are major public health issues, particularly for women. The implications of PTSD for cardiovascular and brain health for women is poorly understood.ObjectiveTo assess whether PTSD symptoms among midlife women are associated with carotid intima media thickness (IMT), an indicator of carotid atherosclerosis; brain white matter hyperintensity volume (WMHV), an indicator of brain small vessel disease; and cognitive performance and to test a modifying role of the APOEε4 genotype.Design, Setting, and ParticipantsIn this cross-sectional study, participants were enrolled between 2016 to 2021 and completed questionnaires (PTSD Checklist–Civilian Version), physical measures, phlebotomy, neuropsychological testing, a carotid ultrasonographic examination, and 3-Tesla brain magnetic resonance imaging. Participants included community-based women ages 45 to 67 years without a history of CVD, stroke, or dementia. Data were analyzed from July 2022 to September 2023.ExposuresPTSD symptoms.Main Outcomes and MeasuresOutcomes of interest were associations of PTSD symptoms with carotid IMT, brain WMHV, and cognition, assessed in linear regression models. Interactions by APOEε4 were tested. Covariates included age, race and ethnicity, education, and CVD risk factors.ResultsAmong 274 participants (mean [SD] age, 59.03 [4.34] years; 6 Asian participants [2.2%]; 48 Black participants [17.5%]; 215 White participants [78.5%]; 5 multiracial participants [1.8%]), 64 participants (24.71%) were APOEε4 genotype carriers. Higher PTSD symptoms were associated with greater carotid IMT (multivariable β = 0.07 [95% CI, 0.01 to 0.13]; P = .03). Associations of PTSD symptoms with neurocognitive outcomes significantly varied by APOEε4 status. Among women with APOEε4, PTSD symptoms were associated with greater whole-brain WMHV (β = 0.96 [95% CI, 0.30 to 1.63]; P = .009), periventricular WMHV (β = 0.90 [95% CI, 0.24 to 1.56]; P = .02), deep WMHV (β = 1.21 [95% CI, 0.23 to 2.20]; P = .01), and frontal WMHV (β = 1.25 [95% CI, 0.05 to 2.45]; P = .04), as well as with poorer cognition, specifically attention and working memory (β = −3.37 [95% CI, −6.12 to −0.62]; P = .02), semantic fluency (β = −6.01 [95% CI, −10.70 to −1.31]; P = .01), perceptual speed (β = −12.73 [95% CI, −20.71 to −4.75]; P = .002), and processing speed (β = −11.05 [95% CI, −17.80 to −4.30]; P = .002) in multivariable models.Conclusions and RelevanceIn this cross-sectional study of midlife women, greater PTSD symptoms were associated with higher carotid atherosclerosis and, among women who were APOEε4 carriers, greater brain small vessel disease and poorer cognitive performance. These findings point to the adverse implications of PTSD symptoms for cardiovascular and neurocognitive health among women in midlife, particularly for women who are APOEε4 carriers.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women

Thurston,

Jakubowski,

Chang

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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“…6,8,9 In a longitudinal cohort study women with higher PTSD symptom levels (n = 8218; Mean (M) age = 61) showed a 2 times faster cognitive decline in learning and working memory than those without PTSD symptoms (n = 4052; Mage = 61), independent of age. 10 PTSD severity is positively correlated with degree of cognitive impairment 11 although results vary, most consistent correlations with PTSD has been found with verbal learning deficits and memory (eg immediate and delayed recall, recognition), 6,12,13 and executive function (eg inhibition, working memory). 12 PTSD treatment may improve these neurobiological abnormalities and as a consequence also cognitive functioning.…”

Section: Introductionmentioning

confidence: 97%

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

Gielkens,

Rossi,

van Alphen

et al. 2023

J Geriatr Psychiatry Neurol

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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.

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Association of Cardiovascular Events With Spouse’s Subsequent Dementia

Komura,

Tsugawa,

Mayeda

et al. 2024

JAMA Neurol

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Association of Posttraumatic Stress Disorder With Accelerated Cognitive Decline in Middle-aged Women

Cited by 17 publications

References 79 publications

Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women

Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women

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

Association of Cardiovascular Events With Spouse’s Subsequent Dementia

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