Hippocampal Volumes in Patients With Chronic Combat-Related Posttraumatic Stress Disorder: A Systematic Review

Childress, Jason; McDowell, Emily J.; Dalai, Venkata Vijaya K.; Bogale, Saivivek R.; Ramamurthy, Chethan; Jawaid, Ali; Kunik, Mark E.; Qureshi, Salah U.; Schulz, Paul E.

doi:10.1176/appi.neuropsych.12010003

Cited by 34 publications

(29 citation statements)

References 66 publications

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“…38 A recent systematic review found that smaller total hippocampal volume is the most frequently reported structural difference in studies comparing individuals with PTSD to healthy control subjects. 39 This review and an older meta-analysis both reported mostly right-sided reductions. 39,40 Similarly, a recent study in combat veterans with chronic and current PTSD found that PTSD duration was inversely correlated with hippocampal volume, but only on the right.…”

Section: Functional Neuroimagingmentioning

confidence: 94%

“…39 This review and an older meta-analysis both reported mostly right-sided reductions. 39,40 Similarly, a recent study in combat veterans with chronic and current PTSD found that PTSD duration was inversely correlated with hippocampal volume, but only on the right. 41 However, two metaanalyses that focused on whole brain studies that included trauma-exposed control subjects reported left laterality.…”

Section: Functional Neuroimagingmentioning

confidence: 94%

“…44 Other studies, including some in combat veterans, have not found volume differences in this structure. 11,37,39,[45][46][47] A challenge in this area of research has been to distinguish whether a smaller hippocampus is a risk factor for PTSD or is acquired after trauma. The inverse correlation noted above between PTSD duration and hippocampal volume could indicate an effect of PTSD or could indicate a risk factor for development of persistent symptoms.…”

Section: Functional Neuroimagingmentioning

confidence: 99%

“…41 Strong evidence from an identical twin study suggests low hippocampal volume is a risk factor for combat-related PTSD. 39,48,49 Another study in combat veterans reported that current PTSD was associated with smaller total hippocampal volume, whereas remitted PTSD was not. 50 A prospective longitudinal (18 months) study of active duty military personnel divided the group by direction of change in left hippocampal volume (manual segmentation).…”

Section: Functional Neuroimagingmentioning

confidence: 99%

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Psychotherapy for PTSD: Neuroimaging of Recovery Processes

Erickson¹,

Hurley²,

Taber³

2014

JNP

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Much of the neurobiological research on posttraumatic stress disorder (PTSD) has focused on brain structures implicated in the fear circuit. Illustrated and labeled here are the locations and general extent of the amygdala (pink), hippocampus (purple), and limbic-related cerebral cortex (yellow), which includes the cingulate and parahippocampal gyri and uncus. The general region that is considered to be ventromedial prefrontal cortex (PFC) is circled. COVER and FIGURE 2. There is considerable variability across functional imaging studies assessing neural differences associated with PTSD, in part due to small sample size. Other important aspects include whether the analysis focused only on specific regions of interest or examined the whole brain and the tasks used to evoke changes in neural activity. Summarized here are the results of two recent meta-analyses that focused primarily on studies that reported whole brain analysis, used some form of symptom provocation (e.g., trauma reminders), and compared subjects with PTSD to healthy trauma exposed individuals. 1,2 Warm colors (pink, orange) indicate areas with higher activation in subjects with PTSD, and cool colors (blue, green) indicate areas with lower activation in subjects with PTSD. Both metaanalyses found hyperactivation within multiple areas in the cingulate cortex and noted the importance of this region for salience processing. Neither meta-analysis found the response of the amygdala to differ significantly between subjects with PTSD and trauma-exposed control subjects during symptom provocation. As noted in one study, this may be due to the inherent difficulty with acquiring functional imaging of this small area or may indicate that amygdala dysfunction is not as important in PTSD as previously thought. 1 FIGURE 3. Only a handful of imaging studies have assessed treatment-related changes in brain activations induced by trauma reminders in subjects with PTSD. The results of three studies that used single photon emission computed tomography (SPECT) to compare regional cerebral blood flow (CBF) in subjects who responded to treatment compared with their own baseline or subjects who did not respond to treatment are summarized. 3-5 Warm colors (pink, orange) indicate areas with higher CBF, and cool colors (blue, greens) indicate areas with lower CBF. One study reported only general areas (e.g. Brodmann areas [BA], hippocampus) and did not specify laterality, so these are indicated by large circles in both hemispheres. 3 Smaller circles mark the locations from the two studies that reported coordinates. 4,5 The only areas reported in all three studies are in dorsolateral PFC and medial temporal lobe, but the laterality and direction of change varies. Although very preliminary, these results suggest that both normalization and compensatory changes may occur.

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Section: Functional Neuroimagingmentioning

confidence: 94%

Section: Functional Neuroimagingmentioning

confidence: 94%

Section: Functional Neuroimagingmentioning

confidence: 99%

Section: Functional Neuroimagingmentioning

confidence: 99%

See 2 more Smart Citations

Psychotherapy for PTSD: Neuroimaging of Recovery Processes

Erickson¹,

Hurley²,

Taber³

2014

JNP

View full text Add to dashboard Cite

show abstract

“…The time course of structural change is much longer than the half-life of cortisol; cortisol elevation needs to be sustained to cause longer-lasting brain changes. Smaller hippocampi are common among people with PTSD or trauma exposure [62, 63] and they also are linked to increased risk for PTSD development [64] so the causative relationship is uncertain. Further, PTSD sufferers are at higher risk of dementia [65] and those with smaller hippocampi have increased the risk of dementia [66].…”

Section: Measurement Of Stressmentioning

confidence: 99%

A systems approach to stress, stressors and resilience in humans

Oken

Chamine

Wakeland

2015

Behavioural Brain Research

215

148

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The paper focuses on the biology of stress and resilience and their biomarkers in humans from the system science perspective. A stressor pushes the physiological system away from its baseline state towards a lower utility state. The physiological system may return towards the original state in one attractor basin but may be shifted to a state in another, lower utility attractor basin. While some physiological changes induced by stressors may benefit health, there is often a chronic wear and tear cost due to implementing changes to enable the return of the system to its baseline state and maintain itself in the high utility baseline attractor basin following repeated perturbations. This cost, also called allostatic load, is the utility reduction associated with both a change in state and with alterations in the attractor basin that affect system responses following future perturbations. This added cost can increase the time course of the return to baseline or the likelihood of moving into a different attractor basin following a perturbation. Opposite to this is the system’s resilience which influences its ability to return to the high utility attractor basin following a perturbation by increasing the likelihood and/or speed of returning to the baseline state following a stressor. This review paper is a qualitative systematic review; it covers areas most relevant for moving the stress and resilience field forward from a more quantitative and neuroscientific perspective.

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Posttraumatic stress disorder symptoms and cognitive function in a large cohort of middle-aged women

et al. 2017

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Background Posttraumatic stress disorder (PTSD) has been linked to cognitive decline, but research in women is generally lacking. We examined whether trauma and elevated PTSD symptoms were associated with worse cognitive function in middle-aged civilian women. A secondary objective was to investigate the possible role of depression in the relation of PTSD symptoms to cognitive function. Methods The sample comprised 14,029 middle-aged women in the Nurses’ Health Study II. Lifetime trauma exposure, lifetime PTSD symptoms, and past-week depressive symptoms were measured in 2008. Cognitive function was measured in 2014–2016 using the Cogstate Brief Battery, a self-administered online cognitive battery that assesses psychomotor speed, attention, learning, and working memory. We used linear regression models to estimate mean differences in cognition across PTSD symptom levels. Results Compared to no trauma, elevated PTSD symptoms consistent with probable PTSD (i.e., 4+ symptoms on a screening questionnaire) were associated with worse performance on psychomotor speed/attention (b=−0.08 standard units, p=.001) and learning/working memory (b=−0.09, p<.001) composites, after adjusting for socio-demographics. Although attenuated, associations remained significant when adjusted for depressive symptoms and other cognitive risk factors. We found the strongest associations among women with comorbid probable PTSD and depression. Conclusions PTSD symptoms were negatively related to measures of psychomotor speed/attention and learning/working memory in middle-aged women. Our study adds to a growing literature that suggests that mental disorders are associated with worse cognitive function over the life course.

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Hippocampal Volumes in Patients With Chronic Combat-Related Posttraumatic Stress Disorder: A Systematic Review

Cited by 34 publications

References 66 publications

Psychotherapy for PTSD: Neuroimaging of Recovery Processes

Psychotherapy for PTSD: Neuroimaging of Recovery Processes

A systems approach to stress, stressors and resilience in humans

Posttraumatic stress disorder symptoms and cognitive function in a large cohort of middle-aged women

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