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HomeHealthMedicinePTSD May Accelerate Cognitive Decline Over Time

PTSD May Accelerate Cognitive Decline Over Time

Posttraumatic stress disorder (PTSD) is related to accelerated cognitive decline over time, new analysis suggests.

In an evaluation of greater than 12,000 middle-aged girls who had skilled not less than one trauma of their lives, these with PTSD signs confirmed an roughly two-fold sooner decline in cognition throughout follow-up in contrast with those that didn’t have PTSD signs.

These associations weren’t absolutely defined by different identified cognition-related components akin to depression, the researchers word.

“PTSD may increase the risk of dementia by accelerating cognitive decline at midlife,” coinvestigator Jiaxuan Liu, MPH, a doctoral candidate on the Harvard TH Chan School of Public Health, Boston, Massachusetts, advised Medscape Medical News.

“Our findings may suggest the value of earlier cognitive screening among individuals with PTSD and the importance of PTSD prevention and treatment across the lifespan,” she added.

The outcomes had been published online June 30 in JAMA Network Open.

Vital Public Health Issue

“Cognitive decline at midlife and older is of vital public health interest,” Liu stated. “It is a danger issue for quite a lot of poor well being outcomes and strongly predicts Alzheimer’s disease and different dementias.”

Although PTSD has been linked to decrease cognitive operate and dementia incidence, it has not been identified whether or not it’s related to decline in cognitive operate, she added.

“In addition, both PTSD and dementia are more common in women than men, so it’s important to understand a possible link,” Liu stated.

Because no large-scale examine had examined whether or not PTSD is related to cognitive decline in girls, the present researchers examined PTSD signs and their affiliation with repeated measures of cognitive operate amongst a big civilian trauma-exposed cohort of ladies aged 50 to 70 years at examine baseline.

Participants had been drawn from the Nurses’ Health Study II: a longitudinal examine of a cohort of 116,429 US feminine nurses who had been between 25 and 42 years outdated at enrollment in 1989. Participants accomplished biennial questionnaires, with follow-up on an ongoing foundation.

The present evaluation included 12,270 trauma-exposed girls (imply age at baseline, 61.1 years) who accomplished assessments each 1 or 12 months for as much as 24 months after baseline. The imply follow-up time was 0.9 years.

In the examine inhabitants, 95.9% had been non-Hispanic White, 1.3% had been Hispanic, 1% had been Asian, 0.6% had been Black, and 1.2% had been categorized as “other.”

Higher Depression Scores

Lifetime trauma publicity and PTSD signs had been assessed from March 1, 2008, to February 28, 2010, utilizing the Short Screening Scale for DSM-IV PTSD.

In complete, 67% of the individuals reported experiencing PTSD signs. The girls had been divided into 4 teams, on the premise of symptom quantity:

  • No PTSD signs (n = 4052)

  • 1-3 PTSD signs (n = 5058)

  • 4-5 PTSD signs (n = 2018)

  • 6-7 PTSD signs (n = 1052)

The Cogstate Brief Battery, a validated and self-administered on-line cognitive evaluation, was accomplished by individuals between October 3, 2014, and July 30, 2019. The researchers measured cognitive operate with two composite scores: psychomotor pace and a spotlight, and studying and dealing reminiscence.

Covariates probably related to cognitive decline included demographic, instructional, and behavior-related well being components akin to physique mass index, bodily exercise, cigarette smoking, weight-reduction plan high quality, and alcohol consumption.

The researchers moreover carried out secondary analyses that adjusted for signs and historical past of despair as nicely as the results of potential apply results of taking the check a number of instances.

Behavior-related well being components “did not substantially differ by PTSD symptom level,” the investigators word. However, in contrast with girls who didn’t have PTSD signs, those that had such signs had larger depressive symptom scores and better charges of clinician-diagnosed despair.

Both cognitive composite scores improved by means of the follow-up interval, “likely because of practice effects,” the researchers write. But after adjusting for apply results, they discovered a decline over time in each composite scores.

Dose-Related Trajectories

Results confirmed that having extra PTSD signs was related to dose-related poorer cognitive trajectories.

After adjusting for demographic traits, girls with the best symptom degree (6-7 signs) had a considerably worse price of change in each composite domains of studying and dealing reminiscence (β = −0.08 SD/y; 95% CI, −0.11 to −0.04 SD/y; P  < .001) and of psychomotor pace and a spotlight (β = −0.05 SD/y; 95% CI, −0.09 to −0.01 SD/y; P  = .02) in contrast with girls with no PTSD signs.

Women with 4 to 5 PTSD signs confirmed a worse price of change in studying and dealing reminiscence in contrast with those that had no signs, however not in psychomotor pace and a spotlight. Women with one to a few PTSD signs had related cognitive scores to these of ladies with out PTSD signs.

Notably, the associations of PTSD with cognitive change remained evident after extra adjustment for behavioral components and well being circumstances — and had been solely “partially attenuated but still evident” after additional adjustment for apply results and comorbid despair, the investigators write.

“We thought PTSD might be associated with worse cognitive decline through health behaviors like smoking and alcohol drinking and higher risk of other health conditions like hypertension and despair,” Liu stated.

However, these components didn’t account for the present examine’s findings, she famous.

“We could not determine why women with PTSD had faster cognitive decline than those without PTSD,” she stated.

Liu recommended that PTSD “may have effects on the brain, such as altering brain structures and affecting brain immune function.” However, extra analysis is required “to investigate these mechanisms that might underlie the association we found between PTSD and cognitive decline,” she stated.

Neurotoxic Effect

Commenting for Medscape Medical News, Howard Fillit, MD, cofounder and chief science officer of the Alzheimer’s Drug Discovery Foundation, stated, “It is well known that stress is neurotoxic, and PTSD is a particularly serious form of stress.”

Fillit can be a medical professor of geriatric drugs and palliative care, drugs, and neuroscience, Mount Sinai Hospital, New York, and was not concerned with the examine.

“We tend to think of PTSD in post-acute settings, such as soldiers returning from war,” he stated. “This study contributes to our understanding of the long-term effects of PTSD on cognitive decline, measured objectively over time”

Fillit famous that an necessary implication is that, by growing the danger for cognitive decline, PTSD additionally will increase danger for Alzheimer’s illness. This results in the “main take-home, which is that PTSD is a risk factor not only for cognitive decline but also for Alzheimer’s and related dementias,” he stated.

However, this opens a possible therapeutic strategy, Fillit added.

Because cortisol and different stress hormones drive the stress response, discovering methods to dam the neurotoxic results of those hormones “might be a target to prevent cognitive decline and decrease Alzheimer’s disease risk,” he stated.

JAMA Netw Open. Published on-line June 30, 2022. Full text

The examine was supported by grants from the National Institute of Mental Health and the National Institutes of Health. Liu studies no related monetary relationships. The different investigators’ disclosures are listed within the authentic paper. Fillit studies no related monetary relationships.

Batya Swift Yasgur MA, LSW, is a contract author with a counseling apply in Teaneck, NJ. She is an everyday contributor to quite a few medical publications, together with Medscape and WebMD, and is the writer of a number of consumer-oriented well being books in addition to Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom(the memoir of two courageous Afghan sisters who advised her their story).

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