PTSD Might Accelerate Cognitive Decline Above Time
Posttraumatic pressure problem (PTSD) is connected with accelerated cognitive decline around time, new research implies.
In an investigation of additional than 12,000 center-aged women who experienced expert at minimum a single trauma in their lives, those people with PTSD signs or symptoms confirmed an roughly two-fold speedier decrease in cognition in the course of abide by-up when compared with those who did not have PTSD signs and symptoms.
These associations had been not absolutely defined by other acknowledged cognition-associated components such as melancholy, the researchers take note.
“PTSD may perhaps raise the possibility of dementia by accelerating cognitive drop at midlife,” coinvestigator Jiaxuan Liu, MPH, a doctoral applicant at the Harvard TH Chan University of Community Health, Boston, Massachusetts, explained to Medscape Medical News.
“Our findings could propose the benefit of earlier cognitive screening among individuals with PTSD and the importance of PTSD prevention and procedure across the lifespan,” she extra.
The final results ended up posted online June 30 in JAMA Network Open.
Critical Community Overall health Problem
“Cognitive decline at midlife and older is of important public wellness curiosity,” Liu said. “It is a hazard issue for a wide variety of poor overall health results and strongly predicts Alzheimer’s disease and other dementias.”
Despite the fact that PTSD has been connected to lessen cognitive purpose and dementia incidence, it has not been known regardless of whether it is linked with decline in cognitive purpose, she included.
“In addition, the two PTSD and dementia are much more common in gals than gentlemen, so it’s critical to understand a attainable backlink,” Liu explained.
Due to the fact no huge-scale research had examined no matter whether PTSD is connected with cognitive drop in women, the recent researchers examined PTSD signs or symptoms and their association with recurring steps of cognitive perform among a massive civilian trauma-exposed cohort of gals aged 50 to 70 many years at research baseline.
Members were being drawn from the Nurses’ Overall health Review II: a longitudinal study of a cohort of 116,429 US feminine nurses who were between 25 and 42 several years outdated at enrollment in 1989. Individuals concluded biennial questionnaires, with adhere to-up on an ongoing basis.
The current assessment incorporated 12,270 trauma-uncovered females (suggest age at baseline, 61.1 many years) who completed assessments just about every 1 or 12 months for up to 24 months right after baseline. The necessarily mean stick to-up time was .9 years.
In the analyze population, 95.9% had been non-Hispanic White, 1.3% had been Hispanic, 1% ended up Asian, .6% had been Black, and 1.2% ended up categorised as “other.”
Larger Melancholy Scores
Lifetime trauma exposure and PTSD symptoms ended up assessed from March 1, 2008, to February 28, 2010, utilizing the Limited Screening Scale for DSM-IV PTSD.
In complete, 67% of the participants claimed suffering from PTSD indicators. The females ended up divided into four groups, on the basis of symptom number:
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No PTSD indications (n = 4052)
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1-3 PTSD signs and symptoms (n = 5058)
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4-5 PTSD indications (n = 2018)
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6-7 PTSD indications (n = 1052)
The Cogstate Transient Battery, a validated and self-administered on the net cognitive evaluation, was finished by contributors between October 3, 2014, and July 30, 2019. The researchers measured cognitive function with two composite scores: psychomotor speed and interest, and mastering and performing memory.
Covariates potentially connected with cognitive decrease provided demographic, educational, and behavior-linked health components these kinds of as physique mass index, actual physical activity, cigarette smoking cigarettes, diet program good quality, and liquor use.
The scientists furthermore executed secondary analyses that modified for signs and symptoms and history of depression as well as the implications of prospective apply effects of taking the test various occasions.
Behavior-related wellness variables “did not considerably vary by PTSD symptom stage,” the investigators observe. Nevertheless, as opposed with gals who did not have PTSD symptoms, those people who experienced these kinds of signs and symptoms experienced higher depressive symptom scores and bigger premiums of clinician-identified despair.
The two cognitive composite scores improved by means of the stick to-up time period, “probable because of observe effects,” the researchers compose. But soon after altering for apply results, they discovered a decline about time in equally composite scores.
Dose-Associated Trajectories
Success showed that having a lot more PTSD symptoms was associated with dose-connected poorer cognitive trajectories.
After adjusting for demographic attributes, girls with the optimum symptom stage (6-7 signs or symptoms) had a substantially worse charge of alter in the two composite domains of discovering and working memory (β = −0.08 SD/y 95% CI, −0.11 to −0.04 SD/y P < .001) and of psychomotor speed and attention (β = −0.05 SD/y 95% CI, −0.09 to −0.01 SD/y P = .02) compared with women with no PTSD symptoms.
Women with four to five PTSD symptoms showed a worse rate of change in learning and working memory compared with those who had no symptoms, but not in psychomotor speed and attention. Women with one to three PTSD symptoms had similar cognitive scores to those of women without PTSD symptoms.
Notably, the associations of PTSD with cognitive change remained evident after additional adjustment for behavioral factors and health conditions — and were only “partially attenuated but still evident” after further adjustment for practice effects and comorbid depression, 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 depression,” Liu said.
However, those factors did not account for the current study’s findings, she noted.
“We could not determine why women with PTSD had faster cognitive decline than those without PTSD,” she said.
Liu suggested that PTSD “may have effects on the brain, such as altering brain structures and affecting brain immune function.” However, more research is needed “to investigate these mechanisms that might underlie the association we found between PTSD and cognitive decline,” she said.
Neurotoxic Effect
Commenting for Medscape Medical News, Howard Fillit, MD, cofounder and chief science officer of the Alzheimer’s Drug Discovery Foundation, said, “It is well known that stress is neurotoxic, and PTSD is a particularly serious form of stress.”
Fillit is also a clinical professor of geriatric medicine and palliative care, medicine, and neuroscience, Mount Sinai Hospital, New York, and was not involved with the study.
“We tend to think of PTSD in post-acute settings, such as soldiers returning from war,” he said. “This study contributes to our understanding of the long-term effects of PTSD on cognitive decline, measured objectively over time”
Fillit noted that an important implication is that, by increasing the risk for cognitive decline, PTSD also increases risk for Alzheimer’s disease. This leads to 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 said.
However, this opens a potential therapeutic approach, Fillit added.
Because cortisol and other stress hormones drive the stress response, finding ways to block the neurotoxic effects of these hormones “might be a target to prevent cognitive decline and decrease Alzheimer’s disease risk,” he said.
JAMA Netw Open. Published online June 30, 2022. Full text
The study was supported by grants from the National Institute of Mental Health and the National Institutes of Health. Liu reports no relevant financial relationships. The other investigators’ disclosures are listed in the original paper. Fillit reports no relevant financial relationships.
Batya Swift Yasgur MA, LSW, is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom(the memoir of two brave Afghan sisters who told her their story).
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