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Yeh MSL, Poyares D, D'Elia ATD, Coimbra BM, Mello AF, Tufik S, Mello MF. Sleep characteristics and inflammatory markers in women with post-traumatic stress disorder. BMC Psychiatry 2023; 23:273. [PMID: 37081449 PMCID: PMC10116752 DOI: 10.1186/s12888-023-04765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Sexual violence is one of the most severe traumatic events. It is associated with a higher risk for post-traumatic stress disorder (PTSD) development. Sleep disturbances such as insomnia are frequently reported by PTSD patients and play a key role in the development and course of the disorder. Sleep disturbances are associated with higher levels of pro-inflammatory cytokines emphasizing the importance of sleep studies in individuals with PTSD. OBJECTIVES To investigate the association between subjective and objective sleep measurements and PTSD symptoms with inflammatory markers in women with PTSD following sexual assault. METHODS In this longitudinal study fifty-seven women with PTSD were evaluated for sleep measurements and inflammatory markers. Participants completed the Clinician-Administered PTSD Scale, the Beck Depression Inventory, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index. In addition, patients underwent full in-lab polysomnography and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) measurement. All assessments were performed at baseline and after one year. Patients received pharmacological and/or psychological interventions between baseline and one-year follow-up. RESULTS Despite improving PTSD symptoms severity and sleep quality (expressed in PSQI), we found an increase in the inflammatory markers IL-1β, TNF-α, IL-6 and CRP after one year of follow-up. These findings suggest that neurobiological processes may advance independently of PTSD symptoms. We found a significant increase in the levels of IL-1β and TNF-α associated with decreased slow-wave sleep (p = 0.019 and p = 0.018 respectively), IL-6 associated with arousal index (p = 0.024), and CRP associated with insomnia severity (p = 0.012), and sleep duration longer than 6 h per night (p < 0.001). CONCLUSIONS Sleep impairments in PTSD may be associated with a gradual and persistent alteration in the immune system, resulting in a progressive inflammatory process. Our results suggest that sleep mechanisms are involved in this incident inflammatory process in young women with PTSD.
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Affiliation(s)
- Mary Sau Ling Yeh
- Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil.
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ana Teresa D D'Elia
- Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil
| | - Andrea Feijo Mello
- Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Feijo Mello
- Department of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, 04017-030, SP, Brazil
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Prieto S, Nolan KE, Moody JN, Hayes SM, Hayes JP. Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer's disease biomarkers in Veterans. Transl Psychiatry 2023; 13:102. [PMID: 36990983 PMCID: PMC10060413 DOI: 10.1038/s41398-023-02354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Chronic stress is a risk factor for dementia but whether it explains unique variance in cognitive decline in older adults above Alzheimer's disease (AD) biomarkers is unknown. In a preclinical cohort of Vietnam Veterans, we examined the relationship between posttraumatic stress disorder (PTSD) symptom severity, AD biomarkers of beta-amyloid (Aβ) and tau, and change in cognitive performance on two widely-used screeners, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Analyses indicated that PTSD symptom severity was associated with a greater decline on the MMSE (p < 0.04) and MoCA (p < 0.024) after adjusting for biomarkers of AD, notably on the attention scale of the MoCA and the memory index of the MMSE. These analyses survived multiple comparison corrections. Taken together, PTSD symptom severity is associated with accelerated cognitive decline. Treating PTSD should be considered instrumental to maintaining cognitive function as adults age.
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Affiliation(s)
- Sarah Prieto
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Kate E Nolan
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jena N Moody
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Scott M Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA.
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Kritikos M, Franceschi AM, Vaska P, Clouston SAP, Huang C, Salerno M, Deri Y, Tang C, Pellecchia A, Santiago-Michels S, Sano M, Bromet EJ, Lucchini RG, Gandy S, Luft BJ. Assessment of Alzheimer's Disease Imaging Biomarkers in World Trade Center Responders with Cognitive Impairment at Midlife. World J Nucl Med 2022; 21:267-275. [PMID: 36398306 PMCID: PMC9666002 DOI: 10.1055/s-0042-1750013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Purpose Incidence of early onset neurocognitive dysfunction has been reported in World Trade Center (WTC) responders. Ongoing studies are investigating the underlying etiology, as we are concerned that an underlying risk of neurodegenerative dementia may be occurring because of their stressful and neurotoxic exposures to particulate matter when they responded to the search and rescue efforts on September 11, 2001. The purpose of this study is to report preliminary results from two ongoing positron emission tomography (PET)/magnetic resonance imaging (MRI) imaging studies investigating the presence of Alzheimer's disease (AD) biomarkers, such as β-amyloid, tau, and neurodegeneration, and compare our findings to published norms. Methods We present findings on 12 WTC responders diagnosed with either cognitive impairment (CI) or mild cognitive impairment (MCI), now at midlife, who underwent PET/MRI brain imaging as part of ongoing studies. Six responders with CI received [ 18 F] florbetaben (FBB) to detect β-amyloidosis and six separate responders with MCI received [ 18 F] flortaucipir (FTP) to detect tauopathy. All 12 responders underwent concomitant MRI scans for gray matter volume analysis of neurodegeneration. Results PET analysis revealed 50% FBB and 50% of FTP scans were clinically read as positive and that 50% of FTP scans identified as consistent with Braak's stage I or II. Furthermore, one responder identified as centiloid positive for AD. Gray matter volumes from MRI analyses were compared with age/sex-matched norms (Neuroquant), identifying abnormally low cortical volumes in the occipital and temporal lobes, as well as the inferior temporal gyri and the entorhinal cortex. Conclusion These preliminary results suggest that WTC responders with neurocognitive dysfunction may be at increased risk for a neurodegenerative dementia process as a result of their exposures at September 11, 2001.
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Affiliation(s)
- Minos Kritikos
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Ana M. Franceschi
- Division of Neuroradiology, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Manhasset, New York, United States
| | - Paul Vaska
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Sean A. P. Clouston
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Michael Salerno
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Yael Deri
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Cheuk Tang
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alison Pellecchia
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Stephanie Santiago-Michels
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Evelyn J. Bromet
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Roberto G. Lucchini
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States
| | - Sam Gandy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Department of Neurology, The Barbara and Maurice Deane Center for Wellness and Cognitive Health and the Mount Sinai Center for NFL Neurological Care, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Benjamin J. Luft
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
- Stony Brook World Trade Center Wellness Program, Stony Brook Medicine, Stony Brook, New York, United States
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Ressler KJ, Berretta S, Bolshakov VY, Rosso IM, Meloni EG, Rauch SL, Carlezon WA. Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits. Nat Rev Neurol 2022; 18:273-288. [PMID: 35352034 PMCID: PMC9682920 DOI: 10.1038/s41582-022-00635-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 01/16/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.
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Affiliation(s)
- Kerry J Ressler
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabina Berretta
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Y Bolshakov
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G Meloni
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Carlezon
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
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Sfera A, Osorio C, Rahman L, Zapata-Martín del Campo CM, Maldonado JC, Jafri N, Cummings MA, Maurer S, Kozlakidis Z. PTSD as an Endothelial Disease: Insights From COVID-19. Front Cell Neurosci 2021; 15:770387. [PMID: 34776871 PMCID: PMC8586713 DOI: 10.3389/fncel.2021.770387] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 virus, the etiologic agent of COVID-19, has affected almost every aspect of human life, precipitating stress-related pathology in vulnerable individuals. As the prevalence rate of posttraumatic stress disorder in pandemic survivors exceeds that of the general and special populations, the virus may predispose to this disorder by directly interfering with the stress-processing pathways. The SARS-CoV-2 interactome has identified several antigens that may disrupt the blood-brain-barrier by inducing premature senescence in many cell types, including the cerebral endothelial cells. This enables the stress molecules, including angiotensin II, endothelin-1 and plasminogen activator inhibitor 1, to aberrantly activate the amygdala, hippocampus, and medial prefrontal cortex, increasing the vulnerability to stress related disorders. This is supported by observing the beneficial effects of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in both posttraumatic stress disorder and SARS-CoV-2 critical illness. In this narrative review, we take a closer look at the virus-host dialog and its impact on the renin-angiotensin system, mitochondrial fitness, and brain-derived neurotrophic factor. We discuss the role of furin cleaving site, the fibrinolytic system, and Sigma-1 receptor in the pathogenesis of psychological trauma. In other words, learning from the virus, clarify the molecular underpinnings of stress related disorders, and design better therapies for these conditions. In this context, we emphasize new potential treatments, including furin and bromodomains inhibitors.
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Affiliation(s)
- Adonis Sfera
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
- Patton State Hospital, San Bernardino, CA, United States
| | - Carolina Osorio
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
| | - Leah Rahman
- Patton State Hospital, San Bernardino, CA, United States
| | | | - Jose Campo Maldonado
- Department of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Nyla Jafri
- Patton State Hospital, San Bernardino, CA, United States
| | | | - Steve Maurer
- Patton State Hospital, San Bernardino, CA, United States
| | - Zisis Kozlakidis
- International Agency For Research On Cancer (IARC), Lyon, France
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Dementia in military and veteran populations: a review of risk factors-traumatic brain injury, post-traumatic stress disorder, deployment, and sleep. Mil Med Res 2021; 8:55. [PMID: 34645526 PMCID: PMC8515715 DOI: 10.1186/s40779-021-00346-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/26/2021] [Indexed: 12/13/2022] Open
Abstract
The military population face a unique set of risk factors that may increase the risk of being diagnosed with dementia. Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have a higher prevalence in this group in comparison to the civilian population. By delving into the individual relationships between TBI and dementia, and PTSD and dementia, we are able to better explore dementia in the military and veteran populations. While there are some inconsistencies in results, the TBI-dementia association has become more widely accepted. Moderate-to-severe TBI has been found to increase the risk of being diagnosed with Alzheimer's disease. A correlation between PTSD and dementia has been established, however, whether or not it is a causal relationship remains unclear. Factors such as blast, combat and chemical exposure may occur during a deployment, along with TBI and/or PTSD diagnosis, and can impact the risk of dementia. However, there is a lack of literature exploring the direct effects of deployment on dementia risk. Sleep problems have been observed to occur in those following TBI, PTSD and deployment. Poor sleep has been associated with possible dementia risk. Although limited studies have focused on the link between sleep and dementia in military and veteran populations, sleep is a valuable factor to study due to its association and interconnection with other military/veteran factors. This review aims to inform of various risk factors to the cognitive health of military members and veterans: TBI, PTSD, deployment, and sleep.
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Islamoska S, Hansen ÅM, Ishtiak-Ahmed K, Garde AH, Andersen PK, Garde E, Taudorf L, Waldemar G, Nabe-Nielsen K. Stress diagnoses in midlife and risk of dementia: a register-based follow-up study. Aging Ment Health 2021; 25:1151-1160. [PMID: 32233797 DOI: 10.1080/13607863.2020.1742656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Previous studies indicated that stress diagnoses increase the risk of dementia. However, previous results may be biased by confounding, reverse causation and misclassification. Therefore, the main aim of this study was to investigate the association between clinically diagnosed stress in midlife and later dementia risk, while addressing limitations of previous studies. METHODS The study population was selected from all individuals in Denmark born 1935-1956. Individuals diagnosed with stress in midlife (aged 37-58 years) were matched (1:5) with individuals without stress diagnoses based on sex and birthdate (N = 103,484). Data were retrieved from national registers. Cox regression models were adjusted for socio-demographic factors and different morbidities. RESULTS We found a 2.20 (95% CI: 1.93-2.50) times higher rate of dementia among individuals with any stress diagnosis registered in midlife compared with no stress diagnosis. Hazard rate ratios of dementia were 1.73 (95% CI: 1.13-2.65) among individuals with acute stress reactions, 2.37 (95% CI: 2.05-2.74) among individuals with adjustment disorders, and 2.20 (95% CI: 1.73-2.80) among individuals with unspecified stress reactions. Individuals with PTSD and other stress reactions had non-significantly elevated rates of dementia. Adjustment for confounding only slightly attenuated the association, and reverse causation did not appear to bias the results substantially. CONCLUSION Our results support the hypothesis that severe stress in midlife is an important risk factor for dementia. This finding emphasizes the importance of identifying and treating severe stress in midlife to reduce potential detrimental consequences for brain health in later life.
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Affiliation(s)
- Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Per Kragh Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lærke Taudorf
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Saadi A, Cruz-Gonzalez M, Hwang A, Cohen L, Alegria M. Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults. J Am Geriatr Soc 2021; 69:1019-1026. [PMID: 33399223 PMCID: PMC8290975 DOI: 10.1111/jgs.16986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Trauma survivors with chronic post-traumatic stress disorder (PTSD) have been found to have cognitive impairment. But little is known about these outcomes among Latino and Asians who comprise more than 80% of the U.S. immigrant population. They also experience disparities in PTSD and dementia care albeit increased exposure to trauma. This study aimed to (1) examine the association between trauma exposures and PTSD with cognitive impairment in a sample of Latino and Asian older adults; and (2) assess whether sleep quality attenuated the PTSD-cognitive impairment association. DESIGN Cross-sectional secondary analysis of baseline data from the Positive Minds-Strong Bodies randomized controlled trial on disability prevention. SETTING Community-based organizations serving minority or immigrant older adults in Massachusetts, New York, Florida, or Puerto Rico. PARTICIPANTS Hispanic/Latino and Asian/Pacific Islander adults aged 60 or older eligible per randomized controlled trial screening for elevated mood symptoms and minor-to-moderate physical dysfunction (n = 134 and n = 86, respectively). MEASUREMENTS Neuropsychiatric measures were cognitive impairment (Mini Montreal Cognitive Assessment (MoCA)), PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5), trauma exposure (Brief Trauma Questionnaire), depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder Scale-7), and daytime sleepiness (Epworth Sleepiness Scale). RESULTS Mean age was 72.8 years and 77.5 years for the Latino and Asian groups, respectively. The Asian group was 100% immigrant, whereas 70.2% (n = 92) of the Latino group was foreign-born. In unadjusted models, higher Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual-5 scores were associated with decreased odds of normal cognitive functioning (MoCA ≥25) in the Asian group (odds ratio (95% confidence interval) = .93 (.87, .99)), but not the Latino group (odds ratio (95% confidence interval) = .99 (.95, 1.05)). This association remained significant after adjusting for covariates. Daytime sleepiness did not moderate the association between PTSD and cognitive functioning in the Asian group. CONCLUSION Higher PTSD symptoms were associated with cognitive impairment in Asian, but not Latino, older adults. Clinicians serving older Asians should integrate trauma and cognitive screening to ensure this growing, underserved population receives appropriate evidence-based treatments.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Hwang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren Cohen
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
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Sobczak S, Olff M, Rutten B, Verhey F, Deckers K. Comorbidity rates of Posttraumatic Stress Disorder in dementia: a systematic literature review. Eur J Psychotraumatol 2021; 12:1883923. [PMID: 33968318 PMCID: PMC8075086 DOI: 10.1080/20008198.2021.1883923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Post Traumatic Stress Disorder (PTSD) has been described as an independent risk factor for cognitive decline and dementia. At the same time, cognitive deterioration and increased loss experiences in dementia may increase liability for the reactivation of traumatic memories and thereby PTSD symptoms. Objective: In order to investigate co-occurrence of PTSD in dementia this systematic literature review summarizes all the available evidence on reported comorbidity rates of PTSD in patients with dementia. Method: PubMed, Embase, PsycINFO and CINAHL were searched for potential publications investigating the co-occurrence of PTSD in dementia until 25 November 2019. Cohort and cross-sectional studies were included. To assure current comorbidity of PTSD in dementia, only publications with a recent PTSD diagnosis (<2 years before onset of dementia) were selected. Results: Of the 860 identified abstracts, three studies (0.35%) met the eligibility criteria and were included. These three studies concerned only military veteran populations, and they comprised two cross-sectional cohort studies and one prospective cohort study. The estimated comorbidity rate of PTSD in veterans with dementia varied between 4.7% and 7.8%. Conclusions: The limited research available shows comorbidity rates only in military veterans, which were possibly dependent on investigated population with respect to dementia severity and possibly associated behavioural and psychiatric symptoms of dementia (BPSD). In dementia patients the comorbidity with PTSD may be high and we suggest that worldwide the impact of PTSD in dementia is high and probably underestimated. Research and care on this topic should improve urgently with the current expanding prevalence of dementia. A first step to improve quality of dementia research and care would be to develop a structured tool to diagnose PTSD in these patients.
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Affiliation(s)
- Sjacko Sobczak
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands.,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, Maastricht, The Netherlands
| | - Miranda Olff
- Arq Psychotrauma Research, AMC/University of Amsterdam, Amterdam
| | - Bart Rutten
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
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10
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Song H, Sieurin J, Wirdefeldt K, Pedersen NL, Almqvist C, Larsson H, Valdimarsdóttir UA, Fang F. Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases. JAMA Neurol 2021; 77:700-709. [PMID: 32150226 DOI: 10.1001/jamaneurol.2020.0117] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Posttraumatic stress disorder (PTSD) has been associated with increased risk for dementia. Less is known, however, about other stress-related disorders and their associations with neurodegenerative diseases. Objective To examine the association between stress-related disorders and risk for neurodegenerative diseases. Design, Setting, and Participants This population-matched and sibling cohort study was conducted in Sweden using data from nationwide health registers, including the Swedish National Patient Register. Individuals who received their first diagnosis of stress-related disorders between January 1, 1987, and December 31, 2008, were identified. Individuals who had a history of neurodegenerative diseases, had conflicting or missing information, had no data on family links, or were aged 40 years or younger at the end of the study were excluded. Individuals with stress-related disorders were compared with the general population in a matched cohort design; they were also compared with their siblings in a sibling cohort. Follow-up commenced from the age of 40 years or 5 years after the diagnosis of stress-related disorders, whichever came later, until the first diagnosis of a neurodegenerative disease, death, emigration, or the end of follow-up (December 31, 2013), whichever occurred first. Data analyses were performed from November 2018 to April 2019. Exposures Diagnosis of stress-related disorders (PTSD, acute stress reaction, adjustment disorder, and other stress reactions). Main Outcomes and Measurements Neurodegenerative diseases were identified through the National Patient Register and classified as primary or vascular. Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis were evaluated separately. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% CIs after controlling for multiple confounders. Results The population-matched cohort included 61 748 exposed individuals and 595 335 matched unexposed individuals. A total of 44 839 exposed individuals and their 78 482 unaffected full siblings were included in the sibling cohort analysis. The median (interquartile range) age at the start of follow-up was 47 (41-56) years, and 24 323 (39.4%) of the exposed individuals were male. The median (interquartile range) follow-up was 4.7 (2.1-9.8) years. Compared with unexposed individuals, individuals with a stress-related disorder were at an increased risk of neurodegenerative diseases (HR, 1.57; 95% CI, 1.43-1.73). The risk increase was greater for vascular neurodegenerative diseases (HR, 1.80; 95% CI, 1.40-2.31) than for primary neurodegenerative diseases (HR, 1.31; 95% CI, 1.15-1.48). A statistically significant association was found for Alzheimer disease (HR, 1.36; 95% CI, 1.12-1.67) but not Parkinson disease (HR, 1.20; 95% CI, 0.98-1.47) or amyotrophic lateral sclerosis (HR, 1.20; 95% CI, 0.74-1.96). Results from the sibling cohort corroborated results from the population-matched cohort. Conclusions and Relevance This study showed an association between stress-related disorders and an increased risk of neurodegenerative diseases. The relative strength of this association for vascular neurodegenerative diseases suggests a potential cerebrovascular pathway.
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Affiliation(s)
- Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Sieurin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, University of Southern California, Los Angeles
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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11
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Sun Y, Qu Y, Zhu J. The Relationship Between Inflammation and Post-traumatic Stress Disorder. Front Psychiatry 2021; 12:707543. [PMID: 34456764 PMCID: PMC8385235 DOI: 10.3389/fpsyt.2021.707543] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Stress disorders, such as post-traumatic stress disorder (PTSD), are attracting much attention. However, the relationship between traumatic stress and inflammation is rarely discussed. Subjects and Methods: As studies have linked PTSD to altered susceptibility to various diseases, such a psychiatric condition may lead to long-term systematic changes in physiological functions. We searched PubMed with the keywords "traumatic stress," "stress disorders," "post-traumatic stress disorder," and "inflammation." Results: Based on 65 previously published studies, we reviewed the long-term effects of PTSD, as well as traumatic events, on inflammatory function from both epidemiological and biological perspectives. Post-traumatic stress disorder is related to the immune response, including an increase in inflammatory factors and a reduction in anti-inflammatory factors. Additionally, it has been demonstrated that traumatic stress disorder and immune disease share a common genetic basis at the gene expression level. Conclusions: Understanding this relationship is of great significance for optimizing treatment plans for patients with PTSD.
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Affiliation(s)
- Yajing Sun
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jianwei Zhu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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12
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Anand A, Ghani A, Sharma K, Kaur G, Khosla R, Devi C, Podder V, Sivapuram MS, Maity K, Kaur H. War-Related Mental Health Issues and Need for Yoga Intervention Studies: A Scoping Review. Int J Yoga 2021; 14:175-187. [PMID: 35017859 PMCID: PMC8691442 DOI: 10.4103/ijoy.ijoy_60_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
Conflicts and humanitarian crises lead to serious mental health disorders, including depression, anxiety, stress, and cognitive decline. Exposure to these circumstances in early life can lead to the development of disorders such as mild cognitive impairment, dementia, and Alzheimer's disease (AD), for which no treatments are available. In this review, various research papers have been compiled to develop an understanding about mental health of population affected due to wars and conflicts and how stress and depression can accelerate the development of dementia and AD. Due to failure of drugs in the treatment of dementia and AD, yoga and mindfulness-based approach has been proposed for future investigations. Although studies have shown that yoga and mindfulness can be helpful in the management of stress, anxiety, depression, and posttraumatic stress disorder in the war-afflicted areas, limited mechanistic studies in yoga and mindfulness remain the chief cause precluding its clinical application in such warzones. The molecular studies in the field of yoga can be undertaken by targeting these warzones. This review provides a scientific evaluation of mind-body techniques as a justification for mental health rehabilitation in the war-afflicted zones in face of failed clinical trials for various drugs. This may help reduce the risk of developing dementia and AD in this susceptible population.
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Affiliation(s)
- Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India,CCRYN Center for Mind Body Interventions through Yoga PGIMER, Chandigarh, India,Centre for Cognitive Sciences and Phenomenology, Panjab University, Chandigarh, India,Address for correspondence: Prof. Akshay Anand, Department of Neurology, Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Abdul Ghani
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanupriya Sharma
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Gurkeerat Kaur
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Radhika Khosla
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Chandra Devi
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Vivek Podder
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India
| | - Madhava S. Sivapuram
- Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
| | - Kalyan Maity
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - Harmandeep Kaur
- Department of Physical Education, Panjab University, Chandigarh, India
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13
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Alper HE, Tuly RA, Seil K, Brite J. Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197330. [PMID: 33049920 PMCID: PMC7579594 DOI: 10.3390/ijerph17197330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.
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Affiliation(s)
- Howard E. Alper
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
- Correspondence: ; Tel.: +1-718-786-4387; Fax: +1-718-786-4006
| | - Rifat A. Tuly
- School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Kacie Seil
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
| | - Jennifer Brite
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
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14
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Seelye A, Leese MI, Dorociak K, Bouranis N, Mattek N, Sharma N, Beattie Z, Riley T, Lee J, Cosgrove K, Fleming N, Klinger J, Ferguson J, Lamberty GJ, Kaye J. Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study. JMIR Form Res 2020; 4:e16371. [PMID: 32310138 PMCID: PMC7308933 DOI: 10.2196/16371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. OBJECTIVE This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. METHODS Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants' environments for 12 months between clinical study visits. RESULTS Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants' homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. CONCLUSIONS Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples.
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Affiliation(s)
- Adriana Seelye
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Mira Isabelle Leese
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Katherine Dorociak
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Nicole Bouranis
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Nora Mattek
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Nicole Sharma
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Thomas Riley
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Jonathan Lee
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Kevin Cosgrove
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Nicole Fleming
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
| | - Jessica Klinger
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - John Ferguson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Greg John Lamberty
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Portland, OR, United States
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15
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Dieter JN, Engel SD. Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War. Neurosci Insights 2019; 14:1179069519892933. [PMID: 32363347 PMCID: PMC7176398 DOI: 10.1177/1179069519892933] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
Scientific literature is reviewed supporting a “consequence of war syndrome (CWS)” in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn soldiers. CWS constituents include chronic pain and insomnia, other physical complaints, posttraumatic stress disorder (PTSD), anxiety, depression, and neuropsychological deficits. The foundation of CWS lies with the chronic stressors inherent to deployment and the cascade of biological events mediated and maintained by hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Such dysregulation is modified by the individual’s specific experiences at war, difficulty reintegrating to post-deployment life, and the onset or exacerbation of the chronic and comorbid physical, emotional, and cognitive disorders. The circuit network between the prefrontal cortex (PFC), amygdala, and hippocampus is particularly sensitive to the consequences of war. The review’s specific conclusions are as follows: HPA axis dysregulation contributes to the chronic insomnia and hyperarousal seen in soldiers. There is considerable symptom overlap between PTSD and blast-related head injury, and it is difficult to determine the relative contributions of the two disorders to abnormal imaging studies. In some cases, traumatic brain injury (TBI) may directly precipitate PTSD symptoms. While not intuitive, the relationship between TBI and postconcussion syndrome appears indirect and mediated through PTSD. Blast-related or conventional head injury may have little long-term impact on neuropsychological functioning; contrarily, PTSD particularly accounts for current cognitive deficits. The psychological experience of CWS includes a “war-within” where soldiers continue to battle an internalized enemy. Successful treatment of CWS entails transdisciplinary care that addresses each of the constituent disorders.
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Affiliation(s)
- John Ni Dieter
- Intrepid Spirit Center, Carl R. Darnall Army Medical Center, U.S. Army, Fort Hood, TX, USA
| | - Scot D Engel
- Intrepid Spirit Center, Carl R. Darnall Army Medical Center, U.S. Army, Fort Hood, TX, USA
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16
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Averill LA, Abdallah CG, Levey DF, Han S, Harpaz-Rotem I, Kranzler HR, Southwick SM, Krystal JH, Gelernter J, Pietrzak RH. Apolipoprotein E gene polymorphism, posttraumatic stress disorder, and cognitive function in older U.S. veterans: Results from the National Health and Resilience in Veterans Study. Depress Anxiety 2019; 36:834-845. [PMID: 31385647 DOI: 10.1002/da.22912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/13/2019] [Accepted: 04/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although the ε4 allele of the apolipoprotein E (APOE) gene and posttraumatic stress disorder (PTSD) have been linked to cognitive dysfunction and dementia risk, it is unknown whether they interact to predict cognitive dysfunction. METHODS We analyzed data from European-American (EA) veterans who participated in the National Health and Resilience in Veterans Study (NHRVS): main sample (n = 1,386) and primary replication sample (n = 509). EAs from the Yale-Penn Study cohort (n = 948) served as a second replication sample. Multivariable analyses were conducted to evaluate the predictive effects of ε4 carrier status and PTSD on cognitive functioning, with a focus on whether PTSD moderates the effect of ε4 carrier status. RESULTS APOE ε4 allele carrier status (d = 0.15 and 0.17 in the main and primary replication NHRVS samples, respectively) and PTSD (d = 0.31 and 0.17, respectively) were independently associated with lower cognitive functioning. ε4 carriers with PTSD scored lower than those without PTSD (d = 0.68 and 1.29, respectively) with the most pronounced differences in executive function (d's = 0.75-1.50) and attention/concentration (d's = 0.62-1.33). A significant interaction was also observed in the Yale-Penn sample, with ε4 carriers with PTSD making more perseverative errors on a measure of executive function than those without PTSD (24.7% vs. 17.6%; d = 0.59). CONCLUSIONS APOE ε4 allele carriers with PTSD have substantially greater cognitive difficulties than ε4 carriers without PTSD. These results underscore the importance of assessing, monitoring, and treating PTSD in trauma-affected individuals who are at genetic risk for cognitive decline and dementia.
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Affiliation(s)
- Lynnette A Averill
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Chadi G Abdallah
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel F Levey
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Departments of Genetics and Neurobiology, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Shizhong Han
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Henry R Kranzler
- Department of Psychiatry, Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Veterans Integrated Service Network 4 Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Steven M Southwick
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Joel Gelernter
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Departments of Genetics and Neurobiology, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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17
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Mohlenhoff BS, Insel PS, Mackin RS, Neylan TC, Flenniken D, Nosheny R, Richards A, Maruff P, Weiner MW. Total Sleep Time Interacts With Age to Predict Cognitive Performance Among Adults. J Clin Sleep Med 2018; 14:1587-1594. [PMID: 30176964 DOI: 10.5664/jcsm.7342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate interactions between high and low amounts of sleep and other predictors of cognitive performance. METHODS We used four cognitive tests to determine whether sleep time interacted with age, personal history of a memory problem, parental history of a memory problem, or personal concerns about memory and were associated with cognitive performance. Data were collected from an internet-based cohort study. We used an ordinary least squares regression with restricted cubic splines, controlling for demographic variables and comorbidities. RESULTS We found significant nonlinear interactions between (1) total sleep time and age and (2) total sleep time and personal history of a memory problem and cognitive performance. Short and long sleep durations and self-reported memory complaints were associated with poorer performance on a test of attention and this was true to a greater degree in younger and older adults. A repeat analysis excluding subjects reporting dementia was significant only for the test of attention. CONCLUSIONS These results extend existing data on sleep duration and cognition across the lifespan by combining in a single study the results from four specific cognitive tests, both younger and older adults, and four self-reported risk factors for cognitive impairment. Longitudinal studies with biomarkers should be undertaken to determine whether causal mechanisms, such as inflammation or amyloid buildup, account for these associations.
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Affiliation(s)
- Brian S Mohlenhoff
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Philip S Insel
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, Veterans Health Research Institute (NCIRE), San Francisco, California
| | - R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,San Francisco Veterans Affairs Medical Center, Veterans Health Research Institute (NCIRE), San Francisco, California
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Derek Flenniken
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,San Francisco Veterans Affairs Medical Center, Veterans Health Research Institute (NCIRE), San Francisco, California
| | - Rachel Nosheny
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,San Francisco Veterans Affairs Medical Center, Veterans Health Research Institute (NCIRE), San Francisco, California
| | - Anne Richards
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Paul Maruff
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Cogstate, Ltd., Melbourne, Victoria, Australia
| | - Michael W Weiner
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco, California.,Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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18
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Abstract
PURPOSE OF REVIEW Posttraumatic stress disorder (PTSD) is characterized by hyperarousal and recurrent stressful memories after an emotionally traumatic event. Extensive research has been conducted to identify the neurobiological determinants that underlie the pathophysiology of PTSD. In this review, we examine evidence regarding the molecular and cellular pathophysiology of PTSD focusing on two primary brain regions: the vmPFC and the amygdala. RECENT FINDINGS This discussion includes a review of the molecular alterations related to PTSD, focusing mainly on changes to glucocorticoid receptor signaling. We also examine postmortem gene expression studies that have been conducted to date and the molecular changes that have been observed in peripheral blood studies of PTSD patients. Causal, mechanistic evidence is difficult to obtain in human studies, so we also review preclinical models of PTSD. Integration of peripheral blood and postmortem studies with preclinical models of PTSD has begun to reveal the molecular changes occurring in patients with PTSD. These findings indicate that the pathophysiology of PTSD includes disruption of glucocorticoid signaling and inflammatory systems and occurs at the level of altered gene expression. We will assess the impact of these findings on the future of PTSD molecular research.
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Affiliation(s)
- Matthew J Girgenti
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Center for Genes and Behavior, Yale University School of Medicine, New Haven, CT, 06508, USA
| | - Brendan D Hare
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Center for Genes and Behavior, Yale University School of Medicine, New Haven, CT, 06508, USA
| | - Sriparna Ghosal
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Center for Genes and Behavior, Yale University School of Medicine, New Haven, CT, 06508, USA
| | - Ronald S Duman
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Center for Genes and Behavior, Yale University School of Medicine, New Haven, CT, 06508, USA.
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Abstract
PURPOSE OF REVIEW The aim of this paper is to review the recent literature on traumatic stress-related accelerated aging, including a focus on cellular mechanisms and biomarkers of cellular aging and on the clinical manifestations of accelerated biological aging. RECENT FINDINGS Multiple lines of research converge to suggest that PTSD is associated with accelerated aging in the epigenome, and the immune and inflammation systems, and this may be reflected in premature onset of cardiometabolic and cardiovascular disease. The current state of research paves the way for future work focused on identifying the peripheral and central biological mechanisms linking traumatic stress to accelerated biological aging and medical morbidity, with an emphasis on processes involved in inflammation, immune functioning, oxidative stress, autonomic arousal, and stress response. Ultimately, such work could help reduce the pace of biological aging and improve health and wellness.
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Affiliation(s)
- Erika J Wolf
- National Center for PTSD, VA Boston Healthcare System, (116B-2), 150 South Huntington Ave, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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