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Jagger-Rickels A, Rothlein D, Stumps A, Evans TC, Bernstein J, Milberg W, McGlinchey R, DeGutis J, Esterman M. An executive function subtype of PTSD with unique neural markers and clinical trajectories. Transl Psychiatry 2022; 12:262. [PMID: 35760805 PMCID: PMC9237057 DOI: 10.1038/s41398-022-02011-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Previous work identified a cognitive subtype of PTSD with impaired executive function (i.e., impaired EF-PTSD subtype) and aberrant resting-state functional connectivity between frontal parietal control (FPCN) and limbic (LN) networks. To better characterize this cognitive subtype of PTSD, this study investigated (1) alterations in specific FPCN and LN subnetworks and (2) chronicity of PTSD symptoms. In a post-9/11 veteran sample (N = 368, 89% male), we identified EF subgroups using a standardized neuropsychological battery and a priori cutoffs for impaired, average, and above-average EF performance. Functional connectivity between two subnetworks of the FPCN and three subnetworks of the LN was assessed using resting-state fMRI (n = 314). PTSD chronicity over a 1-2-year period was assessed using a reliable change index (n = 175). The impaired EF-PTSD subtype had significantly reduced negative functional connectivity between the FPCN subnetwork involved in top-down control of emotion and two LN subnetworks involved in learning/memory and social/emotional processing. This impaired EF-PTSD subtype had relatively chronic PTSD, while those with above-average EF and PTSD displayed greater symptom reduction. Lastly, FPCN-LN subnetworks partially mediated the relationship between EF and PTSD chronicity (n = 121). This study reveals (1) that an impaired EF-PTSD subtype has a specific pattern of FPCN-LN subnetwork connectivity, (2) a novel above-average EF-PTSD subtype displays reduced PTSD chronicity, and (3) both cognitive and neural functioning predict PTSD chronicity. The results indicate a need to investigate how individuals with this impaired EF-PTSD subtype respond to treatment, and how they might benefit from personalized and novel approaches that target these neurocognitive systems.
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Affiliation(s)
- Audreyana Jagger-Rickels
- National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA, USA. .,Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - David Rothlein
- grid.410370.10000 0004 4657 1992National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA
| | - Anna Stumps
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.33489.350000 0001 0454 4791Department of Psychological and Brain Sciences, University of Delaware, Newark, DE USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA
| | - Travis Clark Evans
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - John Bernstein
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA
| | - William Milberg
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,grid.410370.10000 0004 4657 1992Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA USA
| | - Regina McGlinchey
- grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,grid.410370.10000 0004 4657 1992Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA USA
| | - Joseph DeGutis
- grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Michael Esterman
- grid.410370.10000 0004 4657 1992National Center for PTSD (NCPTSD), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA ,grid.410370.10000 0004 4657 1992Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA USA ,grid.410370.10000 0004 4657 1992Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA USA
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