Is posttraumatic stress disorder associated with specific deficits in episodic memory?

Neurocognitive difficulties in trauma-exposed adults with metabolic syndrome: no influence of PTSD status or PTSD and metabolic syndrome comorbidity

BACKGROUND

Metabolic syndrome (MetS) and posttraumatic stress disorder (PTSD) often co-occur and both may compromise cognition, owing in part to common underlying mechanisms. Few studies have investigated the additive effects of these disorders on cognitive performance. Our aims were to compare cognitive performance between patients with PTSD and trauma-exposed controls (TEC) and investigate the additive effects of MetS factors on cognition.

METHODS

In this case-control study, we included 474 adult participants, 236 with PTSD and 238 TEC. Demographic, neuropsychiatric, metabolic-related, and neurocognitive assessments were undertaken and MANCOVAs performed controlling for age. Cognitive domains (immediate and delayed memory, attention, language, visuospatial performance, working memory and global cognition) were the dependent variables in the analysis. Patient status and presence/absence of MetS or MetS components were independent variables, in each model.

RESULTS

Patients with PTSD did not demonstrate worse cognitive performance than TEC on the neurocognitive domains assessed, and the presence of MetS in patients with PTSD did not alter this finding. Individuals with MetS also did not demonstrate worse cognition when compared to those without MetS. When we looked at individual MetS features, higher BMI was associated with poorer visuospatial performance, CONCLUSIONS: These findings contrast with many previous studies showing worse neurocognitive performance related to both PTSD and MetS. Further investigation is required to establish the contribution of MetS to cognitive deficits in those with PTSD. Generalisability and inferences regarding the directionality of associations are limited.

Psychological symptoms and brain activity alterations in women with PCOS and their relation to the reduced quality of life: a narrative review

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common feminine endocrine disorder, characterized by androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. The negative impact of symptoms on the quality of life (QoL) of patients is still not clear.

PURPOSE

The present review aimed at studying the impact of the symptoms, the psychological symptoms, and brain alterations in women with PCOS.

METHODS

A systematic search was undertaken for studies that assessed the impact of PCOS symptoms on QoL, psychological symptoms, and brain alterations in PCOS patients.

RESULTS

Most of the information about QoL came from psychometric studies, which used culture-based questionnaires. Alterations of sleep quality, body image, and mood disorders can negatively affect the QoL of the patients. Sexual satisfaction and desire were affected by PCOS. Brain imaging studies showed functional alterations that are associated with impairments of visuospatial working memory, episodic and verbal memory, attention, and executive function.

CONCLUSIONS

Several factors can negatively influence the quality of life of the patients, and they are directly related to hyperandrogenism and the risk of infertility. In particular, obesity, hirsutism, acne, and the fear of infertility can have a direct impact on self-esteem and sexual function. Metabolic and psychiatric comorbidities, such as mood, anxiety, and eating disorders, can affect the well-being of the patients. Moreover, specific cognitive alterations, such as impairments in attention and memory, can limit PCOS patients in a series of aspects of daily life.

Concordance of Posttraumatic Stress Disorder Symptoms Assessed via Retrospective Report Versus Experience Sampling Methods in Community Women Experiencing Intimate Partner Violence

Posttraumatic stress disorder (PTSD) is one of the most prominent negative health consequences that women experiencing intimate partner violence (IPV) may develop. However, research on PTSD among women experiencing IPV has largely relied on retrospective reporting methods, which are vulnerable to bias and may consequently misrepresent PTSD symptoms. This study evaluated the concordance between PTSD symptoms assessed via retrospective self-report and experience sampling methods (ESM), which involve repeated within-day sampling of experiences in near real-time and in natural environments. Community women (N = 134) experiencing IPV (Mage = 40.7, 30.4% Black) responded to ESM surveys three times a day for 30 days and then completed a follow-up interview. Retrospective self-report of PTSD symptoms, which were assessed during the follow-up interview, were compared to ESM reports of PTSD symptoms. Retrospective reports of PTSD symptoms were significantly different from PTSD symptoms reported during the ESM period, but most closely resembled peak PTSD symptoms. Notably, retrospective reports of PTSD symptoms were significantly different, with a very large effect size, from average PTSD symptoms reported during the ESM period. Discordance scores were significantly negatively associated with the number of days on which any IPV occurred, suggesting that as the frequency of IPV experiences increased, differences between retrospective PTSD symptoms and each ESM symptom pattern decreased. This study provides an important contribution to the literature by highlighting meaningful differences in PTSD symptoms assessed via retrospective self-report versus ESM and the role of IPV context. Findings emphasize the importance of utilizing ESM in PTSD research with women experiencing IPV.

Scene Construction and Spatial Processing in Post-traumatic Stress Disorder

Introduction

Post-traumatic stress disorder (PTSD) is associated with hippocampal system structural and functional impairments. Neurobiological models of PTSD posit that contextual memory for traumatic events is impaired due to hippocampal system dysfunction whilst memory of sensory details is enhanced due to amygdalar impact on sensory cortices. If hippocampal system dysfunction is a core feature of PTSD, then non-traumatic hippocampal-dependent cognitive functions such as scene construction, spatial processing, and memory should also be impaired in individuals with PTSD.

Methods

Forty-six trauma survivors, half diagnosed with PTSD, performed two tasks that involved spatial processing. The first was a scene construction task which requires conjuring-up spatially coherent multimodal scenarios, completed by all participants. Twenty-six participants (PTSD: n = 13) also completed a navigation task in a virtual environment, and underwent structural T1, T2 and diffusion-tensor MRI to quantify gray and white matter integrity. We examined the relationship between spatial processing, neural integrity, and symptom severity in a multiple factor analysis.

Results

Overall, patients with PTSD showed impaired performance in both tasks compared to controls. Scenes imagined by patients were less vivid, less detailed, and generated less sense of presence; importantly they had disproportionally reduced spatial coherence between details. Patients also made more errors during virtual navigation. Two components of the multiple factor analysis captured group differences. The first component explained 25% of the shared variance: participants that constructed less spatially coherent scenes also made more navigation errors and had reduced white matter integrity to long association tracts and tracts connecting the hippocampus, thalamus, and cingulate. The second component explained 20% of the variance: participants who generated fewer scene details, with less spatial coherence between them, had smaller hippocampal, parahippocampal and isthmus cingulate volumes. These participants also had increased white matter integrity to the right hippocampal cingulum bundle.

Conclusion

Our results suggest that patients with PTSD are impaired at imagining even neutral spatially coherent scenes and navigating through a complex spatial environment. Patients that showed reduced spatial processing more broadly had reduced hippocampal systems volumes and abnormal white matter integrity to tracts implicated in multisensory integration.

Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting

OBJECTIVE

Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome.

METHODS

Adults with serious mental illness and sleep and circadian dysfunction (N = 99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up.

RESULTS

Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome.

CONCLUSIONS

The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.

Using a wearable camera to support everyday memory following brain injury: a single-case study

Background:

Wearable cameras have been shown to improve memory in people with hippocampal amnesia and Alzheimer's disease. It is not known whether this benefit extends to people with amnesia of complex or uncertain origin.

Method:

This case study examined the effect of wearable camera use on memory and occupational performance in a patient with memory loss and complex mental health problems following a severe neurological incident. With the help of his occupational therapist (OT), Mr A used a wearable camera to record a series of eight personally significant events over a 6-week period. During visits from his OT, Mr A was asked to report what he could remember about the events, both before (baseline) and during the review of time-lapsed photographs captured automatically by the camera.

Results:

The results showed striking improvements in recall while reviewing the photographs, relative to baseline recall, but the additional details recalled during review did not appear to be maintained at later tests, after several days. Across the study period, there were moderate increases in occupational performance, measured using the Canadian Occupational Performance Measure. However, after the study period ended, Mr A ceased to use the wearable camera due to technological difficulty.

Conclusion:

There was a clear benefit of wearable camera use, but the real-world impact of the technology was limited by the complexity of the system. The results of the study are discussed alongside novel clinical insights and suggestions for developing wearable camera support systems that can be used independently by people with memory problems.

Posttraumatic Stress Disorder-Associated Cognitive Deficits on the Repeatable Battery for the Assessment of Neuropsychological Status in a Veteran Population

Background

Posttraumatic stress disorder (PTSD) is a frequent problem of veterans receiving care and is often associated with cognitive deficits. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well-validated cognitive screening measure often used in the US Department of Veterans Affairs (VA), particularly in neurorehabilitation settings. However, the influence of PTSD on RBANS performance is unclear, particularly within a heterogeneous VA outpatient population in which PTSD and traumatic brain injury (TBI) may not be the primary focus of care.

Methods

Participants included 153 veterans with complex deployment-related health problems, including a diagnosis of PTSD (n = 98) and a history of TBI (n = 92). All veterans completed a targeted cognitive battery that included the Wechsler Test of Adult Reading, the Wechsler Adults Intelligence Scale, measure assessing processing speed, attention, and cognitive flexibility, and RBANS.

Results

A diagnosis of PTSD was associated with worse performance on the Story Recall subtest of the RBANS, but not on any other cognitive measures. A diagnosis of mild TBI, or co-occurring PTSD and TBI did not predict cognitive performance on any measures.

Conclusions

The RBANS best captured cognitive deficits associated with PTSD compared with a history of mild TBI or co-occurring mild TBI and PTSD. These findings may provide insight into the interpretation and attribution of cognitive deficits in the veteran population.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak. Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity. Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress. Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

What can directed forgetting tell us about clinical populations?

This paper reviews and critically assesses the implications of directed forgetting (DF) research on clinical populations. We begin by reviewing the typical methods and results of the item method and list method directed forgetting procedures and provide best practice recommendations for future studies using clinical populations. Next, we note that DF was often interpreted as being due to inhibition, and when clinical populations showed impaired directed forgetting, it was treated as evidence in inhibitory control difficulties. However, inhibition may not be the cause of DF effects, based on current understanding of these cognitive tasks. We instead suggest that item method DF is tied to attentional control, which might include inhibitory mechanisms (or might not). In contrast, list method DF is tied to two forms of memory control: control of mental context (indicated by effective forgetting of List 1), and changes in the strategies used to remember (indicated by better learning of List 2). We review the current state of the clinical DF literature, assess its strength based on our best practice recommendations, and call for more research when warranted.

Impaired hippocampus-dependent associative learning as a mechanism underlying PTSD: A meta-analysis

Smaller hippocampal volume is associated with increased risk for PTSD following trauma, but the hippocampal functions involved remain unknown. We propose a conceptual model that identifies broad impairment in hippocampus-dependent associative learning as a vulnerability factor for PTSD. Associative learning of foreground cues and background context is required to form an integrated representation of an event. People with poor associative learning may have difficulty remembering who or what was present during a trauma, where the trauma occurred, or the sequence of events, which may contribute to PTSD symptoms. We argue that associative learning difficulties in PTSD exist for cues and context, regardless of the emotional nature of the information. This contrasts with PTSD models that focus exclusively on threat-processing or contextual-processing. In a meta-analysis, people with PTSD exhibited poor associative learning of multiple information types compared to those without PTSD. Differences were of medium effect size and similar magnitude for neutral and negative/trauma-related stimuli. We provide evidence for associative learning difficulties as a neurocognitive pathway that may contribute to PTSD.

Expansion of hippocampal and amygdala shape in posttraumatic stress and early life stress

OBJECTIVE

The aim of this study was to examine the effect of Posttraumatic Stress Disorder (PTSD) and childhood adversity on brain structure. We assessed hippocampal and amygdala shape in veterans with varying levels of PTSD symptom severity and exposure to early life stressors (ELS).

METHODS

A total of 70 male veterans, who were deployed to a combat area during OIF/OEF/OND and who had been exposed to trauma during deployment, were included in the study. We applied a vertex-wise shape analysis of 3T MRI scans to measure indentation or expansion in hippocampal and amygdala shape.

RESULTS

Analyses showed a positive correlation between number of ELS and vertices in the right amygdala and the right hippocampus, as well as a positive correlation between PTSD symptom severity and right hippocampal vertices. There were no significant interactions between PTSD symptoms, ELS, and brain shape.

DISCUSSION

Results indicate a relationship between exposure to more childhood adversity and expansion in amygdala and hippocampal shape as well as between more severe PTSD symptoms and expansion in hippocampal shape. These findings may have important implications for the pathophysiology of trauma-related disorders.

Deficits in episodic memory and mental time travel in patients with post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is characterized by impairments in mnestic functions, especially in the domain of episodic memory. These alterations might affect different aspects of episodic memory functioning. Here we tested PTSD patients and healthy controls (matched for age, sex and education) in a newly developed virtual reality episodic memory test (VR-EMT), a test for mental time travel, episodic future thinking, and prospective memory (M3xT). In a cross-validation experiment, their performance was further evaluated in the Rivermead Behavioral Memory Test (RBMT). PTSD patients demonstrated impairments in episodic memory formation and mental time travel and showed difficulties in utilizing information from episodic memory to solve problems. Diminished attention and concentration in PTSD did not account for performance deficits in these tasks but higher levels of negative arousal were found in PTSD patients. Furthermore, performance in the VR-EMT and RBMT in PTSD patients correlated negatively with self-reported measures of stress and depression. Our results suggest that deficits in episodic memory formation and mental time travel in PTSD lead to difficulties in utilizing the content of episodic memories for solving problems in the present or to plan future behavior. Clinical implications of these findings and suggestions for cognitive-behavioral treatment of PTSD are discussed.

Patient recall of specific cognitive therapy contents predicts adherence and outcome in adults with major depressive disorder

The current study examined whether and which specific contents of patients' memory for cognitive therapy (CT) were associated with treatment adherence and outcome. Data were drawn from a pilot RCT of forty-eight depressed adults, who received either CT plus Memory Support Intervention (CT + Memory Support) or CT-as-usual. Patients' memory for treatment was measured using the Patient Recall Task and responses were coded into cognitive behavioral therapy (CBT) codes, such as CBT Model and Cognitive Restructuring, and non-CBT codes, such as individual coping strategies and no code. Treatment adherence was measured using therapist and patient ratings during treatment. Depression outcomes included treatment response, remission, and recurrence. Total number of CBT codes recalled was not significantly different comparing CT + Memory Support to CT-as-usual. Total CBT codes recalled were positively associated with adherence, while non-CBT codes recalled were negatively associated with adherence. Treatment responders (vs. non-responders) exhibited a significant increase in their recall of Cognitive Restructuring from session 7 to posttreatment. Greater recall of Cognitive Restructuring was marginally significantly associated with remission. Greater total number of CBT codes recalled (particularly CBT Model) was associated with non-recurrence of depression. Results highlight the important relationships between patients' memory for treatment and treatment adherence and outcome.

Working memory function is linked to trauma exposure, independently of post-traumatic stress disorder symptoms

INTRODUCTION

The purpose of the study was to examine how working memory (WM) may be related to exposure to potentially traumatic events and symptoms of post-traumatic stress disorder (PTSD).

METHOD

In four studies, we measured WM function using adaptations of the running span and the reading span tasks. We compared the performance of women reporting experiences of sexual abuse to control participants (total n = 144 controls and 84 victims). We measured severity of the sexual abuse experiences as well as exposure to general life stress.

RESULTS

In all studies, trauma-exposed participants showed significantly lower WM function compared to control participants. In addition to traditional null hypothesis testing, we used a mini-meta analysis to estimate the combined estimated effect size of this difference, which was in the moderate range (d = 0.43 with 0.15-0.70 95% confidence interval). Regression equations showed that PTSD symptoms did not mediate the relationship between trauma exposure and WM function.

CONCLUSIONS

Our results show that trauma exposure per se can be associated with important cognitive correlates even in individuals who do not develop psychopathological reactions.

The Effect of Trier Social Stress Test (TSST) on Item and Associative Recognition of Words and Pictures in Healthy Participants

Psychological stress, induced by the Trier Social Stress Test (TSST), has repeatedly been shown to alter memory performance. Although factors influencing memory performance such as stimulus nature (verbal/pictorial) and emotional valence have been extensively studied, results whether stress impairs or improves memory are still inconsistent. This study aimed at exploring the effect of TSST on item versus associative memory for neutral, verbal, and pictorial stimuli. 48 healthy subjects were recruited, 24 participants were randomly assigned to the TSST group and the remaining 24 participants were assigned to the control group. Stress reactivity was measured by psychological (subjective state anxiety ratings) and physiological (Galvanic skin response recording) measurements. Subjects performed an item-association memory task for both stimulus types (words, pictures) simultaneously, before, and after the stress/non-stress manipulation. The results showed that memory recognition for pictorial stimuli was higher than for verbal stimuli. Memory for both words and pictures was impaired following TSST; while the source for this impairment was specific to associative recognition in pictures, a more general deficit was observed for verbal material, as expressed in decreased recognition for both items and associations following TSST. Response latency analysis indicated that the TSST manipulation decreased response time but at the cost of memory accuracy. We conclude that stress does not uniformly affect memory; rather it interacts with the task’s cognitive load and stimulus type. Applying the current study results to patients diagnosed with disorders associated with traumatic stress, our findings in healthy subjects under acute stress provide further support for our assertion that patients’ impaired memory originates in poor recollection processing following depletion of attentional resources.

The development and validation of the Memory Support Rating Scale

Patient memory for treatment information is poor, and worse memory for treatment information is associated with poorer clinical outcomes. Memory support techniques have been harnessed to improve patient memory for treatment. However, a measure of memory support used by treatment providers during sessions has yet to be established. The present study reports on the development and psychometric properties of the Memory Support Rating Scale (MSRS)-an observer-rated scale designed to measure memory support. Adults with major depressive disorder (MDD; N = 42) were randomized to either cognitive therapy plus memory support (CT + MS; n = 22) or cognitive therapy as-usual (CT-as-usual; n = 20). At posttreatment, patients freely recalled treatment points via the patient recall task. Sessions (n = 171) were coded for memory support using the MSRS, 65% of which were also assessed for the quality of cognitive therapy via the Cognitive Therapy Rating Scale (CTRS). A unidimensional scale composed of 8 items was developed using exploratory factor analysis, though a larger sample is needed to further assess the factor structure of MSRS scores. High interrater and test-retest reliabilities of MSRS scores were observed across 7 MSRS coders. MSRS scores were higher in the CT + MS condition compared with CT-as-usual, demonstrating group differentiation ability. MSRS scores were positively associated with patient recall task scores but not associated with CTRS scores, demonstrating convergent and discriminant validity, respectively. Results indicate that the MSRS yields reliable and valid scores for measuring treatment providers' use of memory support while delivering cognitive therapy. (PsycINFO Database Record

Negative Emotional Arousal Impairs Associative Memory Performance for Emotionally Neutral Content in Healthy Participants

The effect of emotional arousal on memory presents a complex pattern with previous studies reporting conflicting results of both improved and reduced memory performance following arousal manipulations. In this study we further tested the effect of negative emotional arousal (NEA) on individual-item recognition and associative recognition of neutral stimuli in healthy participants, and hypothesized that NEA will particularly impair associative memory performance. The current study consists of two experiments; in both, participants studied a list of word-pairs and were then tested for items (items recognition test), and for associations (associative recognition test). In the first experiment, the arousal manipulation was induced by flashing emotionally-negative or neutral pictures between study-pairs while in the second experiment arousal was induced by presenting emotionally-negative or neutral pictures between lists. The results of the two experiments converged and supported an associative memory deficit observed under NEA conditions. We suggest that NEA is associated with an altered ability to bind one stimulus to another as a result of impaired recollection, resulting in poorer associative memory performance. The current study findings may contribute to the understanding of the mechanism underlying memory impairments reported in disorders associated with traumatic stress.

A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.

A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.

Objective neuropsychological deficits in post-traumatic stress disorder and mild traumatic brain injury: what remains beyond symptom similarity?

This exploratory study intends to characterize the neuropsychological profile in persons with post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) using objective measures of cognitive performance. A neuropsychological battery of tests for attention, memory and executive functions was administered to four groups: PTSD (n = 25), mTBI (n = 19), subjects with two formal diagnoses: Post-traumatic Stress Disorder and Mild Traumatic Brain Injury (mTBI/PTSD) (n = 6) and controls (n = 25). Confounding variables, such as medical, developmental or neurological antecedents, were controlled and measures of co-morbid conditions, such as depression and anxiety, were considered. The PTSD and mTBI/PTSD groups reported more anxiety and depressive symptoms. They also presented more cognitive deficits than the mTBI group. Since the two PTSD groups differ in severity of PTSD symptoms but not in severity of depression and anxiety symptoms, the PTSD condition could not be considered as the unique factor affecting the results. The findings underline the importance of controlling for confounding medical and psychological co-morbidities in the evaluation and treatment of PTSD populations, especially when a concomitant mTBI is also suspected.

Clinical and neuropsychological predictors of posttraumatic stress disorder

Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity.One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD.Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive.These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.

Memory for therapy in bipolar disorder and comorbid insomnia

OBJECTIVE

To examine the extent to which patients recall the contents of therapy from 1 session to the next and to determine whether recall is associated with treatment outcome.

METHOD

Thirty interepisode individuals with bipolar disorder and comorbid insomnia (ages 21-62 years, 56.7% women, 56.7% Caucasian) participated in a randomized controlled trial of psychotherapies. Patients received either cognitive behavior therapy for insomnia (CBTI-BP; n = 17) or psychoeducation (PE; n = 13). At the beginning of each weekly session, patients freely recalled as many therapy points (i.e., distinct ideas, principles, and experiences) as they could from their previous session. After each session, therapists recorded a list of all therapy points delivered. Treatment outcome was measured via the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index, Patient-Reported Outcome Measurement Info System-Sleep, and Quality of Life-Sleep (QOL-Sleep), administered pre- and posttreatment, and treatment evaluation questions administered posttreatment.

RESULTS

Patients recalled 19.6% to 36.9% of therapy points listed by therapists. Raw numbers of therapy points recalled were positively correlated with reductions in ISI scores and gains in QOL-Sleep and with most treatment evaluation questions. Percentages of therapy points recalled were positively correlated with gains in QOL-Sleep but with no other sleep outcome measures or any of the treatment evaluation questions. Patients in CBTI-BP recalled more therapy points than did those in PE but did not differ in the percentages of points recalled.

CONCLUSIONS

Memory for therapy is poor. The amount of content recalled is positively associated with treatment outcome. Enhancing memory for therapy might play a key role in improving treatment outcome.

Episodic memories in anxiety disorders: clinical implications

The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.

Improving Outcome of Psychosocial Treatments by Enhancing Memory and Learning

Mental disorders are prevalent and can lead to significant impairment. Some progress has been made toward establishing treatments; however, effect sizes are small to moderate, gains may not persist, and many patients derive no benefit. Our goal is to highlight the potential for empirically supported psychosocial treatments to be improved by incorporating insights from cognitive psychology and research on education. Our central question is: If it were possible to improve memory for the content of sessions of psychosocial treatments, would outcome substantially improve? We leverage insights from scientific knowledge on learning and memory to derive strategies for transdiagnostic and transtreatment cognitive support interventions. These strategies can be applied within and between sessions and to interventions delivered via computer, the Internet, and text message. Additional novel pathways to improving memory include improving sleep, engaging in exercise, and using imagery. Given that memory processes change across the lifespan, services to children and older adults may benefit from different types and amounts of cognitive support.

Understanding heterogeneity in PTSD: fear, dysphoria, and distress

Fear, dysphoria, and distress are prominent components in the conceptualization of posttraumatic stress disorder (PTSD). However, because our diagnostic categories are open concepts, relying on observed patterns of symptoms for classification, it is unclear whether these components represent core or auxiliary features of the disorder. Convergence across multiple indices is critical for this understanding. In this paper, we examine these components of PTSD across observed symptom patterns, broader theoretical conceptualizations, underlying information processing mechanisms of attention and memory, and underlying learning and neurobiological mechanisms. For each, evidence for similarity or distinctiveness of PTSD with other anxiety disorders and depression is examined. Throughout the review, key points of similarity to the anxiety disorders and divergence with depression argue for a distinction between core fear symptoms and auxiliary dysphoria and distress symptoms. Implications are discussed, noting that, as heterogeneity increases, core characteristics will become more diffused and ancillary constructs will gain an inflated degree of importance.

Reduced corpus-callosum volume in posttraumatic stress disorder highlights the importance of interhemispheric connectivity for associative memory

Memory deficits are a common complaint of patients with posttraumatic stress disorder (PTSD). Despite vivid trauma-related memory, previous studies report memory impairment for nontrauma-related stimuli when compared to controls, specifically in associative memory (Guez et al., 2011). Healthy individuals show hemispheric memory asymmetry with left-prefrontal lateralization of encoding and right-prefrontal lateralization of episodic retrieval, suggesting a role for interhemispheric communication in memory-related tasks (Gazzaniga, ; Ringo, Doty, Demeter, & Simard, ). Because brain magnetic resonance imaging (bMRI) studies in PTSD patients report volume changes in various regions, including white matter and corpus callosum (CC), we aimed to test the relationship between memory deficits and CC volume in PTSD patients. We probed for specific alterations in associative memory in PTSD and measured the volume of subportions within the CC employing bMRI. Our main finding was a reduction in CC white-matter volume in PTSD patients, as compared to controls, t(35) = -2.7, p = .010, that was correlated with lower associative performance (r = .76, p = .003). We propose that CC volume reduction is a substrate for the associative memory deficits found in PTSD.

Associative memory impairment in acute stress disorder: characteristics and time course

Stress and episodic memory impairment have previously been associated. Acute stress disorder (ASD) is a maladaptive stress response, which develops in some individuals following traumatic life events. Recently, the authors demonstrated a specific deficit in associative memory for emotionally neutral stimuli in ASD and posttraumatic stress disorder (PTSD). This study further tested the relationship between this memory impairment and the course of ASD. We assessed new learning and memory for item and associative information in patients diagnosed with ASD (n=14) and matched trauma naïve controls (n=14). Memory performance and posttraumatic symptoms were examined for approximately 1 and 10 week periods following the traumatic experience. In the two experiments, participants studied a list of stimuli pairs (verbal or visual) and were then tested for their memory of the items (item recognition test), or for the association between items in each pair (associative recognition test). In both experiments, ASD patients showed a marked associative memory deficit compared to the control group. After 10 weeks, ASD symptoms were resolved in most patients. Interestingly, their performance on associative recognition for verbal stimuli improved, while the associative deficit for visual stimuli remained unchanged. Potential mechanisms underlying such an associative memory deficit in post-trauma patients are discussed.

The basolateral amygdala is critical for learning about neutral stimuli in the presence of danger, and the perirhinal cortex is critical in the absence of danger

The perirhinal cortex (PRh) and basolateral amygdala (BLA) appear to mediate distinct aspects of learning and memory. Here, we used rats to investigate the involvement of the PRh and BLA in acquisition and extinction of associations between two different environmental stimuli (e.g., a tone and a light) in higher-order conditioning. When both stimuli were neutral, infusion of the GABAA, muscimol, or the NMDA receptor (NMDAR) antagonist ifenprodil into the PRh impaired associative formation. However, when one stimulus was neutral and the other was a learned danger signal, acquisition and extinction of the association between them was unaffected by manipulations targeting the PRh. Temporary inactivation of the BLA had the opposite effect: formation and extinction of an association between two stimuli was spared when both stimuli were neutral, but impaired when one stimulus was a learned danger signal. Subsequent experiments showed that the experience of fear per se shifts processing of an association between neutral stimuli from the PRh to the BLA. When training was conducted in a dangerous environment, formation and extinction of an association between neutral stimuli was impaired by BLA inactivation or NMDAR blockade in this region, but was unaffected by PRh inactivation. These double dissociations in the roles of the PRh and BLA in learning under different stimulus and environmental conditions imply that fear-induced activation of the amygdala changes how the brain processes sensory stimuli. Harmless stimuli are treated as potentially harmful, resulting in a shift from cortical to subcortical processing in the BLA.

Neural dysregulation in posttraumatic stress disorder: evidence for disrupted equilibrium between salience and default mode brain networks

OBJECTIVE

Convergent research demonstrates disrupted attention and heightened threat sensitivity in posttraumatic stress disorder (PTSD). This might be linked to aberrations in large-scale networks subserving the detection of salient stimuli (i.e., the salience network [SN]) and stimulus-independent, internally focused thought (i.e., the default mode network [DMN]).

METHODS

Resting-state brain activity was measured in returning veterans with and without PTSD (n = 15 in each group) and in healthy community controls (n = 15). Correlation coefficients were calculated between the time course of seed regions in key SN and DMN regions and all other voxels of the brain.

RESULTS

Compared with control groups, participants with PTSD showed reduced functional connectivity within the DMN (between DMN seeds and other DMN regions) including the rostral anterior cingulate cortex/ventromedial prefrontal cortex (z = 3.31; p = .005, corrected) and increased connectivity within the SN (between insula seeds and other SN regions) including the amygdala (z = 3.03; p = .01, corrected). Participants with PTSD also demonstrated increased cross-network connectivity. DMN seeds exhibited elevated connectivity with SN regions including the insula (z = 3.06; p = .03, corrected), and SN seeds exhibited elevated connectivity with DMN regions including the hippocampus (z = 3.10; p = .048, corrected).

CONCLUSIONS

During resting-state scanning, participants with PTSD showed reduced coupling within the DMN, greater coupling within the SN, and increased coupling between the DMN and the SN. Our findings suggest a relative dominance of threat-sensitive circuitry in PTSD, even in task-free conditions. Disequilibrium between large-scale networks subserving salience detection versus internally focused thought may be associated with PTSD pathophysiology.

Neurocognitive deficits in HIV-infected women and victims of childhood trauma

The study investigated the behavioral and brain effects of childhood trauma and human immunodeficiency virus (HIV) infection, both separately and in combination, and assessed potential interactions in women who were dually affected. Eighty-three HIV-positive and 47 matched HIV-negative South African women underwent neuromedical, neuropsychiatric, and neurocognitive assessments. Univariate tests of significance assessed if either HIV infection or childhood trauma, or the combination, had a significant effect on neurocognitive performance. The majority of women were Black (96%) and had an average age of 30 years. An analysis of covariance revealed significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials (p < 0.01) and the Halstead Category Test (HCT) (p < 0.05). A significant trauma effect was seen on the HVLT delay trial (p < 0.05). The results provide evidence for neurocognitive dysfunction in memory and executive functions in HIV-infected women and memory disturbances in trauma exposed women.

Endocannabinoid system and psychiatry: in search of a neurobiological basis for detrimental and potential therapeutic effects

Public concern on mental health has noticeably increased given the high prevalence of neuropsychiatric disorders. Cognition and emotionality are the most affected functions in neuropsychiatric disorders, i.e., anxiety disorders, depression, and schizophrenia. In this review, most relevant literature on the role of the endocannabinoid (eCB) system in neuropsychiatric disorders will be presented. Evidence from clinical and animal studies is provided for the participation of CB1 and CB2 receptors (CB1R and CB2R) in the above mentioned neuropsychiatric disorders. CBRs are crucial in some of the emotional and cognitive impairments reported, although more research is required to understand the specific role of the eCB system in neuropsychiatric disorders. Cannabidiol (CBD), the main non-psychotropic component of the Cannabis sativa plant, has shown therapeutic potential in several neuropsychiatric disorders. Although further studies are needed, recent studies indicate that CBD therapeutic effects may partially depend on facilitation of eCB-mediated neurotransmission. Last but not least, this review includes recent findings on the role of the eCB system in eating disorders. A deregulation of the eCB system has been proposed to be in the bases of several neuropsychiatric disorders, including eating disorders. Cannabis consumption has been related to the appearance of psychotic symptoms and schizophrenia. In contrast, the pharmacological manipulation of this eCB system has been proposed as a potential strategy for the treatment of anxiety disorders, depression, and anorexia nervosa. In conclusion, the eCB system plays a critical role in psychiatry; however, detrimental consequences of manipulating this endogenous system cannot be underestimated over the potential and promising perspectives of its therapeutic manipulation.

Traumatic stress is linked to a deficit in associative episodic memory

Individuals with posttraumatic stress disorder (PTSD) are haunted by persistent memories of the trauma, but ironically are impaired in memories of daily life. The current set of 4 experiments compared new learning and memory of emotionally neutral content in 2 groups of patients and aged- and education-matched controls: 20 patients diagnosed with chronic posttraumatic stress disorder (C-PTSD) and 20 patients diagnosed with acute stress disorder (ASD). In all experiments, participants studied a list of stimuli pairs (words or pictures) and were then tested for their memory of the items, or for the association between items in each pair. Results indicated that both types of patients showed associative memory impairment compared to a control group, although their item memory performance was relatively intact. Potential mechanisms underlying such associative memory deficits in posttraumatic patients are discussed.

The association between childhood trauma and memory functioning in schizophrenia

OBJECTIVE

Both neurocognitive impairments and a history of childhood abuse are highly prevalent in patients with schizophrenia. Childhood trauma has been associated with memory impairment as well as hippocampal volume reduction in adult survivors. The aim of the following study was to examine the contribution of childhood adversity to verbal memory functioning in people with schizophrenia.

METHODS

Eighty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of chronic schizophrenia were separated into 2 groups on the basis of self-reports of childhood trauma. Performance on measures of episodic narrative memory, list learning, and working memory was then compared using multivariate analysis of covariance.

RESULTS

Thirty-eight (45%) participants reported moderate to severe levels of childhood adversity, while 47 (55%) reported no or low levels of childhood adversity. After controlling for premorbid IQ and current depressive symptoms, the childhood trauma group had significantly poorer working memory and episodic narrative memory. However, list learning was similar between groups.

CONCLUSION

Childhood trauma is an important variable that can contribute to specific ongoing memory impairments in schizophrenia.

Chronic stress, cognitive functioning and mental health

This review aims to discuss the evidence supporting the link between chronic stress, cognitive function and mental health. Over the years, the associations between these concepts have been investigated in different populations. This review summarizes the findings that have emerged from older populations as well as from populations suffering from pathological aging, namely Mild Cognitive Impairment and Alzheimer's Disease. Although older adults are an interesting population to study in terms of chronic stress, other stress-related diseases can occur throughout the lifespan. The second section covers some of these stress-related diseases that have recently received a great deal of attention, namely burnout, depression, and post-traumatic stress disorder. Given that chronic stress contributes to the development of certain pathologies by accelerating and/or exacerbating pre-existing vulnerabilities that vary from one individual to the other, the final section summarizes data obtained on potential variables contributing to the association between chronic stress and cognition.

Memory and executive dysfunctions associated with acute posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) in its chronic form has been associated with a number of neurocognitive impairments involving emotionally neutral stimuli. It remains unknown whether such impairments also characterize acute PTSD. In the present investigation, neurocognitive functions were examined in trauma exposed individuals with (n=21) and without (n=16) acute PTSD, as well as in a group of individuals never exposed to trauma (n=17) using specific and standardized tasks such as the Rey Auditory Verbal Learning Test, the Aggie's Figure Learning Test, the Autobiographical Memory Interview, the D2 test, the Stroop task, the digit and visual span tasks of the Wechsler Memory Scale-III, the Trail Making Test, the Tower of London and the vocabulary subtest of the Wechsler Adult Intelligence Scale-III. A number of deficits in the cognitive domains of memory, high-level attentional resources, executive function and working memory were found in the group with a diagnosis of acute PTSD only and not among the other groups. The findings, which point to the possibility of disturbed fronto-temporal system function in trauma-exposed individuals with acute PTSD, are particularly relevant for the early clinical management of this disorder.

The influence of pre-deployment neurocognitive functioning on post-deployment PTSD symptom outcomes among Iraq-deployed Army soldiers

This study evaluated associations between pre-deployment neurocognitive performance and post-deployment posttraumatic stress disorder (PTSD) symptoms in a sample of deployed active duty Army soldiers. As part of a larger longitudinal study, each participant completed baseline measures of memory, executive attention, and response inhibition, and baseline and post-deployment self-report measures of PTSD symptom severity. Data were subjected to multiple regression analyses that examined associations between baseline neurocognitive performances and longitudinal PTSD symptom outcome. Results revealed that pre-trauma immediate recall of visual information was associated with post-deployment PTSD symptom severity, even after controlling for pre-deployment PTSD symptom levels, combat intensity, age, gender, and test-retest interval. There was also an interaction between pre-deployment PTSD symptom severity and pre-deployment immediate visual recall and verbal learning, indicating that neurocognitive performances were more strongly (and negatively) associated with residualized post-deployment PTSD symptoms at higher levels of pre-deployment PTSD symptoms. These findings highlight the potential role of pre-trauma neurocognitive functioning in moderating the effects of trauma exposure on PTSD symptoms

Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: perspectives from cognitive neuroscience

A significant proportion of military personnel deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been exposed to war-zone events potentially associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). There has been significant controversy regarding healthcare policy for those service members and military veterans who returned from OEF/OIF deployments with both mild TBI and PTSD. There is currently little empirical evidence available to address these controversies. This review uses a cognitive neuroscience framework to address the potential impact of mild TBI on the development, course, and clinical management of PTSD. The field would benefit from research efforts that take into consideration the potential differential impact of mild TBI with versus without persistent cognitive deficits, longitudinal work examining the trajectory of PTSD symptoms when index trauma events involve TBI, randomized clinical trials designed to examine the impact of mild TBI on response to existing PTSD treatment interventions, and development and examination of potential treatment augmentation strategies.

The effects of an acute psychosocial stressor on episodic memory

Although stressors are believed to impair memory, experimental studies with humans have provided inconsistent support for this conclusion. The current study was designed to examine the effect of an acute psychosocial stressor, and subsequent reactivity, on episodic memory. One hundred participants completed a list-recall task before and after random assignment into a stressor or nonstressor condition. Participants assigned to the stressor condition exhibited both impaired delayed and immediate recall, and also exhibited increasesin the commission of intrusions and perseverations. The experience of off-task thoughts and intentional suppression of such thoughts, were associated with greater impairment of immediate recall. Changes in state anxiety, negative mood, and heart rate were unrelated to changes in memory. These data indicate that exposure to a stressor impaired the recall of previously learned information, and compromised the recall of newly acquired information. Furthermore, cognitive interference is an important factor regarding stress-related impairments of episodic memory. memory.

Neuropsychological performance is related to current social and occupational functioning in veterans with posttraumatic stress disorder

BACKGROUND

Several studies have reported deficits in both immediate and delayed recall of verbal memory in patients with posttraumatic stress disorder (PTSD). However, most of these studies had several methodological disadvantages. None of these studies assessed parameters related to social or occupational functioning.

METHODS

Fifty Dutch veterans of UN peacekeeping missions (25 with PTSD and 25 without PTSD) were assessed with a comprehensive neuropsychological test battery consisting of four subtests of the Wechsler Adult Intelligence Scale-III, California Verbal-Learning Test, and the Rey Auditory Verbal-Learning Test. Veterans with PTSD were free of medication and substance abuse.

RESULTS

Veterans with PTSD had similar total intelligence quotient scores compared to controls, but displayed deficits of figural and logical memory. Veterans with PTSD also performed significantly lower on measures of learning and immediate and delayed verbal memory. Memory performance accurately predicted current social and occupational functioning.

CONCLUSIONS

Deficits of memory performance were displayed in a sample of medication- and substance abuse-free veterans with PTSD. Deficits in memory performance were not related to intelligence quotient, length of trauma exposure, or time since trauma exposure. This study showed that cognitive performance accurately predicted current social and occupational functioning in veterans with PTSD.

Doctors' health and fitness to practise: performance problems in doctors and cognitive impairments

BACKGROUND

As a response to concerns over the safety of patient care and quality of care provided by doctors, there has been an increasing interest in identifying the reasons for medical errors.

METHODS

This paper reviews briefly the common neurocognitive causes for performance problems in doctors and provides an updated account of the current literature. Search on Medline and PsychINFO for English language articles between 1956 and September 2006 was performed, as well as a manual search by the authors for other relevant articles.

RESULTS

Neuropsychiatric and neuropsychological assessment is increasingly accepted as an accurate evaluation tool to clarify the performance problems in doctors. Furthermore, it seems that neurocognitive difficulties are commonly found to be the cause for such problems.

CONCLUSIONS

The performance problems in doctors need to be acknowledged 'better too soon than too late'. Neuropsychiatric and neuropsychological assessment helps to create an accurate treatment and rehabilitation plan for the specific functional tasks of the particular doctor's duties.

Consistent impaired verbal memory in PTSD: a meta-analysis

BACKGROUND

Qualitative review papers have indicated that verbal memory impairment is found to be the most consistent cognitive impairment related to PTSD. These review papers have used qualitative methods to describe the effects, and consequently they have not been able to estimate the strength of the memory-PTSD association.

METHODS

This meta-analysis of 28 studies examined the empirical evidence for this relationship, and factors affecting the results.

RESULTS

Overall, the results showed medium effect sizes in patients with PTSD compared to controls on verbal memory across studies. Marked impairment was found in the patient groups compared to healthy controls, while modest impairment was found compared to exposed non-PTSD controls. Meta-analyses found strongest effects in war veterans compared to sexual and physical assault related PTSD. Rather unexpectedly no effect was found for the sexually abused PTSD groups compared to exposed controls. The analyses further showed that the effect was dependent on the test procedures used. The studies using WMS and AVLT had stronger effects than studies using CVLT.

LIMITATIONS

Insufficient data were available to analyze a more complete attention-memory profile.

CONCLUSIONS

This meta-analysis confirms that verbal memory impairment is present in adults with PTSD, and they are consistent across studies. This impairment should be the focus of work in clinical settings.

Neural correlates of associative learning and memory in veterans with posttraumatic stress disorder

Impaired attention and memory are symptoms frequently associated with posttraumatic stress disorder (PTSD). Although patients with PTSD frequently report memory difficulties and empirical research provides support for a memory deficit in PTSD, as of yet, no fMRI study has adequately investigated the neural correlates of learning and memory of neutral (i.e. not trauma related) material in patients with PTSD compared to controls. Twelve male veterans with PTSD, and twelve male veterans without PTSD, were recruited, and matched for age, region and year of deployment. Encoding and retrieval of 12 word-pair associates was assessed during fMRI in both experimental groups. Compared to controls veterans with PTSD revealed underactivation of the frontal cortex, and overactivation of the temporal cortex during the encoding phase. Retrieval of the paired associates resulted in underactivation of right frontal cortex, bilateral middle temporal gyri, and the left posterior hippocampus/parahippocampal gyrus in patients with PTSD. Deficits in memory performance in PTSD appear to be related to altered activity in fronto-temporal areas during both the encoding and retrieval phase of memory processing.