Learning and memory in Holocaust survivors with posttraumatic stress disorder

Impaired episodic memory in PTSD patients - A meta-analysis of 47 studies

Episodic memory impairments beyond the traumatic event might be a characteristic hallmark of post-traumatic stress disorder (PTSD). Although several studies support such a claim, empirical findings are inconsistent. Therefore, we performed a random-effects meta-analysis including data from a total of 47 studies and 3,062 subjects. As main finding, we can show that PTSD patients show episodic memory deficits compared to all controls. This effect was significantly stronger for PTSD vs. non-traumatized healthy controls as compared to PTSD vs. traumatized controls without PTSD. Finally, episodic memory impairments in PTSD were most pronounced in verbal memory tests as compared to non-verbal memory tests. Our results provide new evidence that PTSD is characterized by impaired episodic long-term memory beyond the traumatic event, and these deficits are particularly pronounced in verbal memory. We will discuss our findings in the context of physiological, psychological and trauma related memory models. From a broader perspective, our findings may have implications for the treatment of PTSD by suggesting that the assessment and, if necessary, training of memory deficits could be included as part of diagnostics and psychotherapeutic treatment.

Association between resilience and cortical thickness in the posterior cingulate cortex and the temporal pole in Japanese older people: A population-based cross-sectional study

BACKGROUND

Resilience is a crucial factor preventing the onset of mental illness and contributing to the well-being and healthy longevity, whose neural bases are not fully elucidated in older people. The present study aimed to identify the cortical thickness associating with resilience in older adults.

METHODS

This is a part of the cross-sectional Arakawa geriatric cohort study for people aged 65 years or older, consisting of 1001 individuals. A Self-Reported Resilience Scale (RS), neuropsychological batteries, face-to-face interviews for diagnosis, and a three-dimensional T1-weighted magnetic resonance imaging were conducted. Cortical thickness was computed by the FreeSurfer. The relationships among cortical thickness, total RS score, and clinico-demographic data were investigated using univariate and multivariable regression analyses.

RESULTS

The total RS score was correlated with age, education, and scores of the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) in univariate analyses. The total RS score was associated with cortical thicknesses in the left posterior cingulate (β [95 % CI of B] = 0.07 [0.16-14.84]) and the left temporal pole (β [95 % CI of B] = 0.08 [0.63-9.93]) after adjusting sex, age, imaging acquisition site, education, MMSE and GDS scores, hypertension, hyperlipidemia, diabetes mellitus, Barthel index, BMI, and living situation in multivariable regression analyses.

CONCLUSION

The present analyses suggest that the resilience capacity may be related to the cortical thickness in the posterior cingulate and temporal cortices in older adults. Our findings warrant further longitudinal studies to confirm the causal relationship between stress events, resilience, and brain structures.

The extent of the neurocognitive impairment in elderly survivors of war suffering from PTSD: meta-analysis and literature review

Objectives

We performed a meta-analysis and systematic review on elderly survivors of war suffering from PTSD to estimate the variability in their cognitive impairment based on individual neuropsychological tests.

Methods

We included case control studies that explored the association of cognitive deficits in elderly PTSD civilian survivor of wars (age >60 years), using MEDLINE, Embase and PsycINFO from the inception to January 2018. We compared the cognitive performances in three comparisons i) PTSD+ vs. PTSD− civilian survivors of war; ii) PTSD+ vs. Control and iii) PTSD− vs. Control. The risk of bias was assessed using the Newcastle-Ottawa Scale for case-control studies.

Results

Out of 2939 titles and abstracts, 13 studies were eligible for data extraction. As compared to PTSD− civilian survivors of war, PTSD+ civilian survivors of war demonstrated significant deficits on TMT-A, TMT-B, Digit span backward, explicit memory low pair associate, CVLT recognition, WAIS-verbal and non-verbal tests. As compared to health controls, PTSD+ survivors demonstrated significantly lower performance on explicit memory low pair and high associate, RAVLT immediate and delayed recall, CVLT delayed and short cued recall. Performance on the neuropsychological test between PTSD− survivors of war and controls was not significant for all tests.

Conclusion

The pattern suggests that PTSD+ survivors of war had poorer performance in tasks requiring processing speed, executive function, attention, working memory and learning. The magnitude of the cognitive deficits in our pooled analysis was small to moderate depending on the neuropsychological test. Most of our pooled analysis suffered from a high risk of bias, which lowered the confidence in our results.

Risk and protective factors of dementia among adults with post-traumatic stress disorder: a systematic review protocol

INTRODUCTION

Post-traumatic stress disorder (PTSD) is associated with an increased risk of dementia. Individual epidemiological studies have controlled for several confounders of the relationship between PTSD and increased dementia risk, yet particular risk factors underlying this relationship have not been determined. This systematic review protocol aims to identify risk and protective factors of dementia among adults with PTSD.

METHODS AND ANALYSIS

We will conduct an electronic search of the databases: PubMed, CINAHL, PsychINFO, The Cochrane Library, Scopus and ProQuest Dissertation and Theses Global. After screening the studies, quantitative synthesis will be performed, if possible. Otherwise, a narrative synthesis will be performed. We will include randomised controlled trials and other types of research evidence including longitudinal cohort studies. Strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations method. Examples of variables that will be extracted are: year of PTSD diagnosis, comorbid conditions, health behaviours, pharmacological treatments and year of mild cognitive impairment or dementia diagnosis. We developed this systematic review protocol according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement.

ETHICS AND DISSEMINATION

The proposed study will not collect individual-level data and, therefore, does not require ethical approval. Results of this study will provide current evidence on risk and protective factors of dementia in adults with PTSD. Findings will be disseminated in peer-reviewed publications and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42019128553.

Dysregulation of inflammation, neurobiology, and cognitive function in PTSD: an integrative review

Compelling evidence from animal and human research suggest a strong link between inflammation and posttraumatic stress disorder (PTSD). Furthermore, recent findings support compromised neurocognitive function as a key feature of PTSD, particularly with deficits in attention and processing speed, executive function, and memory. These cognitive domains are supported by brain structures and neural pathways that are disrupted in PTSD and which are implicated in fear learning and extinction processes. The disruption of these supporting structures potentially results from their interaction with inflammation. Thus, the converging evidence supports a model of inflammatory dysregulation and cognitive dysfunction as combined mechanisms underpinning PTSD symptomatology. In this review, we summarize evidence of dysregulated inflammation in PTSD and further explore how the neurobiological underpinnings of PTSD, in the context of fear learning and extinction acquisition and recall, may interact with inflammation. We then present evidence for cognitive dysfunction in PTSD, highlighting findings from human work. Potential therapeutic approaches utilizing novel pharmacological and behavioral interventions that target inflammation and cognition also are discussed.

Early-Life Conditions and Cognitive Function in Middle-and Old-Aged Chinese Adults: A Longitudinal Study

A range of previous studies have suggested that early-life conditions (ELCs) are associated with various health problems throughout life in Western societies. The aim of this study was to investigate whether, and how, early-life conditions predicted the level and trajectory of cognitive function in middle- and old-aged Chinese adults. Data were obtained from China Health and Retirement Longitudinal Study which comprised 16,258 adults at baseline. Cognitive function was assessed using mental intactness and episodic memory and ELCs were measured by early parental death, childhood socioeconomic status (SES), food deprivation, and childhood health. Growth curve modeling was used to examine the trajectory of cognitive function (three waves in a 6-year period)with particular attention paid to the effects of ELCs on cognition. The results show that early maternal death is associated with the baseline cognitive level among middle- and old-aged Chinese adults (β range between −0.44 and −0.35, p < 0.05), but that this association is also largely attenuated by adulthood education. Higher childhood SES predicts an enhanced level of baseline cognition in both age groups (β range between 0.08 and 1.27, p < 0.001), but only protects against cognitive decline at baseline in middle-aged adults. Participants who were less healthy during childhood tended to have lower cognitive performance than those who had enjoyed good health (β range between −0.36 and −0.14, p < 0.05). The results of this study highlight the detrimental impact of deleterious ELCs on cognitive function throughout later life.

The impact of sleep on eyewitness identifications

Sleep aids the consolidation of recently acquired memories. Evidence strongly indicates that sleep yields substantial improvements on recognition memory tasks relative to an equivalent period of wake. Despite the known benefits that sleep has on memory, researchers have not yet investigated the impact of sleep on eyewitness identifications. Eyewitnesses to crimes are often presented with a line-up (which is a type of recognition memory test) that contains the suspect (who is innocent or guilty) and fillers (who are known to be innocent). Sleep may enhance the ability to identify the guilty suspect and not identify the innocent suspect (i.e. discriminability). Sleep may also impact reliability (i.e. the likelihood that the identified suspect is guilty). In the current study, we manipulated the presence or the absence of sleep in a forensically relevant memory task. Participants witnessed a video of a mock crime, made an identification or rejected the line-up, and rated their confidence. Critically, some participants slept between witnessing the crime and making a line-up decision, while others remained awake. The prediction that participants in the sleep condition would have greater discriminability compared to participants in the wake condition was not supported. There were also no differences in reliability.

A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications

Stress is recognized as an important issue in basic and clinical neuroscience research, based upon the founding historical studies by Walter Canon and Hans Selye in the past century, when the concept of stress emerged in a biological and adaptive perspective. A lot of research after that period has expanded the knowledge in the stress field. Since then, it was discovered that the response to stressful stimuli is elaborated and triggered by the, now known, stress system, which integrates a wide diversity of brain structures that, collectively, are able to detect events and interpret them as real or potential threats. However, different types of stressors engage different brain networks, requiring a fine-tuned functional neuroanatomical processing. This integration of information from the stressor itself may result in a rapid activation of the Sympathetic-Adreno-Medullar (SAM) axis and the Hypothalamus-Pituitary-Adrenal (HPA) axis, the two major components involved in the stress response. The complexity of the stress response is not restricted to neuroanatomy or to SAM and HPA axes mediators, but also diverge according to timing and duration of stressor exposure, as well as its short- and/or long-term consequences. The identification of neuronal circuits of stress, as well as their interaction with mediator molecules over time is critical, not only for understanding the physiological stress responses, but also to understand their implications on mental health.

Investigating the separate and interactive associations of trauma and depression on neurocognition in urban dwelling adults

BACKGROUND

Trauma and depression have each been associated with neurocognitive alterations, but their combined effect on neurocognition is unclear. We investigated the separate and interactive associations of trauma and depression on neurocognition in a sample of ethnically diverse urban dwellers, and explored the impact of age on these effects.

METHODS

284 adults aged 30-89 were divided into groups based on their current depression and trauma history. Individuals meeting DSM-IV criteria for depression were considered Depressed (D+) and individuals rated through diagnostic interview as having trauma history were considered positive for Trauma (T+). Resulting Ns were 73 D+T+, 56 D+T-, 68 D-T+, and 87 D-T-. A principal component analysis of neuropsychological scores resulted in a 3-factor solution representing verbal learning/memory/recognition (VERBAL-LMR), visual learning/memory/recognition, and speeded attention/cognitive flexibility accounting for 70.21% of the variance.

RESULTS

Multivariable linear regressions adjusting for age revealed that Trauma, regardless of Depression, is associated with worse VERBAL-LMR performance. This Trauma association was driven by verbal list and prose passages learning and memory, but not recognition memory. Age-stratified (<60 versus ≥60 years) regressions revealed the Trauma association was only significant for older adults. No main or interactive effects for Depression were observed.

CONCLUSIONS

Trauma, regardless of Depression, is associated with worse verbal learning and memory, but not recognition performance. These results suggest that trauma exposure may negatively impact neurocognition. Clinicians working with adults in urban settings should query for trauma in addition to depression when considering subjective and objective measures of neurocognitive functioning, particularly in older adults.

PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda

Background: In the ongoing conflict in the Democratic Republic of the Congo (DRC), civilians have been heavily exposed to traumatic stressors. Traumatizing experiences cumulatively heighten the risk for trauma-related disorders, and with it affect cognitive and psycho-social functioning. Objectives: We aimed at investigating the association between trauma-related disorders and cognitive and psycho-social functioning and hypothesized that PTSD symptom severity would negatively correlate with executive functioning, working memory and psycho-social functioning in everyday life. Method: In total, 323 Congolese refugees (mean age: 31.3 years) who arrived in the Ugandan Nakivale refugee settlement after January 2012 were assessed regarding their exposure to traumatic events, PTSD symptom severity (posttraumatic symptom scale interview), executive functioning (Tower of London), working memory performance (Corsi block tapping task) and psycho-social dysfunctioning (Luo functioning scale). Results: Hierarchical regression analyses indicated a significant negative association between PTSD symptom severity and working memory (β = -0.32, p < 0.001), as well as executive functions (β = -0.19, p = 0.003). Furthermore, the impairment of psycho-social functioning in everyday life was positively related with PTSD symptom severity (β = 0.70, p < 0.001), and negatively with executive functioning (β = -0.15, p = 0.003). However, working memory performance was not significantly related to psycho-social dysfunctioning (β = 0.09, p > 0.05). Conclusion: Trauma survivors not only suffer from the core PTSD symptoms but also from impaired cognitive functioning. PTSD symptom severity seems furthermore to be related to impaired psycho-social functioning. Our findings suggest that trauma-related mental health problems may heighten the risk for poverty and lack of prospect and further aggravate the consequences of war and conflict.

Prospective Memory in Posttraumatic Stress Disorder

OBJECTIVES

Neuropsychological studies of posttraumatic stress disorder (PTSD) have revealed deficits in attention/working memory, processing speed, executive functioning, and retrospective memory. However, little is known about prospective memory (PM) in PTSD, a clinically relevant aspect of episodic memory that supports the encoding and retrieval of intentions for future actions.

METHODS

Here we examined PM performance in 40 veterans with PTSD compared to 38 trauma comparison (TC) veterans who were exposed to combat but did not develop PTSD. All participants were administered the Memory for Intentions Test (MIST; Raskin, Buckheit, & Sherrod, 2010), a standardized and validated measure of PM, alongside a comprehensive neurocognitive battery, structured diagnostic interviews for psychiatric conditions, and behavioral questionnaires.

RESULTS

Veterans with PTSD performed moderately lower than TC on time-based PM, with errors primarily characterized as PM failure errors (i.e., omissions). However, groups did not differ in event-based PM, ongoing task performance, or post-test recognition of PM intentions for each trial. Lower time-based PM performance was specifically related to hyperarousal symptoms of PTSD. Time-based-performance was also associated with neuropsychological measures of retrospective memory and executive functions in the PTSD group. Nevertheless, PTSD was significantly associated with poorer PM above and beyond age and performance in retrospective memory and executive functions.

DISCUSSION

Results provide initial evidence of PM dysfunction in PTSD, especially in strategic monitoring during time-based PM tasks. Findings have potential implications for everyday functioning and health behaviors in persons with PTSD, and deserve replication and future study. (JINS, 2016, 22, 724-734).

Parental bonding and neuropsychological performance are associated with episodic simulation of future events in trauma-exposed patients with major depressive disorder

INTRODUCTION

Major depressive disorder (MDD) and trauma-related disorders are associated with deficits in remembering the past and imagining the future (i.e., episodic simulation). We examined parental bonding and neuropsychological performance in relation to episodic simulation in trauma-exposed patients with recurrent MDD.

METHODS

Trauma-exposed patients with MDD (n = 21) and matched controls (n = 20) completed a future-oriented Autobiographical Interview, the Parental Bonding Instrument, and a standardized neuropsychological battery.

RESULTS

Patients with major depressive disorder generated fewer episodic details for future neutral events compared to controls. Although higher reported levels of maternal care were associated with increased specificity of negative future events among the patient group, higher maternal overprotection was related to decreased specificity of negative and positive future events. Higher levels of performance on measures of intelligence, verbal memory, executive functioning, and sustained attention were associated with increased specificity of future events.

CONCLUSIONS

Maternal relations during childhood and neuropsychological performance are related to the specificity of episodic simulation in adult patients with MDD. Childhood experience continues to influence memory performance into adulthood.

Attentional processes in posttraumatic stress disorder and the associated changes in neural functioning

Posttraumatic Stress Disorder (PTSD) is associated with alterations in attention at the behavioral and neural levels. However, there are conflicting findings regarding the specific type of attention impairments present in PTSD, as the commonly used tests of attention do not isolate the mechanisms behind attention abnormalities, and the constructs measured do not map onto the neurocircuits governing attention. Here, we review the literature on attention processing in PTSD and offer directions for future research to clarify these unanswered questions. First, using instruments that allow assessment of behavioral and neurophysiological attention components will be necessary to understand attention deficits in PTSD. Second, focus on intra-individual variability in addition to assessment of central tendency may help clarify some of the mixed findings. Third, longitudinal studies on attentional processes are warranted to determine how attention contributes to the development and maintenance of PTSD. Integration of behavioral and neural measures of attention will be useful in understanding the pathophysiology of PTSD.

Dissociative symptoms are associated with reduced neuropsychological performance in patients with recurrent depression and a history of trauma exposure

BACKGROUND

Although preliminary work suggests that dissociative symptoms may impact neuropsychological performance in trauma-exposed populations, the relation between dissociation and cognitive performance has not been explored in patients with depression.

OBJECTIVE

The present study examined dissociative symptoms in relation to neuropsychological performance in participants with a primary diagnosis of recurrent major depressive disorder (MDD) and a history of trauma exposure.

METHOD

Twenty-three participants with MDD and 20 healthy controls who did not differ in age, sex, education, or IQ were assessed. In addition to a standardized neuropsychological battery assessing frontotemporally mediated cognitive processes, participants completed clinical measures assessing dissociative symptoms, illness severity, and past history of trauma exposure.

RESULTS

Among participants with MDD, greater severity of derealization was associated with reduced performance on measures of delayed visuospatial recall and recognition on a task of verbal memory recognition. In addition, more severe depersonalization was associated with slower processing speed and a response style lending itself toward better performance in a less active environment.

CONCLUSIONS

These findings point toward dissociative symptoms as a transdiagnostic factor associated with neuropsychological dysfunction in patients with depression and a history of trauma. Limitations and recommendations for future research are discussed.

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.

In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission

RATIONALE

Prior studies have found that cognitive dysfunction is common in intensive care unit (ICU) survivors. Yet, relatively little is known about potentially modifiable risk factors for longer-term post-ICU cognitive impairment.

OBJECTIVES

To determine if in-hospital acute stress symptoms were associated with impaired 12-month cognitive functioning among ICU survivors.

METHODS

We prospectively enrolled 150 nontrauma patients without cognitive impairment or a dementia diagnosis who were admitted to an ICU for more than 24 hours. Patients were interviewed before hospital discharge and again via telephone at 12 months post-ICU.

MEASUREMENTS AND MAIN RESULTS

Demographics and clinical information were obtained through medical record reviews and in-person interviews. In-hospital acute stress symptoms were assessed with the Posttraumatic Stress Disorder Checklist-Civilian Version. Twelve-month post-ICU cognition was assessed with the modified Telephone Interview for Cognitive Status. Follow-up interviews were completed with 120 (80%) patients. Patients' mean age at hospitalization was 48.2 years (SD, 13.7). In unadjusted analyses, a greater number of in-hospital acute stress symptoms was associated with significantly greater impairment in 12-month cognitive functioning (β, -0.1; 95% confidence interval, -0.2 to -0.004; P = 0.04). After adjusting for patient and clinical factors, in-hospital acute stress symptoms were independently associated with greater impairment in 12-month cognitive functioning (β, -0.1; 95% CI, -0.2 to -0.01; P = 0.03).

CONCLUSIONS

In-hospital acute stress symptoms may be a potentially modifiable risk factor for greater impairment in cognitive functioning post-ICU. Early interventions for at-risk ICU survivors may improve longer-term outcomes.

Verbal learning deficits in posttraumatic stress disorder and depression

Verbal learning and memory deficits are frequently reported in posttraumatic stress disorder (PTSD), but may be a product of its psychiatric comorbidities, especially major depressive disorder (MDD). To evaluate this hypothesis, 25 medication-free patients with PTSD and comorbid MDD were compared to 148 medication-free patients with equally severe MDD alone and to 96 nonpatients on a measure of verbal learning and memory. Additional measures of attention, working memory, and executive function were administered to evaluate their contribution to verbal memory impairment. Patients with comorbid PTSD and MDD demonstrated the greatest deficit in verbal learning compared to both MDD patients and nonpatients (omnibus effect sizes ranged d = 0.41 to 0.50), one that was not accounted for by other cognitive deficits. Findings suggest that a current diagnosis of PTSD makes a contribution to verbal learning deficits beyond the effect of depression alone.

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.

Attentional and executive functions are differentially affected by post-traumatic stress disorder and trauma

BACKGROUND

Among the neurocognitive impairments observed in patients with Post-traumatic Stress Disorder (PTSD), attentional and executive dysfunctions appear to correlate with negative effects on education, work, daily life activities, and social relations, as well as the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. However, there is no consensus regarding which aspects of attentional and executive functions are impaired in PTSD patients.

METHODS

Attentional and executive functions were assessed using the digit span (WAIS-III) and spatial span (WMS-III) tests under forward and backward recall conditions, the Stroop Test, and the Wisconsin Card Sorting Test (WCST). Our sample was composed of victims of urban violence who developed PTSD (PTSD+) (n = 81), victims of urban violence who did not develop PTSD (PTSD-) (n = 70), and healthy controls not exposed to trauma (HC) (n = 50).

RESULTS

The PTSD+ group had poorer performance on the spatial span forward subtest (p = 0.023; eta(2) = 0.038) and poorer execution time (p = 0.023; eta(2) = 0.042) and accuracy (p = 0.019; eta(2) = 0.044) on the Stroop Test compared to HC.

CONCLUSIONS

These data suggest that there are few differences between the PTSD+ and HC groups, which are restricted to less complex measures of attentional and executive functional processes (short term capacity, selective attention, processing speed, and inhibitory control) and are related to visual stimuli. Therefore, cognitive impairments directly correlated with the manifestation of PTSD.

Persistent fear of aftershocks, impairment of working memory, and acute stress disorder predict post-traumatic stress disorder: 6-month follow-up of help seekers following the L'Aquila earthquake

The aim of our 6-month follow-up study was to assess predictors of post-traumatic stress disorder (PTSD) among individuals seeking treatment at the General Hospital Psychiatric Unit within the first month following the L'Aquila earthquake. Clinical, trauma-related and neurocognitive variables were considered. At the 6-month follow-up, 91 (74.5%) out of 122 subjects were re-assessed and administered the Impact of Events Scale-revised (IES-R) for the detection of PTSD according to DSM-IV criteria. Within 4 weeks following the earthquake, patients were assessed with a checklist of traumatic-event-related variables, along with the Stanford Acute Stress Disorder Questionnaire (SASDQ) for the detection of ASD, with a short battery on working (Wechler Memory Scale-R, Digit Forward and Backward) and verbal memory (subtest of Milan Overall Dementia Assessment, MODA). A statistically significant higher proportion of subjects affected by 'partial' ASD showed a PTSD diagnosis (80.6%, N = 29) compared to not diagnosed subjects (40%, N = 22) and a PTSD diagnosis was shown by all the 4 subjects (4.4%) affected by 'full' ASD at the entry in the study. At the 6-month follow-up 56% of the sample could be considered affected by PTSD on the IES-R scale. The results of the logistic regression analysis on our selected predictors indicated that the persistent fear of aftershocks seemed to increase by over 57 times the likelihood of positive estimate of PTSD, followed by impairment of working memory backward (OR 48.2), and having being diagnosed as ASD case in the first 4 week after the earthquake (OR 17.4). This study underlines the importance of identifying PTSD predictors, in order to planning early treatment interventions after natural disasters.

A meta-analysis of cognitive functioning in older adults with PTSD

A meta-analysis was conducted to summarize and integrate the literature on the cognitive functioning of older adults with posttraumatic stress disorder (PTSD). We hypothesized that those with PTSD would exhibit worse performance in each of the cognitive domains studied when compared to older adults without PTSD. Major databases were queried and eleven articles met criteria for review. As predicted, there was evidence of worse performance across cognitive measures in older adult samples with PTSD relative to older samples without PTSD. The strongest effect across samples was found for lower test scores in the broad domain of memory among older adults with PTSD, and there was evidence that trauma exposure is uniquely associated with worse performance on tests specific to learning. We outline factors thought to contribute to the interactions among PTSD, cognitive deficits, and the aging process. These findings highlight the need for thorough evaluation of cognitive functioning in older adults with PTSD, particularly in the areas of processing speed, learning, memory, and executive functioning.

Schizophrenia patients with and without post-traumatic stress disorder (PTSD) have different mood symptom levels but same cognitive functioning

OBJECTIVE

To investigate differences in cognitive function and level of psychopathology in patients with schizophrenia (SZ) with or without psychological traumatization/post-traumatic stress disorder (PTSD). We hypothesized that traumatized patients with or without PTSD would have more severe cognitive impairments because of the neuropathological changes associated with PTSD, and more severe psychopathology compared with non-traumatized SZ patients.

METHOD

Seventy-five SZ patients with traumatization and 217 SZ patients without traumatization were evaluated regarding the symptoms and cognitive functioning, using standard symptom scales (PANSS; CDSS) and a neuropsychological test battery (IQ, verbal memory, attention, working memory, psychomotor speed, and executive functioning).

RESULTS

No significant differences were observed between the groups in cognitive test performance. The patients in the traumatized group with PTSD showed significantly more current depression than the non-traumatized group (P = 0.012).

CONCLUSION

The findings did not support the hypothesis that the presence of comorbid PTSD/traumatization in SZ is associated with increased cognitive impairment. The increase in current depression in SZ with comorbid traumatization suggests that more severe psychopathology is associated with traumatization.

Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature

Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.

The long-term impact of early adversity on late-life psychiatric disorders

Early adversity is a strong and enduring predictor of psychiatric disorders including mood disorders, anxiety disorders, substance abuse or dependence, and posttraumatic stress disorder. However, the mechanisms of this effect are not well understood. The purpose of this review is to summarize and integrate the current research knowledge pertaining to the long-term effects of early adversity on psychiatric disorders, particularly in late life. We explore definitional considerations including key dimensions of the experience such as type, severity, and timing of adversity relative to development. We then review the potential biological and environmental mediators and moderators of the relationships between early adversity and psychiatric disorders. We conclude with clinical implications, methodological challenges and suggestions for future research.

A consideration of select pre-trauma factors as key vulnerabilities in PTSD

Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.

Pattern of cognitive impairment in older veterans with posttraumatic stress disorder evaluated at a memory disorders clinic

BACKGROUND

We determined the pattern of clinically significant cognitive impairment (CI) among older veterans with posttraumatic stress disorder (PTSD) evaluated in a memory disorders clinic.

METHODS

Data were collected from 19 ethnically diverse veterans. Cognitive functioning in six domains (verbal learning, memory, attention, language, executive functioning, and information processing speed) was assessed.

RESULTS

The majority of veterans (57%) demonstrated CI on a measure of single trial list learning, 44% exhibited CI on short delay memory for lists, and 31% exhibited CI in long delay memory for lists. CI on measures of memory for stories (14%) and executive functioning (6%) were less common, and none of the participants demonstrated CI on measures of attention, language, or information processing speed.

CONCLUSIONS

CI on measures of single trial list learning and memory for lists are common in older patients with PTSD evaluated in a memory disorders clinic and are likely to contribute to functional deficits.

PTSD in the elderly: the interaction between trauma and aging

BACKGROUND

Because an increasingly large cohort of individuals is approaching their elderly years, there is concern about how the healthcare system will cope with the greater demands placed upon it. One area of concern is the impact of trauma and post traumatic stress disorder (PTSD) in the aged. Although several reviews have highlighted the lack of knowledge and research on the topic, there still remain gaps in the literature. Nevertheless, some recent behavioral, endocrinological and neuroimaging studies may provide new insights into the discussion. The central aims of this paper are to summarize the etiological, epidemiological and clinical aspects of PTSD, trauma, and the elderly, and to integrate this knowledge with (i) what is known about PTSD in adults, and (ii) the behavioral, hormonal and cerebral changes associated with healthy aging.

METHODS

A comprehensive search was performed with ISI Web of Science and PubMed for articles pertinent to the psychology and biology of PTSD, trauma, and the elderly.

RESULTS

There exist both significant similarities and differences between adults and elderly with PTSD concerning cognitive and biological profile. Evidence suggests that PTSD in the elderly does not follow a simple clinical trajectory.

CONCLUSIONS

PTSD in the elderly must be considered within the context of normal aging. Strong claims about an interaction between PTSD and aging are difficult to make due to sample heterogeneity, but it is clear that PTSD in this age group presents unique aspects not seen in younger cohorts. Further research must integrate their studies with the biological, psychological, and social changes already associated with the aging process.

A specific deficit in spatial memory acquisition in post-traumatic stress disorder and the role of sleep in its consolidation

Posttraumatic stress disorder (PTSD) is characterized by the presence of anatomo-functional hippocampal alterations. To date, the ability to orient within the environment, which relies on hippocampal integrity, has never been investigated in PTSD. We hypothesized that the ability to form a cognitive map of the environment would be impaired in PTSD. Moreover, spatial memory consolidation benefits from postlearning sleep. Because PTSD individuals often complain about sleep disturbances, we hypothesized that any sleep effect on memory performance would be hampered in these subjects. Twenty-two subjects, all survivors of the L'Aquila 2009 earthquake, were divided into a PTSD and a control group, based on clinical evaluation. After an acquisition phase, they were tested twice ("test" and "retest") on a virtual navigation task. In addition, participants were administered the Digit Span and Task Switching. Subjective sleep quality and sleep disturbances were also assessed. The two testing sessions were on consecutive mornings, interspersed with a night of sleep. During the acquisition phase, the PTSD group took more than twice as long to form a cognitive map of the environment compared to the control group. However, once this phase was successfully completed, the two groups did not differ at test, but they tendentially differed at postsleep retest. Additional analyses comparing performances between groups on test-retest difference scores confirm that sleep-dependent consolidation may be differentially affected in the two groups. Our findings are strictly confined to the navigation performance, excluding a generalized cognitive deficit. PTSD also reported more subjective sleep disturbances and shorter sleep time than controls, which were correlated to worse performance at retest. The specific deficit in the formation of a cognitive map reported in PTSD may be related to hippocampal dysfunctions as well as to the sleep disturbances experienced by these patients. The possible deficiency of sleep-dependent spatial performance improvement should however be confirmed by further studies comprising a wake control group.

Relationship between the number of life events and memory capacity in children

Stressful life events can result into declined memory performance at later age. One hypothesis suggests that stress affects the hippocampus, a brain area important for memory functioning. This study explored a potential relationship between the number of negative stressful life events and hippocampus-dependent declarative but not hippocampus-independent procedural memory performance in a community sample of 255 children, aged 6-12 years. The findings revealed that negative stressful life events were negatively related to verbal declarative memory, but not to nonverbal declarative and procedural memory. The memory impairments could not be accounted for by attention and sleep disturbances, and parenting characteristics as perceived by the child did not influence the vulnerability for the stress-related memory impairments. These findings provide further insight into the deleterious effects of negative stressful life events on learning in school-aged children.

Patients with posttraumatic stress disorder show decreased cognitive control: evidence from dichotic listening

The influence of posttraumatic stress disorder (PTSD) on cognitive control and auditory attention modulation was examined with the use of a dichotic-listening (DL) task. The participants were 45 war-exposed refugees. The PTSD group comprised 22 participants meeting the DSM-IV criteria for PTSD, and the Control group comprised 23 war-exposed participants without PTSD. Both groups were tested with a consonant-vowel syllables DL task under three different attentional instructions. The two groups did not differ in the non-forced and forced-right conditions and showed, as expected, right-ear advantages. The Control group showed, as expected, a left-ear advantage in the forced-left (FL) condition. However, the PTSD group continued to show a right-ear advantage--and only minor modulation of the performance during the FL condition. This finding suggests that PTSD is associated with a reduced capacity for top-down attentional control of a bottom-up or stimulus-driven effect. The result shows that participants with PTSD have impaired cognitive control functions when tested on information processing of neutral stimuli.

Greater prevalence and incidence of dementia in older veterans with posttraumatic stress disorder

To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans.

DESIGN

Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network.

SETTING

Veterans Integrated Service Network 16.

PARTICIPANTS

Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH-, n=3,660), those with PH and no PTSD (PTSD-/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD-/PH-, n=5,165).

MEASUREMENTS

Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression.

RESULTS

The PTSD+/PH- group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH- group as in the PTSD-/PH+ or PTSD-/PH- group after adjusting for the confounding factors. There were no statistically significant differences between the other groups.

CONCLUSION

The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.

A three-year follow-up study of the psychosocial predictors of delayed and unresolved post-traumatic stress disorder in Taiwan Chi-Chi earthquake survivors

AIMS

To predict the longitudinal course of post-traumatic stress disorder (PTSD) in survivors three years following a catastrophic earthquake using multivariate data presented six months after the earthquake.

METHODS

Trained assistants and psychiatrists used the Disaster-related Psychological Screening Test (DRPST) to interview earthquake survivors 16 years and older and to assess current and incidental psychopathology. A total of 1756 respondents were surveyed over the three-year follow-up period.

RESULTS

A total of 38 (9.1%) of the original 418 PTSD subjects and 40 of the original 1338 (3.0%) non-PTSD subjects were identified as having PTSD at the 3-year post-earthquake follow up. Younger age, significant financial loss, and memory/attention impairment were predictive factors of unresolved PTSD and delayed PTSD.

CONCLUSIONS

The longitudinal course of PTSD three years after the earthquake could be predicted as early as six months after the earthquake on the basis of demographic data, PTSD-related factors, and putative factors for PTSD.

Do Holocaust survivors show increased vulnerability or resilience to post-Holocaust cumulative adversity?

Prior trauma can hinder coping with additional adversity or inoculate against the effect of recurrent adversity. The present study further addressed this issue by examining whether a subsample of Holocaust survivors and comparison groups, drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe, were differentially affected by post-Holocaust cumulative adversity. Post-Holocaust cumulative adversity had a stronger effect on the lifetime depression of Holocaust survivors than on that of comparisons. However, comparisons were more negatively affected by post-Holocaust cumulative adversity when examining markers of physical and cognitive functioning. Our findings suggest that previous trauma can both sensitize and immunize, as Holocaust survivors show general resilience intertwined with specific vulnerability when confronted with additional cumulative adversity.

Neurocognitive function in schizophrenia with comorbid posttraumatic stress disorder

Individuals with schizophrenia are at a greater risk for experiencing trauma and developing posttraumatic stress disorder (PTSD) than the general population. Despite an increased incidence of neurocognitive dysfunction in both schizophrenia and PTSD, there are few studies that have examined the potential compounding effects of these diagnoses when they co-occur. The current study examined this issue by administering comprehensive diagnostic, symptom, and neurocognitive evaluations to four groups including normal controls (C), as well as individuals with PTSD (PTSD), schizophrenia (SZ), or both schizophrenia and PTSD (SZP). Results indicated that when compared to the SZ group, the SZP group exhibited higher rates of positive symptoms, general psychopathology, and PTSD symptoms, as well as lower rates of negative symptoms. Regarding neurocognitive test performance, both schizophrenia groups performed significantly worse than the C and PTSD groups across all neurocognitive domains. However, differences were not significant between the SZP and SZ groups, although a differential pattern of performance between the groups was indicated. Results of this study do not support the idea that the presence of comorbid PTSD in SZ results in a substantial increase in cognitive impairment.

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

Longitudinal effects of PTSD on memory functioning

Numerous studies have demonstrated explicit and working memory deficits related to posttraumatic stress disorder (PTSD), but few have addressed longitudinal changes in memory functioning. There is some evidence to suggest an interactive effect of PTSD and aging on verbal memory decline in Holocaust survivors (Yehuda et al., 2006). However, the longitudinal trajectory of neuropsychological functioning has not been investigated in Vietnam veterans, a younger but substantial population of aging trauma survivors. We administered tests of visual and verbal memory, and working memory to derive different dependent measures in veterans between the ages of 41 and 63, the majority of whom served in the Vietnam War. Twenty-five veterans with PTSD and 22 veterans without PTSD were assessed over two time points (mean age at follow-up = 54.0; mean inter-test interval = 34 months). The PTSD+ group, consisting of veterans with chronic, primarily combat-related PTSD, did not show a significant change in PTSD symptoms over time. Compared to veterans without PTSD, veterans with PTSD showed a greater decline in delayed facial recognition only, and this decline was extremely subtle.

The use of proton magnetic resonance spectroscopy in PTSD research--meta-analyses of findings and methodological review

Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.

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.

The effect of retrieval on recall of information in individuals with posttraumatic stress disorder

Cognitive theories of posttraumatic stress disorder (PTSD) suggest that associative memory processes may play a crucial role in the development and maintenance of the disorder. In the current study we examined the effect of associative pair rehearsal on recall ability for threatening and non-threatening information using the retrieval-practice paradigm in individuals with PTSD, traumatized controls (TC), and non-traumatized controls (NAC). Across word type, NACs demonstrated a typical retrieval-induced forgetting effect. However, individuals with PTSD benefited less from rehearsal, and failed to inhibit recall of unpracticed words in practiced categories. Participants in the TC group displayed a retrieval-induced forgetting effect similar to those individuals in the PTSD group. These findings are consistent with research indicating that individuals with PTSD may derive less benefit from rehearsal and display general inhibitory difficulties when compared to non-traumatized controls.

Verbal learning and memory impairments in posttraumatic stress disorder: the role of encoding strategies

The present study examined mechanisms underlying verbal memory impairments in patients with posttraumatic stress disorder (PTSD). Earlier studies have reported that the verbal learning and memory alterations in PTSD are related to impaired encoding, but the use of encoding and organizational strategies in patients with PTSD has not been fully explored. This study examined organizational strategies in 21 refugees/immigrants exposed to war and political violence who fulfilled DSM-IV criteria for chronic PTSD compared with a control sample of 21 refugees/immigrants with similar exposure, but without PTSD. The California Verbal Learning Test was administered to examine differences in organizational strategies and memory. The semantic clustering score was slightly reduced in both groups, but the serial cluster score was significantly impaired in the PTSD group and they also reported more items from the recency region of the list. In addition, intrusive errors were significantly increased in the PTSD group. The data support an assumption of changed memory strategies in patients with PTSD associated with a specific impairment in executive control. However, memory impairment and the use of ineffective learning strategies may not be related to PTSD symptomatology only, but also to self-reported symptoms of depression and general distress.

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.

Verbal memory and treatment response in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is often associated with verbal memory deficits, which could influence treatment outcome. We assessed neuropsychological functioning in individuals with PTSD and their response to cognitive-behavioural therapy (CBT). Treatment non-responders had significantly poorer performance on measures of verbal memory compared with responders and demonstrated narrative encoding deficits. Differences were not explained by IQ, performance on tasks of attention, initial PTSD severity, depression, time since trauma, or alcohol/substance misuse. Verbal memory deficits seem to diminish the effectiveness of CBT and should be considered in its implementation.

Memory impairments in posttraumatic stress disorder are related to depression

The present study focuses on verbal learning and memory alterations in refugees with posttraumatic stress disorder, and whether the alterations are related to attention, acquisition, storage, or retrieval. Twenty-one refugees exposed to war and political violence with chronic PTSD, were compared to an exposed control sample of 21 refugees without PTSD. No differences were found in attention span, but tests of verbal memory showed less efficient learning in the PTSD sample. Group differences in delayed recall could be explained by learning efficiency. No differences were seen in recognition memory. These results indicate that memory alterations in PTSD are related to impaired acquisition and less effective encoding of the memory material and not to impaired attention span and/or impaired retrieval. Controlling for specific PTSD symptom clusters and self-reported depression showed that the intrusion subscale and depressive reactions are the most important symptoms in understanding the memory alterations in PTSD.

The effects of exposure to an acute naturalistic stressor on working memory, state anxiety and salivary cortisol concentrations

Exposure to an acute naturalistic stressor induces both psychological and physiological changes in humans. The two studies reported here explored the impact of exposure to an acute naturalistic stressor on state anxiety, working memory and HPA axis activation (salivary cortisol). In both experiments, ten healthy male participants were exposed to an acute naturalistic stressor, helicopter underwater evacuation training (HUET), and their physiological and behavioural responses before (first study) and after (second study) the stressor were compared to ten non-stressed controls. The results of both experiments showed that working memory performance was preserved during anticipation of an acute stressor, but impairments were observed immediately after stress exposure. Participants reported significantly higher state anxiety levels during anticipation and following stress exposure, whereas significant elevations in cortisol levels were only observed 25 min post exposure to stress, but not before or immediately after stress exposure. The results of both experiments demonstrated a dissociation between behavioural and biochemical measures and provided evidence for a dissociation of the effects of stress on cognitive and physiological measures depending on the time of testing, with cognitive impairments most evident following stress exposure.