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Post-traumatic stress disorder symptom remission and cognition in a large cohort of civilian women

Published online by Cambridge University Press:  14 August 2023

Jiaxuan Liu Open the ORCID record for Jiaxuan Liu [Opens in a new window] ,
Andrea L. Roberts ,
Rebecca B. Lawn ,
Shaili C. Jha ,
Laura Sampson ,
Jennifer A. Sumner ,
Jae H. Kang ,
Eric B. Rimm ,
Francine Grodstein  and
Liming Liang
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Jiaxuan Liu*
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Andrea L. Roberts
Affiliation:
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Rebecca B. Lawn
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Shaili C. Jha
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Laura Sampson
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Jennifer A. Sumner
Affiliation:
Department of Psychology, University of California, Los Angeles, CA, USA
Jae H. Kang
Affiliation:
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Eric B. Rimm
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Francine Grodstein
Affiliation:
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
Liming Liang
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Sebastien Haneuse
Affiliation:
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Laura D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Karestan C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Lori B. Chibnik
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
*
Corresponding author: Jiaxuan Liu; Email: j_liu@g.harvard.edu
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Abstract

Background

Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit.

Methods

Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively.

Results

Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression.

Conclusion

Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.

Keywords

Agingcognitioncognitive declineCogstatepost-traumatic stress disorderremissionwomen
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 2 , January 2024 , pp. 419 - 430
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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