2 results
78 The Effects of Hypertension and Obstructive Sleep Apnea on Auditory Learning and Memory in Veterans with PTSD Symptomology
- Valerie Z. Alipio Jocson, Julie Gretler, Marcel Chen, Jerome A. Yesavage, Lisa M. Kinoshita
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 586-587
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Objective:
Obstructive sleep apnea (OSA) has been associated with cognitive deficits as evidenced by neuropsychological testing in the domains of attention/working memory, verbal memory, processing speed, and executive function. OSA is often comorbid with hypertension and has been considered a risk factor for hypertension (Kareem et al., 2018; Tietjens et al., 2019). Both hypertension and OSA have been shown to be independent predictors of memory (Kinoshita et al., 2012). OSA and posttraumatic stress disorder (PTSD) are also frequently co-occurring, especially among veterans. In a group of veterans with a history of PTSD, we seek to explore the effects of sleep apnea and hypertension on cognitive functioning, particularly auditory learning/memory.
Participants and Methods:One hundred and three male and female participants with comorbid OSA and PTSD symptomology were screened as part of a larger VA Palo Alto Health Care System study. Participants (age: x=56.3, a=13.8, 24-81 years; education: x=14.6, a=2.3, 8-20 years; 9.6% female, 89.6% male) completed a neuropsychological battery, including the CVLT-II and WMS-IV Logical Memory. Presence or absence of hypertension was dichotomously coded and AHI severity was categorically coded. An auditory learning/memory composite variable was created using the z-score transformation method (Dodge et al., 2020). Variables and covariates were entered into a hierarchical regression.
Results:The initial regression model revealed hypertension and OSA severity to be independent predictors of performance on auditory learning/memory (hypertension: ß= -0.71, p<0.01; OSA: ß= -0.42, p<0.01), where presence of hypertension or increased severity of OSA resulted in worse performance on the auditory learning/memory composite.
Conclusions:Results suggest that hypertension and OSA may independently and negatively affect performance on measures of auditory learning/memory in veterans with PTSD symptomology and OSA. Such findings underscore the importance of assessing and treating both hypertension and OSA among veterans with PTSD to improve not only physical health, but also cognitive health. Further research demonstrating similar findings is recommended along with studies investigating whether or not the treatment of hypertension and OSA can improve auditory learning/memory.
1 The Impact of APOzA and BDNF val66met on Executive Function in Older Veterans with Post-traumatic Stress Disorder
- Julie E Gretler, Madeline D.W. Noland, Laura Lazzeroni, Arthur Noda, Jerome A Yesavage, Lisa M Kinoshita
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 521-522
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Objective:
Both Apolipoprotein z4 (APOz4) and Brain-Derived Neurotropic Factor val66met (BDNF-met) have been implicated as cognitive risk polymorphisms and may signal a more rapid trajectory of cognitive decline (Boots et al., 2017; Lim et al., 2015). The presence of both risk alleles may additively result in greater cognitive difficulties (Cechova et al., 2020), specifically executive functioning (Sapkota et al., 2017). As executive functioning difficulties can be associated with Posttraumatic Stress Disorder (PTSD; Woon et al., 2017), individuals with PTSD who carry these polymorphisms may be at higher risk for decline in executive functioning. In this study, we examined the cross-sectional and longitudinal impact of these alleles on executive functioning performance in Veterans with PTSD.
Participants and Methods:Seventy community-dwelling male Veterans were enrolled as part of a larger study at VAPAHCS and consented to genetic analysis. A current or lifetime history of PTSD (score > 40 on the CAPS-IV; Blake et al., 1995) was required for study participation. Trail Making Test B (TMT-B; Army Individual Test Battery, 1994) was used to assess executive functioning. TMT-B was part of a comprehensive neuropsychological battery administered at baseline and yearly over the following three years. Mean age and education were 61 years old (SD = 4.5; range = 55-78) and 14 years (SD = 2.3; range = 8-20), respectively.
The majority of the sample was White (71%) and were from the Korean and Vietnam War eras.
Results:APOz4 and BDNF-met were present in 29% and 27% of the sample, respectively; both were present in six participants. Regression models were fitted separately for TMT-B raw time-to-complete and number of errors, both cross-sectionally at screening and then longitudinally. The presence of BDNF-met was a significant predictor of TMT-B time and number of errors in both models (Time: ß = 0.09, p = 0.03 and ß = 0.11, p < 0.01; Errors: IRR = 2.4, p = 0.01 and IRR = 1.9, p = 0.01), while APOz4 only predicted errors longitudinally (IRR = 1.8, p = 0.03). There was no significant allelic interaction; however, the presence of both alleles additively multiplied TMT-B errors by approximately 3.7 times at screening (IRR = 3.7; p = 0.01) and 3.3 times longitudinally (IRR = 3.3; p < 0.01).
Conclusions:Altogether, these results are suggestive of an adverse, additive, effect of the APOz4 and BDNF-met polymorphisms on executive functioning, in particular error-proneness, with their combined presence tripling the errors made on TMT-B cross-sectionally and longitudinally. Consistent with previous research, the TMT-B error analysis increases detection of cognitive impairment, similar to other clinical samples (Varjacic et al., 2018). While TMT-B errors are typically interpreted qualitatively, the strong effect of these established risk alleles on error rates further support this metric as a clinically useful indicator of executive dysfunction in a PTSD population. In keeping with the Boston Process approach, these findings support the importance of error analysis in clinical interpretation of neuropsychological performance.