Changes in brain anatomy during the course of posttraumatic stress disorder

San Francisco Veterans Affairs Medical Center, San Francisco, CA ,CA 94121 United States.
Psychiatry Research (Impact Factor: 2.47). 06/2011; 193(2):93-100. DOI: 10.1016/j.pscychresns.2011.01.013
Source: PubMed


The goal of this study was to determine whether posttraumatic stress disorder (PTSD) was associated with an increase in time-related decline in macrostructural brain volume and whether these changes were associated with accelerated cognitive decline. To quantify brain structure, three-dimensional T1-weighted MRI scans were performed at baseline and again after a minimum of 24months in 25 patients with PTSD (PTSD+) and 22 controls (PTSD-). Longitudinal changes in brain volume were measured using deformation morphometry. For the group as a whole, PTSD+ patients did not show significant ongoing brain atrophy compared to PTSD-. PTSD+ patients were then subgrouped into those with decreasing or increasing symptoms. We found little evidence for brain markers of accelerated atrophy in PTSD+ veterans whose symptoms improved over time, with only a small left parietal region showing greater ongoing tissue loss than PTSD-. PTSD patients whose symptoms increased over time showed accelerated atrophy throughout the brain, particularly brainstem and frontal and temporal lobes. Lastly, for the sample as a whole, greater rates of brain atrophy were associated with greater rates of decline in verbal memory and delayed facial recognition.

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Available from: Valerie A Cardenas, Apr 28, 2014
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    • "Multiple studies have identified smaller hippocampal volumes in subjects with posttraumatic stress disorder (PTSD) [2] [3] [4] [5] [6] [7]. Not all studies have found smaller hippocampal volumes [8] [9] [10] [11], and various groups have suggested that hippocampal volume differences in PTSD are attributable to comorbid conditions such as alcoholism [12] or depression [13]. Still, in most studies of hippocampal volume in PTSD investigators have controlled for major psychiatric comorbidities , including substance abuse, and meta-analyses reveal that the correlation between PTSD and smaller hippocampal volume is widely replicated [6,14–16]. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is associated with smaller volumes of the hippocampus, as has been demonstrated by meta-analyses. Proposed mechanistic relationships are reviewed briefly, including the hypothesis that sleep disturbances mediate the effects of PTSD on hippocampal volume. Evidence for this includes findings that insomnia and restricted sleep are associated with changes in hippocampal cell regulation and impairments in cognition. We present results of a new study of 187 subjects in whom neither PTSD nor poor sleep was associated with lower hippocampal volume. We outline a broad research agenda centered on the hypothesis that sleep changes mediate the relationship between PTSD and hippocampal volume.
    Alzheimer's and Dementia 06/2014; 10(3):S146–S154. DOI:10.1016/j.jalz.2014.04.016 · 12.41 Impact Factor
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    • "While we did not find the hypothesized relationship between PTSD symptoms and hippocampal volume, these temporal regions are highly interconnected with the hippocampus [63]. Further, reduced volume in middle or other temporal regions has been repeatedly found in previous studies as relating to PTSD diagnosis or symptom severity [20], [21], [64], [65]. The parahippocampal gyrus has been associated with representation of space and spatial context and perhaps contextual associations in general [66]–[70]. "
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    ABSTRACT: Combat-related PTSD has been associated with reduced gray matter volume in regions of the prefrontal and temporal cortex, hippocampus, insula, and amygdala. However, the relationship between gray matter volume and specific deployment and post-deployment experiences has not been investigated. The aim of this study was to delineate how such experiences may contribute to structural brain changes for combat veterans. Operation Iraqi Freedom/Operation Enduring Freedom veterans (N = 32) completed magnetic resonance imaging, the Deployment Risk and Resilience Inventory, Alcohol Use Disorders Identification Test, and Clinical Administered PTSD Scale. Voxel-wise Huber robust multiple regressions were used to quantify the relationship between gray matter volume and deployment experiences (combat experiences, military social support) and post-deployment symptoms (PTSD, alcohol use). There was an interaction between severity of combat experiences and military social support for orbitofrontal gyrus gray matter volume. Specifically, individuals with more orbitofrontal gyrus gray matter volume reported less combat experiences and higher unit support. Individuals with more severe PTSD symptoms showed reduced gray matter volume within a large temporal region (inferior temporal and parahippocampal gyrus). The identified association between unit support and orbitofrontal gyrus volume supports two potential resilience mechanisms to be delineated with future longitudinal studies. First, individuals with larger orbitofrontal gyrus may engage in greater quality of social interactions and thus experience combat as less stressful. Second, individuals who experience greater unit support may preserve a larger orbitofrontal gyrus, serving to "protect" them from aversive consequences of combat.
    PLoS ONE 09/2013; 8(9):e75880. DOI:10.1371/journal.pone.0075880 · 3.23 Impact Factor
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    • "Veterans with PTSD have been shown to have reduced hippocampal volume that correlates with impaired memory, and functional imaging studies indicate that patients with PTSD have impaired brain function in the medial prefrontal cortex, amygdala, and hippocampus [19]. Brain atrophy in PTSD is also affected by PTSD severity [20] [21]. However, chronic stress due to PTSD has also been shown to cause hypertrophy of the amygdala, an area of the brain that has evolved to deal with stressful, dangerous, and threatening situations. "
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    ABSTRACT: Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are signature injuries of the wars in Iraq and Afghanistan and have been linked to an increased risk of Alzheimer's disease (AD) and other dementias. A meeting hosted by the Alzheimer's Association and the Veterans' Health Research Institute (NCIRE) in May 2012 brought together experts from the U.S. military and academic medical centers around the world to discuss current evidence and hypotheses regarding the pathophysiological mechanisms linking TBI, PTSD, and AD. Studies underway in civilian and military populations were highlighted, along with new research initiatives such as a study to extend the Alzheimer's Disease Neuroimaging Initiative (ADNI) to a population of veterans exposed to TBI and PTSD. Greater collaboration and data sharing among diverse research groups is needed to advance an understanding and appropriate interventions in this continuum of military injuries and neurodegenerative disease in the aging veteran.
    Alzheimer's & dementia: the journal of the Alzheimer's Association 07/2013; 9(4):445-51. DOI:10.1016/j.jalz.2013.03.005 · 12.41 Impact Factor
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