Posttraumatic Stress Disorder and Cognitive Decline in Women: What’s the Link?

Posttraumatic stress disorder (PTSD) is associated with accelerated cognitive decline in middle-aged women, according to study findings published in JAMA Network Open.

Cognitive decline is associated with worse health and Alzheimer disease (AD). Stress and PTSD may impair learning and memory, but few longitudinal studies have evaluated whether PTSD is associated with subsequent decline in cognitive function. Women, who have a higher incidence of PTSD and dementia, have a higher lifetime risk for AD compared with men, so the researchers hypothesized that PTSD may be a risk factor for cognitive decline and dementia in women. This is the first study to evaluate whether PTSD is linked with cognitive function among middle-aged women, according to the researchers.

Researchers analyzed data on cognitive assessments of 12,270 women exposed to trauma aged 61.1±4.6 years (95.9% non-Hispanic White; 67% reporting PTSD symptoms) in the PTSD substudy of the Nurses’ Health Study II, which was a longitudinal cohort study. The Nurses’ Health Study II included community-dwelling middle-aged nurses in the United States who had at least a 2-year nursing degree when they enrolled in 1989.

The researchers classified women by self-report of trauma exposure and PTSD symptoms. Participants who reported 7 PTSD symptoms regarding their worst trauma were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) PTSD. Individuals completed the Cogstate Brief Battery, and researchers created 2 composite scores: psychomotor speed and attention and learning and working memory.

Mean follow-up time was 0.9 years. Nearly two-thirds of women completed at least 2 assessments.

The researchers found that women with PTSD symptoms had higher depressive symptom scores and rates of clinician-diagnosed depression.

Adjusted for demographic factors, women with 6 to 7 PTSD symptoms had a worse rate of change in learning and working memory compared with women without PTSD (β=−0.08 SD/y; 95% CI, −0.11 to −0.04 SD/y; P <.001). They also had reduced psychomotor speed and attention (β=−0.05 SD/y; 95%CI, −0.09 to −0.01 SD/y; P =.02). Adjusting for behavioral factors and health conditions maintained the association.

The association decreased but remained significant after the researchers adjusted for practice effects (eg, 6 to 7 symptoms in the analysis of learning and working memory: β=−0.07 SD/y; 95% CI, −0.10 to −0.03 SD/y; P <.001) and comorbid depression (eg, 6 to 7 symptoms in the analysis of learning and working memory: β=−0.07 SD/y; 95% CI, −0.11 to −0.03 SD/y; P <.001).

Study limitations included potential challenges with generalization outside the occupational cohort of mostly non-Hispanic White female nurses, self-report of PTSD, underestimating lifetime PTSD symptoms, and any unmeasured risk factors shared between PTSD and cognitive decline.

Overall, the study findings revealed a correlation between PTSD in middle-aged women and accelerated cognitive decline.

“Given that cognitive decline is associated with subsequent Alzheimer disease and related dementias, better understanding of this association may be important to promote healthy aging. These findings also highlight the importance of PTSD prevention and treatment to ensure heathy cognitive aging and suggest the value of earlier cognitive screening among women with PTSD,” the researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Roberts AL, Liu J, Lawn RB, et al. Association of posttraumatic stress disorder with accelerated cognitive decline in middle-aged women. JAMA Network Open. Published online June 30, 2022. doi: 10.1001/jamanetworkopen.2022.17698