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AIMS Neuroscience

2021, Volume 8, Issue 1: 47-73. doi: 10.3934/Neuroscience.2021003
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The extent of the neurocognitive impairment in elderly survivors of war suffering from PTSD: meta-analysis and literature review

  • 1.
    Health Research Methodology, McMaster University, Hamilton, ON, Canada
  • 2.
    Faculty of Health Sciences, McMaster University, Hamilton ON, Canada
  • 3.
    Faculty of Life Sciences, McMaster University, Hamilton ON, Canada
  • 4.
    School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
  • Received: 27 August 2020 Accepted: 23 November 2020 Published: 25 November 2020

  • 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.

    Citation: Yasir Rehman, Cindy Zhang, Haolin Ye, Lionel Fernandes, Mathieu Marek, Andrada Cretu, William Parkinson. The extent of the neurocognitive impairment in elderly survivors of war suffering from PTSD: meta-analysis and literature review[J]. AIMS Neuroscience, 2021, 8(1): 47-73. doi: 10.3934/Neuroscience.2021003

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  • 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.


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    Conflict of interest


    No conflict of interest.

    [1] Samuelson KW, Neylan TC, Metzler TJ, et al. (2006) Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. Neuropsychology 20: 716-726. doi: 10.1037/0894-4105.20.6.716
    [2] Vasterling JJ, Proctor SP, Amoroso P, et al. (2006) Neuropsychological Outcomes of Army Personnel Following Deployment to the Iraq War. JAMA 296: 519-529. doi: 10.1001/jama.296.5.519
    [3] Schinka JA, Loewenstein DA, Raj A, et al. (2010) Defining mild cognitive impairment: impact of varying decision criteria on neuropsychological diagnostic frequencies and correlates. Am J Geriatr Psychiatry 18: 684-691. doi: 10.1097/JGP.0b013e3181e56d5a
    [4] Avorn J (1995) Medication use and the elderly: current status and opportunities. Health Aff (Millwood) 14: 276-286. doi: 10.1377/hlthaff.14.1.276
    [5] Shenoy P, Harugeri A (2015) Elderly patients' participation in clinical trials. Perspect Clin Res 6: 184-189. doi: 10.4103/2229-3485.167099
    [6] Hoge CW, Castro CA, Messer SC, et al. (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 351: 13-22. doi: 10.1056/NEJMoa040603
    [7] Yaffe K, Vittinghoff E, Lindquist K, et al. (2010) Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry 67: 608-613. doi: 10.1001/archgenpsychiatry.2010.61
    [8] Brandes D, Ben-Schachar G, Gilboa A, et al. (2002) PTSD symptoms and cognitive performance in recent trauma survivors. Psychiatry Res 110: 231-238. doi: 10.1016/S0165-1781(02)00125-7
    [9] Dohrenwend BP, Turner JB, Turse NA, et al. (2006) The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science 313: 979-982. doi: 10.1126/science.1128944
    [10] Spiro A, Schnurr PP, Aldwin CM (1994) Combat-related posttraumatic stress disorder symptoms in older men. Psychol Aging 9: 17-26. doi: 10.1037/0882-7974.9.1.17
    [11] Qureshi SU, Long ME, Bradshaw MR, et al. (2011) Does PTSD Impair Cognition Beyond the Effect of Trauma? J Neuropsychiatry Clin Neurosci 23: 16-28. doi: 10.1176/appi.neuropsych.23.1.16
    [12] Schuitevoerder S, Rosen JW, Twamley EW, et al. (2013) A meta-analysis of cognitive functioning in older adults with PTSD. J Anxiety Disord 27: 550-558. doi: 10.1016/j.janxdis.2013.01.001
    [13] Scott Mackin R, Lesselyong JA, Yaffe K (2012) Pattern of cognitive impairment in older veterans with posttraumatic stress disorder evaluated at a memory disorders clinic. Int J Geriatr Psychiatry 27: 637-642. doi: 10.1002/gps.2763
    [14] Sapolsky RM (2000) Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch Gen Psychiatry 57: 925-935. doi: 10.1001/archpsyc.57.10.925
    [15] Van Achterberg ME, Rohrbaugh RM, Southwick SM (2001) Emergence of PTSD in trauma survivors with dementia. J Clin Psychiatry 62: 206-207. doi: 10.4088/JCP.v62n0312c
    [16] Mittal D, Torres R, Abashidze A, et al. (2001) Worsening of post-traumatic stress disorder symptoms with cognitive decline: case series. J Geriatr Psychiatry Neurol 14: 17-20. doi: 10.1177/089198870101400105
    [17] Johnston D (2000) A series of cases of dementia presenting with PTSD symptoms in World War II combat veterans. J Am Geriatr Soc 48: 70-72. doi: 10.1111/j.1532-5415.2000.tb03032.x
    [18] Cook JM, Ruzek JI, Cassidy E (2003) Practical Geriatrics: Possible Association of Posttraumatic Stress Disorder With Cognitive Impairment Among Older Adults. Psychiatr Serv 54: 1223-1225. doi: 10.1176/appi.ps.54.9.1223
    [19] Boscarino JA (2004) Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. Ann N Y Acad Sci 1032: 141-153. doi: 10.1196/annals.1314.011
    [20] Drescher KD, Rosen CS, Burling TA, et al. (2003) Causes of death among male veterans who received residential treatment for PTSD. J Trauma Stress 16: 535-543. doi: 10.1023/B:JOTS.0000004076.62793.79
    [21] Zatzick DF, Marmar CR, Weiss DS, et al. (1997) Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 154: 1690-1695. doi: 10.1176/ajp.154.12.1690
    [22] Chaplin R (2000) Psychiatrists can cause stigma too. Br J Psychiatry 177: 467. doi: 10.1192/bjp.177.5.467
    [23] Kleim B, Ehlers A (2008) Reduced autobiographical memory specificity predicts depression and posttraumatic stress disorder after recent trauma. J Consult Clin Psychol 76: 231-242. doi: 10.1037/0022-006X.76.2.231
    [24] Levine ME (2012) Modeling the Rate of Senescence: Can Estimated Biological Age Predict Mortality More Accurately Than Chronological Age? J Gerontol A Biol Sci Med Sci 68: 667-674. doi: 10.1093/gerona/gls233
    [25] Harvey PD (2019) Domains of cognition and their assessment. Dialogues Clin Neurosci 21: 227-237. doi: 10.31887/DCNS.2019.21.3/pharvey
    [26] Sachdev PS, Blacker D, Blazer DG, et al. (2014) Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol 10: 634-642. doi: 10.1038/nrneurol.2014.181
    [27] Moore SA, Zoellner LA (2007) Overgeneral autobiographical memory and traumatic events: an evaluative review. Psychol Bull 133: 419-437. doi: 10.1037/0033-2909.133.3.419
    [28] Guez J, Naveh-Benjamin M, Yankovsky Y, et al. (2011) Traumatic stress is linked to a deficit in associative episodic memory. J Trauma Stress 24: 260-267. doi: 10.1002/jts.20635
    [29] Lagarde G, Doyon J, Brunet A (2010) Memory and executive dysfunctions associated with acute posttraumatic stress disorder. Psychiatry Res 177: 144-149. doi: 10.1016/j.psychres.2009.02.002
    [30] Kanagaratnam P, Asbjørnsen AE (2007) Executive deficits in chronic PTSD related to political violence. J Anxiety Disord 21: 510-525. doi: 10.1016/j.janxdis.2006.06.008
    [31] Sachinvala N, Von Scotti H, McGuire M, et al. (2000) Memory, attention, function, and mood among patients with chronic posttraumatic stress disorder. J Nerv Ment Dis 188: 818-823. doi: 10.1097/00005053-200012000-00005
    [32] Vasterling JJ, Duke LM, Brailey K, et al. (2002) Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. Neuropsychology 16: 5-14. doi: 10.1037/0894-4105.16.1.5
    [33] Green E, Fairchild JK, Kinoshita LM, et al. (2015) Effects of Posttraumatic Stress Disorder and Metabolic Syndrome on Cognitive Aging in Veterans. Gerontologist 56: 72-81. doi: 10.1093/geront/gnv040
    [34] Hart J, Kimbrell T, Fauver P, et al. (2008) Cognitive Dysfunctions Associated With PTSD: Evidence from World War II Prisoners of War. J Neuropsychiatry Clin Neurosci 20: 309-316. doi: 10.1176/jnp.2008.20.3.309
    [35] Yehuda R, Golier JA, Tischler L, et al. (2007) Hippocampal volume in aging combat veterans with and without post-traumatic stress disorder: relation to risk and resilience factors. J Psychiatr Res 41: 435-445. doi: 10.1016/j.jpsychires.2005.12.002
    [36] Liberati A, Altman DG, Tetzlaff J, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339: b2700. doi: 10.1136/bmj.b2700
    [37] Singh S, Bajorek B (2014) Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada) 12: 489. doi: 10.4321/S1886-36552014000400007
    [38] Harugeri A, Joseph J, Parthasarathi G, et al. (2010) Potentially inappropriate medication use in elderly patients: a study of prevalence and predictors in two teaching hospitals. J Postgrad Med 56: 186-191. doi: 10.4103/0022-3859.68642
    [39] Weathers FW, Bovin MJ, Lee DJ, et al. (2018) The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess 30: 383-395. doi: 10.1037/pas0000486
    [40] McCarthy S (2008) Post-Traumatic Stress Diagnostic Scale (PDS). Occup Med (Lond) 58: 379-379. doi: 10.1093/occmed/kqn062
    [41] Foa EB, McLean CP, Zang Y, et al. (2016) Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5). Psychol Assess 28: 1159-1165. doi: 10.1037/pas0000259
    [42] Ruglass LM, Papini S, Trub L, et al. (2014) Psychometric Properties of the Modified Posttraumatic Stress Disorder Symptom Scale among Women with Posttraumatic Stress Disorder and Substance Use Disorders Receiving Outpatient Group Treatments. J Trauma Stress Disord Treat 4.
    [43] Golier JA, Yehuda R, Lupien SJ, et al. (2002) Memory performance in Holocaust survivors with posttraumatic stress disorder. Am J Psychiatry 159: 1682-1688. doi: 10.1176/appi.ajp.159.10.1682
    [44] Golier JA, Yehuda R, Lupien SJ, et al. (2003) Memory for trauma-related information in Holocaust survivors with PTSD. Psychiatry Res 121: 133-143. doi: 10.1016/S0925-4927(03)00120-3
    [45] Golier JA, Yehuda R, De Santi S, et al. (2005) Absence of hippocampal volume differences in survivors of the Nazi Holocaust with and without posttraumatic stress disorder. Psychiatry Res 139: 53-64. doi: 10.1016/j.pscychresns.2005.02.007
    [46] Yehuda R, Golier JA, Harvey PD, et al. (2005) Relationship between cortisol and age-related memory impairments in Holocaust survivors with PTSD. Psychoneuroendocrinology 30: 678-687. doi: 10.1016/j.psyneuen.2005.02.007
    [47] Yehuda R, Golier JA, Halligan SL, et al. (2004) Learning and memory in Holocaust survivors with posttraumatic stress disorder. Biol Psychiatry 55: 291-295. doi: 10.1016/S0006-3223(03)00641-3
    [48] Freeman T, Kimbrell T, Booe L, et al. (2006) Evidence of resilience: Neuroimaging in former prisoners of war. Psychiatry Res 146: 59-64. doi: 10.1016/j.pscychresns.2005.07.007
    [49] Yehuda R, Tischler L, Golier JA, et al. (2006) Longitudinal assessment of cognitive performance in Holocaust survivors with and without PTSD. Biol Psychiatry 60: 714-721. doi: 10.1016/j.biopsych.2006.03.069
    [50] Agency for Healthcare Research and Quality (US), Rockville (MD) Cognitive Outcomes After Cardiovascular Procedures in Older Adults: A Systematic Review (2014) .Available from: https://pubmed.ncbi.nlm.nih.gov/25905147/.
    [51] Parkinson WL, Rehman Y, Rathbone M, et al. (2020) Performances on individual neurocognitive tests by people experiencing a current major depression episode: A systematic review and meta-analysis. J Affective Disord 276: 249-259. doi: 10.1016/j.jad.2020.07.036
    [52] Rathbone M, Parkinson W, Rehman Y, et al. (2016) Magnitude and variability of effect sizes for the associations between chronic pain and cognitive test performances: a meta-analysis. Br J Pain 10: 141-155. doi: 10.1177/2049463716642600
    [53] Wells G, Shea B, O'connell D, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses (2014) .
    [54] Guyatt GH, Oxman AD, Vist GE, et al. (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336: 924-926. doi: 10.1136/bmj.39489.470347.AD
    [55] Wittekind CE, Jelinek L, Kellner M, et al. (2010) Intergenerational transmission of biased information processing in posttraumatic stress disorder (PTSD) following displacement after World War II. J Anxiety Disord 24: 953-957. doi: 10.1016/j.janxdis.2010.06.023
    [56] Golier JA, Harvey PD, Legge J, et al. (2006) Memory performance in older trauma survivors: implications for the longitudinal course of PTSD. Ann N Y Acad Sci 1071: 54-66. doi: 10.1196/annals.1364.006
    [57] Jelinek L, Wittekind CE, Moritz S, et al. (2013) Neuropsychological functioning in posttraumatic stress disorder following forced displacement in older adults and their offspring. Psychiatry Res 210: 584-589. doi: 10.1016/j.psychres.2013.06.037
    [58] Wessel I, Merckelbach H, Dekkers T (2002) Autobiographical Memory Specificity, Intrusive Memory, and General Memory Skills in Dutch–Indonesian Survivors of the World War II Era. J Trauma Stress 15: 227-234. doi: 10.1023/A:1015207428675
    [59] Schoenberg MR, Lange RT, Marsh P, et al. (2011) Premorbid Intelligence. Encyclopedia of Clinical Neuropsychology New York: Springer New York, 2004-2010. doi: 10.1007/978-0-387-79948-3_2140
    [60] Cicerone KD, Azulay J (2002) Diagnostic utility of attention measures in postconcussion syndrome. Clin Neuropsychol 16: 280-289. doi: 10.1076/clin.16.3.280.13849
    [61] Munjiza J, Britvic D, Radman M, et al. (2017) Severe war-related trauma and personality pathology: a case-control study. BMC Psychiatry 17: 100. doi: 10.1186/s12888-017-1269-3
    [62] Murman DL (2015) The Impact of Age on Cognition. Semin Hear 36: 111-121. doi: 10.1055/s-0035-1555115
    [63] Lapp LK, Agbokou C, Ferreri F (2011) PTSD in the elderly: the interaction between trauma and aging. Int Psychogeriatr 23: 858-868. doi: 10.1017/S1041610211000366
    [64] Hayes JP, Vanelzakker MB, Shin LM (2012) Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies. Front Integr Neurosci 6: 89. doi: 10.3389/fnint.2012.00089
    [65] Ben-Zion Z, Fine NB, Keynan NJ, et al. (2018) Cognitive Flexibility Predicts PTSD Symptoms: Observational and Interventional Studies. Front Psychiatry 9: 477. doi: 10.3389/fpsyt.2018.00477
    [66] Tanev KS, Federico LE, Terry DP, et al. (2019) Cognitive Impairment and Predicting Response to Treatment in an Intensive Clinical Program for Post-9/11 Veterans With Posttraumatic Stress Disorder. J Neuropsychiatry Clin Neurosci 31: 337-345. doi: 10.1176/appi.neuropsych.18090208
    [67] Kessler RC, Berglund P, Demler O, et al. (2005) Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62: 593-602. doi: 10.1001/archpsyc.62.6.593
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