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What we know
Prior work has demonstrated that chronic stress is associated with cognitive dysfunction in the context of aging (Zuelsdorff et al., 2013). Long-term activation of the stress-response system and the subsequent overexposure of cortisol that follows can disrupt almost all bodily processes. In particular, stress-related effects can impact the prefrontal cortex and limbic system, regions of the brain that have a large number of glucocorticoid receptors (Lucassen et al., 2014). However, prior work has not sufficiently disentangled the role of stress exposures compared with posttraumatic stress disorder (PTSD) symptom severity on cognitive functioning. 
What we wanted to know
The primary aim of the current study was to examine associations between PTSD symptom severity and the number of stressors experienced with cognitive outcomes. In other words, we sought to understand if exposure to life stressors influences cognition to the same extent as PTSD symptoms. We studied Vietnam War Veterans who participated in the Department of Defense Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. Our sample included 274 participants between the ages of 60 and 85 years old (99.3% male, 84.3% White). Cognition was assessed using the Montreal Cognitive Assessment (MoCA; Nasreddine, 2005).
What we learned
PTSD symptom severity, but not total number of stressful events, was associated with poorer cognitive performance on the MoCA. These findings are important because they suggest that cognitive performance is particularly disrupted by persistent and severe stress symptoms following a traumatic event, rather than exposure to multiple stressful events. These results underscore the important role of PTSD symptomatology in the previously observed association between stress and cognitive dysfunction. 
What’s next
Altogether, our findings demonstrate that PTSD symptoms are associated with negative cognitive performance in our sample of older veterans of the Vietnam War. However, given that the study is cross-sectional, we cannot infer causal associations between stress and cognitive dysfunction. The next step in this line of work would be to conduct a longitudinal study to determine stress-induced changes in cognitive function. Future work should also explore whether treating PTSD symptoms helps to maintain cognitive function during the aging process. It is possible that treating symptoms of PTSD as soon as possible following trauma may be helpful in preserving cognitive status into older age. This kind of information can help policymakers, clinicians, and researchers moving forward. 

Target Article 

Prieto, S., Moody, J.N., Valerio, K.E., & Hayes, J.P. (in press). Posttraumatic stress disorder symptom severity is associated with reduced outcomes on the MOCA in a sample of Vietnam Veterans. Journal of Traumatic Stress. https://doi.org/10.1002/jts.22830

Discussion Questions

  1. How might findings from this study be integrated into recommendations to preserve cognition in aging veterans? 
  2. How can we continue to use cognitive outcomes data to inform effective PTSD research?
  3. How may these findings differ in samples with different demographic or trauma-relevant characteristics (e.g., female, ethnically/racially diverse, community samples of PTSD, etc.)?
  4. How can we increase the dissemination of interventions that promote healthy cognitive aging?

About the Authors

Sarah Prieto, MS, is pursuing a PhD in clinical psychology with a concentration in cognitive neuroscience at The Ohio State University. Her research interests include the effects of chronic and traumatic stress on metrics of cognitive health. She is an active member of the Society for Clinical Neuropsychology (SCN) Science Advisory Committee, Ohio State University Psychology Graduate Student Diversity, Equity, and Inclusion (DEI) Committee, and Mindfulness Student Interest Group. Sarah can be contacted at prieto.39@buckeyemail.osu.edu or via twitter @Sarah__Prieto. 
Jena N. Moody, MS, is a Clinical Psychology PhD student at The Ohio State University. Her research interests include stress, TBI, and the relationship between the brain and behavior. She received her MS from The Ohio State University in 2021. She trains under the mentorship of Dr. Jasmeet Hayes. Jena can be contacted at moody.279@osu.edu.
Kate E. Valerio, MS, is a Clinical Psychology PhD student at The Ohio State University. Her research interests include TBI and the relationship between brain and cognition. She received her MS from The Ohio State University in 2021. She trains under the mentorship of Dr. Jasmeet Hayes. Kate can be contacted at valerio.33@buckeyemail.osu.edu.
Jasmeet P. Hayes, PhD, is Associate Professor of Psychology and Director of the MINDSET Lab at The Ohio State University. Dr. Hayes’s research examines links between traumatic brain injury/concussion, psychological stress and neurodegenerative disease using neuroimaging genetics and multi-omics approaches. As a licensed clinical psychologist, Dr. Hayes’ clinical interests include neuropsychological assessment of TBI, PTSD, and dementia.

References Cited

Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society53(4), 695-699.

Zuelsdorff, M. L., Engelman, C. D., Friedman, E. M., Koscik, R. L., Jonaitis, E. M., Rue, A. L., & Sager, M. A. (2013). Stressful events, social support, and cognitive function in middle-aged adults with a family history of Alzheimer’s disease. Journal of Aging and Health, 25(6), 944–959. https://doi.org/10.1177/08982643134984.

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