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. 2022 Aug 15;43(12):3694-3705.
doi: 10.1002/hbm.25877. Epub 2022 Apr 15.

Accelerated longitudinal cortical atrophy in OEF/OIF/OND veterans with severe PTSD and the impact of comorbid TBI

Emma M Brown  1   2 , David H Salat  1   2   3 , William P Milberg  1   2   4   5 , Catherine B Fortier  2   4   5 , Regina E McGlinchey  1   2   4   5
Affiliations

Accelerated longitudinal cortical atrophy in OEF/OIF/OND veterans with severe PTSD and the impact of comorbid TBI

Emma M Brown et al. Hum Brain Mapp. .

Abstract

Veterans who deployed in support of Operation Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) commonly experience severe psychological trauma, often accompanied by physical brain trauma resulting in mild traumatic brain injury (mTBI). Prior studies of individuals with posttraumatic stress disorder (PTSD) have revealed alterations in brain structure, accelerated cellular aging, and impacts on cognition following exposure to severe psychological trauma and potential interactive effects of military-related mTBI. To date, however, little is known how such deployment-related trauma changes with time and age of injury of the affected veteran. In this study, we explored changes in cortical thickness, volume, and surface area after an average interval of approximately 2 years in a cohort of 254 OEF/OIF/OND Veterans ranging in age from 19 to 67 years. Whole-brain vertex-wise analyses revealed that veterans who met criteria for severe PTSD (Clinician-Administered PTSD Scale ≥60) at baseline showed greater negative longitudinal changes in cortical thickness, volume, and area over time. Analyses also revealed a significant severe-PTSD by age interaction on cortical measures with severe-PTSD individuals exhibiting accelerated cortical degeneration with increasing age. Interaction effects of comorbid military-related mTBI within the severe-PTSD group were also observed in several cortical regions. These results suggest that those exhibiting severe PTSD symptomatology have accelerated atrophy that is exacerbated with increasing age and history of mTBI.

Keywords: FreeSurfer; aging; cortical thickness; longitudinal; mild traumatic brain injury; posttraumatic stress disorder.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Group (severe‐PTSD+ and severe‐PTSD−) by age interaction on cortical change. Whole‐brain vertex‐wise analysis of the severe‐PTSD × age interaction on annual percent change in (a) cortical thickness and (b) volume. Clusters remained significant following cluster correction (p < .05). Maps are presented on the inflated cortical surface of an average brain. Blue indicates a more negative association between age and annual percent change in the severe‐PTSD+ group, red/yellow indicates a positive relationship. Uncorrected maps can be found in the supplemental information (Figure S3). PTSD, posttraumatic stress disorder
FIGURE 2
FIGURE 2
Regions in which the annual percent change of cortical measures with age shows more rapid decline with severe‐PTSD. Plots of annual percent change in cortical thickness in the left rostral middle frontal gyrus and precuneus, and right superior frontal and paracental gyri by age. Scatter plots are color coded with red triangles and green circles corresponding to severe‐PTSD+ and severe‐PTSD−, respectively. PTSD, posttraumatic stress disorder
FIGURE 3
FIGURE 3
Subgroup (severe‐PTSD with mTBI and severe‐PTSD only) by age interaction on cortical change significance maps. Whole‐brain vertex‐wise analysis of the severe‐PTSD + mTBI subgroup × age interaction on annual percent change in (a) cortical thickness and (b) volume. Clusters remained significant following cluster correction (p < .05). Maps are presented on the inflated cortical surface of an average brain. Blue indicates a more negative association between age and annual percent change in the severe‐PTSD+ group, red/yellow indicates a positive relationship. Uncorrected maps can be found in the supplemental information (Figure S4). mTBI, mild traumatic brain injury; PTSD, posttraumatic stress disorder
FIGURE 4
FIGURE 4
Regions in which the annual percent change of cortical measures with age shows more rapid decline with comorbid severe‐PTSD and military mTBI. Plots of annual percent change in cortical thickness in the left rostral middle frontal gyrus and isthmus cingulate by age. Scatter plots are color coded with red triangles and blue circles corresponding to comorbid PTSD + mTBI and PTSD‐only, respectively. Linear models of annual percent change versus age within each group are corrected (p < .05). mTBI, mild traumatic brain injury; PTSD, posttraumatic stress disorder
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