Posttraumatic Stress Disorder and Cognitive Decline in Women

描述(申请人提供)：创伤后应激障碍(PTSD)是一种在美国人口中普遍存在的令人衰弱的精神障碍，在女性中尤其常见：每9名女性中就有1人在一生中符合诊断标准。创伤后应激障碍是前哨应激相关的精神障碍，以下丘脑-垂体-肾上腺轴和神经内分泌失调为特征；动物模型和人类相关研究将这种HPA轴和神经内分泌功能失调与多种认知过程、脑结构和功能的改变联系起来。然而，关于创伤后应激障碍及其相关的失调压力反应是否会导致认知能力下降的问题仍然存在，因为现有的研究报告的结果相互矛盾。了解创伤后应激障碍和认知健康的关系--包括影响关联的因素，如症状的持续时间和强度，以及关联背后的机制，如睡眠质量、健康状况、心血管疾病--可以为旨在减轻创伤后应激障碍对认知健康构成的任何风险的干预措施提供信息。我们建议对来自护士健康研究II的54,282名年龄在48-65岁之间的女性进行创伤后应激障碍和随后的认知功能检查，她们是1989年以来跟踪调查的关于创伤后应激障碍的详细数据的子队列的一部分。女性目前的年龄在48-65岁之间。我们的主要目的是评估独立于抑郁症的创伤后应激障碍是否与中年女性认知能力较差有关，并收集有关认知变化的初步数据。为了实现这一目标，我们将利用一个简短的、有效的、计算机化的认知电池(CogState)，允许这些精通计算机的护士高效地收集DAA。作为次要目标，我们将评估创伤后应激障碍与认知的任何关系的具体因素，包括充当中介和效果修饰物的因素，这些因素可以作为干预的目标。先前关于创伤后应激障碍和认知的工作侧重于特定人群的小样本，如大屠杀幸存者或主要是男性军事人员或退伍军人的大样本。这一应用是一个独特的机会，可以开始利用一大批现有的妇女，以非常低的成本了解创伤后应激障碍在更广泛的人群中的更大范围的影响。女性患创伤后应激障碍的风险是男性的两倍，因此，了解创伤后应激障碍对女性认知的影响具有重要的公共卫生意义。最后，除了直接解决我们的目标外，我们还将产生重要的数据，用于规划未来关于创伤后应激障碍以及其他感兴趣领域的研究；例如，关于这个年龄段认知变化率的初步数据将使我们能够适当地设计推动创伤后应激障碍和认知之间关系的机制的前瞻性研究，包括其他健康、心理健康和生活方式变量。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a pervasive and debilitating mental disorder in the U.S. population and particularly common among women: 1 in 9 women will meet criteria for the diagnosis during their lives. PTSD is the sentinel stress-related mental disorder and is characterized by hypothalamic-pituitary-adrenal axis and neuroendocrine dysregulation; animal models and human correlational studies have linked such dysregulation in the HPA axis and neuroendocrine function to alterations in multiple cognitive processes, brain structure, and function. However, questions remain as to whether PTSD and its associated dysregulated stress response produce cognitive decrements as extant studies report conflicting results. Understanding the relation of PTSD and cognitive health -- including elements influencing an association, such as duration and intensity of symptoms and mechanisms underlying an association, such as sleep quality, health status, cardiovascular disease -- could inform interventions aimed at mitigating any risks PTSD may pose for cognitive health. We propose to examine PTSD and subsequent cognitive function within 54,282 women age 48-65 years from the Nurses' Health Study II, who are part of a sub-cohort followed since 1989 with detailed data on PTSD. Women are currently age 48-65 years. Our primary aim is to evaluate if PTSD, independent of depression, is associated with worse cognition in middle-aged women and to collect preliminary data on cognitive change. In accomplishing this aim, we will utilize a brief, validated, computerized cognitive battery (CogState), allowing highly efficient daa collection in these computer-savvy nurses. As a secondary aim we will evaluate specific elements of any relation of PTSD to cognition, including factors acting as mediators and effect modifiers, which could be targeted for interventions. Prior work on PTSD and cognition has focused on small samples from specific populations, such as Holocaust survivors or larger samples of primarily male military personnel or veterans. This application represents a unique opportunity to begin to leverage a large, existing cohort of women to understand the larger scope of effects of PTSD in the broader-based population - at very modest cost. Women's risk of PTSD is twice that of men' risk and, therefore, understanding the impact of PTSD on cognition in women of great public health importance. Finally, in addition to directly addressing our Aims, we will generate important data for planning future research on PTSD, and other areas of interest as well; for example, preliminary data on rates of cognitive change in this age group will allow us to appropriately design prospective studies of the mechanisms driving the relation between PTSD and cognition, including other health, mental health and lifestyle variables.