We present three cases of post-traumatic stress disorder (PTSD) symptoms associated with cognitive decline. Patient age ranged from 57 to 70 years old and all patients had war-related PTSD. In each case, the patient had a history of PTSD that was under fairly good control until the onset of cognitive impairment due to Alzheimer's disease or vascular or alcohol-related dementia. These cases suggest that neurodegeneration of memory pathways may dis inhibit symptoms of PTSD. (J Geriatr Psychiatry Neurol 2001; 14:17-20).
References
1.
Clark C., Klonoff H., McDougall G., et al. The neuropsychological, psychiatric, and physical effects of prolonged and severe stress: 30 years later. J Nerv Ment Dis1976; 163:246-252.
2.
Hamner MBExacerbation of post-traumatic stress disorder symptoms with medical illness . Gen Hosp Psychiatry1994; 16:135-137.
3.
Brady KTPost-traumatic stress disorder and comorbidity: recognizing the many faces of PTSD. J Clin Psychiatry1997; 58(Suppl 9):12-15.
4.
Johnston D.A series of cases of dementia presenting with PTSD symptoms in World War II combat veterans. JAm Geriatr Soc2000 ; 48:70-72.
5.
Cassiday KL, Lyons JARecall of traumatic memories following cerebral vascular accident . J Traumat Stress1992; 5:627-631.
6.
Benitez JA, Berthier ML, Kulisevsky J., et al. Activation of post-traumatic stress disorder after minor head injury. Depress Anxiety1998; 8:43-47.
7.
Hamilton JD, Workman RHPersistence of combat-related post-traumatic stress symptoms for 75 years . J Traumat Stress1998; 11:763-768.
8.
van der Kolk BAThe body keeps the score: memory and the evolving psychobiology of post-traumatic stress. Harv Rev Psychiatry1994; 1:253-265.
9.
Schneider F. , Grodd W., Weiss U., et al. Functional MRI reveals left amygdala activation during emotion. Psychiatry Res1997; 76:75-82.
10.
van der Kolk BA, Greenberg MS, Boyd H., Krystal J.Inescapable shock, neurotransmitters and addiction to trauma: towards a psychobiology of post traumatic stress. Biol Psychiatry1985; 20:314-325.
11.
Charney DS, Deutch AY, Krystal JH, et al. Psychobiologic mechanisms of post-traumatic stress disorder . Arch Gen Psychiatry1993; 50:294-305.
12.
Krystal JH, Bennett AL, Bremner JD, et al. Toward a cognitive neuroscience of dissociation and altered memory functions in post-traumatic stress disorder. In: Friedman MJ, Charney DS, Deutsch AY, eds. Neurobiological and clinical consequences of stress: from normal adaptation to post traumatic stress disorder . Philadelphia: Lippincott-Raven , 271-287.
13.
McNish KA, Gewirtz JC, Davis M.Evidence of contextual fear after lesions of the hippocampus: a disruption of freezing but not fear-potentiated startle. JNeurosci1997;17:9353-9360.
14.
Rauch SL, Shin LM, Whalen PJ, Pitman RKNeuroimaging and the neuroanatomy of post-traumatic stress disorder . CNS Spectrum1998; 3(Suppl 2):31-41.
15.
Sapolsky RMWhy stress is bad for your brain. Science1996; 273:749-750.
16.
Sheline YI, Wang PW, Gado MH, et al. Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A1996; 93:3908-3913.
17.
Starkman MN , Gebarski SS, Berent S., et al. Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing's syndrome. Biol Psychiatry1992; 32:756-765.
18.
Bremner JD, Randall P., Scott TM, et al. MRI-based measurement of hippocampal volume in patients with combat-related post-traumatic stress disorder. Am J Psychiatry1995; 152:973-980.
19.
Gurvits TV, Shenton ME, Hokama H., et al. Magnetic resonance imaging study of hippocampal volume in chronic combat-related post-traumatic stress disorder. Biol Psychiatry1996; 40:1091-1099.
20.
Bremner JD, Randall P., Vermetten E., et al. Magnetic resonance imaging-based measurement of hippocampal volume in post-traumatic stress disorder related to childhood physical and sexual abuse-a preliminary report. Soc Biol Psychiatry1997; 41:23-32.
21.
Stein MB, Koverola C., Hanna C., et al. Hippocampal volume in women victimized by childhood sexual abuse . Psychol Med1997; 27:951-957.
22.
Axelroad J. , Reisine TDStress hormones: their interaction and regulation . Science1984; 224:452-459.
23.
Nemeroff CB , Widerlov E., Bissette G., et al. Elevated concentrations of CSF corticotropin-releasing factor-like immunoreactivity in depressed patients . Science1984; 226:1342-1344.
24.
Bremner JD, Licinio J., Darnell A., et al. Elevated CSF corticotropin-releasing factor concentrations in post-traumatic stress disorder. Am J Psychiatry1997; 154:624-629.
25.
Hyman BT, Van Hoesen GW, Damasio AR, et al. Alzheimer's disease: cell-specific pathology isolates the hippocampal formation. Science1984; 225:1168-1170.
26.
Van Hoesen GW , Damasio ARNeural correlates of cognitive impairment in Alzheimer's disease. In: Mountcastle V , Plum F, eds. Handbook of physiology: higher functions of the nervous system. Bethesda, MD: American Physiological Society, 1987:871-898.
27.
Eslinger PJ , Damasio ARPreserved motor learning in Alzheimer's disease: implications for anatomy and behavior. J Neurosci1986; 6:3006-3009.