Background

Adolescence is a critical period for neural development and has been associated with high rates of alcohol abuse. This research examined potential long-term brain and behavioral effects of early versus late-onset adolescent binge drinking in an adult sample of post-9/11 Veterans.

Methods

We compared cortical thickness measures in Veterans with a history of binge drinking that began before the age of 15 (n = 50; mean age = 32.1 years) to those with a history of binge drinking with onset after the age of 15 (n = 300; mean age = 32.1 years). Data processing was conducted with FreeSurfer. A targeted neuropsychological battery (Digit Span test, Delis-Kaplan Executive Function System Color-Word Interference Test, California Verbal Learning Test-II) was used to examine the relationships between cortical thickness and attention, memory, and inhibition. A reference group of social drinkers with no history of early binge drinking (n = 31) was used to provide normative data.

Results

Early-onset adolescent binge drinkers (EBD) had greater cortical thickness in several regions than late-onset adolescent binge drinkers (LBD); both binge-drinking groups had greater cortical thickness than the reference group. There was a stronger negative association between cortical thickness and age in EBDs than LBDs in the (i) lateral orbitofrontal cortex, (ii) supramarginal gyrus, (iii) paracentral lobule, and (iv) anterior caudal cingulate. Poorer performance on the attention and inhibition tasks in the EBDs was also associated with thicker cortices.

Conclusions

This study demonstrates greater cortical thickness across frontoparietal regions in adults who began binge drinking in early versus late adolescence. A stronger negative association between cortical thickness and age in the EBDs suggests that early-onset adolescent binge drinking may be associated with accelerated cortical thinning. Thicker cortex in these regions, which are known to mediate inhibitory control, may increase impulsive behavior and contribute to the risk of alcohol addiction.

Objective: 
To adapt the Boston Assessment of TBI-Lifetime (BAT-L) interview specifically for female survivors of intimate partner violence (IPV), validate the adapted BAT-L/IPV, and report the prevalence of head injury.

Setting: 
The BAT-L is the first validated instrument to diagnose traumatic brain injuries (TBIs) throughout the life span for post-9/11 veterans. The BAT-L/IPV was adapted to target diagnostic issues belonging exclusively to IPV while maintaining its life span approach.

Participants: 
Community-dwelling convenience sample of 51 female survivors of IPV with subthreshold (n = 10) or full diagnostic criteria (n = 41) of posttraumatic stress disorder.

Design: 
Standard TBI criteria were evaluated using a semistructured clinical interview.

Main Measures: 
The BAT-L/IPV is compared with the Ohio State University TBI Identification Method (OSU-TBI-ID) scoring approach as the criterion standard.

Results: 
Correspondence between the BAT-L/IPV and the OSU-TBI-ID score was excellent (Cohen κ = 0.86; Kendall τ-b = 0.89). Sensitivity = 89.3% (95% CI, 81.2-97.4); specificity = 98.3% (95% CI, 95.0-100); positive predictive value = 98.0% (95% CI, 94.2-100); and negative predictive value = 90.6% (95% CI, 83.5-97.7). On the BAT-L/IPV, more than one-third (35.3%) of IPV survivors reported TBI secondary to an IPV-related assault, 76.5% reported IPV subconcussive head injury, 31.4% reported attempted strangulation, and 37.3% reported non-IPV TBI.

Conclusions: 
The BAT-L/IPV performed well in diagnosing TBI in female IPV survivors as compared with the criterion standard. The prevalence of TBI was frequent; subconcussive head injury was pervasive. Greater awareness for head injury risk and increased diagnostic specificity of TBI in IPV survivors is needed.

Aims

To demonstrate that early adolescent binge drinking (BD) increases the risk for and/or severity of psychopathology in post-9/11 Veterans and determine if mild traumatic brain injury (mTBI) modifies risk.

Methods

Post-9/11 Veterans (n = 375) were classified into two groups: 57 Veterans with a history of early adolescent BD (E-BD; age of onset <15) and 318 who did not BD until age 15 or older (late-BD or L-BD; age of onset ≥15). History of military mTBI and mental health disorders were also assessed following military service.

Results

Logistic regression and analysis of variance (ANOVA) analyses revealed that the E-BD’s had significantly higher prevalence of alcohol use disorders (AUDs) and more severe symptoms of AUD, substance use disorder (SUD), depression and stress. Two-way ANOVAs showed that history of military mTBI was differentially associated with posttraumatic stress disorder (PTSD) incidence and severity among Veterans who had engaged in early adolescent BD. Specifically, Veterans with a history of both early adolescent BD and military mTBI were at greater risk for a PTSD diagnosis and had more severe symptoms of PTSD than those with only a history of adolescent BD. The greater PTSD symptom severity in the comorbid group was driven by hyperarousal symptoms.

Conclusions

A history of BD during early adolescence is prevalent among Veterans and is related to higher risk for AUD and more severe AUD, SUD, mood and stress symptoms later in life. Veterans with early BD and military mTBI showed greater incidence and severity of PTSD, indicating that mTBI, a common comorbidity among post-9/11 Veterans, exacerbates risk.

Background

A major obstacle in understanding and treating posttraumatic stress disorder (PTSD) is its clinical and neurobiological heterogeneity. To address this barrier, the field has become increasingly interested in identifying subtypes of PTSD based on dysfunction in neural networks alongside cognitive impairments that may underlie the development and maintenance of symptoms. The current study aimed to determine if subtypes of PTSD, based on normative-based cognitive dysfunction across multiple domains, have unique neural network signatures.

Methods

In a sample of 271 veterans (90% male) that completed both neuropsychological testing and resting-state fMRI, two complementary, whole-brain functional connectivity analyses explored the link between brain functioning, PTSD symptoms, and cognition.

Results

At the network level, PTSD symptom severity was associated with reduced negative coupling between the limbic network (LN) and frontal-parietal control network (FPCN), driven specifically by the dorsolateral prefrontal cortex and amygdala Hubs of Dysfunction. Further, this relationship was uniquely moderated by executive function (EF). Specifically, those with PTSD and impaired EF had the strongest marker of LN-FPCN dysregulation, while those with above-average EF did not exhibit PTSD-related dysregulation of these networks.

Conclusion

These results suggest that poor executive functioning, alongside LN-FPCN dysregulation, may represent a neurocognitive subtype of PTSD.

Purpose : To investigate the association between the number of mild traumatic brain injuries (mTBI) during military service and distance acuity in Post-9/11 Veterans.

Methods : Participants were recruited from the Translational Research Center for TBI and Stress Disorders (TRACTS) longitudinal cohort study. The core battery for this ongoing study of Post-9/11 Veterans includes biologic/medical and genetic screening, structural and functional neuroimaging, as well as cognitive and psychological assessments. Screening assessments include the Boston Assessment of Traumatic Brain Injury – Lifetime (BAT-L), a semi-structured interview used to assess history of TBIs prior to, during, and after military service. Military TBIs include TBIs acquired during military service through blast exposure or any other mechanisms (e.g. blunt force trauma). A clinical exam was completed in addition to the core TRACTS battery in a random subset of participants between August 2015 and April 2017 at their repeat evaluation. The exam included measuring near and distance acuity, refractive error, ocular alignment, convergence, accommodation, and eye movements (fixation, pursuit, and saccades).

Results : Sixty-three eyes of thirty-two Post-9/11 veterans were included in analyses (90% male; mean age = 36.97±10.18). Multiple linear regression analyses completed with age and pinhole acuity as covariates show that the number of military mTBIs was associated with deficits in distance acuity (β=0.353, t=3.332, p=0.001). Including only the subset of participants with a positive history of military mTBIs, we find that this relationship remains when the years since last TBI is included as a covariate in the regression model. Additional analyses showed that the number of military mTBIs was not associated with deficits in near acuity thresholds (p=0.261).

Conclusions : The current results show that increasing numbers of military mTBIs is associated with decreasing visual acuity function in this sample of Post-9/11 Veterans. This relationship cannot be accounted for by the age of participants or the time since the last mTBI, and does not generalize to near acuity. This result is consistent with post-traumatic pseudomyopia that has been previously reported in other closed-head injury studies, though additional work is ongoing to further delineate the underlying mechanism leading to the observed changes in distance acuity functioning.

Introduction

Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD.

Materials and Methods

This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman’s rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression.

Results

Peak oxygen uptake (⁠V˙V˙O_2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = −0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = −0.61, P = 0.03 and diastolic blood pressure rho = −0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized β = −0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) β = −0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) β = −0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status.

Conclusions

These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.

Background

Cerebral blood flow (CBF) is critically important in the overall maintenance of brain health, and disruptions in normal flow have been linked to the degradation of the brain’s structural integrity and function. Recent studies have highlighted the potential role of CBF as a link between psychiatric disorders and brain integrity. Although interpersonal early life trauma (IP-ELT) is a risk factor for the development of psychiatric disorders and has been linked to disruptions in brain structure and function, the mechanisms through which IP-ELT alters brain integrity and development remain unclear. The goal of this study was to understand whether IP-ELT was associated with alterations in CBF assessed during adulthood. Further, because the cognitive implications of perfusion disruptions in IP-ELT are also unclear, this study sought to investigate the relationship between IP-ELT, perfusion, and cognition. Methods: 179 Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) Veterans and military personnel completed pseudo-continuous arterial spin labeling (pCASL) imaging, clinical interviews, the Traumatic Life Events Questionnaire (TLEQ), and a battery of neuropsychological tests that were used to derive attention, memory, and executive function cognitive composite scores. To determine whether individuals were exposed to an IP-ELT, events on the TLEQ that specifically queried interpersonal trauma before the age of 18 were tallied for each individual. Analyses compared individuals who reported an interpersonal IP-ELT (IP-ELT+, n = 48) with those who did not (IP-ELT-, n = 131). Results: Whole brain analyses revealed that IP-ELT+ individuals had significantly greater CBF in the right inferior/middle temporal gyrus compared to those in the IP-ELT- group, even after controlling for age, sex, and posttraumatic stress disorder (PTSD). Further, perfusion in the right inferior/middle temporal gyrus significantly mediated the relationship between IP-ELT and memory, not attention or executive function, such that those with an IP-ELT had greater perfusion, which, in turn, was associated with poorer memory. Examination of other clinical variables such as current PTSD diagnosis and severity as well as the interaction between IP-ELT and PTSD yielded no significant effects. Conclusions: These results extend prior work demonstrating an association between ELT and cerebral perfusion by suggesting that increased CBF may be an important neural marker with cognitive implications in populations at risk for psychiatric disorders.

Rationale Tobacco use is highly prevalent among individuals with posttraumatic stress disorder(PTSD), depressive disorders, and pain. Research has revealed pairwise relationships among these conditions but has not examined more complex relationships that may influence symptom severity, chronicity, and treatment outcome. Objective To examine the clustering of current PTSD, depressive disorders, and clinically significant pain according to current tobacco use and dependence among post-9/11 deployed veterans. Methods Logistic regression was used to examine the clustering of these conditions in relationship to current tobacco use/dependence, while adjusting for age and total combat exposure, in 343 post-9/11 deployed veterans enrolled in the Translational Research Center for TBI and Stress Disorders (TRACTS) cohort (Mage = 32.1 + 8.3 years; 38% current tobacco use; 25% low and 12% moderate/high tobacco dependence). Results A three-way clustering of PTSD, depressive disorder, and pain was more likely than any single or pairwise combination of these conditions in moderate/high tobacco-dependent veterans compared to tobacco non-users (adjusted ORs = 3.50 to 4.18). This multi-morbidity cluster also was associated with increased PTSD severity. Conclusions Moderate to high dependence on tobacco is associated with substantially increased clustering of PTSD, depression, and clinically significant pain in veterans. Research examining synergistic interactions among these conditions, biological vulnerabilities shared among them, andthe direct impact of tobacco use on the pathophysiology of PTSD, depression, and pain is needed. The results of such work may spur development of more effective integrated treatments to reduce the negative impact of these multi-morbid conditions on veterans’ wellbeing and long-term health.

Background

Alcohol misuse often manifests in two different patterns of drinking; Binge Drinking (BD; ≥4 (women) or ≥ 5 (men) drinks/day, ≤12 days/month) or Heavy Drinking (HD; ≥3 (women) or ≥4 (men) drinks/day, ≥16 days/month). Although direct comparisons have not been made, structural MRI studies indicate that the two types of drinking behaviors might be associated with different neuromorphometric characteristics.

Methods

This study used a cross-sectional design to compare brain structure (using MRI derived subcortical volume and cortical thickness measures) between participants with histories of BD (N = 16), HD (N = 15), and Healthy Controls (HC; N = 21). Whole-brain analyses were used to quantify group differences in subcortical volume and cortical thickness. Resulting cortical thickness clusters were quantified for their areas of overlap with resting-state network parcellations.

Results

BD was associated with decreased volumes of the bilateral global pallidus and decreased cortical thickness within the left superior-parietal cluster (p < .05). This cortical cluster overlapped in surface area with the dorsal-attention (50.86%) and the fronto-parietal network parcellations (49.14%). HD was associated with increased cortical thickness in the left medial occipito-parietal cluster (p < .05). This cluster primarily overlapped with the visual network parcellation (89%) and, to a lesser extent, with a widespread number of network parcellations (dorsal-attention: 3.8%; fronto-parietal: 3.5%; default-mode: 3.2%).

Conclusions

These data indicate that histories of BD and HD patterns are associated with distinct neuromorphometric characteristics. BD was associated with changes within the executive control networks and the globus pallidus. HD was associated with widespread changes, that are primarily localized within the visual network.

Objective: This study investigated sleep problems and physical pain as moderators of the relationship between PTSD symptoms and aggression among returning veterans. Prior research has demonstrated associations between PTSD symptoms and aggression, but little work has sought to identify moderators ofthis relationship. Sleep problems and physical pain are both common clinical problems among veterans and have theoretical links to aggression. Method: Participants were 103 returning service members and veterans recruited from the greater Boston area and enrolled in the VA Translational Research Center for Traumatic Brain Injury (TBI) and Stress Disorders (TRACTS). Aggression outcomes included physical andpsychological intimate partner aggression (IPA), as well as physical and psychological general aggression(GA). Variables were measured via self-report questionnaires, with the exception of PTSD symptoms, which were assessed via clinician interview. Results: Bivariate correlations revealed significant associations between PTSD symptoms, sleep problems, physical pain, and aggression outcomes. Both sleep problems and physical pain significantly moderated the relationship between PTSD symptoms and physical GA, such that this relationship became stronger at higher levels of these moderator variables. However, moderation was not found for the other aggression outcomes. Conclusions: Findings suggest that sleep problems and physical pain strengthen the relationship between veterans’ PTSD symptoms and physical aggressiontoward others. Although further replication and elucidation is needed, these factors may disinhibit aggression among those at higher risk due to their PTSD symptoms.