Associations of Post-Traumatic Stress Disorder and Objective Subtle Cognitive Difficulties in Cognitively Unimpaired Older Veterans

Mary Ellen Garcia, VA San Diego Healthcare System, San Diego, United States
Peter Rantins, SDSU/VA San Diego, San Diego, United States
Alin Alshaheri Durazo, SDSU/VA San Diego, San Diego, United States
Uriel Urias, SDSU/UCSD, San Diego, United States
Alexandra Weigand, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, United States
Kathrine Bangen, VA San Diego/UCSD, San Diego, United States
Amy Jak, VA San Diego/UCSD, San Diego, United States
Mark Bondi, VA San Diego/UCSD, San Diego, United States
Kelsey Thomas, VA San Diego/UCSD, San Diego, United States


Psychiatric conditions such as post-traumatic stress disorder (PTSD) or depression are associated with a twofold increased risk of dementia in Veterans. Objectively-defined subtle cognitive difficulties (Obj-SCD) have been shown to be associated with future cognitive decline as well as with Alzheimer’s disease biomarker levels. However, Obj-SCD has not yet been investigated in the context of psychiatric disorders. Therefore, we investigated the rates of Obj-SCD among Veterans with and without specific psychiatric conditions.

Participants and Methods:

Our study included 179 Veterans (mean age=66.08 [SD=9.06], range=50-92; mean education=14.59 [SD=2.45], range=9-20; 7.8% women; 0.6% American Indian/Alaska Native, 3.9% Asian, 7.3% Black/African American, 7.8% Filipino, 76.5% White, 3.9% Unknown/Declined to Answer; 10.3% Hispanic/Latino) who underwent a comprehensive neuropsychological evaluation at the VA San Diego Healthcare System and were found to be cognitively unimpaired according to both clinical consensus and Jak/Bondi actuarial criteria for mild cognitive impairment. Neuropsychological data and presence of psychiatric conditions were coded via retrospective review of consecutive medical records. Consistent with previous criteria, Veterans were classified as Obj-SCD (n=44) or no Obj-SCD (n=135) if they performed in the impaired range (>1 SD below the normed mean) on (A) two total scores in different cognitive domains, (B) on two process scores, or (C) on one total score and one process score. Cognitive domains of the total scores included: Memory (California Verbal Learning Test-II [CVLT] Trial 1-5 Immediate Recall and Long Delay Free Recall), Language (Boston Naming Test, Category Fluency), Attention/Processing Speed (Digit Span, Coding), and Executive Functioning (Letter Fluency, D-KEFS Trail Making Test Number-Letter Switching). Process scores were obtained from the CVLT-II and included Trials 1-5 Learning Slope, Cued Recall Intrusion Errors, and Recency Effect.


Veterans with PTSD were more likely to be classified as Obj-SCD than those without PTSD (54.5% vs. 28.9%, p=.002). Obj-SCD did not have higher rates of other psychiatric conditions such as Major Depressive Disorder (27.3% vs. 25.9%, p=.860), Generalized Anxiety Disorder (15.9% vs. 12.6%, p=.575), Bipolar II Disorder (0.0% vs. 2.2%, p=.319), Other Depressive Disorders (27.3% vs. 21.5%, p=.427), ADHD (2.3% vs. 5.2%, p=.417), or Substance Use Disorders (4.5% vs. 3.0%, p=.619). In follow-up analyses examining performance on the specific measures used in the Obj-SCD classification by PTSD status, only Coding (d=0.327, p=.043), D-KEFS Trail Making Test Number-Letter Switching (d=0.335, p=.040), and CVLT-II Cued Recall Intrusion Errors (d=0.376, p=.017) differed in Veterans with (n=63) and without (n=116) PTSD.


Results suggest that within cognitively unimpaired Veterans, those with PTSD were more likely to experience subtle cognitive difficulties on neuropsychological measures, highlighting a circumscribed association that was not present for other psychiatric conditions. Measures of efficiency seem to be driving the higher rates of Obj-SCD in PTSD, including two speeded measures and one measure capturing errors on the CVLT. Further research is needed to determine whether these subtle cognitive difficulties are reduced with treatment of PTSD and if Obj-SCD in Veterans with PTSD is associated with elevated Alzheimer’s disease and/or vascular biomarkers and greater risk of longitudinal cognitive decline.

Category: Aging

Keyword 1: post-traumatic stress disorder
Keyword 2: aging (normal)
Keyword 3: aging disorders