Stricker Nikki H, Lippa Sara M, Green Deborah L, McGlynn Susan M, Grande Laura J, Milberg William P, McGlinchey Regina E
a VA Boston Healthcare System , Boston , MA , USA.
b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.
J Clin Exp Neuropsychol. 2017 Oct;39(8):768-785. doi: 10.1080/13803395.2016.1264575. Epub 2016 Dec 15.
Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample.
This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups.
Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression.
Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.
调查创伤后应激障碍（PTSD）神经认知影响的研究通常会发现各个认知领域存在“缺陷”。然而，PTSD患者的认知障碍发生率仍不明确，因为研究集中在零假设检验（NHT）以及推断障碍模式上，而非通过实证确定该样本中的认知障碍发生率。
本研究采用特定领域的方法，对未寻求治疗的持久自由行动/伊拉克自由行动/新黎明行动服役军人及退伍军人进行认知障碍发生率的研究，这些军人和退伍军人中，92例患有PTSD，79例未患PTSD，且均无药物滥用/依赖情况，他们通过了一项表现效度测试，并在年龄、教育程度、估计智商和种族方面进行了匹配。使用卡方分析，基于使用三个临界值（-1、-1.5和-2标准差）的常模分数，比较各组之间的认知障碍发生率。NHT也用于比较各组之间的表现。
与对照组相比，患有PTSD的个体在记忆方面（-1标准差临界值）的障碍发生率更高，但在注意力、处理速度和执行功能方面的障碍发生率相当；在NHT上未发现显著差异。在任何领域的障碍在PTSD患者中也更为普遍（-1、-1.5和-2标准差临界值）。在患有（n = 34）和未患有（n = 58）抑郁症的PTSD患者中，NHT或障碍发生率均未发现差异。
与对照组相比，PTSD患者更有可能符合记忆障碍标准，并且在任何领域都表现出障碍。与仅患有PTSD的患者相比，患有PTSD且合并抑郁症的患者在任何认知领域出现障碍的可能性并不更高，在个体认知任务上的得分也不会更低。如果缺陷仅限于记忆，临床医生在将患有PTSD个体的认知障碍归因于其他病因之前应谨慎行事。
