Cognitive control-related brain activation in veterans and service members with PTSD

患有创伤后应激障碍 (PTSD) 的退伍军人和服役人员与认知控制相关的大脑激活

• 批准号: 10738254
• 负责人: Randall S. Scheibel
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10738254
• 关键词: Address; Amygdaloid structure; Anterior; Area; Autonomic nervous system; Behavior Therapy; Bilateral; Biological; Brain; Catecholamines; Clinical; Clinical Trials; Cognitive; Common Data Element; Cross-Sectional Studies; DSM-V; Data; Development; Diagnosis; Differential Diagnosis; Disease; Emotional; Event; Exhibits; Failure; Freedom; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Health; Human Resources; Image; Impaired cognition; Impairment; Inferior; Inferior frontal gyrus; Insula of Reil; Investigation; Left; Lobule; Measures; Medial; Mediating; Mental Depression; Middle frontal gyrus structure; Modeling; Motor; Neurobiology; Neuronal Dysfunction; Neurophysiology - biologic function; Outcome Measure; Parietal; Participant; Pathway interactions; Patients; Pattern; Post-Traumatic Stress Disorders; Prefrontal Cortex; Procedures; Prognosis; Publications; Recording of previous events; Regression Analysis; Regulation; Reporting; Research; Resources; Rest; Risk; Role; Sampling; Sensory; Severities; Sleep; Sleeplessness; Social Problems; Structure; Substance abuse problem; Symptoms; System; Temporal Lobe; Veterans; anatomic imaging; association cortex; blast exposure; cingulate cortex; cingulate gyrus; cognitive control; cognitive skill; cognitive testing; combat; combat trauma; combat veteran; comorbid depression; comorbidity; comparison group; conditioned fear; daily functioning; design; diagnostic criteria; disability; effectiveness evaluation; emotion regulation; executive function; experience; imaging modality; mild traumatic brain injury; mortality; neural; neuroimaging; neuroimaging marker; operation; participant enrollment; pharmacologic; post-traumatic symptoms; psychosocial; service member; symptom cluster; tool; trauma exposure; treatment trial

The underlying neurobiology of posttraumatic stress disorder (PTSD) has been hypothesized to involve dysfunction within neural systems that mediate fear conditioning, emotional control, and central regulation of the autonomic nervous system. However, functional neuroimaging research examining cognitive skills has also started to identify alterations within other neural systems. In a recent publication we reported preliminary results from a functional magnetic resonance imaging (fMRI) cognitive control paradigm, the Arrows Task, which was used to examine elevated posttraumatic stress symptoms (PTSS) and brain function following Operation Enduring Freedom/Operation Iraqi Freedom/New Dawn (OEF/OIF/OND) combat deployment. Those findings were consistent with a neural resource shift away from higher-level association areas and supported a conceptual model of posttraumatic stress disorder (PTSD) that emphasizes the role of hyperarousal and alterations in central catecholamines. Previous investigations using executive function fMRI paradigms to study PTSD and PTSS, including our own research, have all suffered from one or more limitations such as the enrollment of participants who did not meet full diagnostic criteria for PTSD, use of fMRI paradigms that combined both executive function and symptom provocation procedures, examination of samples without combat trauma, and the failure to screen or control adequately for co-morbid disorders such as depression and mild traumatic brain injury (mTBI). The current application proposes a well-designed functional neuroimaging study that would focus on combat-related PTSD while implementing such controls. The proposed study's primary objective would be to examine PTSD-related changes in neural function associated with cognitive control and the relationship between this activation and clinical symptoms, daily functioning (i.e., sleep, psychosocial function), and external measures of executive functions. Another important aim of this study would be to examine alterations in resting state functional connectivity and to relate these to activation during cognitive control. It would be conducted as a cross sectional study of OEF/OIF/OND veterans with a confirmed PTSD diagnosis and would include a trauma exposed comparison group and an additional comparison group to examine PSTD in combination with co-morbid mTBI. Co-morbid depression would also be addressed and all participants would complete a formal assessment for PTSD and related conditions (e.g., substance abuse), including the Clinician-Assisted PTSD Scale for DSM-5 and other PTSD common data elements as key measures. The project's duration would be three and a half years and it would acquire event-related and resting state fMRI data, anatomical imaging, and data from symptom and outcome measures to characterize the sample. We hypothesize that the engagement of cognitive control in patients with PTSD will be associated with an Arrows Task activation pattern which, relative to the comparison groups, will include decreased activation within heteromodal association cortex and increases within other structures involved in emotional regulation and primary sensory or motor functions. Image regression analyses would also be performed and these activation changes are expected to be related to abnormal connectivity, clinical symptoms, cognitive impairment, and problems with daily functioning.

创伤后应激障碍 (PTSD) 的神经生物学基础 假设涉及介导恐惧调节的神经系统功能障碍， 情绪控制和自主神经系统的中枢调节。然而，功能性 检查认知技能的神经影像学研究也开始发现内部的变化 其他神经系统。在最近的一份出版物中，我们报告了功能性的初步结果 磁共振成像（fMRI）认知控制范式，箭头任务， 用于检查创伤后应激症状（PTSS）和脑功能 持久自由行动/伊拉克自由行动/新黎明行动 (OEF/OIF/OND) 战斗 部署。这些发现与神经资源从更高层次的转移相一致 协会领域并支持创伤后应激障碍（PTSD）的概念模型 这强调了过度兴奋和中枢儿茶酚胺变化的作用。以前的 使用执行功能功能磁共振成像范例来研究 PTSD 和 PTSS 的调查，包括我们的 自己的研究都受到一种或多种限制，例如招募 不符合 PTSD 完整诊断标准的参与者，使用功能磁共振成像范式 结合执行功能和症状激发程序，检查 没有战斗创伤的样本，并且未能充分筛查或控制共病 抑郁症和轻度创伤性脑损伤 (mTBI) 等疾病。当前应用 提出了一项精心设计的功能性神经影像研究，重点关注与战斗相关的 PTSD，同时实施此类控制。 拟议研究的主要目标是检查与 PTSD 相关的变化 与认知控制相关的神经功能以及这种激活和认知控制之间的关系 临床症状、日常功能（即睡眠、心理社会功能）和外部措施 的执行职能。这项研究的另一个重要目的是检查 静息状态功能连接并将其与认知控制期间的激活联系起来。它 将对 OEF/OIF/OND 退伍军人进行横断面研究，并确定 PTSD 诊断将包括一个暴露于创伤的对照组和一个额外的 对照组结合共病 mTBI 检查 PSTD。共病 抑郁症也将得到解决，所有参与者都将完成正式评估 针对 PTSD 和相关病症（例如药物滥用），包括临床医生辅助的 PTSD DSM-5 和其他 PTSD 常见数据元素的量表作为关键衡量标准。该项目的 持续时间为三年半，它将获得事件相关和静止状态 fMRI 数据、解剖成像以及来自症状和结果测量的数据来表征 样品。我们假设 PTSD 患者认知控制的参与将 与箭头任务激活模式相关联，相对于比较组， 将包括异模式关联皮层内的激活减少和异模式关联皮层内的激活增加 涉及情绪调节和主要感觉或运动功能的其他结构。图像 还将进行回归分析，这些激活变化预计将被 与异常连接、临床症状、认知障碍和问题有关 日常运作。

项目成果

Close proximity to blast: No long-term or lasting effect on cognitive performance in service members with and without TBI during blast exposure.

近距离接触爆炸：在爆炸暴露期间，对有或没有 TBI 的服役人员的认知表现没有长期或持久的影响。

• 发表时间: 2023-07
• 作者: Lu, L H;Reid, M W;Troyanskaya, M;Scheibel, R S;Muncy, C;Kennedy, J E
• 通讯作者: Kennedy, J E

Varying failure criteria on performance validity tests influences interpretation of cognitive outcomes.

表现有效性测试的不同失败标准会影响认知结果的解释。

• 发表时间: 2023-01
• 影响因子: 2.4
• 作者: Tierney, Savanna M;Taiwo, Zinat;Choudhury, Tabina K;Lippa, Sara M;Troyanskaya, Maya;Pastorek, Nicholas J;Miller, Brian;Romesser, Jennifer;Sim, Anita
• 通讯作者: Sim, Anita