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Posttraumatic stress disorder, symptoms, and white matter abnormalities among combat-exposed veterans

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Abstract

Posttraumatic stress disorder (PTSD) is associated with abnormalities in functional connectivity of a specific cortico-limbic network; however, less is known about white matter abnormalities providing structural connections for this network. This study investigated whether the diagnosis and symptoms of PTSD are associated with alterations in fractional anisotropy (FA), an index reflecting white matter organization, across six, a priori-defined tracts. White matter FA was quantified by diffusion tensor imaging using 3 T-MRI among 57 male, combat-exposed veterans with no history of moderate to severe head injuries or current alcohol dependence: 31 met criteria for PTSD and 26 were demographically comparable, combat-exposed controls without PTSD. Clinician-administered and self-report questionnaires assessed PTSD severity, dissociation, and mood. PTSD + veterans had significantly higher FA than exposed controls in the superior fronto-occipital fasciculus (SFOF) and borderline higher FA in the anterior corona radiata (ACR) and cingulum (CGC), controlling for age and neurovascular comorbidities. When lifetime alcohol use disorders was included, only the association of PTSD with SFOF-FA remained significant. Among PTSD + veterans, higher SFOF-FA was associated with greater mood disturbance, dissociative symptoms, and re-experiencing, while lower FA of the uncinate fasciculus (UF) was associated with greater mood disturbance symptoms. Compared to combat-exposed controls without PTSD, veterans with PTSD exhibited higher white matter FA in the SFOF, and a similar tendency in the ACR and CGC, tracts involved in conflict-processing and spatial attention. Prior alcohol use might explain the associations of PTSD with ACR-FA and CGC-FA but not the association with SFOF-FA.

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Notes

  1. Note: Percentages do not sum to 100% as some participants indicated both race and Hispanic ethnicity, and some participants checked “Other” for race.

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Authors and Affiliations

  1. Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, San Francisco, CA, 94158, USA

    Kirstin Aschbacher & Owen M. Wolkowitz

  2. Department of Psychiatry, University of California, San Francisco, 3333 California Street, San Francisco, CA, 94118, USA

    Kirstin Aschbacher

  3. The Institute for Integrative Health, 1407 Fleet Street, Baltimore, MD, 21231, USA

    Kirstin Aschbacher

  4. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA

    Synthia H. Mellon

  5. Stephen and Alexandra Cohen Veterans Center, Department of Psychiatry, New York University Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA

    Clare Henn-Haase, Duna Abu-Amara & Charles R. Marmar

  6. Department of Psychiatry, Icahn School of Medicine at Mount Sinai/James J. Peters Veterans Administration Medical Center, 130 W Kingsbridge Rd, Bronx, NY, 10468, USA

    Rachel Yehuda, Janine D. Flory & Linda M. Bierer

  7. Department of Radiology and Biomedical Imaging, University of California San Francisco, 4150 Clement Street, San Francisco, CA, 94121, USA

    Susanne G. Mueller

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  1. Kirstin Aschbacher
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  2. Synthia H. Mellon
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  3. Owen M. Wolkowitz
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  4. Clare Henn-Haase
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  9. Charles R. Marmar
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Correspondence to Kirstin Aschbacher.

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Funding

This study was supported by the following grants: U.S. Department of Defense, W81XWH-11-2-0223 (PI: Charles R. Marmar); U.S. Department of Defense, W81XWH-10-1-0021 (PI: Owen M. Wolkowitz); The Mental Illness Research, Education and Clinical Center (MIRECC). Dr. Kirstin Aschbacher received support from The Institute of Integrative Health (TIIH), The Hellman Foundation, and the NIH/NHLBI: K23 HL112955.

Conflict of interest

No authors have conflicts of interest to disclose. This publication arises from collaborative activities among eight institutions under the U.S. Department of Defense contract “Systems Biology Studies of PTSD”: University of California San Francisco, New York University Langone Medical Center, Icahn School of Medicine at Mount Sinai, US Army Medical Command (MEDCOM), University of California Santa Barbara, Institute for Systems Biology, Emory University and the Veterans Administration Health Care System. The first author works with Jawbone/Aliph; however, that company had no role in the design, funding, or writing of this article.

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This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Aschbacher, K., Mellon, S.H., Wolkowitz, O.M. et al. Posttraumatic stress disorder, symptoms, and white matter abnormalities among combat-exposed veterans. Brain Imaging and Behavior 12, 989–999 (2018). https://doi.org/10.1007/s11682-017-9759-y

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