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Sexual assault and white matter hyperintensities among midlife women

Abstract

Traumatic experiences have been linked to poor mental and physical health. However, there has been little examination of their relationship to neuroimaging markers of cerebrovascular risk. White matter hyperintensities (WMHs) are markers of brain small vessel disease. WMHs can be detected decades before the onset of dementia and other disorders and can serve as early markers for these brain disorders. We tested whether traumatic experiences were associated with brain WMH volume among midlife women. In the MsBrain study, 145 women (mean age = 59 years) without cardiovascular disease, stroke, or dementia were recruited. Women completed questionnaires [trauma checklist, depression, post-traumatic stress measures]; physical measures [body mass index (BMI), blood pressure (BP)]; phlebotomy; actigraphy sleep measurement, and 3 Tesla magnetic resonance brain imaging for WMHs. Cross-sectional associations between traumatic experiences and WMH volume were assessed in linear regression models. Covariates were age, race/ethnicity, education, BMI, BP, lipids, preeclampsia, sleep, and additionally depressive and post-traumatic stress disorder symptoms. 68% of women endorsed at least one of the traumas assessed. The most common trauma was sexual assault (23% of women). Women with trauma exposure had greater WMH volume than women without trauma [B(SE) = .24 (.09), p = .01, multivariable]. The single trauma most associated with WMH was sexual assault [B(SE) = .25 (.11), p = .02, multivariable]. Results persisted adjusting for depressive or post-traumatic stress symptoms. A trauma history, particularly sexual assault, was associated with greater WMH volume controlling for covariates, including depressive and post-traumatic symptoms. Sexual assault may place women at risk for poor brain health.

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Anonymized data are shared upon request from qualified investigators consistent with National Institutes of Health guidelines.

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Funding

This research was supported by the National Institutes of Health (NIH), National Institute on Aging (RF1AG053504 to Thurston & Maki), the NIH Heart Lung and Blood Institute (R01HL105647 and 2K24HL123565 to Thurston), and the National Institute on Mental Health (R01MH101269 to Koenen). This work was also supported by the University of Pittsburgh Clinical and Translational Science Institute (NIH Grant UL1TR000005) and the University of Pittsburgh Small Molecule Biomarker Core (NIH Grant S10RR023461 to Poloyac).

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Author contributions included conception and study design (RCT, PM), data collection or

acquisition (KJ, MW), statistical analysis (RCT, PM, YC), interpretation of results (All authors), drafting the manuscript work or revising it critically for important intellectual content (All authors), and approval of final version to be published and agreement to be accountable for the integrity and accuracy of all aspects of the work (All authors).

Corresponding author

Correspondence to Rebecca C. Thurston.

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Procedures were approved by the University of Pittsburgh Institutional Review Board. Participants provided written informed consent.

Conflict of Interest

Dr. Maki receives consultant fees from Pfizer, Abbvie, and Balchem.

Dr. Thurston receives consultant fees from Astellas, Pfizer, Procter & Gamble, and Virtue Health.

Drs. Aizenstein, Chang, Jakubowski, Derby, Koenen, Barinas-Mitchell and Wu report no financial interests or potential conflicts of interest.

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Thurston, R.C., Jakubowski, K.P., Wu, M. et al. Sexual assault and white matter hyperintensities among midlife women. Brain Imaging and Behavior (2021). https://doi.org/10.1007/s11682-021-00536-2

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Keywords

  • Trauma
  • White matter hyperintensities
  • Sexual assault
  • Cerebrovascular
  • Women