PTSD can impair and age your brain

Last week, singer-songwriter Ariana Grande posted images on Instagram showing a scan of her brain as she battles post-traumatic stress disorder. Grande is correct to say that PTSD doesn't only impact one’s physical and mental health, but it can negatively affect one’s brain. What Grande didn’t say, and what she may not know, is that PTSD is also associated with cognitive impairment and accelerated aging.

Large epidemiological studies indicate that about 70 percent of adults in the United States experience at least one potentially traumatic event across their lifespan. While many people do not carry any residual harm from their trauma, and some fully recover, a significant number experience distress for years after the event.

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Decades of scientific studies have shown that people who experience trauma are more likely to have mental health and substance abuse problems, work and relationship difficulties, and poorer quality of life. People with PTSD also often have extensive physical health problems, such as cardiovascular disease, Type 2 diabetes and gastrointestinal disorders. In addition, those with PTSD also can have a hard time learning and retaining new information.

More recently, scientists have discovered that individuals with PTSD are also more likely to be diagnosed with dementia as they age. Two large studies present the strongest evidence for the link between PTSD and dementia. One study had over 181,000 veterans, aged 55 and over, including more than 53,000 with PTSD.

Those with PTSD were more than twice as likely to develop dementia over six years of follow-up. Another study had almost 10,000 veterans age 65 and older. Some with and without PTSD as well as some with and without a Purple Heart medal, a military decoration awarded to those wounded while serving. In general, there were higher rates of dementia in those with PTSD. Most particularly, the veterans with PTSD, who were not Purple Heart recipients, had almost twice the odds of developing dementia compared to the other three groups. What this means is that PTSD is likely a greater risk factor for the development of dementia than exposure to combat-related trauma alone.

While this data is in its infancy, and has some methodological shortcomings, it should be enough to give us pause. True, much of the research has been conducted on veterans. And, measurement of cognitive status was primarily based on self-report, and typically not verified by neuropsychological testing or observations in everyday settings.

However this is in line with some more disturbing news. A review published by researchers at the University of California at San Diego found that PTSD also accelerates the aging process. Specifically, people with PTSD have distinct biological markers of premature aging when compared to members of a normal, control group. What does biological early aging look like? Scientists do not define it as premature gray hair, wrinkles in the skin, or getting shorter. Rather, when we talk about cellular aging, we do so in terms of shorter telomere length and more pro-inflammatory markers.

Telomeres are often compared to plastic tips at the end of shoelaces. Without these tips, shoelaces become frayed. Telomeres protect each lace or strand of our DNA and guard our chromosomes. Without telomeres, DNA strands become damaged and then cells no longer work as they are supposed to.

The exact cause and effect relationship between PTSD and accelerated aging is also not fully understood. It is possible that these biomarkers are risk factors for PTSD and that individuals with shorter telomeres may be at risk for PTSD, or conversely that telomeres may be shortened as a result of trauma or the onset of PTSD.

While more research is needed, this should not be a reason or rationalization to delay action. On the research front, the next logical step is to do prospective longitudinal research measuring cognitive functioning and telomere length among those patients pre- and post-trauma or to commission studies which repeatedly measure cognition and telomeres among those with PTSD. In the public health and policy area, we need to address not only the mental health of patients with PTSD, but to also treat their biological and neuro-cognitive health.

As trauma mental health specialists, we greatly appreciate Ariana Grande’s openness in regards to her struggles with PTSD since a 2017 attack at her concert in Manchester, England. By sharing her vulnerabilities, she serves as an incredible role model for speaking out and getting needed help. Maybe another reason to seek and receive evidence-based treatments for PTSD is to be able to stop or curtail one’s cognitive impairments and accelerated cellular aging.

Joan M. Cook Ph.D. is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors, and people who escaped the former World Trade Center towers on 9/11. Mario Fahed, M.D. is a Yale physician and a board certified psychiatrist who specializes in treating older adults.