1. U C S F IN VETERANS WITH POSTTRAUMATIC STRESS DISORDER
International Neuropsychological Society, Boston, MA; February, 2016
PRELIMINARY EFFECTS OF HEAVY DRINKING AND AGE ON COGNITIVE FUNCTIONING
IN VETERANS WITH POSTTRAUMATIC STRESS DISORDER
L. C. Hoyman, D. L. Pennington, T. Wong, J. Dack, J. Bielenberg, E. Tomlinson, B. Lasher,
E. Schrodek, S. Yohannes, J. McDonald, & S. L. Batki
UCSF Department of Psychiatry and San Francisco VA Medical Center
Introduction
Both alcohol use disorder (AUD; Moselhy, Georgiou, & Kahn, 2001) and age (Levy, 1994) are associated with cognitive impairment in veterans with PTSD
Heavy alcohol use and age are known to have a synergistic impact on cognitive functioning beyond normal aging effects (Oscar-Berman & Marinkovic, 2003)
We sought to examine age and heavy drinking effects on cognitive functioning in veterans with PTSD entering a RCT of topiramate treatment to reduce alcohol use (Batki et al., 2014)
Table 1: AUD Patient Characteristics Mean ± SD n 52
Age
50.76 ± 12.29
Education
13.4 ± 1.67
Race: White (Hispanic/Latino) 26
African American 13
Native American 1
Mixed Race 9
Native Hawaiian or Pacific Islander
Unknown or not reported 2
Drinks per week (DPW)
66.18 ± 50.47
PCL-C
55.74 ± 14.35
Beck Anxiety Inventory (BAI)
20.43 ± 12.1
Beck Depression Inventory-II (BDI-II)
24.93 ± 11.2
Cognitive Reserve (WTAR)
± 14.7
Processing Speed (Trail Making Test A)
45.04 ± 9.48
Cognitive Flexibility (Trail Making Test B)
53.52 ± 10.87
Working Memory (WAIS-III DS/Ar)
8.77 ± 2.24
Cognitive Inhibition (Stroop Color-Word)
43.15 ± 8.24
Verbal Fluency (FAS + Animal)
47.16 ± 9.91
Auditory-Verbal Learning (HVLT-R)
36.22 ± 11.14
Auditory-Verbal Recall (HVLT-R)
37.55 ± 12.12
Decision-Making (IGT)
5.26 ± 2.56
Risk-Taking (BART) ±
Choice Inhibition (SST)
± 76.55
*Standard alcoholic drink is defined as containing 13.6g of pure alcohol. Drink consumption was averaged over 90 days preceding study consent.
Table 2: p-Values and Correlations
Step 3 w/ Interaction of Age and DPW
p-value R2
Working Memory
F(4,44)=5.53
<.01
.27
Auditory-Verbal Learning
F(4,46)=3.93
.19
Auditory-Verbal Recall
F(4,46)=2.96
<.04
.12
Choice Inhibition
F(4,41)=2.28
.08
.10
Correlations
Working Memory vs. DPW
-.061
Working Memory vs. Age
-.105
Auditory-Verbal Learning vs. DPW
-.205
Auditory-Verbal Learning vs. Age
-.235
Auditory-Verbal Recall vs. DPW
-.139
Auditory-Verbal Recall vs. Age
-.166
Methods
Participants:
52 male Veterans with AUD and PTSD (Table 1)
PTSD diagnosis was confirmed through the Posttraumatic Stress Checklist-Civilian (PCL-C)
Mood and alcohol use was assessed via the Beck Depression Invenotry –II, Beck Anxiety Inventory,
AUD symptom/alcohol use was assessed at baseline using the Timeline Follow Back, which yields average drinks per week (DPW)
Veterans completed the following measures of cognitive reserve and performance:
Cognitive Reserve: Wechsler Test of Adult Reading (WTAR; standard score)
Processing Speed: Trail Making Test A (TMT-A; t-score)
Cognitive Flexibility: Trail Making Test B (TMT-B; t-score)
Working Memory: Wechsler Adult Intelligence Scales-III Digit Span and Arithmetic (WAIS-III DS/Ar; raw score)
Cognitive Inhibition: Stroop Color-Word (t-score)
Verbal Fluency: Letter (FAS) and Animal Fluency (t-score)
Auditory Verbal Learning and Recall: Hopkins Verbal Learning Test-Revised (HVLT-R; t-score)
Decision-Making: Iowa Gambling Task (IGT, raw score)
Risk-Taking: Balloon Analogue Risk Task (BART, raw score)
Choice Inhibition: Stop Signal Task (SST, raw score)
Procedures:
A four-step hierarchical regression model (HRM) was conducted for each cognitive domain. The following independent variables were entered at each step: 1) Cognitive reserve-WTAR; 2) DPW; 3) Age; and 4) Interaction term of age-by-DPW
Cognitive reserve was trimmed from the HRMs when it was not significantly associated with cognition.
Results
The HRMs containing the age-by-DPW interaction term significantly predicted performance on:
Working memory
Auditory-verbal learning
Auditory-verbal recall
Choice inhibition (tended)
Only step 2 of the HRM containing DPW significantly predicted verbal fluency [F(2,48) = 4.04, p<.02, R2=.11]
Multiple correlations observed between age, DPW, and various cognitive domains
Summary and Future Implications
Age and heavy alcohol use have a negative synergistic impact on working memory, auditory verbal learning and recall, and choice impulsivity
These domains may be potential targets in developing cognitive training paradigms for aging veterans with PTSD entering alcohol treatment
Clinicians are encouraged to consider a standard assessment of cognitive functioning in treatment planning and delivery for heavy drinking veterans with PTSD
Figure 1: Correlation of Age with Auditory-Verbal Learning
Batki, S. L., Pennington, D. L., Lasher, B., Neylan, T. C., Metzler, T., Waldrop, A., ... & Herbst, E. (2014). Topiramate treatment of alcohol use disorder in veterans with posttraumatic stress disorder: a randomized controlled pilot trial. Alcoholism: Clinical and Experimental Research, 38(8),
Levy, R. (1994). Aging-associated cognitive decline. International Psychogeriatrics, 6(01),
Moselhy, H. F., Georgiou, G., & Kahn, A. (2001). Frontal lobe changes in alcoholism: a review of the literature. Alcohol and Alcoholism, 36(5),
Oscar-Berman, M., & Marinkovic, K. (2003). Alcoholism and the brain: An overview. Alcohol Research and Health, 27(2),
References
Author correspondence: Lisa Hoyman U C S F
Clinical and Translational Science Institute / CTSI
Grant Support: Department of Defense Grants: W81XWH , W81XWH , W81XWH (Batki)
No conflicts of interest to report. The contents of this poster are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or DoD.