Reduced Hippocampal Volume in Alcohol and Substance Naïve Vietnam Combat Veterans with Posttraumatic Stress Disorder

Hedges, Dawson W.; Allen, Steven N.; Tate, David F.; Thatcher, Grant William; Miller, Michael J.; Rice, Sara A.; Cleavinger, Howard B.; Sood, Shabnam; Bigler, Erin D.

doi:10.1097/00146965-200312000-00003

Cited by 74 publications

(47 citation statements)

References 17 publications

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“…Stein et al [68] found a 5% reduction in left hippocampal volume. Other studies of PTSD also have found smaller hippocampal volume and/or reductions in N-acetylaspartate (NAA), a marker of neuronal integrity [69][70][71][72][73][74][75][76][77][78][79][80][81][82]. We have reported smaller hippocampal volume in PTSD subjects compared to trauma-exposed non-PTSD subjects [70] while other investigators have observed reductions in both trauma-exposed non-PTSD and trauma-exposed PTSD relative to healthy comparison subjects [83].…”

Section: Changes In Brain Structure In Ptsd and Stress Related Disordersmentioning

confidence: 53%

Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

Bremner

2007

Neuroimaging Clinics of North America

138

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SynopsisTraumatic stress has a broad range of effects on the brain. Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Studies in patients with posttraumatic stress disorder (PTSD) and other psychiatric disorders related to stress have replicated findings in animal studies by finding alterations in these brain areas. Brain regions implicated in PTSD also play an important role in memory function, highlighting the important interplay between memory and the traumatic stress response. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD and other stress-related psychiatric disorders. EFFECTS OF TRAUMATIC STRESS ON THE INDIVIDUALTraumatic stressors including childhood abuse can lead to posttraumatic stress disorder (PTSD), as well as depression [1,2], substance abuse [3,4], dissociative disorders [5], personality disorders [6,7], and health problems [8]. For many trauma victims, PTSD, which affects about 8% of Americans at some time in their lives [3], may be a life-long problem [9]. However, the development of effective treatments is limited by gaps in knowledge about the underlying neurobiological mechanisms that mediate symptoms of trauma related disorders like PTSD. Until twelve years ago, no brain imaging studies had been performed in patients with PTSD or other stress-related psychiatric disorders. The past decade has seen an explosion of research using brain imaging to assess the effects of traumatic stress on the brain [10]. These studies have implicated the amygdala, hippocampus, and medial prefrontal cortex (including anterior cingulate) in PTSD and other stress related psychiatric disorders. This chapter reviews brain imaging studies looking at the effects of traumatic stress on the brain, and integrates them with basic science findings on the neuroscience of stress. NEURAL CIRCUITS OF PTSDPTSD is characterized by specific symptoms, including intrusive thoughts, hyperarousal, flashbacks, nightmares, and sleep disturbances, changes in memory and concentration, and startle responses. Symptoms of PTSD are hypothesized to represent the behavioral manifestation of stress-induced changes in brain structure and function. Stress results in acute and chronic changes in neurochemical systems and specific brain regions, which result in longterm changes in brain "circuits" involved in the stress response [11][12][13][14]. Brain regions that are

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Section: Changes In Brain Structure In Ptsd and Stress Related Disordersmentioning

confidence: 53%

Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

Bremner

2007

Neuroimaging Clinics of North America

138

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“…Bilateral hippocampal volume was significantly smaller in a small sample study of substance and alcohol naïve subjects with combat-related PTSD compared to controls. 336 In monozygotic twins discordant for trauma exposure, Gilbertson et al 337 revealed that the identical nonexposed twins of PTSD combat veterans had comparable hippocampi to their PTSD twin, but significantly smaller hippocampi than combat veterans without PTSD and their noncombat exposed twins, showing…”

Section: 330mentioning

confidence: 99%

MR-based in vivo hippocampal volumetrics: 2. Findings in neuropsychiatric disorders

2004

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Magnetic resonance imaging (MRI) has opened a new window to the brain. Measuring hippocampal volume with MRI has provided important information about several neuropsychiatric disorders. We reviewed the literature and selected all English-language, human subject, data-driven papers on hippocampal volumetry, yielding a database of 423 records. Smaller hippocampal volumes have been reported in epilepsy, Alzheimer's disease, dementia, mild cognitive impairment, the aged, traumatic brain injury, cardiac arrest, Parkinson's disease, Huntington's disease, Cushing's disease, herpes simplex encephalitis, Turner's syndrome, Down's syndrome, survivors of low birth weight, schizophrenia, major depression, posttraumatic stress disorder, chronic alcoholism, borderline personality disorder, obsessive-compulsive disorder, and antisocial personality disorder. Significantly larger hippocampal volumes have been correlated with autism and children with fragile X syndrome. Preservation of hippocampal volume has been reported in congenital hyperplasia, children with fetal alcohol syndrome, anorexia nervosa, attention-deficit and hyperactivity disorder, bipolar disorder, and panic disorder. Possible mechanisms of hippocampal volume loss in neuropsychiatric disorders are discussed.

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“…Some of these studies have found lower bilateral hippocampal volumes in patients with PTSD than those observed in control groups (Gurvits et al, 1996;Villarreal et al, 2002;Bremner et al, 2003;Hedges et al, 2003). Others have found hemispheric asymmetries in such differences, with significantly greater reductions in either the left (Bremner et al, 1997;Stein et al, 1997;Nakano et al, 2002;Lindauer et al, 2004) or right (Bremner et al, 1995;Shin et al, 2004;Wignall et al, 2004;Winter and Irle, 2004) hemispheres.…”

Section: Introductionmentioning

confidence: 98%

Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: A meta-analysis of structural MRI studies

2005

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Over the last decade a significant number of studies have reported smaller hippocampal volume in individuals with symptoms of post-traumatic stress disorder (PTSD) relative to control groups, and in some cases hemispheric asymmetries in this effect have been noted. However these reported asymmetries have not been in a consistent direction, and other well-controlled studies have failed to observe any hippocampal volume difference. This paper reports a systematic review and meta-analysis of studies in which hippocampal volume was estimated from magnetic resonance images in adult patients with PTSD. After applying a variety of selection criteria intended to minimize potential confounds in pooled effect-size estimates, the meta-analysis included 13 studies of adult patients with PTSD that compared the patients to well-matched control groups, for a total of 215 patients and 325 control subjects. The studies varied with respect to participant age, gender distribution, source of trauma, severity of symptoms, duration of disorder, the nature of the control groups, and the methods employed for volumetric quantification. Despite these differences, pooled effect size calculations across the studies indicated significant volume differences in both hemispheres. On average PTSD patients had a 6.9% smaller left hippocampal volume and a 6.6% smaller right hippocampal volume compared with control subjects. These volume differences were smaller when comparing PTSD patients with control subjects exposed to similar levels of trauma, and larger when comparing PTSD patients to control subjects without significant trauma exposure. Such differences are consistent with the notion that exposure to stressful experiences can lead to hippocampal atrophy, although prospective studies would be necessary to unambiguously establish such a relationship.

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Reduced Hippocampal Volume in Alcohol and Substance Naïve Vietnam Combat Veterans with Posttraumatic Stress Disorder

Cited by 74 publications

References 17 publications

Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

MR-based in vivo hippocampal volumetrics: 2. Findings in neuropsychiatric disorders

Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: A meta-analysis of structural MRI studies

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