title: Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder.
abstract: BACKGROUND
  Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample.
  
  
  METHODS
  This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups.
  
  
  RESULTS
  Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression.
  
  
  CONCLUSIONS
  Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.
authors.affiliation: a VA Boston Healthcare System , Boston , MA , USA.|b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.|c Department of Psychiatry and Psychology , Mayo Clinic , Rochester , MN , USA.
authors.forename: Nikki H
authors.identifier: http://orcid.org/0000-0001-9034-1252
authors.initials: NH
authors.lastname: Stricker
authors.affiliation: d Defense and Veterans Brain Injury Center , Bethesda , MD , USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lippa
authors.affiliation: a VA Boston Healthcare System , Boston , MA , USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Green
authors.affiliation: a VA Boston Healthcare System , Boston , MA , USA.|b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: McGlynn
authors.affiliation: b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Grande
authors.affiliation: e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.|f Department of Psychiatry , Harvard Medical School , Boston , MA , USA.
authors.forename: William P
authors.identifier: http://orcid.org/0000-0002-6078-7066
authors.initials: WP
authors.lastname: Milberg
authors.affiliation: e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.|f Department of Psychiatry , Harvard Medical School , Boston , MA , USA.
authors.forename: Regina E
authors.initials: RE
authors.lastname: McGlinchey
mesh_terms: D000328:Adult; D001288:Attention; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D009483:Neuropsychological Tests; D015995:Prevalence; D011930:Reaction Time; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*
keywords: Memory; Military personnel; Neuropsychological tests; Posttraumatic stress disorder; Veterans