Skip to main content
Log in

Neurocognitive Functioning in Posttraumatic Stress Disorder

  • Published:
Neuropsychology Review Aims and scope Submit manuscript

Abstract

This paper reviews the literature on performance on standard neuropsychological tests among individuals with posttraumatic stress disorder (PTSD). Of 19 studies, 16 reported impairment of attention or immediate memory (or both); however, most of these studies included PTSD patients with significant psychiatric comorbidity, so that the extent to which the observed deficits are specifically attributable to PTSD remains unclear. Other potential confounds, including medical illness, substance abuse, and motivational factors, further preclude definitive conclusions at present. Results of structural and functional neuroimaging studies of PTSD are also summarized. Two studies have reported correlations between hippocampal volume and cognitive findings in PTSD patients; functional studies have indicated specific findings in limbic regions, although the relationship of these results to neuropsychological performance remains to be explored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Anonymous (1988). Health status of Vietnam veterans. I. Psychosocial characteristics. The Centers for Disease Control Vietnam Experience Study. Journal of the American Medical Association 259: 2701–2707.

  • Barrett, D. H., Green, M. L., Morris, R., Giles, W. H., and Croft, J. B. (1996). Cognitive functioning and posttraumatic stress disorder. American Journal of Psychiatry 153: 1492–1494.

    Google Scholar 

  • Brady, K. T., Pearlstein, T., Asnis, G. M., Barker, D., Rothbaum, B., Sikes, C. R., and Farfel, G. M. (2000). Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association 283: 1831–1844.

    Google Scholar 

  • Bremner, J. D., Innis, R. B., Ng, C. K., Staib, L., Salomon, R., Bronen, R. A., Markey, J., Duncan, J., Krystal, J. H., Rich, D., Zubal, G., Dey, H., Soufer, R., and Charney, D. S. (1997a). PET measurements of cerebral metabolic correlates of yohimbine administration in combat-related post-traumatic stress disorder. Archives of General Psychiatry 54: 246–254.

    Google Scholar 

  • Bremner, J. D., Krystal, J. H., Southwick, S. M., and Charney, D. S. (1995a). Functional neuroanatomical correlates of the effects of stress on memory. Journal of Traumatic Stress 8: 527–553.

    Google Scholar 

  • Bremner, J. D., Narayan, M., Staib, H., Southwick, S. M., McGlashan, T., and Charney, D. S. (1999a). Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. American Journal of Psychiatry 156: 1787–1795.

    Google Scholar 

  • Bremner, J. D., Penny, R., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C., Capelli, S., McCarthy, G., Innis, R. B., and Charney, D. S. (1997b). Magnetic resonance imaging-based measurement of hippocampal volume in post-traumatic stress disorder related to childhood physical and sexual abuse: A preliminary report. Biological Psychiatry 41: 23–32.

    Google Scholar 

  • Bremner, J. D., Randall, P., Scott, T. M., Bronen, R. A., Seibyl, J. P., Southwick, S. M., Delaney, R. C., McCarthy, G., Charney, D. S., and Innis, R. B. (1995b). MRI-based measurement of hippocampal volume in patients with combat-related post-traumatic stress disorder. American Journal of Psychiatry 152: 973–981.

    Google Scholar 

  • Bremner, J. D., Randall, P., Scott, T. M., Capelli, S., Delaney, R., McCarthy, G., and Charney, D. S. (1995c). Deficits in short-term memory in adult survivors of childhood abuse. Psychiatry Research 59: 97–107.

    Google Scholar 

  • Bremner, J. D., Scott, T. M., Delaney, R. C., Southwick, S. M., Mason, J. W., Johnson, D. R., Innis, R. B., McCarthy, G., and Charney, D. S. (1993). Deficits in short-term memory in posttraumatic stress disorder. American Journal of Psychiatry 150: 1015–1019.

    Google Scholar 

  • Bremner, J. D., Staib, L. H., Kaloupek, D., Southwick, S. M., Soufer, R., and Charney, D. S. (1999b). Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: A positron emission tomography study. Biological Psychiatry 45: 806–816.

    Google Scholar 

  • Breslau, N., Davis, G. C., Peterson, E. L., and Schultz, L. (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry 54: 81–87.

    Google Scholar 

  • Carlin, A. S., and O'Malley, S. (1996). Neuropsychological consequences of drug abuse. In Grant, I., and Adams, K. M. (eds.), Neuropsychological Assessment of Neuropsychiatric Disorders, 2nd edn., Oxford University Press, New York, pp. 486–503.

    Google Scholar 

  • Dalton, J. E., Pederson, S. L., and Ryan, J. J. (1989). Effects of post-traumatic stress disorder on neuropsychological test performance. International Journal of Clinical Neuropsychology 11: 121–124.

    Google Scholar 

  • Elhai, J. D., Frueh, B. C., Gold, P. B., Gold, S. N., and Hamner, M. B. (2000). Clinical presentations of posttraumatic stress disorder across trauma populations: A comparison of MMPI-2 profiles of combat veterans and adult survivors of childhood sexual abuse. Journal of Nervous and Mental Disease 188: 708–713.

    Google Scholar 

  • Everly, G. S., and Horton, A. M. (1989). Neuropsychology of posttraumatic stress disorder: A pilot study. Perceptual and Motor Skills 68: 807–810.

    Google Scholar 

  • Foa, E. B., Davidson, J. R. T., Frances, A., Culpepper, L., Ross, R., and Ross, D. (eds.). (1999). The expert concensus guideline series: Treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry 60(Suppl. 16): 4–76.

    Google Scholar 

  • Freeman, T. W., Cardwell, D., Karson, C. N., and Komoroski, A. (1998). In vivo proton magnetic resonance spectroscopy of the medial temporal lobes of subjects with combat-related posttraumatic stress disorder. Magnetic Resonance Medicine 40: 66–71.

    Google Scholar 

  • Frueh, B. C., Gold, P. B., and de Arellano, M. A. (1997). Symptom overreporting in combat veterans evaluated for PTSD: Differentiation on the basis of compensation seeking status. Journal of Personality Assessment 68: 369–384.

    Google Scholar 

  • Frueh, B. C., Hamner, M. B., Cahill, S. P., Gold, P. B., and Hamlin, K. (2000). Apparent symptom overreporting in combat veterans evaluated for PTSD. Clinical Psychology Review 20: 853–885.

    Google Scholar 

  • Gil, T., Calev, A., Greenberg, D., Kugelmass, S., and Lerer, B. (1990). Cognitive functioning in post-traumatic stress disorder. Journal of Traumatic Stress 3: 29–45.

    Google Scholar 

  • Grant, I. (1987). Alcohol and the brain: Neuropsychological correlates. Journal of Consulting and Clinical Psychology 55: 310–324.

    Google Scholar 

  • Gurvits, T.V., Lasko, N. B., Schachter, S. C., Kuhne, A. A., Orr, S. P., and Pitman, R. A. (1993). Neurological status of Vietnam veterans with chronic posttraumatic stress disorder. The Journal of Neuropsychiatry and Clinical Neurosciences 5: 183–188.

    Google Scholar 

  • Gurvits, T. G., Shenton, M. R., Hokama, H., Ohta, H., Lasko, N. B., Gilbertson, M. W., Orr, S. P., Kikinis, R., Jolesz, F. A., McCarley, R.W., and Pitman, R. K. (1996). Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Biological Psychiatry 40: 1091–1099.

    Google Scholar 

  • Hamner, M. B., Lorberbaum, J. P., and George, M. S. (1999a). Potential role of the anterior cingulate cortex in PTSD: Review and hypothesis. Depression and Anxiety 9: 1–14.

    Google Scholar 

  • Hamner, M. B., Ulmer, H. G., Horne, D. F., George, M. S., and Arana, G.W. (1999b). Procaine administration and behavioral responsivity in post-traumatic stress disorder: A pilot study of tolerability. Human Psychopharmacology Clinical and Experimental 14: 105–111.

    Google Scholar 

  • Hertzberg, M. A., Feldman, M. E., Beckham, J. C., Kudler, H. S., and Davidson, J. R. (2000). Lack of efficacy for fluoxetine in PTSD: A placebo controlled trial in combat veterans. Annals of Clinical Psychiatry 12: 101–105.

    Google Scholar 

  • Horner, M. D. (1999). Attentional functioning in abstinent cocaine abusers. Drug and Alcohol Dependence 54: 19–33.

    Google Scholar 

  • Jenkins, M. A., Langlais, P. J., Delis, D., and Cohen, R. (1998). Learning and memory in rape victims with posttraumatic stress disorder. American Journal of Psychiatry 155: 278–279.

    Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., and Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52: 1048–1060.

    Google Scholar 

  • King, D. A., and Caine, E. D. (1996). Cognitive impairment and major depression: Beyond the pseudodementia syndrome. In Grant, I., and Adams, K. M. (eds.), Neuropsychological Assessment of Neuropsychiatric Disorders, 2nd edn., Oxford University Press, New York, pp. 200–217.

    Google Scholar 

  • Krystal, J. H., Bennett, A. L., Bremner, J. D., Southwick, S. M., and Charney, D. S. (1995). Toward a cognitive neuroscience of dissociation and altered memory functions in post-traumatic stress disorder.In Friedman, M. J., Charney, D. S., and Deutch, A. Y. (eds.), Neurobiological and Clinical Consequences of Stress: From Normal Adaptation to PTSD, Lippincott-Raven Publishers, Philadelphia.

    Google Scholar 

  • Levy, C. (1988). Agent Orange exposure and posttraumatic stress disorder. Journal of Nervous and Mental Disease 176: 242–245.

    Google Scholar 

  • Liberzon, I., Taylor, S. F., Fig, L. M., and Koeppe, R. A. (1996/1997). Alteration of cortocithalamic perfusion ratios during a PTSD flashback. Depression and Anxiety 4: 146–150.

    Google Scholar 

  • McFarlane, A. C., Weber, D. L., and Clark, C. R. (1993). Abnormal stimulus processing in posttraumatic stress disorder. Biological Psychiatry 34: 311–320.

    Google Scholar 

  • O'Donnell, D. W., and Calev, A. (1999). Neuropsychology of nonpsychotic, nonaffective psychiatric disorders. In Calev, A. (ed.), Assessment of Neuropsychological Functions in Psychiatric Disorders, American Psychiatric Press, Washington, DC, pp. 99–134.

    Google Scholar 

  • Rauch, S. L., van der Kolk, B. A., Fisler, R. E., Alpert, N. M., Orr, S. P., Savage, C. R., Fischman, A. J., Jenike, M. A., and Pitman, R. K. (1996). A symptom provocation study of posttraumatic stress disorder using positron emission tomography of script-driven imagery. Archives of General Psychiatry 53: 380–387.

    Google Scholar 

  • Rauch, S. L., Whalen, P. J., Shin, L. M., McInerney, S. C., Macklin, M. L., Lasko, N. B., Orr, S. P., and Pitman, R. K. (2000). Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study. Biological Psychiatry 47: 769–776.

    Google Scholar 

  • Resnick, P. J. (1995). Guidelines for the evaluation of malingering in posttraumatic stress disorder. In Simon, R. I. (ed.), Posttraumatic Stress Disorder in Litigation, American Psychiatric Press, Washington, DC, pp. 117–134.

    Google Scholar 

  • Resnick, H. S., Kilpatrick, D. G., and Lipovsky, J. A. (1991). Assessment of rape-related posttraumatic stress disorder: Stressor and symptom dimensions. Journal of Consulting and Clinical Psychology 13: 561–572.

    Google Scholar 

  • Rourke, S. B., and Loberg, T. (1996). The neurobehavioral correlates of alcoholism. In Grant, I., and Adams, K. M. (eds.), Neuropsychological Assessment of Neuropsychiatric Disorders, 2nd edn., Oxford University Press, New York, pp. 423–485.

    Google Scholar 

  • Sapolsky, R. M. (2000). Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Archives of General Psychiatry 57: 925–935.

    Google Scholar 

  • Semple, W. E., Goyer, P. F., McCormick, R., Compton-Toth, B., Morris, E., Donovan, B., Muswick, G., Nelson, D., Garnett, M. L., Sharkoff, J., Leisure, G., Miraldi, F., and Schulz, C. (1996). Attention and regional cerebral blood flow in posttraumatic stress disorder patients with substance abuse histories. Psychiatry Research: Neuroimaging 67: 17–28.

    Google Scholar 

  • Shin, L. M., Kosslyn, S. M., McNally, R. J., Alpert, N. M., Thompson, W. L., Rauch, S. L., Macklin, M. L., and Pitman, P. K. (1997).Visual imagery and perception in posttraumatic stress disorder: A positron emission tomography investigation. Archives of General Psychiatry 54: 233–241.

    Google Scholar 

  • Stein, M. B., Koverola, C., Hanna, C., Torchia, M. G., and McClarty, B. (1997). Hippocampal volume in women victimized by childhood sexual abuse. Psychological Medicine 27: 951–959.

    Google Scholar 

  • Strickland, T. L., and Stein, R. (1995). Cocaine-induced cerebrovascular impairment: Challenges to neuropsychological assessment. Neuropsychology Review 5: 69–79.

    Google Scholar 

  • Sutker, P. B., Vasterling, J. J., Brailey, K., and Allain, A. N. (1995). Memory, attention, and executive deficits inPOWsurvivors: Contributing biological and psychological factors. Neuropsychology 9: 118–125.

    Google Scholar 

  • Sutker, P. B., Winstead, D. K., Galina, Z. H., and Allain, A. N. (1990). Assessment of long-term psychosocial sequelae among POW survivors of the Korean conflict. Journal of Personality Assessment 54: 170–180.

    Google Scholar 

  • Sutker, P. B., Winstead, D. K., Galina, Z. H., and Allain, A. N. (1991). Cognitive deficits and psychopathology among former prisoners of war and combat veterans of the Korean conflict. American Journal of Psychiatry 148: 67–72.

    Google Scholar 

  • Uddo, M., Vasterling, J. J., Brailey, K., and Sutker, P. B. (1993). Memory and attention in combat-related post-traumatic stress disorder. Journal of Psychopathology and Behavioral Assessment 15: 43–52.

    Google Scholar 

  • Van der Kolk, B. A., Drefuss, D., Michaels, M., Shera, D., Berkowitz, R., Fisler, R., and Saxe, G. (1994). Fluoxetine in posttraumatic stress disorder. Journal of Clinical Psychiatry 55: 517–522.

    Google Scholar 

  • Vasterling, J. J., Brailey, K., Constans, J. I., and Sutker, P. B. (1998). Attention and memory dysfunction in posttraumatic stress disorder. Neuropsychology 12: 125–133.

    Google Scholar 

  • Veiel, H. O. F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology 19: 587–603.

    Google Scholar 

  • Yehuda, R., Giller, E. L., Levengood, R. A., Southwick, S. M., and Siever, L. J. (1995a). Hypothalamic-pituitary-adrenal functioning in posttaumatic stress disorder: Expanding the concept of the stress response spectrum. In Friedman, M. J., Charney, D. S., and Deutch, A. Y. (eds.), Neurobiological and Clincial Consequences of Stress: From Normal Adaptation to PTSD, Lippincott-Raven Publishers, Philadelphia.

    Google Scholar 

  • Yehuda, R., Keefe, R. S., Harvey, P. D., Levengood, R. A., Gerber, D. K., Geni, J., and Siever, L. J. (1995b). Learning and memory in combat veterans with posttraumatic stress disorder. American Journal of Psychiatry 152: 137–139.

    Google Scholar 

  • Zalewski, C., Thompson, W., and Gottesman, I. (1994). Comparison of neuropsychological test performance in PTSD, generalized anxiety disorder, and control Vietnam veterans. Assessment 1: 133–142.

    Google Scholar 

  • Zubieta, J. K., Chinitz, J. A., Lombardi, U., Fig, L. M., Cameron, O. G., and Liberzon, I. (1999). Medial frontal cortex involvement in PTSD symptoms: A SPECT study. Journal of Psychiatric Research 33: 259–264.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horner, M.D., Hamner, M.B. Neurocognitive Functioning in Posttraumatic Stress Disorder. Neuropsychol Rev 12, 15–30 (2002). https://doi.org/10.1023/A:1015439106231

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1015439106231

Navigation