Neural Correlates of Cognitive Rehabilitation in Post-Traumatic Stress Disorder (PTSD)

1. Objective(s) Post Traumatic Stress Disorder (PTSD) has been established as relatively
common in a significant number of OEF/OIF Veterans (Vasterling & Brailey, 2005; Hoge et
al., 2008). Attention deficits, which are prominent in PTSD, may be due to difficulty
sustaining attention over time and encoding or getting information into storage which
leads to reduced attention and memory scores on neuropsychological measures.
Disruptions in attention are common in many types of neurological and psychiatric
disorders. Deficient attentional skills may negatively affect cognitive performance in
other areas (e.g., memory, planning) and thereby reduce effectiveness navigating daily
life tasks as well as decrease the Veteran's life satisfaction after returning home.

The origin of the attention impairment may be amenable to sophisticated remediation
approaches using a "bottom up, neuroscience based" visual training program (i.e., Posit
Science, Inc. cognitive rehabilitation program), which has been successful in improving
neurocognitive function in healthy older adults (e.g., Mahncke et al., 2006) and
patients with Schizophrenia (e.g., Bell at al., 2008). By engaging Veterans with PTSD
in targeted remediation, it is expected that both behavioral (seen in
neuropsychological test gains) and neural activity (e.g., BOLD response through fMRI)
will reflect the improvement and this may be linked to improved outcomes in daily
functioning.

2. Research Design: The longitudinal research design for this project will be a three
factor mixed factorial design with between subject factors of PTSD (+PTSD x -PTSD) and
cognitive remediation [cogrem x video game] and within subject variable of time tested
(pre-training, post-training, 3 month follow up). There will be 40 participants
enrolled in the following groups of 10 each: 1) +PTSD/cogrem, 2) +PTSD/video game, 3)
-PTSD/cogrem, and 4) -PTSD/video game. PTSD status is determined by a diagnosis of
PTSD identified through a clinical interview for DSM-IV diagnostic criteria for PTSD.
The active treatment is cognitive training. Veterans in this group will receive the
Posit Science (Mahncke et al., 2006) visual cognitive remediation paradigm of 40 hours
of training. The control treatment is a video game designed by Nintendo for the DS
handheld system, which intended to improve mental functioning called Brain Age
(Nintendo, Inc.) which will be played for 40 hours. Groups will be compared on the
difference scores for neuropsychological, neurobehavioral and neuroimaging data to see
if there is a benefit in cognitive training and if that benefit is greater in the group
with PTSD.

3. Methodology: Forty outpatient Veterans will be enrolled. All individuals will receive a
neurobehavioral interview, neuropsychological testing and neuroimaging at the baseline
visit, post training and at follow-up visits. After the baseline visit, each volunteer
will be randomized to one of two conditions.

4. Findings: This is a new study and there are no findings to date.

5. Clinical Relationships: This study will examine the effects of a standard cognitive
rehabilitation program with OEF/OIF veterans who have cognitive deficits due to PTSD.

6. This project will impact veterans' healthcare by identifying cognitive problems in PTSD
and will test the ability of a rehabilitation program to remediate those problems.