Memory Performance in Holocaust Survivors with Posttraumatic Stress Disorder
Golier JA, Yehuda R, Lupien SJ, Harvey PD, Grossman R and Elkin A;
Commented by , 28 Oct 2002
Aim of the study
The aim of the study was to evaluate the association of Posttraumatic Stress Disorder (PTSD) occurring after exposure to the Holocaust with explicit and implicit memory performance in later life.
Method
Participants were survivors of the Nazi Holocaust with current PTSD stemming from the trauma of the Holocaust (N=31), Holocaust survivors without current or lifetime PTSD (N=16), and healthy Jewish adults without a history of exposure to the Holocaust or other extreme traumas (N=35).
Explicit memory was evaluated using paired-associate recall (of both unrelated and related words). Implicit memory was measured by word-stem completion.
Diagnostic assessments were made on the basis of the Clinician-Administered PTSD Scale.
“An approximation of ” IQ was obtained using the combined vocabulary and block design scaled scores from the Wechsler Adult Intelligence Scale-Revised (Wais-R).
Results
The three groups did not differ in age and gender distribution. The survivors with PTSD had however significantly lower Wais-R scores and significantly fewer years of education than did the survivors without PTSD and the healthy nonexposed subjects.
The survivors with PTSD scored lower on recall of both unrelated words (relative to the survivors with PTSD and to the healthy nonexposed subjects) and related words (relative to nonexposed subjects).
About one-third of the survivors with PTSD performed at a level indicative of frank cognitive impairment relative to the survivors without PTSD and to the nonexposed subjects. Recall worsened significantly with age in the survivors with PTSD but not in the other two groups.
There was no significant difference in performance between the three groups on word-stem completion.
Discussion
The study presents several major limitations: it is retrospective, cross-sectional and based on a small number of subjects. The fact that the survivors with PTSD had significantly lower IQs and fewer years of education than the two other groups represents an additional methodological problem, in particular because there is evidence from other studies that lower IQs and lesser education may be risk factors for the development of PTSD.
In spite of these shortcomings, this is an interesting study which raises fascinating questions.
First, explicit memory performance was significantly poorer in Holocaust survivors with PTSD relative to survivors without PTSD and to nonexposed healthy subjects. What is the significance of the relationship between PTSD and explicit memory? Can PTSD have a negative impact on explicit memory? Can PTSD lead to persistant impairment of explicit memory?
Second, decline in explicit memory was significantly accelerated in survivors with PTSD relative to the two other groups. This raises the question of a possible relationship between aging and cognitive functioning in PTSD. Could PTSD represent a factor contributing to or accelerating the development of cognitive decline and dementia?
The results showed no differences in implicit memory performances between the three groups and as such do not contribute any new information on what might be the role of implicit memory in PTSD.