Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-30T17:59:27.648Z Has data issue: false hasContentIssue false
  • English
  • Français

PTSD in the elderly: the interaction between trauma and aging

Published online by Cambridge University Press:  22 March 2011

Leann Kimberly Lapp ,
Catherine Agbokou  and
Florian Ferreri
Leann Kimberly Lapp*
Affiliation:
Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Sorbonne Universités, Paris VI, Paris, France Université Paris 7 - Denis Diderot, Paris, France
Catherine Agbokou
Affiliation:
Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Sorbonne Universités, Paris VI, Paris, France
Florian Ferreri
Affiliation:
Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Sorbonne Universités, Paris VI, Paris, France
*
Correspondence should be addressed to: Leann K. Lapp, Service de Psychiatrie et de Psychologie Médicale de l'Adulte, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris VI, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France. Phone: +33 1 49 28 26 35; Fax +33 1 49 28 20 10. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Because an increasingly large cohort of individuals is approaching their elderly years, there is concern about how the healthcare system will cope with the greater demands placed upon it. One area of concern is the impact of trauma and post traumatic stress disorder (PTSD) in the aged. Although several reviews have highlighted the lack of knowledge and research on the topic, there still remain gaps in the literature. Nevertheless, some recent behavioral, endocrinological and neuroimaging studies may provide new insights into the discussion. The central aims of this paper are to summarize the etiological, epidemiological and clinical aspects of PTSD, trauma, and the elderly, and to integrate this knowledge with (i) what is known about PTSD in adults, and (ii) the behavioral, hormonal and cerebral changes associated with healthy aging.

Methods: A comprehensive search was performed with ISI Web of Science and PubMed for articles pertinent to the psychology and biology of PTSD, trauma, and the elderly.

Results: There exist both significant similarities and differences between adults and elderly with PTSD concerning cognitive and biological profile. Evidence suggests that PTSD in the elderly does not follow a simple clinical trajectory.

Conclusions: PTSD in the elderly must be considered within the context of normal aging. Strong claims about an interaction between PTSD and aging are difficult to make due to sample heterogeneity, but it is clear that PTSD in this age group presents unique aspects not seen in younger cohorts. Further research must integrate their studies with the biological, psychological, and social changes already associated with the aging process.

Keywords

traumaPTSDelderlyaging
Type
Review Article
Information
International Psychogeriatrics , Volume 23 , Issue 6 , August 2011 , pp. 858 - 868
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarts, P. G. H. and Op den Velde, W. (1996). Prior traumatization and the process of aging: theory and clinical implications. In van der Kolk, B.A., McFarlane, A.C. and Weisaeth, L. (eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (pp. 359–377). New York: Guilford.Google Scholar
Acierno, R., Brady, K., Gray, M., Kilpatrick, D., Resnick, D. and Best, C. (2002). Psychopathology following interpersonal violence: a comparison of risk factors in older and younger adults. Journal of Clinical Geropsychology, 8, 13–23.CrossRefGoogle Scholar
Alpass, F., Long, N., Blakey, J. and Pachana, N. (2004). Post-traumatic stress disorder, social support and cognitive status in community-based older veterans. Australasian Journal on Aging, 23, 97–99.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Averill, P. M. and Beck, J. G. (2000). Posttraumatic stress disorder in older adults: a conceptual review. Journal of Anxiety Disorders, 14, 133–156.CrossRefGoogle ScholarPubMed
Bowlby, J. (1973). Attachment and Loss. Vol. 2. Separation: Anxiety and Anger. New York: Basic Books.Google Scholar
Bramsen, I., van der Ploeg, H. M. and Twisk, J. W. R. (2002). Secondary traumatization in Dutch couples of World War II survivors. Journal of Consulting and Clinical Psychology, 70, 241–245.CrossRefGoogle ScholarPubMed
Bramsen, I., van der Ploeg, H. M. and Boers, M. (2006). Posttraumatic stress in aging World War II survivors after a fireworks disaster: a controlled prospective study. Journal of Traumatic Stress, 19, 291–300.CrossRefGoogle ScholarPubMed
Brewin, C. R., Andrews, B. and Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.CrossRefGoogle ScholarPubMed
Brodaty, H., Joffe, C., Luscombe, G. and Thompson, C. (2004). Vulnerability to post-traumatic stress disorder and psychological morbidity in aged holocaust survivors. International Journal of Geriatric Psychiatry, 19, 968–979.CrossRefGoogle ScholarPubMed
Browne, C. J. and Shlosberg, E. (2006). Attachment theory, aging and dementia: a review of the literature. Aging and Mental Health, 10, 134–142.CrossRefGoogle ScholarPubMed
Bryant, R. A. and Guthrie, R. M. (2007). Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 75, 812–815.CrossRefGoogle ScholarPubMed
Busuttil, W. (2004). Presentations and management of Post Traumatic Stress Disorder and the elderly: a need for investigation. International Journal of Geriatric Psychiatry, 19, 429–439.CrossRefGoogle ScholarPubMed
Cassidy, J. and Mohr, J. J. (2001). Unsolvable fear, trauma, and psychopathology: theory, research, and clinical considerations related to disorganized attachment across the life span. Clinical Psychology: Science and Practice, 8, 275–298.Google Scholar
Chung, M. C., Werrett, J., Easthope, Y. and Farmer, S. (2004). Coping with post-traumatic stress: young, middle-aged and elderly comparisons. International Journal of Geriatric Psychiatry, 19, 333–343.CrossRefGoogle ScholarPubMed
Chung, M. C., Berger, Z, Jones, R. and Rudd, H. (2006). Posttraumatic stress disorder and general health problems following myocardial infarction (post-MI PTSD) among older patients: the role of personality. International Journal of Geriatric Psychiatry, 21, 1163–1174.CrossRefGoogle Scholar
Chung, M. C., Preveza, E., Papandreou, K. and Prevezas, N. (2006). The relationship between posttraumatic stress disorder following spinal cord injury and locus of control. Journal of Affective Disorders, 93, 229–232.CrossRefGoogle ScholarPubMed
Chung, M. C., Berger, Z, Jones, R. and Rudd, H. (2008). Posttraumatic stress and co-morbidity following myocardial infarction among older patients: the role of coping. Aging and Mental Health, 12, 124–133.CrossRefGoogle Scholar
Chung, M. C. et al. (2009). Posttraumatic Stress Disorder in older people after a fall. International Journal of Geriatric Psychiatry, 24, 955–964.CrossRefGoogle ScholarPubMed
Cook, J. M. and O'Donnell, C. (2005). Assessment and psychological treatment of posttraumatic stress disorder in older adults. Journal of Geriatric Psychiatry and Neurology, 18, 61–71.CrossRefGoogle ScholarPubMed
Cook, J. M., Ruzek, J. I. and Cassidy, E. (2003). Possible association of posttraumatic stress disorder with cognitive impairment among older adults. Psychiatric Services, 54, 1223–1225.CrossRefGoogle ScholarPubMed
Creamer, M. and Parslow, R. (2008). Trauma exposure and posttraumatic stress disorder in the elderly: a community prevalence study. American Journal of Geriatric Psychiatry, 16, 853–856.CrossRefGoogle ScholarPubMed
de Vries, G. J. and Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress, 22, 259–267.CrossRefGoogle ScholarPubMed
Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. (1987). The California Verbal Learning Test. San Antonio, TX: Psychological Corporation.Google Scholar
Diamond, L. M., and Fagundes, C. P. (2010). Psychobiological research on attachment. Journal of Social and Personal Relationships, 27, 218–225.CrossRefGoogle Scholar
Dirkzwager, A. J. E., Bramsen, I. and van der Ploeg, H. M. (2001). The longitudinal course of posttraumatic stress disorder symptoms among aging military veterans. Journal of Nervous and Mental Disease, 189, 846–853.CrossRefGoogle ScholarPubMed
Ehring, T., Ehlers, A. and Glucksman, E. (2008). Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. Journal of Consulting and Clinical Psychology, 76, 219–230.CrossRefGoogle ScholarPubMed
Elklit, A. and O'Connor, M. (2005). Post-traumatic stress disorder in a Danish population of elderly bereaved. Scandinavian Journal of Psychology, 46, 439–445.CrossRefGoogle Scholar
Erickson, K., Drevets, W. and Schulkin, J. (2003). Glucocorticoid regulation of diverse cognitive functions in normal and pathological emotional states. Neuroscience and Biobehavioral Reviews, 27, 233–246.CrossRefGoogle ScholarPubMed
Erikson, E. H. (1966). Eight ages of man. International Journal of Psychiatry, 2, 281–307.Google ScholarPubMed
Eysenck, H. J. (1983). Stress, disease, and personality: the inoculation effect. In Cooper, C. L. (ed.), Stress Research (pp. 121–146) New York: Wiley.Google Scholar
Field, E. L., Norman, P. and Barton, J. (2008). Cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder symptoms following stroke. Behaviour Research and Therapy, 46, 62–70.CrossRefGoogle ScholarPubMed
Floyd, M., Rice, J. and Black, S. (2002). Recurrence of posttraumatic stress disorder in late life: a cognitive aging perspective. Journal of Clinical Geropsychology, 8, 303–11.CrossRefGoogle Scholar
Frans, O., Rimmo, P. A., Aberg, L. and Fredrikson, M. (2005). Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatrica Scandinavica, 111, 291–299.CrossRefGoogle ScholarPubMed
Freeman, T. et al. (2006). Evidence of resilience: neuroimaging in former prisoners of war. Psychiatry Research-Neuroimaging, 146, 59–64.CrossRefGoogle ScholarPubMed
Gilbertson, M. W. et al. (2002). Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nature Neuroscience, 5, 1242–1247.CrossRefGoogle ScholarPubMed
Golier, J. A., Yehuda, R., Lupien, S. J., Harvey, P. D., Grossman, R. and Elkin, A. (2002). Memory performance in Holocaust survivors with posttraumatic stress disorder. American Journal of Psychiatry, 159, 1682–1688.CrossRefGoogle ScholarPubMed
Golier, J. A., Yehuda, R., Lupien, S. J. and Harvey, P. D. (2003). Memory for trauma-related information in Holocaust survivors with PTSD. Psychiatry Research, 121, 133–143.CrossRefGoogle ScholarPubMed
Golier, J. A., Yehuda, R., De Santi, S., Segal, S., Dolan, S. and de Leon, M. J. (2005). Absence of hippocampal volume differences in survivors of the Nazi Holocaust with and without posttraumatic stress disorder. Psychiatry Research – Neuroimaging, 139, 53–64.CrossRefGoogle ScholarPubMed
Grossman, A. B., Levin, B. E., Katzen, H. L. and Lechner, S. (2004). PTSD symptoms and onset of neurologic disease in elderly trauma survivors. Journal of Clinical and Experimental Neuropsychology, 26, 698–705.CrossRefGoogle ScholarPubMed
Grossman, R., Yehuda, R., Golier, J. A., McEwen, B. S., Harvey, P. D. and Maria, N. S. (2006). Cognitive effects of intravenous hydrocortisone in subjects with PTSD and healthy control subjects. Annals of the New York Academy of Sciences, 1071, 410–421.CrossRefGoogle ScholarPubMed
Hantman, S. and Solomon, Z. (2007). Recurrent trauma: Holocaust survivors cope with aging and cancer. Social Psychiatry and Psychiatric Epidemiology, 42, 396–402.CrossRefGoogle ScholarPubMed
Hart, J. et al. (2008). Cognitive dysfunctions associated with PTSD: evidence from World War II prisoners of war. Journal of Neuropsychiatry and Clinical Neurosciences, 20, 309–316.CrossRefGoogle ScholarPubMed
Hiskey, S., Luckie, M., Davies, S. and Brewin, C. R. (2008). The emergence of posttraumatic distress in later life: a review. Journal of Geriatric Psychiatry and Neurology, 21, 232–241.CrossRefGoogle ScholarPubMed
Horowitz, M. (1974). Stress response syndromes: character style and dynamic psychotherapy. Archives of General Psychiatry, 31, 768–781.CrossRefGoogle ScholarPubMed
Joffe, C., Brodaty, H., Luscombe, G. and Ehrlich, F. (2003). The Sydney Holocaust Study: posttraumatic stress disorder and other psychosocial morbidity in an aged community sample. Journal of Traumatic Stress, 16, 39–47.CrossRefGoogle Scholar
Johnston, D. (2000). A series of cases of dementia presenting with PTSD symptoms in World War II combat veterans. Journal of the American Geriatrics Society, 48, 70–72.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Kluznick, J. C., Speed, N., van Valkenburg, C. and Magraw, R. (1986). Forty-year follow-up of United States prisoners of war. American Journal of Psychiatry, 143, 1443–1446.Google Scholar
Kohn, R., Levav, I., Garcia, I.D., Machuca, M. E. and Tamashiro, R. (2005). Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country. International Journal of Geriatric Psychiatry, 20, 835–841.CrossRefGoogle ScholarPubMed
Kubzansky, L. D., Koenen, K. C., Spiro, A., Vokonas, P. S. and Sparrow, S. (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the normative aging study. Archives of General Psychiatry, 64, 109–116.CrossRefGoogle ScholarPubMed
Lee, T. M. C., Chi, I., Chung, L. W. M. and Chou, K. L. (2006). Aging and psychological response during the post-SARS period. Aging and Mental Health, 10, 303–311.CrossRefGoogle ScholarPubMed
Liu, A. Z. et al. (2006). An epidemiologic study of posttraumatic stress disorder in flood victims in Hunan China. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie, 51, 350–354.CrossRefGoogle ScholarPubMed
Lupien, S. J. and McEwen, B. S. (1997). The acute effects of corticosteroids on cognition: integration of animal and human model studies. Brain Research Review, 24, 1–27.CrossRefGoogle ScholarPubMed
Lupien, S. J. et al. (2005). Stress hormones and human memory function across the lifespan. Psychoneuroendocrinology, 30, 225–242.CrossRefGoogle ScholarPubMed
Lupien, S. J. et al. (2007). Hippocampal volume is as variable in young as in older adults: implications for the notion of hippocampal atrophy in humans. Neuroimage, 34, 479–485.CrossRefGoogle Scholar
Macleod, A. D. (1994). The reactivation of posttraumatic-stress disorder in later life. Australian and New Zealand Journal of Psychiatry, 28, 625–634.CrossRefGoogle ScholarPubMed
McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.CrossRefGoogle Scholar
Mittal, D., Torres, R., Abashidze, A. and Jimerson, N. (2001). Worsening of post-traumatic stress disorder symptoms with cognitive decline: case series. Journal of Geriatric Psychiatry and Neurology, 14, 17–20.CrossRefGoogle ScholarPubMed
Moore, S. A. (2009). Cognitive abnormalities in posttraumatic stress disorder. Current Opinion in Psychiatry, 22, 19–24.CrossRefGoogle ScholarPubMed
Norris, F. H., Murphy, A. D., Baker, C. K., Perilla, J. L., Rodriguez, F. G. and Rodriguez, J. D. (2003). Epidemiology of trauma and posttraumatic stress disorder in Mexico. Journal of Abnormal Psychology, 112, 646–656.CrossRefGoogle ScholarPubMed
Op den Velde, W. et al. (1993). Posttraumatic stress disorder in Dutch resistance veterans from World War II. In Wilson, J. P. and Raphael, B. (eds.), International Handbook of Traumatic Stress Syndromes (pp. 219–230). New York: Plenum.CrossRefGoogle Scholar
Owens, G. P., Baker, D. J., Kasckow, J., Ciesla, J. A. and Mohamed, S. (2005). Review of assessment and treatment of PTSD among elderly American armed forces veterans. International Journal of Geriatric Psychiatry, 20, 1118–1130.CrossRefGoogle ScholarPubMed
Ozer, E. J., Best, S. R., Lipsey, T. L. and Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin, 129, 52–73.CrossRefGoogle ScholarPubMed
Pitman, R. K. (2010). Posttraumatic stress disorder and dementia. What is the origin of the association? JAMA, 303, 2287–2288.CrossRefGoogle ScholarPubMed
Port, C. L., Engdahl, B. and Frazier, P. (2001). A longitudinal and retrospective study of PTSD among older prisoners of war. American Journal of Psychiatry, 158, 1474–1479.CrossRefGoogle ScholarPubMed
Port, C. L., Engdahl, B., Frazier, P. and Eberly, R. E. (2002). Factors related to the long-term course of PTSD in older ex-prisoners of war. Journal of Clinical Geropsychology, 8, 203–214.CrossRefGoogle Scholar
Ruzich, M. J., Looi, J. C. L. and Robertson, M. D. (2005). Delayed onset of posttraumatic stress disorder among male combat veterans: a case series. American Journal of Geriatric Psychiatry, 13, 424–427.CrossRefGoogle ScholarPubMed
Sapolsky, R. M., Krey, L. C. and McEwen, B. S. (1986). The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocrine Reviews, 7, 284–301.CrossRefGoogle ScholarPubMed
Shin, L. M., Rauch, S. L. and Pitman, R. K. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Science, 1071, 67–79.CrossRefGoogle ScholarPubMed
Solomon, Z. and Ginzburg, K. (1998). War trauma and the aged: an Israeli perspective. Handbook of Aging and Mental Health, 135–152.CrossRefGoogle Scholar
Solomon, Z. and Mikulincer, M. (2006). Trajectories of PTSD: a 20-year longitudinal study. American Journal of Psychiatry, 163, 659–666.CrossRefGoogle ScholarPubMed
Solomon, Z., Helvitz, H. and Zerach, G. (2009). Subjective age, PTSD and physical health among war veterans. Aging and Mental Health, 13, 405–413.CrossRefGoogle ScholarPubMed
Spitzer, C., Barnow, S., Volzke, H., John, U., Freyberger, H. J. and Grabe, H. J. (2008). Trauma and posttraumatic stress disorder in the elderly: findings from a German community study. Journal of Clinical Psychiatry, 69, 693–700.CrossRefGoogle Scholar
Tennant, C., Fairley, M. J., Dent, O. F., Sulway, M. and Broe, G. A. (1997). Declining prevalence of psychiatric disorder in older former prisoners of war. Journal of Nervous and Mental Disease, 185, 686–89.CrossRefGoogle ScholarPubMed
Trappler, B., Cohen, C. I. and Tulloo, R. (2007). Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz. American Journal of Geriatric Psychiatry, 15, 79–83.CrossRefGoogle ScholarPubMed
Tulving, E. (1985). How many memory systems are there? American Psychologist, 40, 385–398.CrossRefGoogle Scholar
van Achterberg, M. E., Rohrbaugh, R. M. and Southwick, S. M. (2001). Emergence of PTSD in trauma survivors with dementia. Journal of Clinical Psychiatry, 62, 206–207.CrossRefGoogle ScholarPubMed
van Ameringen, M., Mancini, C., Patterson, B. and Boyle, M. H. (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience and Therapeutics, 14, 171–181.CrossRefGoogle ScholarPubMed
van Zelst, W. H., de Beurs, E., Beekman, A. T. F., Deeg, D. J. H. and van Dyck, R. (2003). Prevalence and risk factors of posttraumatic stress disorder in older adults. Psychotherapy and Psychosomatics, 72, 333–342.CrossRefGoogle ScholarPubMed
van Zelst, W. H., de Beurs, E., Beekman, A. T. F., van Dyck, R. and Deeg, D. D. H. (2006). Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD. International Journal of Geriatric Psychiatry, 21, 180–188.CrossRefGoogle ScholarPubMed
Yaffe, K. et al. (2010). Posttraumatic stress disorder and risk of dementia among US veterans. Archives of General Psychiatry, 67, 608–613.CrossRefGoogle ScholarPubMed
Yehuda, R. (2009). Status of glucocorticoid alterations in post-traumatic stress disorder. Annals of the New York Academy of Sciences, 1179, 56–69.CrossRefGoogle ScholarPubMed
Yehuda, R., Schmeidler, J., Siever, L. J., Binder-Brynes, K. and Elkin, A. (1997). Individual differences in posttraumatic stress disorder symptom profiles in Holocaust survivors in concentration camps or in hiding. Journal of Traumatic Stress, 10, 453–463.CrossRefGoogle ScholarPubMed
Yehuda, R., Halligan, S. L., Grossman, R., Golier, J. A. and Wong, C. (2002). The cortisol and glucocorticoid receptor response to low dose dexamethasone administration in aging combat veterans and Holocaust survivors with and without posttraumatic stress disorder. Biological Psychiatry, 52, 393–403.CrossRefGoogle ScholarPubMed
Yehuda, R., Golier, J. A., Halligan, S. L. and Harvey, P. D. (2004). Learning and memory in Holocaust survivors with posttraumatic stress disorder. Biological Psychiatry, 55, 291–295.CrossRefGoogle ScholarPubMed
Yehuda, R., Golier, J. A., Tischler, L., Stavitsky, K. and Harvey, P. D. (2005a). Learning and memory in aging combat veterans with PTSD. Journal of Clinical and Experimental Neuropsychology, 27, 504–515.CrossRefGoogle ScholarPubMed
Yehuda, R., Golier, J. A. and Kaufman, S. (2005b). Circadian rhythm of salivary cortisol in holocaust survivors with and without PTSD. American Journal of Psychiatry, 162, 998–1000.CrossRefGoogle ScholarPubMed
Yehuda, R. et al. (2005c). Relationship between cortisol and age-retated memory impairments in Holocaust survivors with PTSD. Psychoneuroendocrinology, 30, 678–687.CrossRefGoogle ScholarPubMed
Yehuda, R. et al. (2006). Longitudinal assessment of cognitive performance in Holocaust survivors with and without PTSD. Biological Psychiatry, 60, 714–721.CrossRefGoogle ScholarPubMed
Yehuda, R., Harvey, P. D., Buchsbaum, M., Tischler, L. and Schmeidler, J. (2007a). Enhanced effects of cortisol administration on episodic and working memory in aging veterans with PTSD. Neuropsychopharmacology, 32, 2581–2591.CrossRefGoogle ScholarPubMed
Yehuda, R. et al. (2007b). Hippocampal volume in aging combat veterans with and without post-traumatic stress disorder: relation to risk and resilience factors. Journal of Psychiatric Research, 41, 435–445.CrossRefGoogle ScholarPubMed
Yehuda, R. et al. (2009). Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors. Acta Psychiatrica Scandinavia, 119, 25–34.CrossRefGoogle ScholarPubMed
Zlotnick, C., Johnson, J., Kohn, R., Vicente, B., Rioseco, P. and Saldivia, S. (2006). Epidemiology of trauma, post-traumatic stress disorder (PTSD) and co-morbid disorders in Chile. Psychological Medicine, 36, 1523–1533.CrossRefGoogle ScholarPubMed