Understanding Neurocognitive Impairment After Trauma Exposure

Study Overview
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Brief Summary
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Individuals living in Canterbury (New Zealand) have experienced significant stress related to the Canterbury earthquake sequence. Previous research conducted at the Department of Psychological Medicine (Christchurch, New Zealand) has shown significant cognitive difficulties in a group of Cantabrians exposed to high levels of earthquake trauma. A high proportion (30%) perceive themselves to have significant cognitive difficulties, even seven years post-earthquake. People who perceive that they have cognitive difficulties find this distressing and tend to function less well in work and parenting. Understanding pathways underlying cognitive difficulties in the population is vital for developing appropriate treatments and strategies to help with this. This will be the first study to investigate rates of, and factors contributing to, perceived cognitive difficulties in a large population exposed to multiple stressors and is important for the population of Canterbury, and populations affected by natural and man-made disasters worldwide. Four hundred and sixty people who were exposed to the Canterbury earthquake sequence will be recruited from the Christchurch Health and Development Study (CHDS). Psychological, cognitive, functional and biological factors will be compared between those with the greatest levels of perceived cognitive difficulty and those with the lowest levels of difficulty. This will determine what factors relate most strongly to perceived cognitive difficulties, which will in turn be used to develop treatments for this population.

Official Title
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Understanding Neurocognitive Impairment After Trauma Exposure

Conditions
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Trauma, Psychological, Earthquake

Intervention / Treatment
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* Other: Trauma exposure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cohort member of the Christchurch Health and Development Study (born in 1977) Exposed to the Canterbury earthquake sequence In the highest or lowest quartile with regards to score on the Cognitive Failures Questionnaire Exclusion Criteria: lifetime diagnosed psychotic disorder previous moderate to severe head injury (> 30 minutes loss of consciousness) current pregnancy intellectual disability (IQ < 80) residing outside of Canterbury

Ages Eligible for Study
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Minimum Age: 44 Years
Maximum Age: 46 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Christchurch Health and Development Study (CHDS)<br>The Christchurch Health and Development Study (CHDS) is a birth cohort study comprising 1265 people born in Christchurch in 1977. Participants have been followed to age 40, with 75-80% retention at data collection points. | Other: Trauma exposure<br>* Exposure to the Canterbury earthquake sequence and other relevant psychological trauma<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subjective cognitive function | Assessed with the Cognitive Failures Questionnaire Minimum score = 0, maximum score = 100, higher scores reflect worse subjective cognitive function | Past 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global cognitive composite | Global cognitive composite will average Z-scores across the cognitive domains of (i) verbal learning and memory, (ii) visuospatial learning and memory, (iii) psychomotor speed, (iv) executive function, (v) working memory, (vi) sustained attention, and (vii) emotion processing. The Global cognitive composite score will be a single, averaged Z-value score, with a higher score reflecting better objective cognitive performance. | Baseline | 
| Verbal learning and memory | Z-scores from variables of the Rey Auditory Verbal Learning Test will be averaged to create a singe Z-score for the domain of 'Verbal Learning and Memory', with higher scores reflecting better performance. | Baseline | 
| Visuospatial learning and memory | Z-scores from variables of the Groton Maze Learning Test (CogState) will be averaged to create a singe Z-score for the domain of 'Visuospatial Learning and Memory', with higher scores reflecting better performance. | Baseline | 
| Psychomotor speed | Z-scores from variables of the Timed Chase Test (CogState), Trail Making Test - Part A, and Digit Symbol Coding Test will be averaged to create a singe Z-score for the domain of 'Psychomotor speed', with higher scores reflecting better performance. | Baseline | 
| Executive function | Z-scores from variables of the Trail Making Test - Part B and Category Fluency will be averaged to create a singe Z-score for the domain of 'Executive function', with higher scores reflecting better performance. | Baseline | 
| Working memory | Z-scores from variables of the Digit Span Test will be averaged to create a singe Z-score for the domain of 'Working memory', with higher scores reflecting better performance. | Baseline | 
| Sustained attention | Z-scores from variables of the Continuous Performance Test will be averaged to create a singe Z-score for the domain of 'Sustained attention', with higher scores reflecting better performance. | Baseline | 
| Facial emotion processing | Z-scores from variables of the Facial Expression Recognition Test and the Reading the Mind in the Eyes Test will be averaged to create a singe Z-score for the domain of 'Facial emotion processing', with higher scores reflecting better performance. | Baseline | 
| Rumination | Assessed with the Ruminative Responses Scale Minimum score = 25, maximum score = 100, higher scores reflect more severe rumination | Baseline | 
| Metacognitive beliefs | Assessed with the Metacognitions Questionnaire - 30-item version Minimum score = 30, maximum score = 120, higher scores reflect more problematic metacognitive beliefs Minimum score = 25, maximum score = 100, higher scores reflect more severe rumination | Baseline | 
| Psychosocial functioning | Assessed with the Social Adjustment Scale Minimum score = 1, maximum score = 5, higher scores reflect worse psychosocial functioning | Past 2 weeks | 
| Stressful life events | Number of stressful life events is assessed with the Life Events Scale (adapted from the Crisis in Family Systems - Revised Questionnaire) Minimum score = 0, higher score reflects more stressful life events | Past 5 years | 
| COVID-19 impact | Assessed with the COVID Psychosocial Impacts Scale (CPIS) Minimum score = 0, maximum score = 135, higher scores reflect more severe impact of COVID | Past 3 years | 
| Post-traumatic growth | Assessed with the Post-traumatic Growth Inventory (PTGI) | Past 12 years | 
| Mental health diagnoses | Assessed with the Mini International Neuropsychiatric Interview (MINI) | Baseline | 
| Metabolic markers | Blood levels of HbA1C, total cholesterol, HDL cholesterol, LDL cholesterol (calc), triglycerides | Baseline | 
| Inflammation | Blood levels of CRP | Baseline | 
| Sex hormones | Blood levels of progesterone, LH, FSH, testosterone, SHBG (females only) | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Trauma, Earthquake, Cognitive impairment