Accelerated brain aging in Veterans with posttraumatic stress symptoms and mild traumatic brain injury

Exposure to trauma and mild traumatic brain injury (mTBI), which often co-occur and can both trigger acute and chronic pathophysiological processes, have been linked to brain changes indicative of accelerated neurological aging. However, few longitudinal studies have examined the impact of these factors over time or characterized how the chronicity and severity of associated symptoms affect aging trajectories. This study included individuals (N = 79) who were exposed to psychological trauma, with most of the cohort additionally having sustained a mTBI. Participants completed structural MRI scans and behavioral assessments during three study visits over 18 months at nine-month intervals. Utilizing a deep learning method (DeepBrainNet), brain age was estimated using a large, published, normative sample and compared against chronological age. Associations between resultant brain age and neurobehavioral symptoms over time were also examined. Findings revealed that predicted brain age was significantly older (i.e., 4.8 years) than chronological age at baseline (p < 0.0001). This brain age gap progressively widened over the course of evaluation, with a difference of 5.4 and 6.5 years at 9 and 18 months post-baseline, respectively. Participants reported mild to moderate posttraumatic stress disorder, depressive, neurobehavioral, and postconcussive symptoms, which remained stable and were not correlated with the accelerated rate of brain aging. The duration since trauma exposure did not significantly influence the rate of neurological aging. Results suggest that the experience of trauma, and the confluence of factors that frequently co-occur with trauma, have a profound impact on brain health.