Lower Omega-3 Levels Were Found In Post Stroke Post Traumatic Stress Disorder
Swetha Renati1, Marla Hairston1, Weiliang Cen2, Henian Chen2, Andrea Bozeman1, W. Scott Burgin1
1Neurology, 2College of Public Health, University of South Florida
Objective:
This study sought to evaluate potential biomarkers associated with post-stroke (PS) post-traumatic stress disorder (PTSD).
Background:
While post-event anxiety is common after stroke/TIA, a significant proportion develop persistent and disabling symptoms of PS-PTSD. Stress response, fatty acids, and inflammation may influence its development. Related biomarkers may aid in early detection and development of PS-PTSD specific treatments.
Design/Methods:
This was a single-center observational pilot study of 20 adult patients diagnosed with stroke/TIA in the previous 31-365 days. Patients were evaluated with a 20-item PTSD Check List-5 (PCL-5), assessing symptoms of re-experiencing (Criterion B), avoidance (Criterion C), negative alterations in cognition or mood (Criterion D), and hyperarousal (Criterion E). Subjects were classified as having PS-PTSD with PCL-5 score > 33 or endorsement of moderate symptoms in at least one B item, one C item, two D items, and two E items. Levels were measured for potential stress/inflammatory markers (blood C-reactive protein (CRP), blood interleukin-6 (IL-6), and salivary cortisol), and omega-3 fatty acids (including eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid). Statistics included Cohen's D, an effect size measure to indicate the standardized difference between two means (in general: small = 0.2, medium = 0.5, and large = 0.8).
Results:
Twenty patients completed the PCL-5, and 19 completed blood and saliva tests. Seven patients were found to have PS-PTSD but only 6 completed biomarker testing. Those with PS-PTSD had lower total Omega3 fatty acid levels compared to those without PS-PTSD (3 vs. 3.6, Cohen's D=0.8 demonstrating a large effect). A smaller effect was observed with IL-6 (5.1 vs. 7.6, Cohen's D=0.34) and CRP (5.1 vs. 7.8, Cohen's D=0.26).
Conclusions:
Omega3 fatty acids, concentrated in the central nervous system and potentially neuroprotective, may represent a putative biomarker for PS-PTSD. This observation should be explored in a larger trial.