Sexual Assault in Women Tied to Increased Stroke, Dementia Risk

Megan Brooks

September 22, 2021

Traumatic experiences, especially sexual assault, may put women at greater risk for poor brain health.

In the Ms Brain study, middle-aged women with trauma exposure had a greater volume of white matter hyperintensities (WMHs) than those without trauma. In addition, the differences persisted even after adjusting for depressive or post-traumatic stress symptoms. 

WMHs are "an important indicator of small vessel disease in the brain and have been linked to future stroke risk, dementia risk and mortality," lead investigator Rebecca Thurston, PhD, from the University of Pittsburgh School of Medicine, Pennsylvania, told Medscape Medical News.

"What I take from this is really, that sexual assault has implications for women's health, far beyond exclusively mental health outcomes, but also for their cardiovascular health, as we have shown in other work and for their stroke and dementia risk as we are seeing in the present work," Thurston added.

The study was presented at the North American Menopause Society (NAMS) Annual Meeting in Washington, DC, and has been accepted for publication in the journal Brain Imaging and Behavior.

Beyond the Usual Suspects

As part of the study, 145 women (mean age, 59 years) free of clinical cardiovascular disease, stroke, or dementia provided their medical history including history of traumatic experiences, depression, and post-traumatic stress disorder and under magnetic resonance brain imaging for WMHs.

More than two thirds (68%) of the women reported at least one trauma, most commonly sexual assault (23%).

In multivariate analysis, women with trauma exposure had greater WMH volume than women without trauma (P = .01), with sexual assault most strongly associated with greater WMH volume (P = .02).

The associations persisted after adjusting for depressive or post-traumatic stress symptoms.

"A history of sexual assault was particularly related to white matter hyperintensities in the parietal lobe, and these kinds of white matter hyperintensities have been linked to Alzheimer's disease in a fairly pronounced way," Thurston said.

"When we think about risk factors for stroke, dementia, we need to think beyond exclusively our usual suspects and also think about women [who experienced] psychological trauma and experienced sexual assault in particular. So ask about it and consider it part of your screening regimen," she added.

"Burgeoning" Literature

Commenting on the findings for Medscape Medical News, Charles Nemeroff, MD, PhD, professor and chair, Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, and director of its Institute for Early Life Adversity Research, said the research adds to the "burgeoning literature on the long term neurobiological consequences of trauma and more specifically, sexual abuse, on brain imaging measures."

"Our group and others reported several years ago that patients with mood disorders, more specifically bipolar disorder and major depression, had higher rates of WMH than matched controls. Those older studies did not control for a history of early life adversity such as childhood maltreatment," Nemeroff said.

"In addition to this finding of increased WMH in subjects exposed to trauma is a very large literature documenting other central nervous system (CNS) changes in this population including cortical thinning in certain brain areas and clearly an emerging finding that different forms of childhood maltreatment are associated with quite distinct structural brain alterations in adulthood," he noted. 

The North American Menopause Society (NAMS) 2021 Annual Meeting. Abstract S-22. Presented September 22, 2021.

The study was supported by grants from the National Institutes of Health. Thurston and Nemeroff have disclosed no relevant financial relationships.

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