Neuropsychological Deficits Common in Gulf War Illness, Meta-Analysis Shows.
In the 26 years since the first Gulf War, increasing numbers of deployed veterans have complained of cognitive problems, including decrements in attention and memory.
Now, a meta-analysis of recent studies led by School of Public Health researchers confirms those lapses in attention, executive function, visuospatial abilities, and learning and memory, and recommends more focus on those problems in research and treatment trials. The analysis, published in the journal PLOS ONE, pulls together the findings of 14 studies of Gulf War veterans’ neuropsychological functioning.
“Cognitive complaints are one of the most debilitating hallmark symptoms of Gulf War Illness (GWI), and over the past 25 years, researchers have assessed the nature of the dysfunction associated with the disorder using neuropsychological methods,” the analysis says.
“Our results validate previously reported cognitive decrement findings” in deployed veterans, who performed worse than their non-deployed counterparts, and in ill veterans, who performed worse than their healthy peers.
The report is the first meta-analysis intended to clarify the neuropsychological profile of Gulf War veterans, the authors said. They found that a total of 25 separate neuropsychological tests had been administered to veterans and reported in published studies in the last two decades, and that while results varied, cognitive decrements were a recurring finding.
“Across all neuropsychological tests, the … analysis showed that the Gulf-deployed veterans performed worse, with statistically significant reductions in performance, on the visuospatial subtest, all four of the attention and executive function outcomes, and two of the six learning and memory subtests,” the study says. Meanwhile, no tests of motor skills or academic achievement were significantly different.
Self-reports of chemical or biological exposures, such as sarin gas, were significantly associated with deficits in verbal and visual memory and attention, the research has found—not unexpected, given that such exposures are associated with alterations in brain white matter and neural pathways, according to researchers.
“Collectively, these results indicate chronic cognitive effects from neuro-toxicant exposures that would be expected, given the functional correlates of neuroimaging findings in exposed Gulf War populations,” the authors said.
They said the findings confirm that cognitive dysfunction is “an appropriate criterion for diagnosis of GWI, and that specific types of cognitive decrements may be especially important to consider in a new case definition.”
GWI is a disorder that affects about one-third of the 697,000 veterans who served in the first Gulf War. It can include memory and attention problems, fatigue, chronic muscle and joint pain, headaches, persistent diarrhea, respiratory difficulties and skin rashes. Past research has shown that exposure to pesticides, the nerve gas agent sarin, and ingestion of pyridostigmine bromide (PB) pills—intended to protect troops against the effects of possible nerve gas—are associated with GWI and neurological dysfunction.
The meta-analysis was led by Patricia Janulewicz, assistant professor of environmental health. Co-authors include: Alexis Maule, Roberta White, Joanna Cirillo, and Kimberly Sullivan, all with the Department of Environmental Health; Maxine Krengel of the VA Boston Healthcare System and the School of Medicine; Emily Sisson of the Data Coordinating Center; and Timothy Heeren of the Department of Biostatistics.
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