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Research Topics
General Health & Physical Symptoms
Project Summary

Title: Neuropsychological Functioning in Persian Gulf Era Veterans
Synopsis: A comparison study between Gulf War veteran treatment seekers and non-treatment seekers that evaluates the neurological and psychological functioning of Gulf War era veterans who are seeking treatment or diagnostic evaluation for health or adjustment.
Overall Project Objective: Persian Gulf War (PGW) veterans have reported a constellation of health symptoms that have been referred to popularly and in the media as "Gulf War Syndrome". The most commonly reported symptoms of the first 12,774 veterans who reported to their local VA (and registered with the Persian Gulf Registry) include, in order of frequency, excessive fatigue, skin rash, joint pain, headaches, disturbances of concentration and memory. Several different possible causes of these symptoms have been suggested, including exposure to environmental hazards such as diesel fuel, oil fire smoke or pesticides, and biological or chemical warfare agents. Some of the symptoms reported overlap with those of post-traumatic stress disorder (PTSD), multiple chemical sensitivity (MCS), or chronic fatigue syndrome (CFS), three disorders of unknown mechanism that have been seen in other treatment seeking populations. Both exposure to neurotoxicants and the three disorders noted above are known to be capable of producing cognitive impairments. Neuropsychological tests of known validity and sensitivity have been used to document these impairments. The proposed study evaluates the neuropsychological functioning of PGW-era veterans who are seeking treatment or diagnostic evaluation for any type of health or adjustment complaint.
Status/Results to Date: These are the conclusions regarding treatment seekers compared to non-treatment seekers from a prior study (VA-4): deployed treatment seekers perform worse than deployed non-treatment seekers on a variety of neuropsychological tests and report more dysphoria on mood scales. However, treatment seekers reported fewer physical symptoms on health inventories. Treatment-seekers reported similar rates of self-reported exposure to oil well fires, debris from scuds and pyridostigmine bromide but treatment seekers had higher rates of self-reported exposure to pesticides. Exposure to pesticides, human waste burning with diesel fuel, or PB did not explain the europsychological findings among the deployed treatment seekers. PTSD diagnosis may explain some of the findings among the treatment seekers, but it did not provide a complete explanation for them. Findings regarding the role of deployment in the treatment seeking group (compared to non-deployed treatment seekers) were: There was no difference in the rates of diagnosis for: PTSD, MCS, or CFS. The neuropsychological test performance of the deployed group was worse than that of the non-deployed group in three domains and the deployed group was more dysphoric. The findings of deployed group were similar to those in the PTSD group. The conclusions regarding the study's clinical implications are: CNS complaints of PGW-era veterans should be taken seriously and explored with formal testing and neuropsychological diagnosis. Mood complaints are common among deployed and non-deployed PGW-era veterans. PTSD occurs in PGW-era veterans and may be related or unrelated to the war. PGW exposure to environmental agents should be considered in evaluation of PGW veterans' health. Evaluation of CFS and MCS should be done carefully and with established diagnostic criteria. CFS- and MCS-like symptoms are more likely than full blown syndromes.
Agency:Department Of Defense
Location:VAMC Boston
P.I. Name:Roberta F White, Ph. D.
Research Type:Clinical
Research Focus:Brain & Nervous System
Focus Category:General Health & Physical Symptoms
Study Start Date:May 01,1996
Estimated Completion Date:July 01,1999
Specific Aims: The purpose of these group comparisons is to isolate factors that may differentiate those who served in the Gulf who are seeking treatment for health complaints from their treatment seeking counterparts who were not deployed to the Gulf.
Methodology: The group of patients who were deployed to the Gulf will be compared with those who were not deployed to the Gulf. Data from these groups will also be compared with those from a (non-treatment seeking) research sample of PGW veterans who are being studied using the same neuropsychological instruments. In addition, all of these patients and research subjects will be administered a standardized set of questionnaires and semi-structured interviews that will identify their current health symptoms, pre-existing physical and mental health condition, socio-demoqraphic variables, Gulf experiences, and post PGW-era stressors. These instruments also permit PTSD, MCS, CFS, and other psychiatric disorders to be diagnosed.
Most Recent Publications:

Proctor SP, Heaton K, White RF, Wolfe J. Chemical sensitivity and chronic fatigue in Gulf War veterans: a brief report. Journal of Occupational and Environmental Medicine, 43(3): 259-264, Mar 2001. Abstract

Sullivan K, Krengel M, Proctor SP, Devine S, Heeren T, White RF. Cognitive functioning in treatment-seeking Gulf War veterans Effects of Acute Stress and Pyridostigmine Bromide Use. N/A, 2002. Article

Proctor SP. Comparison of functional status (as measured by SF36) in clinical and research studies of GW-deployed military personnel. N/A, Planned in 2000. Manuscripts

Proctor SP, Harley R, Wolfe J, Heeren T, White RF. Health-related quality of life in Persian Gulf War Veterans. Military Medicine, 166(6):510-9, Jun 2001. Abstract

Proctor SP. Methodology to assess environmental exposures in GW-deployed military personnel. N/A, Planned in 2000. Manuscripts

Sullivan K. Neuropsychological deficits in association with stress reaction and pyridostigmine bromide intake in PGW-era veterans. N/A, Planned in 2000. Manuscripts

White RF, Proctor SP, Heeren T, Wolfe J, Krengel M, Vasterling J, Lindem K, Heaton K, Sutker PB, Ozonoff DM. Neuropsychological function in Gulf War veterans: relationships to self-reported toxicant exposures. American Journal of Industrial Medicine, 40(1):42-54. Jul 2001. Abstract

Krengel M. Neuropsychological functioning in PGW era veterans. N/A, Planned in 2000. Manuscripts

Krengel M, Sullivan K, Devine S, Davis L, White RF. Neuropsychological referral patterns in Persian Gulf War era veterans. Conference on Illnesses among Gulf War Veterans. A Decade of Scientific Research, 2001. Presentation