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Neuropsychological functioning of U.S. Gulf War veterans 10 years after the war

Published online by Cambridge University Press:  01 September 2009

ROSEMARY TOOMEY ,
RENEE ALPERN ,
JENNIFER J. VASTERLING ,
DEWLEEN G. BAKER ,
DOMENIC J. REDA ,
MICHAEL J. LYONS ,
WILLIAM G. HENDERSON ,
HAN K. KANG ,
SETH A. EISEN  and
FRANCES M. MURPHY
ROSEMARY TOOMEY*
Affiliation:
Research Service, Boston VA Healthcare System, Boston, Massachusetts The Massachusetts Mental Health Center Public Academic Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts Harvard Institute of Psychiatric Epidemiology and Genetics, Boston, Massachusetts Psychology Department, Boston University, Boston, Massachusetts
RENEE ALPERN
Affiliation:
Cooperative Studies Program Coordinating Center, Hines Veterans Affairs Hospital, Hines, Illinois. (W.G.H. is currently at the University of Colorado Health Outcomes Program and the Department of Preventive Medicine and Biometrics, Aurora, Colorado.)
JENNIFER J. VASTERLING
Affiliation:
VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, New Orleans Veterans Affairs Medical Center, New Orleans, Louisiana Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, Louisiana. (Author is currently at the Psychology Service and VA National Center for PTSD, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.)
DEWLEEN G. BAKER
Affiliation:
Psychiatry Department, University of Cincinnati, Cincinnati, Ohio Psychiatry Service, Cincinnati VA Medical Center (Author is currently at Psychiatry Service, San Diego VA Healthcare System, San Diego, California, and the University of California, San Diego, California.)
DOMENIC J. REDA
Affiliation:
Cooperative Studies Program Coordinating Center, Hines Veterans Affairs Hospital, Hines, Illinois. (W.G.H. is currently at the University of Colorado Health Outcomes Program and the Department of Preventive Medicine and Biometrics, Aurora, Colorado.)
MICHAEL J. LYONS
Affiliation:
Research Service, Boston VA Healthcare System, Boston, Massachusetts The Massachusetts Mental Health Center Public Academic Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts Harvard Institute of Psychiatric Epidemiology and Genetics, Boston, Massachusetts Psychology Department, Boston University, Boston, Massachusetts
WILLIAM G. HENDERSON
Affiliation:
Cooperative Studies Program Coordinating Center, Hines Veterans Affairs Hospital, Hines, Illinois. (W.G.H. is currently at the University of Colorado Health Outcomes Program and the Department of Preventive Medicine and Biometrics, Aurora, Colorado.)
HAN K. KANG
Affiliation:
Environmental Epidemiology Service, Department of Veterans Affairs, Washington D.C.
SETH A. EISEN
Affiliation:
Medical and Research Services, St. Louis Department of Veterans Affairs Medical Center, St. Louis, Missouri. Department of Internal Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri. Health Services Research and Development, Veterans Administration, Washington, D.C.
FRANCES M. MURPHY
Affiliation:
Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, D.C. Uniformed Services University of the Health Sciences, Washington, D.C.
*
*Correspondence and reprint requests: Rosemary Toomey, Ph.D., Psychology Department, Boston University, 648 Beacon Street, 6th Floor, Boston, MA. 02215. E-mail: [email protected]
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Abstract

Many U.S. Gulf War-era veterans complained of poor cognition following the war. This study assessed neuropsychological functioning in veterans 10 years after the war through objective tests. 2189 Gulf War-era veterans (1061 deployed, 1128 non-deployed) were examined at 1 of 16 U.S. Veterans Affairs medical centers. Outcomes included neuropsychological domains derived from factor analysis and individual test scores. Deployed veterans performed significantly worse than non-deployed veterans on 2 of 8 factors (motor speed & sustained attention, analysis not corrected for multiple comparisons) and on 4 of 27 individual test variables (Trails A & B, California Verbal Learning Test – List B, and Continuous Performance Test sensitivity, with only Trails B surviving Bonferroni correction). Within deployed veterans, Khamisiyah exposure was negatively correlated with motor speed after controlling for emotional distress. Depressive symptoms and self-reported exposure to toxicants were independently and significantly associated with worse sustained attention. Other factors were also associated with self-reported exposures. The findings were not a result of differential effort across groups. Gulf War deployment is associated with subtle declines of motor speed and sustained attention, despite overall intact neuropsychological functioning. Evidence suggests that toxicant exposures influence both these functions, and depressive symptoms also influence attention. (JINS, 2009, 15, 717–729.)

Keywords

CognitionPsychological testsNeurotoxicity syndromesEnvironmental medicineMental disordersPsychological stress
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 5 , September 2009 , pp. 717 - 729
Copyright
Copyright © The International Neuropsychological Society 2009

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References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
Anger, W.K., Storzbach, D., Binder, L.M., Campbell, K.A., Rohlman, D.S., McCauley, L., et al. . (1999). Neurobehavioral deficits in Persian Gulf veterans: Evidence from a population-based study. Journal of the International Neuropsychological Society, 5, 203–212.Google Scholar
Army Individual Test Battery. (1944). Manual of directions and scoring. Washington, DC: War Department, Adjutant General’s Office.Google Scholar
Axelrod, B.N., & Milner, I.B. (1997). Neuropsychological findings in a sample of Operation Desert Storm veterans. Journal of Neuropsychiatry and Clinical Neuroscience, 9, 23–28.Google Scholar
Beck, A.T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: The Psychological Corporation, Harcourt Brace & Company.Google Scholar
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory-II Manual (2nd ed.). San Antonio, TX: The Psychological Corporation, Harcourt Brace & Company.Google Scholar
Beckham, J.C., Crawford, A.L., & Feldman, M.E. (1998). Trail Making Test performance in Vietnam combat veterans with and without posttraumatic stress disorder. Journal of Traumatic Stress, 11(4), 811–819.CrossRefGoogle ScholarPubMed
Binder, L.M., Storzbach, D., Anger, W.K., Campbell, K.A., & Rohlman, D.S. (1999). Subjective cognitive complaints, affective distress, and objective cognitive performance in Persian Gulf War veterans. Archives of Clinical Neuropsychology, 14, 531–536.CrossRefGoogle ScholarPubMed
Blanchard, E.B., Jones-Alexander, J., Buckley, T.C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy, 34(8), 669–673.CrossRefGoogle ScholarPubMed
Blanchard, M.S., Eisen, S.A., Alpern, R., Karlinsky, J., Toomey, R., Reda, D.J., et al. . (2006). Chronic multisymptom illness complex in Gulf War I veterans 10 years later. American Journal of Epidemiology, 163(1), 66–75.CrossRefGoogle ScholarPubMed
David, A.S., Farrin, L., Hull, L., Unwin, C., Wessely, S., & Wykes, T. (2002). Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: A comparative study. Psychological Medicine, 32, 1357–1370.CrossRefGoogle ScholarPubMed
Davis, L.E., Eisen, S.A., Murphy, F.M., Alpern, R., Parks, B.J., Blanchard, M., et al. . (2004). Clinical and laboratory assessment of distal peripheral nerves in Gulf War veterans and spouses. Neurology, 63, 1070–1077.CrossRefGoogle ScholarPubMed
Davies, D.R., & Parasuraman, R. (1982). The psychology of vigilance. Orlando, FL: Academic Press.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, BA. (1987). California Verbal Learning Test: Adult Version. San Antonio, TX: The Psychological Corporation.Google Scholar
Egeland, J., Rund, B.R., Sundet, K., Landrø, N.I., Asbjørnsen, A., Lund, A., Roness, A., Stordal, K.I., & Hugdahl, K. (2003). Attention profile in schizophrenia compared with depression: Differential effects of processing speed, selective attention and vigilance. Acta Psychiatrica Scandinavica, 108(4), 276–284.Google Scholar
Eisen, S.A., Kang, H.K., Murphy, F.M., Blanchard, M.S., Reda, D.J., Henderson, W.G., et al. . (2005). Gulf War veterans’ health: Medical evaluation of a U.S. cohort. Annals of Internal Medicine, 142(11), 881–890.CrossRefGoogle Scholar
Fukuda, K., Nisenbaum, R., Stewart, G., Thompson, W.W., Robin, L., Washko, R.M., et al. . (1998). Chronic multisystem illness affecting Air Force veterans of the Gulf War. Journal of the American Medical Association, 280, 981–988.CrossRefGoogle Scholar
Garfield, R., & Leu, C. (2000). A Multivariate method for estimating mortality rates among children under 5 years from health and social indicators in Iraq. International Epidemiological Association, 29, 510–515.Google Scholar
Goldstein, G., Beers, S.R., Morrow, L.A., Shemanski, W.J., & Steinhauer, S.R. (1996). A preliminary neuropsychological study of Persian Gulf War veterans. Journal of the International Neuropsychological Society, 2, 368–371.Google Scholar
Griffin, S.L., Rivera Mindt, M., Rankin, E.J., Ritchie, A.J., & Scott, J.G. (2002). Estimating premorbid intelligence: Comparison of traditional and contemporary methods across the intelligence continuum. Archives of Clinical Neuropsychology, 17(5), 497–507.CrossRefGoogle ScholarPubMed
Gronwall, D.M.A. (1977). Paced Auditory Serial-Addition Task: A measure of recovery from concussion. Perceptual Motor Skills, 44, 367–373.Google Scholar
Haapea, M., Miettunen, J., Läärä, E., Joukamaa, M.I., Järvelin, M., Isohanni, M.K., Veijola, J.M. (2008). Non-participation in a field survey with respect to psychiatric disorders. Scandinavian Journal of Public Health, 36, 728–736.CrossRefGoogle Scholar
Haley, R.W., Hom, J., Roland, P.S., Bryan, W.W., Van Ness, P.C., Bonte, F.J., et al. . (1997b). Evaluation of neurologic function in Gulf War veterans. A blinded case-control study. Journal of the American Medical Association, 277(3), 223–230.CrossRefGoogle ScholarPubMed
Haley, R.W., & Kurt, T.L. (1997c). Self-reported exposure to neurotoxic chemical combinations in the Gulf War. A cross-sectional epidemiologic study. Journal of the American Medical Association, 277(3), 231–237.CrossRefGoogle ScholarPubMed
Haley, R.W., Kurt, T.L., & Hom, J. (1997a). Is there a Gulf War Syndrome? Searching for syndromes by factor analysis of symptoms. Journal of the American Medical Association, 277(3), 215–222.Google Scholar
Halstead, W.C. (1947). Brain and intelligence. Chicago: University of Chicago Press.Google Scholar
Heaton, R.K. (1981). Wisconsin Card Sorting Test manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Heaton, K.J., Palumbo, C.L., Proctor, S.P., Killiany, R.J., Yurgelun-Todd, D.A., & White, R.F. (2007). Quantitative magnetic resonance brain imaging in US army veterans of the 1991 Gulf War potentially exposed to sarin and cyclosarin. Neurotoxicology, 28, 761–769.Google Scholar
Hom, J., Haley, R.W., & Kurt, T.L. (1997). Neuropsychological correlates of Gulf War syndrome. Archives of Clinical Neuropsychology, 12, 531–544.Google Scholar
Iowa Persian Gulf Study Group. (1997). Self-reported illnesses and health status among Gulf War veterans: A population-based study. Journal of the American Medical Association, 277, 238–245.CrossRefGoogle Scholar
Ishoy, T., Suadicani, P., Guldager, B., Appleyard, M., Hein, H., & Gyntelberg, F. (1999). State of health after deployment in the Persian Gulf: The Danish Gulf War study. Danish Medical Bulletin, 46, 416–419.Google Scholar
Jastak, S., & Wilkinson, G.S. (1997). Wide Range Achievement Test–III: Administration manual. Wilmington, DE: Jastak Associates.Google Scholar
Jenkins, M.A., Langlais, P.J., Delis, D., & Cohen, R.A. (2000). Attentional dysfunction associated with posttraumatic stress disorder among rape survivors. The Clinical Neuropsychologist, 14, 7–12.Google Scholar
Johnstone, B., Callahan, C.D., Kapila, C.J., & Bouman, D.E. (1996). The comparability of the WRAT-R reading test and NAART as estimates of premorbid intelligence in neurologically impaired patients. Archives of Clinical Neuropsychology, 11(6), 513–519.Google Scholar
Kang, H.K., & Bullman, T.A. (2001). Mortality among US veterans of the Persian Gulf War: 7 year follow-up. American Journal of Epidemiology, 154, 399–405.CrossRefGoogle Scholar
Kang, H.K., Mahan, C.M., Lee, K.Y., Magee, C.A., & Murphy, F.M. (2000). Illnesses among United States veterans of the Gulf War: A population-based survey of 30,000 veterans. Journal of Occupational and Environmental Medicine, 42, 491–501.CrossRefGoogle Scholar
Lange, G., Tiersky, L.A., DeLuca, J., Scharer, J.B., Policastro, T., Fiedler, N., et al. . (2001). Cognitive functioning in Gulf War illness. Journal of Clinical and Experimental Neuropsychology, 23(2), 240–249.Google Scholar
Letz, R. (1991). NES2 user’s manual (version 4.4). Winchester, MA: Neurobehavioral Systems, Inc.Google Scholar
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.Google Scholar
Lindem, K., Proctor, S.P., Heeren, T., Krengel, M., Vasterling, J., Sutker, P.B., et al. . (2003). Neuropsychological performance in Gulf War era veterans: Neuropsychological symptom reporting. Journal of Psychopathology and Behavioral Assessment, 25(2), 121–127Google Scholar
McDiarmid, M.A., Keogh, J.P., Hooper, F.J., McPhaul, K., Squibbs, K., Kane, R., et al. . (2000). Health effects of depleted uranium on exposed Gulf War veterans. Environmental Research, 82, 168–180.CrossRefGoogle ScholarPubMed
Osterrieth, P.A. (1944). Le test de copie d’une figure complex: Contribution a l’etude de la perception et de la memoire. Archives of Psychology, 30, 286–356.Google Scholar
Partington, J.E., & Leiter, R.G. (1949). Partington’s Pathway Test. The Psychological Service Center Bulletin, 1, 9–20.Google Scholar
Presidential Advisory Committee on Gulf War Veterans’ Illnesses. (1996). Final Report. Washington, DC: U.S. Government Printing Office; ISBN 0-16048942-3.Google Scholar
Proctor, S.P., Heaton, K.J., Heeren, T., & White, R.F. (2006). Effects of sarin and cyclosarin exposure during the 1991 Gulf War on neurobehavioral functioning in US army veterans. Neurotoxicology, 27, 931–939.Google Scholar
Purdue Research Foundation. (1948). Examiner’s manual for the Purdue Pegboard. Chicago: Science Research Associates.Google Scholar
Research Advisory Committee on Gulf War Veterans’ Illnesses. (2008). Gulf War illness and the health of Gulf War veterans: Scientific findings and recommendations. Washington, DC: U.S. Government Printing Office.Google Scholar
Rey, A. (1941). L’examen psychologique dans les cas d’encephalopathie traumatique. Archives of Psychology, 28, 286–340.Google Scholar
Sillanpaa, M.C., Agar, L.M., Milner, I.B., Podany, E.C., Axelrod, B.N., & Brown, G.G. (1997). Gulf War veterans: A neuropsychological examination. Journal of Clinical and Experimental Neuropsychology, 19, 211–219.Google Scholar
Storzbach, D., Campbell, K.A., Binder, L.M., McCauley, L., Anger, W.K., Rohlman, D.S., & Kovera, C.A. (2000). Psychological differences between veterans with and without Gulf War unexplained symptoms. Psychosomatic Medicine, 62, 726–735.CrossRefGoogle ScholarPubMed
Strauss, E., Sherman, E.S., & Spreen, O. (2006). A compendium of neuropsychological tests. New York: Oxford University Press.Google Scholar
SUDAAN, Release 8.0. (2001). Research Triangle Park, NC: Research Triangle Institute.Google Scholar
Tiffin, J. (1968). Purdue Pegboard examiner’s manual. Rosemont, IL: London House.Google Scholar
Tombaugh, T.N. (1996). Test of Memory and Malingering. North Tonawanda, NY: Multi-Health Systems, Inc.Google Scholar
Toomey, R., Kang, H.K., Karlinsky, K., Baker, D.G., Vasterling, J.J., Alpern, R., Reda, D.J., Henderson, W.G., Murphy, F.M., Eisen, S.A.. (2007). Mental health of U.S. Gulf War veterans: A psychological evaluation 10 years after the war. British Journal of Psychiatry, 190, 385–393.Google Scholar
Unwin, C., Blatchley, N., Coker, W., Ferry, S., Hotopf, M., Hull, L., et al. . (1999). Health of UK servicemen who served in the Persian Gulf War. Lancet, 353, 169–178.CrossRefGoogle ScholarPubMed
van der Meere, J., Börger, N., & van Os, T. (2007). Sustained attention in major unipolar depression. Perceptual Motor Skills, 104(3 Pt. 2), 1350–1354.CrossRefGoogle ScholarPubMed
Vasterling, J.J., & Brailey, K. (2005). Neuropsychological findings in adults with PTSD. In Vasterling, J. & Brewin, C.R. (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. New York: Guilford.Google Scholar
Vasterling, J.J., Brailey, K., Constans, J.I., & Sutker, P.B. (1998). Attention and memory dysfunction in posttraumatic stress disorder. Neuropsychology, 12, 125–133.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Brailey, K., Tomlin, H., Rice, J., & Sutker, P.B. (2003). Olfactory functioning in Gulf War-era veterans: Relationships to war-zone duty, self-reported hazards exposures, and psychological distress. Journal of the International Neuropsychological Society, 9, 407–418.Google Scholar
Vasterling, J.J., & Bremner, J.D. (2006). The impact of the 1991 Gulf War on the mind and brain: Findings from neuropsychological and neuroimaging research. Philosophical Transactions of the Royal Society and Biological Sciences, 361(1468), 593–604.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., & White, R.F. (2006). Neuropsychological outcomes of Army personnel following deployment to the Iraq war. Journal of the American Medical Association, 296, 519–529.Google Scholar
Waber, D.P., & Holmes, J.M. (1986). Assessing children’s memory productions of the Rey-Osterrieth Complex Figure. Journal of Clinical and Experimental Neuropsychology, 8, 565–580.Google Scholar
Wechsler, D. (1997). Manual for the Wechsler Adult Intelligence Scale–III. San Antonio, TX: The Psychological Corporation.Google Scholar
White, R.F., Proctor, S.P., Heeren, T., Wolfe, J., Krengel, M., Vasterling, J., et al. . (2001). Neuropsychological function in Gulf War veterans: Relationships to self-reported toxicant exposures. American Journal of Industrial Medicine, 40, 42–52.CrossRefGoogle ScholarPubMed
Winkenwerder, W. (2002). U.S. demolition operations at Khamisiyah. Final Report. Washington, DC: Department of Defense.Google Scholar