Lange, G. Tiersky, L., DeLuca, J., Scharer, J., Policastro,
T.,
Fiedler, N., Natelson, B.H.
Center for Environmental Hazards Research, East Orange,
NJ; EOHSI,
Piscataway, NJ; Kessler Medical Rehabilitation Research and Education
Corporation, West Orange, NJ
Background: Complaints of Gulf War Veterans suffering
from medically unexplained symptoms labeled Gulf War Illness (GWI) include
chronic fatigue and cognitive difficulties, symptoms also commonly reported
by civilians with fatiguing illnesses. The cognitive impairment most often
found in civilians with fatiguing illness, is a subtle, but debilitating
inability to process, manipulate, and encode multiple pieces of information
simultaneously. The purpose of this study was to examine the pattern of
cognitive functioning in Registry Persian Gulf Veterans. It is hypothesized
that since the illness pattern so closely resembles that of civilians
with fatiguing illness, the cognitive impairment in Gulf War Veterans
with a major complaint of chronic fatigue may be similar to that of civilians
with fatiguing illness, that is complex attentional and working memory
functions will be most severely affected.
Methods: The following criteria were used to select
Persian Gulf Veterans with GWI (PGV-F) for this study: 1) presenting with
fatigue as a major complaint, 2) fulfilling clinical case definitions
for Chronic Fatigue Syndrome, Idiopathic Chronic Fatigue, and/or Multiple
Chemical Sensitivity. Sixty-seven Registry PGVs were examined; 44 PGV-F
and 23 did not report any health problems since the Gulf War (PGV-H).
All subjects were assessed neuropsychologically across several cognitive
domains with a standardized test battery. PGV-F and PGV-H group means
on neuropsychological tasks, as well as the amount and frequency of alcohol
use were compared using planned univariate analysis of variance.
Results: Amount and frequency of alcohol use was
similar for both PGV-F and PGV-H. However, on the average, PGV-F tended
to consume less alcohol during the year prior to intake than the PGV-H
group. Neuropsychologically, group performances differed on a the WAIS-R
Digit Span Forward task, a simple attention test, and a number of complex
attention/information processing tasks, such as WAIS-R Digit Span Backwards
subtest, the NES Complex Performance Test, and the PASAT. Scores on the
Trail Making Test B, a test of executive functioning, were also significantly
worse in PGV-F compared to PGV-H. A strong trend toward statistically
significant differences were observed on all measures assessing visual-perceptual
functioning. PGV-F did not manifest learning or memory problems in either
the verbal or visual domains. Likewise, fine motor function as assessed
by the Grooved Pegboard Test was not different between groups.
Conclusion: Persian Gulf Veterans with GWI show evidence
of subtle cognitive impairment in the areas of simple attention, complex
attention/information processing, and possibly visual perceptual. Difficulties
in processing, manipulating and encoding of complex information in PGVs
with GWI is similar to that documented in civilians with fatiguing illness.
KEYWORDS: Gulf War Illness, Cognitive Function, Fatiguing
Illness
New Jersey Center for Environmental Hazards Research, Department
of Veterans Affairs, East Orange, New Jersey |