Abstract
Gulf War (GW) deployed veterans have reported health symptoms since returning from the war that suggest dysfunction of the central nervous system (CNS). These symptoms include memory and concentration difficulties, fatigue, and headaches. Leading hypotheses for the etiology of these cognitive complaints include psychological factors and/or exposures to chemicals with neurotoxic properties. In this study, cognitive functioning was compared in treatment-seeking GW-deployed veterans and a treatment-seeking non–GW-deployed veteran control group. Results indicated that GW-deployed veterans performed significantly worse than the comparison group on tests of attention, visuospatial skills, visual memory, and mood. GW-deployed veterans who reported taking pyridostigmine bromide (PB) performed worse than GW-deployed veterans without PB use on executive system tasks. Treatment-seeking GW-deployed veterans with diagnoses of posttraumatic stress disorder (PTSD) did not differ on cognitive test measures compared with GW-deployed veterans without PTSD. No interaction effect of PTSD and PB use was found.
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Abou-Donia, M. B., Wilmar, K. R., Jensen, K. F., Oehme, F. W., & Kurt, T. L. (1996). Neurotoxicity resulting from co-exposure to pyridostigmine bromide, DEET, and permethrin: Implications of Gulf War chemical exposures. Journal of Toxicology and Environmental Health, 48, 35-56.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., Rev.). Washington, DC: Author.
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.
Baker, E. L., Feldman, R. G., White, R. F., Harley, J. P., Niles, C. A., Dinse, G. E., et al. (1984). Occupational lead neurotoxicity: A behavioral and electrophysiological evaluation. Study design and year one results. British Journal of Industrial Medicine, 41, 353-361.
Black, P. H. (1994). Central nervous system-immune system interactions: Psychoneuroimmunology of stress and its immune consequences. Antimicrobial Agents in Chemotherapy, 38 (1), 1-6.
Blake, D., Weathers, F., Nagy, L., Kaloupeck, D., Klauminzer, G., Charney, D., et al. (1995). Clinician-administered PTSD scale for DSM-IV (CAPS-DX). Boston: Behavioral Science Division, National Center for Posttraumatic Stress Disorder.
Charney, D. S., Deutch, A. Y., Krystal, J. H., Southwick, S. M., & Davis, M. (1993). Psychobiological mechanisms of posttraumatic stress disorder. Archives of General Psychiatry, 50, 294-305.
Delis, D., Kramer, J. H., Kaplan, E., & Ober, B. A. (1987). California Verbal Learning Test manual. New York: The Psychological Corporation.
Engel, C. C., Liu, X., McCarthy, B. D., Miller, R. F., & Ursano, R. (2000). Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns. Psychosomatic Medicine, 62, 739-745.
Friedman, A., Kaufer, D., Shemer, J., et al. (1996). Pyridostigmine brain penetration under stress enhances neuronal excitability and induces early immediate transcriptional response. Nature Medicine, 2, 1383-1385.
Golden, C. J. (1978). Stroop color and word test. Chicago: Stoelting.
Goldstein, G., Beers, S. R., Morrow, L., Shemansky, W. J., & Steinhauer, S. R. (1996). A preliminary neuropsychological study of Persian Gulf veterans. Journal of the International Neuropsychological Society, 2, 368-371.
Gronwall, D. M. A. (1977). Paced auditory serial addition task: A measure of recovery from concussion. Perceptual and Motor Skills, 44, 367-373.
Haley, R. W., & Kurt, T. L. (1997). Self-reported exposure to neurotoxic chemical combinations in the Gulf War. A cross-sectional epidemiologic study. Journal of the American Medical Association, 277, 231-237.
Heaton, K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin Card Sorting Test Manual—Revised and expanded. Odessa, FL: Psychological Assessment Resources.
Hom, J., Haley, R. W., & Kurt, T. L. (1997). Neuropsychological correlates of Gulf War syndrome. Archives of Clinical Neuropsychology, 12, 531-544.
Hooper, H. E. (1958). The Hooper Visual Organization Test manual. Los Angeles: Western Psychological Services.
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 Experiemental Neuropsychology, 23, 240-249.
Letz, R., & Baker, E. L. (1988). Neurobehavioral Evaluation System: NES user's manual. Winchester, MA: Neurobehavioral Systems.
Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.
McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
Moss, J. I. (2001). Many Gulf War illnesses may be autoimmune disorders caused by the chemical and biological stressors, pyridostigmine bromide, and adrenaline. Medical Hypotheses, 56, 155-157.
Proctor, S. P., Heeren, T., White, R. F., Wolfe, J., Borgos, M. S., Davis, J. D., et al. (1998). Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures, and the effect of stress. International Journal of Epidemiology, 27, 1000-1010.
Purdue Research Foundation. (1948). Examiner's manual for the Purdue Pegboard. Chicago: Science Research Associates.
Reitan, R. M., & Davidson, L. A. (1974). Clinical neuropsychology: Current status and applications. New York: Hemisphere.
Reitan, R. M., & Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press.
Shalev, A., Bleich, A., & Ursano, R. J. (1990). Post-traumatic stress disorder: Somatic comorbidity and effort tolerance. Psychosomatics, 31, 197-203.
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.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1990). Structured clinical interview for DSM-III-R-non-patient edition (SCID-NP, Version 1.0). Washington, DC: American Psychiatric Press.
Sutker, P. B., Vasterling, J. J., Brailey, K., & Allain, A. N. (1995). Memory, attention, and executive deficits in POW survivors: Contributing biological and psychological factors. Neuropsychology, 9, 118-195.
Tombaugh, T. (1996). Test of Memory Malingering. New York: Multi-Health Systems.
Van Haaren, F., Haworth, S. C., Bennett, S. M., Cody, B. A., Hoy, J. B., Karlix, J. L., et al. (2001). The effects of pyridostigmine bromide, permethrin and DEET alone, or in combination, on fixed-ratio and fixed-interval behavior in male and female rats. Pharmacology, Biochemistry and Behavior, 69, 23-33.
Vasterling, J. J., Brailey, K., Constans, J. I., Borges, A., & Sutker, P. (1998). Attention and memory performances in post-traumatic stress disorder. Neuropsychology, 12, 125-133.
Vasterling, J. J., Root, L., Brailey, K., Uddo, M., & Sutker, P. B. (1993). Attention and memory performances in post-traumatic stress disorder. Paper presented at the annual meeting of the International Neuropsychological Society, Cincinnati.
Wechsler, D. (1981). Wechsler Adult Intelligence Scale (WAIS)—Revised. New York: Harcourt Brace Jovanovich.
Wechsler, D. (1945). A standardized memory scale for clinical use. Journal of Psychology, 19, 87-95.
Wechsler, D. (1987). Wechsler Memory Scale—Revised. New York: The Psychological Corporation.
White, R. F., & Proctor, S. P. (1992). Research and clinical criteria for the development of neurobehavioral test batteries. Journal of Occupational Medicine, 14, 140-148.
White, R. F., Proctor, S., 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, 42-54.
Wolfe, J., & Charney, D. S. (1991). Use of neuropsychological assessment in posttraumatic stress disorder. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 573-580.
Wolfe, J., Kelley, J. M., Buscela, M. L., & Mark, W. R. (1992). Ft. Devens Reunion Survey: Report of Phase I. In R. Rosenheck, H. Becrei, & A. Blank (Eds.), Returning Persian Gulf Troops: First Year Findings (pp. 19-44). New Haven, CT: Department of Veterans Affairs.
Wolfe, J., & Keane, T. M. (1993). New perspectives in the assessment and diagnosis of combat-related posttraumatic stress disorder. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes. New York: Plenum Press.
Yehuda, R. (1997). Sensitization of the hypothalamic–pituitary–adrenal axis in post-traumatic stress disorder. Annals of the New York Academy of Sciences, 821, 57-75.
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Sullivan, K., Krengel, M., Proctor, S.P. et al. Cognitive Functioning in Treatment-Seeking Gulf War Veterans: Pyridostigmine Bromide Use and PTSD. Journal of Psychopathology and Behavioral Assessment 25, 95–103 (2003). https://doi.org/10.1023/A:1023342915425
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DOI: https://doi.org/10.1023/A:1023342915425