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22 Neuropsychological Outcomes Vary by Sex in Neurotoxicant Exposed Veterans with Gulf War Illness
- Dylan Keating, Jenna Groh, Maxine Krengel, Rosemary Toomey, Linda Chao, Emily Quinn, Julianne Dugas, Kimberly Sullivan
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 812-813
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Objective:
More than 30 years after the 199091 Gulf War (GW), approximately 200,000 veterans are still suffering from Gulf War Illness (GWI). Veterans who have this multi-symptom disorder experience impaired cognition, chronic pain, sustained fatigue, and gastrointestinal issues. GWI is believed to be associated with neurotoxicant exposures during the war. Prior research has shown cognitive deficits in combined samples of male and female GW veterans with GWI. These studies have shown that veterans with GWI have cognitive decrements in memory, learning and sustained attention. Studies have yet to compare neuropsychological outcomes by sex. This is mainly due to the lack of collected data on women GW veterans in the past. This study aims to analyze neuropsychological differences in males compared with female veterans with GWI and in those with neurotoxicant exposures from the Boston, Biorepository and Integrative Network (BBRAIN) for GWI repository dataset.
Participants and Methods:The total sample included 297 veterans with GWI (women n=50, men n=247) who were deployed to the 1990-91 Gulf War with an average age of 52 years. GWI case status was defined by the Kansas GWI criteria. Neuropsychological data including the Conners Continuous Performance Test Third Edition (CPT3), Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test, and the California Verbal Learning Test (CVLT-II) were combined from the BBRAIN repository datasets. War-related exposures, including chemical weapons, anti-nerve gas pills and pesticides were measured by a self-reported survey. Multiple linear regression was used to analyze the association between sex, war-related exposures, and neuropsychological test score outcomes.
Results:After adjusting for age, education level and PTSD, men had a significantly lower number of words correct in the CVLT-II learning Trials 1-5, short delay recall and long delay recall compared with women veterans (p<0.05). The two groups also differed significantly in CPT3 commission scores, and total time on the D-KEFs Color-Word Inference total times in Trials 1 and 2 with men performing worse (p<0.05). Reported exposure to chemical weapons, pesticides, pyridostigmine bromide (PB) anti-nerve gas pills or smoke from oil well fires were all significantly associated with fewer words correctly recalled on all learning trials of the CVLT-II, long delay, and short delay to a greater degree in men as compared to women (p<0.05). Reported exposure to chemical weapons or smoke from oil well fires were significantly associated with more commission errors on CPT3 in men with GWI (p<0.05). Chemical alarms, smoke from oil well fires and PB were associated with slower response time on the Color-Word Interference test Trial 1 in men compared with women veterans.
Conclusions:In this study, men with GWI demonstrated significantly poorer performance in verbal memory, learning, response speed and attention. Male veterans reporting neurotoxicant exposures during the war also showed worse learning and verbal memory, impulsivity and response speed decrements compared to exposed women veterans. Future research should consider men and women separately when examining outcomes from war-related exposures.
21 Toxic Wounds are Associated with Cognitive Decrements in Women Veterans of the 1991 Gulf War
- Dylan Keating, Jenna Groh, Maxine Krengel, Rosemary Toomey, Linda Chao, Emily Quinn, Julianne Dugas, Kimberly Sullivan
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 811-812
-
- Article
-
- You have access Access
- Export citation
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Objective:
Gulf War Illness (GWI) is a debilitating multi-symptom condition that affects nearly a third of 1990-91 Gulf War (GW) veterans. Symptoms include chronic pain, debilitating fatigue, gastrointestinal issues, and cognitive decrements. Prior studies have documented reduced cognitive functioning in this affected population, particularly in the areas of memory, attention and response inhibition. To date, research has focused on cognitive functioning in male and female veterans together. Very limited research has reported on GW women's cognitive functioning separately mostly due to scarcity of data on women veterans. In this study, we had the unique opportunity to utilize a newly combined neuropsychological test dataset from women GW veterans in the Boston, Biorepository and Integrative Network (BBRAIN) for GWI. The aim was to compare neuropsychological outcomes with toxicant exposures in women veterans with and without GWI.
Participants and Methods:Cognitive data from the BBRAIN biorepository was used for this study. The sample consisted of 62 women veterans who were deployed to the Persian Gulf War from 1990-91. Neuropsychological test scores included the Conners Continuous Performance Test Third Edition (CPT3), Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference, and the California Verbal Learning Test Second Edition (CVLT-II). War-related exposure to chemical weapons, anti-nerve gas pills and pesticides were measured by a self-reported survey. For analysis, war-related exposure was classified into three groups: controls with 0-6 days of exposure; cases with 0-6 days of exposure and cases with 7 or more days of exposure. Multiple linear regression modeling was used to measure differences in neuropsychological scores across the three groups by each war-related exposure.
Results:After adjusting for age, education and other exposures, an increase in duration of exposure to pesticides was significantly associated with worse CPT3 commission errors, fewer words correct in the CVLT-II trials 1-5, and an increase in self-corrected errors on DKEFS Color-Word Interference Test Trials 1, 2 and 4 (p<0.05). More days reported hearing chemical alarms and seeing smoke from oil well fires was significantly associated with fewer words correct on all CVLT-II trials, and more self-corrected errors on Color-Word Interference Trials 2 and 4 (p<0.05). An increase in exposure duration to pyridostigmine bromide anti-nerve gas pills was associated with fewer words correct on the CVLT-II learning Trials 1-5 and short delay recall and an increase in self-corrected errors on Color-Word Interference Trials 2, 3, and 4 (p<0.05). When associations were adjusted for PTSD, all significant associations stayed constant (p<0.05).
Conclusions:In this study, women veterans with GWI who had higher levels of exposure to pesticides, oil well fires and who took more antinerve gas pills during the war are showing increased learning difficulties and more deficits in attention and response inhibition. Future research should examine if similar patterns of neuropsychological symptoms are also present in male GW veterans with higher war-time related toxicant exposures.
How Elections Promoted Democracy in Taiwan under Martial Law
- Linda Chao, Ramon H. Myers
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- Journal:
- The China Quarterly / Volume 162 / June 2000
- Published online by Cambridge University Press:
- 12 February 2009, pp. 387-409
- Print publication:
- June 2000
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In October 1952, while addressing the Seventh Congress of the Kuomintang (KMT), the party chairman and president of the Republic of China (ROC) on Taiwan, Chiang Kai-shek, reminded his audience that “Sun Yat-sen's highest goal was to build a political system in which sovereignty resided with the people [zuchuan zaimin]” Chiang then said that “in order to oppose communism and recover our nation, the primary task of our party is to carry out local elections, build our nation's political system, and establish the solid foundations for our people to practise democracy.”