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Chao LL, Sullivan K, Krengel MH, Killiany RJ, Steele L, Klimas NG, Koo BB. The prevalence of mild cognitive impairment in Gulf War veterans: a follow-up study. Front Neurosci 2024; 17:1301066. [PMID: 38318196 PMCID: PMC10838998 DOI: 10.3389/fnins.2023.1301066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Gulf War Illness (GWI), also called Chronic Multisymptom Illness (CMI), is a multi-faceted condition that plagues an estimated 250,000 Gulf War (GW) veterans. Symptoms of GWI/CMI include fatigue, pain, and cognitive dysfunction. We previously reported that 12% of a convenience sample of middle aged (median age 52 years) GW veterans met criteria for mild cognitive impairment (MCI), a clinical syndrome most prevalent in older adults (e.g., ≥70 years). The current study sought to replicate and extend this finding. Methods We used the actuarial neuropsychological criteria and the Montreal Cognitive Assessment (MoCA) to assess the cognitive status of 952 GW veterans. We also examined regional brain volumes in a subset of GW veterans (n = 368) who had three Tesla magnetic resonance images (MRIs). Results We replicated our previous finding of a greater than 10% rate of MCI in four additional cohorts of GW veterans. In the combined sample of 952 GW veterans (median age 51 years at time of cognitive testing), 17% met criteria for MCI. Veterans classified as MCI were more likely to have CMI, history of depression, and prolonged (≥31 days) deployment-related exposures to smoke from oil well fires and chemical nerve agents compared to veterans with unimpaired and intermediate cognitive status. We also replicated our previous finding of hippocampal atrophy in veterans with MCI, and found significant group differences in lateral ventricle volumes. Discussion Because MCI increases the risk for late-life dementia and impacts quality of life, it may be prudent to counsel GW veterans with cognitive dysfunction, CMI, history of depression, and high levels of exposures to deployment-related toxicants to adopt lifestyle habits that have been associated with lowering dementia risk. With the Food and Drug Administration's recent approval of and the VA's decision to cover the cost for anti-amyloid β (Aβ) therapies, a logical next step for this research is to determine if GW veterans with MCI have elevated Aβ in their brains.
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Affiliation(s)
- Linda L. Chao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Maxine H. Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Ronald J. Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Lea Steele
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nancy G. Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Medical Center, Miami, FL, United States
| | - Bang-Bong Koo
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
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Friedman A, Schildroth S, Bauer JA, Coull BA, Smith DR, Placidi D, Cagna G, Krengel MH, Tripodis Y, White RF, Lucchini RG, Wright RO, Horton M, Austin C, Arora M, Claus Henn B. Early-life manganese exposure during multiple developmental periods and adolescent verbal learning and memory. Neurotoxicol Teratol 2023; 100:107307. [PMID: 37832858 PMCID: PMC10834060 DOI: 10.1016/j.ntt.2023.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Manganese (Mn) is both an essential and toxic metal, and associations with neurodevelopment depend on exposure timing. Prospective data examining early life Mn with adolescent cognition are sparse. METHODS We enrolled 140 Italian adolescents (10-14 years old) from the Public Health Impact of Metals Exposure study. Mn in deciduous teeth was measured using laser ablation-mass spectrometry to represent prenatal, postnatal and early childhood exposure. The California Verbal Learning Test for Children (CVLT-C) was administered to assess adolescent verbal learning and memory. Multivariable regression models estimated changes in CVLT-C scores and the odds of making an error per doubling in dentine Mn in each exposure period. Multiple informant models tested for differences in associations across exposure periods. RESULTS A doubling in prenatal dentine Mn levels was associated with lower odds of making an intrusion error (OR = 0.23 [95% CI: 0.09, 0.61]). This beneficial association was not observed in other exposure periods. A doubling in childhood Mn was beneficially associated with short delay free recall: (ß = 0.47 [95% CI: -0.02, 0.97]), which was stronger in males (ß = 0.94 [95% CI: 0.05, 1.82]). Associations were null in the postnatal period. CONCLUSION Exposure timing is critical for understanding Mn-associated changes in cognitive function.
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Affiliation(s)
- Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston, USA.
| | - Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
| | - Julia A Bauer
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Darmouth, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T. H Chan School of Public Health, Boston, USA
| | - Donald R Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, USA
| | - Donatella Placidi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppa Cagna
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maxine H Krengel
- Department of Neurology, Boston University School of Medicine, Boston, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, USA; Department of Neurology, Boston University School of Medicine, Boston, USA
| | - Roberto G Lucchini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Environmental Health Sciences, School of Public Health, Florida International University, Miami, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
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Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Hamblin MR, Fedoruk AE, Poole LG, Cheng C, Koo B. Transcranial Photobiomodulation Treatment: Significant Improvements in Four Ex-Football Players with Possible Chronic Traumatic Encephalopathy. J Alzheimers Dis Rep 2023; 7:77-105. [PMID: 36777329 PMCID: PMC9912826 DOI: 10.3233/adr-220022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background Chronic traumatic encephalopathy, diagnosed postmortem (hyperphosphorylated tau), is preceded by traumatic encephalopathy syndrome with worsening cognition and behavior/mood disturbances, over years. Transcranial photobiomodulation (tPBM) may promote improvements by increasing ATP in compromised/stressed cells and increasing local blood, lymphatic vessel vasodilation. Objective Aim 1: Examine cognition, behavior/mood changes Post-tPBM. Aim 2: MRI changes - resting-state functional-connectivity MRI: salience, central executive, default mode networks (SN, CEN, DMN); magnetic resonance spectroscopy, cingulate cortex. Methods Four ex-players with traumatic encephalopathy syndrome/possible chronic traumatic encephalopathy, playing 11- 16 years, received In-office, red/near-infrared tPBM to scalp, 3x/week for 6 weeks. Two had cavum septum pellucidum. Results The three younger cases (ages 55, 57, 65) improved 2 SD (p < 0.05) on three to six neuropsychological tests/subtests at 1 week or 1 month Post-tPBM, compared to Pre-Treatment, while the older case (age 74) improved by 1.5 SD on three tests. There was significant improvement at 1 month on post-traumatic stress disorder (PTSD), depression, pain, and sleep. One case discontinued narcotic pain medications and had reduced tinnitus. The possible placebo effect is unknown. At 2 months Post-tPBM, two cases regressed. Then, home tPBM was applied to only cortical nodes, DMN (12 weeks); again, significant improvements were seen. Significant correlations for increased SN functional connectivity (FC) over time, with executive function, attention, PTSD, pain, and sleep; and CEN FC, with verbal learning/memory, depression. Increased n-acetyl-aspartate (NAA) (oxygen consumption, mitochondria) was present in anterior cingulate cortex (ACC), parallel to less pain and PTSD. Conclusion After tPBM, these ex-football players improved. Significant correlations of increased SN FC and CEN FC with specific cognitive tests and behavior/mood ratings, plus increased NAA in ACC support beneficial effects from tPBM.
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Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Correspondence to: Margaret A. Naeser, PhD, VA Boston Healthcare System (12A), Jamaica Plain Campus, 150 So. Huntington Ave., Boston, MA 02130 USA. E-mail:
| | - Paula I. Martin
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael D. Ho
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - Maxine H. Krengel
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yelena Bogdanova
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey A. Knight
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,National Center for PTSD - Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa,Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Luke G. Poole
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - ChiaHsin Cheng
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
| | - BangBon Koo
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
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Zundel CG, Price K, Grasso CM, Spiro A, Heeren T, Sullivan K, Krengel MH. The impact of neurotoxicant exposures on posttraumatic stress disorder trajectories: The Ft. Devens Gulf War Veterans Cohort. J Trauma Stress 2022; 35:955-966. [PMID: 35150175 PMCID: PMC9541763 DOI: 10.1002/jts.22802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022]
Abstract
Gulf War veterans (GWVs) were exposed to neurotoxicants, including sarin nerve gas, anti-nerve agent pills, pesticides, oil well fires, and fumes from unvented tent heaters, all of which have been associated with subsequent adverse health. Posttraumatic stress disorder (PTSD) symptoms have also been associated with GW deployment; however, associations between exposures and PTSD symptoms have not been investigated. We assessed PTSD symptom trajectories and associations with neurotoxicant exposures in Ft. Devens Cohort (FDC) veterans (N = 259) who endorsed trauma exposure during deployment and completed the PTSD Checklist at three follow-ups (1992-1993, 1997-1998, 2013-2017). Results indicate that among veterans with more severe initial PTSD symptoms, symptoms remained significantly higher across follow-ups, Bs = -1.489-1.028, whereas among those with low initial PTSD symptoms, symptom severity increased significantly over time, Bs = 1.043-10.304. Additionally, neurotoxicant exposure was associated with a significant increase in PTSD symptoms, Bs = -1.870-9.003. Significant interactions between time and exposures were observed for PTSD symptom clusters, suggesting that among participants with high initial PTSD symptom, unexposed veterans experienced symptom alleviation, whereas exposed veterans' PTSD symptoms remained high. In GWVs with low initial PTSD symptoms, both unexposed and exposed veterans experienced PTSD symptom exacerbations over time; however, this occurred at a faster rate among exposed veterans. These findings suggest that in the years following deployment, GWVs who were exposed to both traumatic events and neurotoxicants may experience more severe and chronic PTSD symptoms than those without neurotoxicant exposures.
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Affiliation(s)
- Clara G. Zundel
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Behavioral Neuroscience ProgramBoston University School of MedicineBostonMassachusettsUSA
| | - Kathryn Price
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Department of PsychologyUniversity of Massachusetts–BostonBostonMassachusettsUSA
| | | | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information CenterVA Boston Healthcare SystemBostonMassachusettsUSA,Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA,Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Timothy Heeren
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Kimberly Sullivan
- Department of Environmental HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Maxine H. Krengel
- Research ServiceVA Boston Healthcare SystemBostonMassachusettsUSA,Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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Oberlin S, Nkiliza A, Parks M, Evans JE, Klimas N, Keegan AP, Sullivan K, Krengel MH, Mullan M, Crawford F, Abdullah L. Sex-specific differences in plasma lipid profiles are associated with Gulf War Illness. J Transl Med 2022; 20:73. [PMID: 35123492 PMCID: PMC8817550 DOI: 10.1186/s12967-022-03272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Nearly 250,000 veterans from the 1990–1991 Gulf War have Gulf War Illness (GWI), a condition with heterogeneous pathobiology that remains difficult to diagnose. As such, availability of blood biomarkers that reflect the underlying biology of GWI would help clinicians provide appropriate care to ill veterans. In this study, we measured blood lipids to examine the influence of sex on the association between blood lipids and GWI diagnosis. Methods Plasma lipid extracts from GWI (n = 100) and control (n = 45) participants were subjected to reversed-phase nano-flow liquid chromatography-mass spectrometry analysis. Results An influence of sex and GWI case status on plasma neutral lipid and phospholipid species was observed. Among male participants, triglycerides, diglycerides, and phosphatidylcholines were increased while cholesterol esters were decreased in GWI cases compared to controls. In female participants, ceramides were increased in GWI cases compared to controls. Among male participants, unsaturated triglycerides, phosphatidylcholine and diglycerides were increased while unsaturated cholesterol esters were lower in GWI cases compared to controls. The ratio of arachidonic acid- to docosahexaenoic acid-containing triglyceride species was increased in female and male GWI cases as compared to their sex-matched controls. Conclusion Differential modulation of neutral lipids and ratios of arachidonic acid to docosahexaenoic acid in male veterans with GWI suggest metabolic dysfunction and inflammation. Increases in ceramides among female veterans with GWI also suggest activation of inflammatory pathways. Future research should characterize how these lipids and their associated pathways relate to GWI pathology to identify biomarkers of the disorder. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03272-3.
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Krengel MH, Zundel CG, Heeren T, Yee M, Spiro A, Proctor SP, Grasso CM, Sullivan K. Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: the Ft. Devens cohort. Environ Health 2022; 21:7. [PMID: 34998396 PMCID: PMC8742929 DOI: 10.1186/s12940-021-00812-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Thirty years ago, Gulf War (GW) veterans returned home with numerous health symptoms that have been associated with neurotoxicant exposures experienced during deployment. The health effects from these exposures have been termed toxic wounds. Most GW exposure-outcome studies utilize group analyses and thus individual fluctuations in symptoms may have been masked. This study investigates health symptom trajectories in the same veterans over 25 years. METHODS Veterans were categorized into 5 a priori trajectory groups for each health symptom and Chronic Multisymptom Illness (CMI) clinical case status. Multinomial logistic regression models were used to investigate associations between these trajectories and neurotoxicant exposures. RESULTS Results indicate that more than 21 Pyridostigmine Bromide (PB) pill exposure was associated with consistent reporting of fatigue, pain, and cognitive/mood symptoms as well as the development of six additional symptoms over time. Chemical weapons exposure was associated with both consistent reporting and development of neurological symptoms over time. Reported exposure to tent heater exhaust was associated with later development of gastrointestinal and pulmonary symptoms. Veterans reporting exposure to more than 21 PB pills were more than 8 times as likely to consistently meet the criteria for CMI over time. CONCLUSION This study highlights the importance of the continued documentation of the health impacts experienced by GW veterans', their resulting chronic health symptoms, and the importance of exposure-outcome relationships in these veterans now 30 years post-deployment.
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Affiliation(s)
- Maxine H. Krengel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Clara G. Zundel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Behavioral Neuroscience Program, Boston University School of Medicine, Boston, MA USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Megan Yee
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Susan P. Proctor
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA USA
| | - Claudia M. Grasso
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
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Martin PI, Chao L, Krengel MH, Ho MD, Yee M, Lew R, Knight J, Hamblin MR, Naeser MA. Transcranial Photobiomodulation to Improve Cognition in Gulf War Illness. Front Neurol 2021; 11:574386. [PMID: 33551948 PMCID: PMC7859640 DOI: 10.3389/fneur.2020.574386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/09/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: Approximately 25-30% of veterans deployed to Kuwait, 1990-91, report persistent multi-symptom Gulf War Illness (GWI) likely from neurotoxicant exposures. Photobiomodulation (PBM) in red/near-infrared (NIR) wavelengths is a safe, non-invasive modality shown to help repair hypoxic/stressed cells. Red/NIR wavelengths are absorbed by cytochrome C oxidase in mitochondria, releasing nitric oxide (increasing local vasodilation), and increasing adenosine tri-phosphate production. We investigated whether PBM applied transcranially could improve cognition, and health symptoms in GWI. Materials and Methods: Forty-eight (40 M) participants completed this blinded, randomized, sham-controlled trial using Sham or Real, red/NIR light-emitting diodes (LED) applied transcranially. Fifteen, half-hour transcranial LED (tLED) treatments were twice a week (7.5 weeks, in-office). Goggles worn by participant and assistant maintained blinding for visible red. Pre-/Post- testing was at Entry, 1 week and 1 month post- 15th treatment. Primary outcome measures were neuropsychological (NP) tests; secondary outcomes, Psychosocial Questionnaires, including PTSD. Results: Primary Analyses (all participants), showed improvement for Real vs. Sham, for Digit Span Forwards (p < 0.01); and a trend for Trails 4, Number/Letter Sequencing (p < 0.10). For secondary outcomes, Real group reported more improvement on the SF-36V Plus, Physical Component Score (p < 0.08). Secondary Analyses included only subjects scoring below norm (50%ile) at Entry, on specific NP test/s. Real and Sham improved at 1 week after 15th treatment; however, at 1 month, only those receiving Real improved further: Digit Span Total, Forwards and Backwards; Trails 4, Number/Letter Sequencing; California Verbal Learning Test-II, long delay free recall; Continuous Performance Test-II, False Alarm Rate; and Color-Word Interference, Stroop, Trial 3, Inhibition; Sham group worsened, toward Entry values. Only those with more post-traumatic stress disorder (PTSD) symptomatology at Entry, receiving Real, continued to have additional PTSD reduction at 1 month; Sham regressed. Conclusion: This study was underpowered (n = 48), with large heterogeneity at Entry. This likely contributed to significance or trend to significance, for only two of the NP tests (Digit Span Forwards; Trails 4, Number/Letter Sequencing) and only one general health measure, the SF-36V Plus, Physical Component Score. More subjects receiving Real, self-reported increased concentration, relaxation and sleep. Controlled studies with newer, transcranial LED home treatment devices are warranted; this is expected to increase enrollment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01782378.
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Affiliation(s)
- Paula I. Martin
- VA Boston Healthcare System, Boston, MA, United States
- Department of Neurology, School of Medicine, Boston University, Boston, MA, United States
| | - Linda Chao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Maxine H. Krengel
- VA Boston Healthcare System, Boston, MA, United States
- Department of Neurology, School of Medicine, Boston University, Boston, MA, United States
| | - Michael D. Ho
- VA Boston Healthcare System, Boston, MA, United States
| | - Megan Yee
- VA Boston Healthcare System, Boston, MA, United States
| | - Robert Lew
- VA Boston Healthcare System, Boston, MA, United States
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | - Jeffrey Knight
- VA Boston Healthcare System, National Center for Posttraumatic Stress Disorder, Boston, MA, United States
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Laser Research Center, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Margaret A. Naeser
- VA Boston Healthcare System, Boston, MA, United States
- Department of Neurology, School of Medicine, Boston University, Boston, MA, United States
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Abou-Donia MB, Lapadula ES, Krengel MH, Quinn E, LeClair J, Massaro J, Conboy LA, Kokkotou E, Abreu M, Klimas NG, Nguyen DD, Sullivan K. Using Plasma Autoantibodies of Central Nervous System Proteins to Distinguish Veterans with Gulf War Illness from Healthy and Symptomatic Controls. Brain Sci 2020; 10:brainsci10090610. [PMID: 32899468 PMCID: PMC7563126 DOI: 10.3390/brainsci10090610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
For the past 30 years, there has been a lack of objective tools for diagnosing Gulf War Illness (GWI), which is largely characterized by central nervous system (CNS) symptoms emerging from 1991 Gulf War (GW) veterans. In a recent preliminary study, we reported the presence of autoantibodies against CNS proteins in the blood of veterans with GWI, suggesting a potential objective biomarker for the disorder. Now, we report the results of a larger, confirmatory study of these objective biomarkers in 171 veterans with GWI compared to 60 healthy GW veteran controls and 85 symptomatic civilian controls (n = 50 myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and n = 35 irritable bowel syndrome (IBS)). Specifically, we compared plasma markers of CNS autoantibodies for diagnostic characteristics of the four groups (GWI, GW controls, ME/CFS, IBS). For veterans with GWI, the results showed statistically increased levels of nine of the ten autoantibodies against neuronal "tubulin, neurofilament protein (NFP), Microtubule Associated Protein-2 (MAP-2), Microtubule Associated Protein-Tau (Tau), alpha synuclein (α-syn), calcium calmodulin kinase II (CaMKII)" and glial proteins "Glial Fibrillary Acidic Protein (GFAP), Myelin Associated Glycoprotein (MAG), Myelin Basic Protein (MBP), S100B" compared to healthy GW controls as well as civilians with ME/CFS and IBS. Next, we summed all of the means of the CNS autoantibodies for each group into a new index score called the Neurodegeneration Index (NDI). The NDI was calculated for each tested group and showed veterans with GWI had statistically significantly higher NDI values than all three control groups. The present study confirmed the utility of the use of plasma autoantibodies for CNS proteins to distinguish among veterans with GWI and other healthy and symptomatic control groups.
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Affiliation(s)
- Mohamed B. Abou-Donia
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA;
- Correspondence: (M.B.A.-D.); (K.S.); Tel.: +1-919-684-2221 (M.B.A.-D.)
| | - Elizabeth S. Lapadula
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Maxine H. Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Emily Quinn
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Jessica LeClair
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Joseph Massaro
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Lisa A. Conboy
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (L.A.C.); (E.K.)
| | - Efi Kokkotou
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; (L.A.C.); (E.K.)
| | - Maria Abreu
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (N.G.K.)
- Department of Immunology, Miami VA Medical Center, Miami, FL 33125, USA
| | - Nancy G. Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (M.A.); (N.G.K.)
- Department of Immunology, Miami VA Medical Center, Miami, FL 33125, USA
| | - Daniel D. Nguyen
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
| | - Kimberly Sullivan
- Departments of Biostatistics and Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (J.L.); (J.M.); (D.D.N.)
- Correspondence: (M.B.A.-D.); (K.S.); Tel.: +1-919-684-2221 (M.B.A.-D.)
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Ansa BE, Sullivan K, Krengel MH, Heboyan V, Wilson C, Iobst S, Coughlin SS. The Gulf War Women's Health Cohort: Study Design and Protocol. Int J Environ Res Public Health 2020; 17:E2423. [PMID: 32252385 PMCID: PMC7177913 DOI: 10.3390/ijerph17072423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
Military service and deployment affect women differently than men, underscoring the need for studies of the health of women veterans and their receipt of health care services. Despite the large numbers of women who served during the 1990-1991 Gulf War, few studies have evaluated Gulf War illness (GWI) and other medical conditions specifically as they affect women veterans of the 1991 Gulf War. The objectives of the Gulf War Women's Health Cohort study are: (1) to establish the Gulf War women's cohort (GWWC), a large sample of women veterans who served in the 1990-1991 Gulf War and a comparison group of women who served in other locations during that period; and (2) to provide current, comprehensive data on the health status of women who served during the 1990-1991 Gulf War, and identify any specific conditions that affect Gulf War women veterans at excess rates. The study will utilize both existing datasets and newly collected data to examine the prevalence and patterns of Gulf War Illness symptoms, diagnosed medical conditions, reproductive health, birth outcomes and other health issues among women who served during the Gulf War. The Gulf War Women's Health Cohort study will address the need for information about the comprehensive health of women veterans who were deployed to the Gulf War, and other wars during the Gulf War era.
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Affiliation(s)
- Benjamin E. Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Applied Health Sciences Program, Augusta University, Augusta, GA 30912, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Maxine H. Krengel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA;
| | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
| | - Candy Wilson
- Uniformed Services University Graduate School of Nursing, Bethesda, MD 20814, USA;
| | - Stacey Iobst
- Henry M. Jackson Foundation at the Uniformed Services University Graduate School of Nursing, Bethesda, MD 20814, USA;
| | - Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Blum K, Gondré-Lewis MC, Modestino EJ, Lott L, Baron D, Siwicki D, McLaughlin T, Howeedy A, Krengel MH, Oscar-Berman M, Thanos PK, Elman I, Hauser M, Fried L, Bowirrat A, Badgaiyan RD. Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization. Mol Neurobiol 2019; 56:7836-7850. [PMID: 31124077 DOI: 10.1007/s12035-019-1600-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a severe polygenic disorder triggered by environmental factors. Many polymorphic genes, particularly the genetic determinants of hypodopaminergia (low dopamine function), associate with a predisposition to PTSD as well as substance use disorder. Support from the National Institutes of Health for neuroimaging research and molecular, genetic applied technologies has improved understanding of brain reward circuitry functions that have inspired the development of new innovative approaches to their early diagnosis and treatment of some PTSD symptomatology and addiction. This review presents psychosocial and genetic evidence that vulnerability or resilience to PTSD can theoretically be impacted by dopamine regulation. From a neuroscience perspective, dopamine is widely accepted as a major neurotransmitter. Questions about how to modulate dopamine clinically in order to treat and prevent PTSD and other types of reward deficiency disorders remain. Identification of genetic variations associated with the relevant genotype-phenotype relationships can be characterized using the Genetic Addiction Risk Score (GARS®) and psychosocial tools. Development of an advanced genetic panel is under study and will be based on a new array of genes linked to PTSD. However, for now, the recommendation is that enlistees for military duty be given the opportunity to voluntarily pre-test for risk of PTSD with GARS, before exposure to environmental triggers or upon return from deployment as part of PTSD management. Dopamine homeostasis may be achieved via customization of neuronutrient supplementation "Precision Behavioral Management" (PBM™) based on GARS test values and other pro-dopamine regulation interventions like exercise, mindfulness, biosensor tracking, and meditation.
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Affiliation(s)
- Kenneth Blum
- Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA. .,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary. .,Department of Psychiatry, Boonshoft School of Medicine, Wright University, Dayton, OH, USA. .,Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA. .,Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA. .,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA. .,Division of Neuroscience & Addiction Research, Pathway Healthcare, LLC., Burmingham, AL, USA.
| | - M C Gondré-Lewis
- Department of Anatomy, Developmental Neuropsychopharmacology Laboratory, Howard University College of Medicine, Washington, DC, USA
| | - E J Modestino
- Department of Psychology, Curry College, Milton, MA, USA
| | - L Lott
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA
| | - D Baron
- Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA
| | - D Siwicki
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA.,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - T McLaughlin
- Center for Psychiatric Medicine, Lawrence, MA, USA
| | - A Howeedy
- Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA
| | - M H Krengel
- Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA
| | - M Oscar-Berman
- Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA
| | - P K Thanos
- Behavioral Neuropharmacology & Neuroimaging Laboratory on Addiction, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - I Elman
- Department of Psychiatry, Cooper University School of Medicine, Camden, NJ, USA
| | - M Hauser
- Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - L Fried
- Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA.,Transformations Treatment Center, Delray Beach, FL, USA
| | - A Bowirrat
- Division of Anatomy, Biochemistry and Genetics Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - R D Badgaiyan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zundel CG, Krengel MH, Heeren T, Yee MK, Grasso CM, Janulewicz Lloyd PA, Coughlin SS, Sullivan K. Rates of Chronic Medical Conditions in 1991 Gulf War Veterans Compared to the General Population. Int J Environ Res Public Health 2019; 16:ijerph16060949. [PMID: 30884809 PMCID: PMC6466358 DOI: 10.3390/ijerph16060949] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
Prevalence of nine chronic medical conditions in the population-based Ft. Devens Cohort (FDC) of GW veterans were compared with the population-based 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort. Excess prevalence was calculated as the difference in prevalence estimates from the Ft. Devens and NHANES cohorts; and confidence intervals and p-values are based on the standard errors for the two prevalence estimates. FDC males were at increased risk for reporting seven chronic medical conditions compared with NHANES males. FDC females were at decreased risk for high blood pressure and increased risk for diabetes when compared with NHANES females. FDC veterans reporting war-related chemical weapons exposure showed higher risk of high blood pressure; diabetes; arthritis and chronic bronchitis while those reporting taking anti-nerve gas pills had increased risk of heart attack and diabetes. GW veterans are at higher risk of chronic conditions than the general population and these risks are associated with self-reported toxicant exposures.
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Affiliation(s)
- Clara G Zundel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Division of Graduate Medical Sciences, Behavioral Neuroscience, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Maxine H Krengel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Megan K Yee
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | - Claudia M Grasso
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | | | - Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
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Abstract
OBJECTIVES Across diverse groups of Gulf War (GW) veterans, reports of musculoskeletal pain, cognitive dysfunction, unexplained fatigue, chronic diarrhoea, rashes and respiratory problems are common. GW illness is a condition resulting from GW service in veterans who report a combination of these symptoms. This study integrated the GW literature using meta-analytical methods to characterise the most frequently reported symptoms occurring among veterans who deployed to the 1990-1991 GW and to better understand the magnitude of ill health among GW-deployed veterans compared with non-deployed GW-era veterans. DESIGN Meta-analysis. METHODS Literature databases were searched for peer-reviewed studies published from January 1990 to May 2017 reporting health symptom frequencies in GW-deployed veterans and GW-era control veterans. Self-reported health symptom data were extracted from 21 published studies. A binomial-normal meta-analytical model was used to determine pooled prevalence of individual symptoms in GW-deployed veterans and GW-era control veterans and to calculate combined ORs of health symptoms comparing GW-deployed veterans and GW-era control veterans. RESULTS GW-deployed veterans had higher odds of reporting all 56 analysed symptoms compared with GW-era controls. Odds of reporting irritability (OR 3.21, 95% CI 2.28 to 4.52), feeling detached (OR 3.59, 95% CI 1.83 to 7.03), muscle weakness (OR 3.19, 95% CI 2.73 to 3.74), diarrhoea (OR 3.24, 95% CI 2.51 to 4.17) and rash (OR 3.18, 95% CI 2.47 to 4.09) were more than three times higher among GW-deployed veterans compared with GW-era controls. CONCLUSIONS The higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal and dermatological symptoms among GW-deployed veterans compared with GW-era controls indicates these symptoms are important when assessing GW veteran health status.
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Affiliation(s)
- Alexis L Maule
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimberly A Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maxine H Krengel
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Megan K Yee
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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Janulewicz PA, Krengel MH, Maule A, White RF, Cirillo J, Sisson E, Heeren T, Sullivan K. Neuropsychological characteristics of Gulf War illness: A meta-analysis. PLoS One 2017; 12:e0177121. [PMID: 28520755 PMCID: PMC5435307 DOI: 10.1371/journal.pone.0177121] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/21/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Gulf War illness (GWI) is a disorder related to military service in the 1991 GW. Prominent symptoms include fatigue, pain and cognitive problems. These symptoms were reported by GW Veterans (GWV) immediately after the war and were eventually incorporated into case definitions of GWI. Neuropsychological function in GW veterans has been studied both among deployed GWV and in GWV diagnosed with GWI. Results have been inconsistent between and across GW populations. The purpose of the present investigation was to better characterize neuropsychological function in this veteran population. METHODS Meta-analysis techniques were applied to published studies on neuropsychological performance in GWV to identify domains of dysfunction in deployed vs. non-deployed GW-era veterans and symptomatic vs. non-symptomatic GWVs. RESULTS Significantly decreased performance was found in three functional domains: attention and executive function, visuospatial skills and learning/memory. CONCLUSIONS These findings document the cognitive decrements associated with GW service, validate current GWI case definitions using cognitive criteria, and identify test measures for use in GWI research assessing GWI treatment trial efficacy.
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Affiliation(s)
- Patricia A. Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Maxine H. Krengel
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Alexis Maule
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Roberta F. White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joanna Cirillo
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Emily Sisson
- Data Coordinating Center, Boston University, Boston, Massachusetts, United States of America
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Yee MK, Zafonte R, Frazier J, Hamblin MR, Koo BB. Transcranial, Red/Near-Infrared Light-Emitting Diode Therapy to Improve Cognition in Chronic Traumatic Brain Injury. Photomed Laser Surg 2016; 34:610-626. [DOI: 10.1089/pho.2015.4037] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Paula I. Martin
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. Ho
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Maxine H. Krengel
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Yelena Bogdanova
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey A. Knight
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Behavioral Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Megan K. Yee
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Judith Frazier
- TBI Research Program, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Bang-Bon Koo
- Boston University Center for Biomedical Imaging, Boston, Massachusetts
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Bogdanova Y, Martin PI, Ho MD, Krengel MH, Ho VT, Yee MK, Knight JA, Hamblin M, Naeser M. LED Therapy Improves Sleep and Cognition In Chronic Moderate TBI: Pilot Case Studies. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Naeser MA, Zafonte R, Krengel MH, Martin PI, Frazier J, Hamblin MR, Knight JA, Meehan WP, Baker EH. Significant improvements in cognitive performance post-transcranial, red/near-infrared light-emitting diode treatments in chronic, mild traumatic brain injury: open-protocol study. J Neurotrauma 2014; 31:1008-17. [PMID: 24568233 DOI: 10.1089/neu.2013.3244] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This pilot, open-protocol study examined whether scalp application of red and near-infrared (NIR) light-emitting diodes (LED) could improve cognition in patients with chronic, mild traumatic brain injury (mTBI). Application of red/NIR light improves mitochondrial function (especially in hypoxic/compromised cells) promoting increased adenosine triphosphate (ATP) important for cellular metabolism. Nitric oxide is released locally, increasing regional cerebral blood flow. LED therapy is noninvasive, painless, and non-thermal (cleared by the United States Food and Drug Administration [FDA], an insignificant risk device). Eleven chronic, mTBI participants (26-62 years of age, 6 males) with nonpenetrating brain injury and persistent cognitive dysfunction were treated for 18 outpatient sessions (Monday, Wednesday, Friday, for 6 weeks), starting at 10 months to 8 years post- mTBI (motor vehicle accident [MVA] or sports-related; and one participant, improvised explosive device [IED] blast injury). Four had a history of multiple concussions. Each LED cluster head (5.35 cm diameter, 500 mW, 22.2 mW/cm(2)) was applied for 10 min to each of 11 scalp placements (13 J/cm(2)). LEDs were placed on the midline from front-to-back hairline; and bilaterally on frontal, parietal, and temporal areas. Neuropsychological testing was performed pre-LED, and at 1 week, and 1 and 2 months after the 18th treatment. A significant linear trend was observed for the effect of LED treatment over time for the Stroop test for Executive Function, Trial 3 inhibition (p=0.004); Stroop, Trial 4 inhibition switching (p=0.003); California Verbal Learning Test (CVLT)-II, Total Trials 1-5 (p=0.003); and CVLT-II, Long Delay Free Recall (p=0.006). Participants reported improved sleep, and fewer post-traumatic stress disorder (PTSD) symptoms, if present. Participants and family reported better ability to perform social, interpersonal, and occupational functions. These open-protocol data suggest that placebo-controlled studies are warranted.
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Pogoda TK, Hendricks AM, Iverson KM, Stolzmann KL, Krengel MH, Baker E, Meterko M, Lew HL. Multisensory impairment reported by veterans with and without mild traumatic brain injury history. ACTA ACUST UNITED AC 2013; 49:971-84. [PMID: 23341273 DOI: 10.1682/jrrd.2011.06.0099] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.
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Affiliation(s)
- Terri K Pogoda
- Center for Organization, Leadership and Management Research, Department of Veterans Affairs, Boston HealthcareSystem, Boston, MA 02130, USA.
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Krengel MH. Neurocognitive and neurobehavioral effects of deployment: the implications of service during the "War on Terror". Neuropsychol Rev 2012; 22:3. [PMID: 22350689 DOI: 10.1007/s11065-012-9189-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 01/30/2012] [Indexed: 11/25/2022]
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Betthauser LM, Bahraini N, Krengel MH, Brenner LA. Self-Report Measures to Identify Post Traumatic Stress Disorder and/or Mild Traumatic Brain Injury and Associated Symptoms in Military Veterans of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF). Neuropsychol Rev 2012; 22:35-53. [DOI: 10.1007/s11065-012-9191-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
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Naeser MA, Saltmarche A, Krengel MH, Hamblin MR, Knight JA. Improved cognitive function after transcranial, light-emitting diode treatments in chronic, traumatic brain injury: two case reports. Photomed Laser Surg 2010; 29:351-8. [PMID: 21182447 DOI: 10.1089/pho.2010.2814] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Two chronic, traumatic brain injury (TBI) cases, where cognition improved following treatment with red and near-infrared light-emitting diodes (LEDs), applied transcranially to forehead and scalp areas, are presented. BACKGROUND Significant benefits have been reported following application of transcranial, low-level laser therapy (LLLT) to humans with acute stroke and mice with acute TBI. These are the first case reports documenting improved cognitive function in chronic, TBI patients treated with transcranial LED. METHODS Treatments were applied bilaterally and to midline sagittal areas using LED cluster heads [2.1″ diameter, 61 diodes (9 × 633 nm, 52 × 870 nm); 12-15 mW per diode; total power: 500 mW; 22.2 mW/cm(2); 13.3 J/cm(2) at scalp (estimated 0.4 J/cm(2) to cortex)]. RESULTS Seven years after closed-head TBI from a motor vehicle accident, Patient 1 began transcranial LED treatments. Pre-LED, her ability for sustained attention (computer work) lasted 20 min. After eight weekly LED treatments, her sustained attention time increased to 3 h. The patient performs nightly home treatments (5 years); if she stops treating for more than 2 weeks, she regresses. Patient 2 had a history of closed-head trauma (sports/military, and recent fall), and magnetic resonance imaging showed frontoparietal atrophy. Pre-LED, she was on medical disability for 5 months. After 4 months of nightly LED treatments at home, medical disability discontinued; she returned to working full-time as an executive consultant with an international technology consulting firm. Neuropsychological testing after 9 months of transcranial LED indicated significant improvement (+1, +2SD) in executive function (inhibition, inhibition accuracy) and memory, as well as reduction in post-traumatic stress disorder. If she stops treating for more than 1 week, she regresses. At the time of this report, both patients are continuing treatment. CONCLUSIONS Transcranial LED may improve cognition, reduce costs in TBI treatment, and be applied at home. Controlled studies are warranted.
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