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• W2069858846 abstract "To the Editor: The June 1998 article on symptoms in Persian Gulf War veterans by Kroenke et al1 reported that the 15 specific symptoms described by Persian Gulf War veterans were prevalent in primary care and community surveys. A review of these cited papers, however, fails to show that memory problems were a common complaint. According to the Persian Gulf Comprehensive Clinical Assessment Program, if a diagnosis is not made on the initial history and physical, which may or may not include a mini-mental examination, a Phase II consultation with a specialist may be undertaken. Neuropsychological testing may be performed at Phase II, but only as indicated by psychiatry consultation. Using psychiatry as a gatekeeper for memory problems reverses the standard occupational - environmental approach. If you are called to an industrial site to assess young workers with memory problems, do you send them to a psychiatrist? How many of the approximately 6000 veterans with memory problems obtained neuropsychological testing? The published neuropsychological data on Gulf War veterans with memory problems are limited. In one study of about 20 veterans, there was evidence of impairment on grooved pegboard performance, Stroop Color-Word performance, and semantic fluency.2 The second study appears to use the same subjects from an Army National Guard Reserve near Detroit, Michigan.3 No difference was found on sustained attention and memory function as measured by the Rey Auditory Verbal Learning Test and the continuous performance test mean response latency. Subtle organic neuropathology may place neuropsychological testing subtests within the normal range, and it may take various subtests of executive function, semantic fluency, and continued data on the pegboard test administered to subjects with mild, moderate, and severe memory complaints to establish testing credibility. Roberta White, a Boston clinical neuropsychologist with more than 30 papers published on environmental and occupational toxin exposure stated that the health symptoms of Gulf War veterans could not be fully explained by posttraumatic stress disorder status or other psychiatric diagnoses.4 Lastly, in the article by Kroenke et al a major emphasis in downplaying toxin exposure was the recognition of memory problems after the war's conclusion. It is quite common to see individuals in a clinic setting who are unaware of dementia, and this extends to family members. A soldier may not perceive problems when all he must do is march, shoot, and perform routine tasks. However, when he rotates back stateside and must learn new technical manuals, or as a reservist he returns to his air controller job that requires assimilation and integration of complex information, he is likely to realize difficulties. Cycad neurotoxin is an example wherein there is a period of time between time of exposure and onset of symptoms.5 Although Pfiesteria toxin has been reported to show reversible neuropsychological tests at 6 months after a brief exposure of less than 40 hours, a prolonged continuous exposure for 4 to 72 hours has not yet been reported.6 The possibility of bioengineering to affect the potency of this agent remains. While chemical exposure as an origin of Gulf War Syndrome is being explored, aerosolized Pfiesteria should also be considered. The occupational and environmental medicine physician would be well advised to await further neuropsychological testing data. Pamela Kaires, MD 3647 Cedarbrae Lane; San Diego, CA 92106" @default.
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• W2069858846 date "1999-11-01" @default.
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• W2069858846 title "Symptoms in Persian Gulf War Veterans" @default.
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• W2069858846 doi "https://doi.org/10.1097/00043764-199911000-00002" @default.
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