According to a current study in JAMA, U.S. Army soldiers who return from military deployment to the Iraq war have an increased risk for mild neuropsychological impairment. Deficits include poorer memory, difficulty sustaining attention, and greater feelings of tension and confusion.
However, in an accompanying editorial, experts question if the effects are clinically significant? Do the minor changes pose a documented danger or impediment to the soldiers as they transition to a ‘normal’ life, or upon redeployment? Are the neuropsychological changes an adaptation to the battle zone that will diminish over time?
As the answers to these questions are currently unknown, follow-up evaluations and testing is planned.
In the article, researchers provide background information documenting cognitive impairment as a prominent risk among veteran health complaints. Government health registries rank the disorders fourth among 1991 Gulf War veteran health problems. Because of its potential negative impact on occupational and psychosocial functioning in a predominantly young population, war-related neuropsychological (cognitive and emotional) impairment has significant public health implications.
Yet, the consequences of war-zone deployment on neuropsychological health remain poorly understood. Knowledge gaps stem largely from a lack of predeployment health information and assessments conducted too long after war-zone exposure.
The researchers found that Iraq deployment, compared with nondeployment, was associated with mild neuropsychological compromise on tasks of sustained attention, verbal learning, and visual-spatial memory. Iraq deployment was also associated with increased negative effects on measures of confusion and tension. In contrast, deployment was associated with improved simple reaction time and no changes on other neuropsychological tasks.
Deployment effects remained statistically significant after taking into account deployment-related head injury and stress and depression symptoms. The researchers interpret their findings as the carry-over into the home environment of what was likely an adaptive brain-based survival response in the combat zone.
The researchers add that because they included only active-duty Army Soldiers in this report, their results may not be generalizable to other military branches or to National Guard and Reserve personnel activated for deployment.
“Even small declines in the ability to sustain attentional focus and learn and remember new information may reflect subtle neural dysfunction, lead to problems in day-to-day life, and negatively affect performance in high-pressure contexts such as subsequent war-zone participation,” the authors write.
In an accompanying editorial, experts pose the following questions: “First, are the reported effects clinically significant? The authors emphasize that the neuropsychological changes are ‘mild’ and ‘subtle.’ Although data on the distribution of test performances are not presented, the implication is that the effect represents a minor change for the population as a whole rather than significant impairments in a few.”
“Another possibility is that the effect is due to the persistence on return home of some of the psychological adaptations required during deployment. The term battlemind captures the way in which deployed military personnel develop ways of adapting that are appropriate and helpful when vigilance is required, decisions have to be taken quickly, targeted aggression is appropriate, and emotional control is essential. Many returning veterans report difficulties switching from these normal responses to the responses required at home.”
“The final question for concerned veterans is whether the changes will persist. Given the lack of prior literature on neuropsychological functioning in populations of returning veterans, the planned follow-up of this cohort, with further rigorous neuropsychological testing and clinical monitoring, will be most welcome and certainly most important,” the authors conclude.
Source: JAMA and Archives Journals