TY - JOUR
T1 - Cholinergic autonomic dysfunction in veterans with gulf war illness
T2 - Confirmation in a population-based sample
AU - Haley, Robert W.
AU - Charuvastra, Elizabeth
AU - Shell, William E.
AU - Buhner, David M.
AU - Marshall, W. Wesley
AU - Biggs, Melanie M.
AU - Hopkins, Steve C.
AU - Wolfe, Gil I.
AU - Vernino, Steven
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2013/2
Y1 - 2013/2
N2 - Background: The authors of prior small studies raised the hypothesis that symptomsin veterans of the 1991 GulfWar, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction, are due to cholinergic autonomic dysfunction. Objective: To perform a confirmatory test of this prestated hypothesis in a larger, representative sample of Gulf War veterans. Design: Nested case-control study. Setting: Clinical and Translational Research Center, University of Texas Southwestern Medical Center, Dallas. Participants: Representative samples of Gulf War veterans meeting a validated case definition of Gulf War illness with 3 variants (called syndromes 1-3) and a control group, all selected randomly from the US Military Health Survey. Main Outcome Measures: Validated domain scales from the Autonomic Symptom Profile questionnaire, the Composite Autonomic Severity Score, and high-frequency heart rate variability from a 24-hour electrocardiogram. Results: The Autonomic Symptom Profile scales were significantly elevated in all 3 syndrome groups (P < .001), primarily due to elevation of the orthostatic intolerance, secretomotor, upper gastrointestinal dysmotility, sleep dysfunction, urinary, and autonomic diarrhea symptom domains. The Composite Autonomic Severity Score was also higher in the 3 syndrome groups (P=.045), especially in syndrome 2, primarily due to a significant reduction in sudomotor function as measured by the Quantitative Sudomotor Axon Reflex Test, most significantly in the foot; the score was intermediate in the ankle and upper leg and was nonsignificant in the arm, indicating a peripheral nerve length-related deficit. The normal increase in high-frequency heart rate variability at night was absent or blunted in all 3 syndrome groups (P< .001). Conclusion: Autonomic symptoms are associated with objective, predominantly cholinergic autonomic deficits in the population of Gulf War veterans.
AB - Background: The authors of prior small studies raised the hypothesis that symptomsin veterans of the 1991 GulfWar, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction, are due to cholinergic autonomic dysfunction. Objective: To perform a confirmatory test of this prestated hypothesis in a larger, representative sample of Gulf War veterans. Design: Nested case-control study. Setting: Clinical and Translational Research Center, University of Texas Southwestern Medical Center, Dallas. Participants: Representative samples of Gulf War veterans meeting a validated case definition of Gulf War illness with 3 variants (called syndromes 1-3) and a control group, all selected randomly from the US Military Health Survey. Main Outcome Measures: Validated domain scales from the Autonomic Symptom Profile questionnaire, the Composite Autonomic Severity Score, and high-frequency heart rate variability from a 24-hour electrocardiogram. Results: The Autonomic Symptom Profile scales were significantly elevated in all 3 syndrome groups (P < .001), primarily due to elevation of the orthostatic intolerance, secretomotor, upper gastrointestinal dysmotility, sleep dysfunction, urinary, and autonomic diarrhea symptom domains. The Composite Autonomic Severity Score was also higher in the 3 syndrome groups (P=.045), especially in syndrome 2, primarily due to a significant reduction in sudomotor function as measured by the Quantitative Sudomotor Axon Reflex Test, most significantly in the foot; the score was intermediate in the ankle and upper leg and was nonsignificant in the arm, indicating a peripheral nerve length-related deficit. The normal increase in high-frequency heart rate variability at night was absent or blunted in all 3 syndrome groups (P< .001). Conclusion: Autonomic symptoms are associated with objective, predominantly cholinergic autonomic deficits in the population of Gulf War veterans.
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U2 - 10.1001/jamaneurol.2013.596
DO - 10.1001/jamaneurol.2013.596
M3 - Article
C2 - 23407784
AN - SCOPUS:84874061611
SN - 2168-6149
VL - 70
SP - 191
EP - 200
JO - JAMA neurology
JF - JAMA neurology
IS - 2
ER -