Key result
Gulf War Illness phenotypes show altered brain connectivity versus controls during attention tasks.
Why the study?
Gulf War Illness presents with cognitive dysfunction and distinct phenotypes, but the role of attention-related brain connectivity differences before exertion was unclear.
Cross-Sectional (n=35)
No
Gulf War Illness phenotypes exhibit unique brain connectivity patterns during an attention task, supporting the concept of recognizable, objective patterns of cognitive dysfunction.
Hypothesis-generating for objective cognitive markers in Gulf War Illness; requires validation in longitudinal cohorts before clinical use.
One quarter of veterans returning from the 1990-1991 Persian Gulf War have developed Gulf War Illness (GWI) with chronic pain, fatigue, cognitive and gastrointestinal dysfunction. Exertion leads to characteristic, delayed onset exacerbations that are not relieved by sleep. We have modeled exertional exhaustion by comparing magnetic resonance images from before and after submaximal exercise. One third of the 27 GWI participants had brain stem atrophy and developed postural tachycardia after exercise (START: Stress Test Activated Reversible Tachycardia). The remainder activated basal ganglia and anterior insulae during a cognitive task (STOPP: Stress Test Originated Phantom Perception). Here, the role of attention in cognitive dysfunction was assessed by seed region correlations during a simple 0-back stimulus matching task ("see a letter, push a button") performed before exercise. Analysis was analogous to resting state, but different from psychophysiological interactions (PPI). The patterns of correlations between nodes in task and default networks were significantly different for START (n = 9), STOPP (n = 18) and control (n = 8) subjects. Edges shared by the 3 groups may represent co-activation caused by the 0-back task. Controls had a task network of right dorsolateral and left ventrolateral prefrontal cortex, dorsal anterior cingulate cortex, posterior insulae and frontal eye fields (dorsal attention network). START had a large task module centered on the dorsal anterior cingulate cortex with direct links to basal ganglia, anterior insulae, and right dorsolateral prefrontal cortex nodes, and through dorsal attention network (intraparietal sulci and frontal eye fields) nodes to a default module. STOPP had 2 task submodules of basal ganglia-anterior insulae, and dorsolateral prefrontal executive control regions. Dorsal attention and posterior insulae nodes were embedded in the default module and were distant from the task networks. These three unique connectivity patterns during an attention task support the concept of Gulf War Disease with recognizable, objective patterns of cognitive dysfunction.
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Clarke et al. (2019) conducted a cross-sectional in Gulf War Illness (GWI) (n=35). Gulf War Illness (GWI) phenotypes (START and STOPP) vs. Healthy controls was evaluated on Brain connectivity patterns (edges) between nodes in task and default networks during a 0-back attention task. Gulf War Illness phenotypes (START and STOPP) exhibited significantly different brain connectivity patterns during a 0-back attention task compared to controls, supporting objective patterns of cognitive dysfunction.
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