• Traumatic Brain Injury

  • Traumatic Brain Injury (TBI) in Vietnam Veterans with PTSD (CA)
    Principal Investigator: Jerome Yesavage, MD
    Co-Investigator: Lisa M. Kinoshita, PhD and Maheen M. Adamnson, PhD
    

    This project is an extension of a Merit Review project examining PTSD and sleep apnea in Vietnam Veterans. Researchers associated with the WRIISC are further evaluating the histories of the participating Veterans for TBI. This project will estimate the incidence of TBI in Vietnam Veterans with PTSD.

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• Women's Health Studies

  • CSP 579, Health Views: Health of Vietnam Era Veteran Women's Study(DC) (DC)

    Principal Investigator: Kathryn Magruder, MPH, PhD, Matthew Reinhard, PsyD

    The VA CSP No. 579 Health ViEWS study represents the most comprehensive examination of a group of women Vietnam Era Veterans to date. This study is designed to evaluate the long-term mental and physical health effects of military service during the Vietnam Era (July 4, 1965 - March 28, 1973) in women. Please see the HealthViews brochure for more details.

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• Cognition

  • Neurocorrelates of Cognition in Veterans Seen by the War Related Illness and Injury Study Center (WRIISC)(CA)

    Principal Investigator: Maheen M. Adamson, PhD

    : Keith Main, PhD

    This project is collecting structural brain data (including Diffusion Tensor Imaging), functional brain data (including task-related and resting state fMRI pilot data on working memory, emotional-regulation, and memory tasks) in Veterans that participate in the clinical WRIISC program and non Veteran subjects in the community. We would like to establish research based protocols that will help provide answers to the complex problems our Veterans face (such as PTSD & TBI) and help focus research questions for future grants. We are also collaborating with Santa Clara Brain Injury Center for this study.

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  • PTSD, Sleep-Disordered Breathing and APOE Genotype: Effects on Cognition (CA)

    Principal Investigator: Jerome Yesavage, MD

    Co-Investigator: Lisa Kinoshita, PhD

    The study objective is to examine whether sleep-disordered breathing, APOE status, increasing age and their interactions will predict rate of cognitive decline in veterans who have PTSD, a population already at risk for cognitive deficits.

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  • Age Associated Cognitive Decline in Aircraft-Pilot Performance (CA)

    Principal Investigator: Jerome Yesavage, MD

    Co-Investigator: Joy L. Taylor, PhD

    The Aviation Safety Laboratory was established in 1983 primarily to test the adverse effects of various drugs and medications of pilots' performance. Over the past decade we have tested such effects using compounds such as marijuana, alcohol and nicotine. Studies have been funded by the National Institute of Drug Abuse, National Institute of Alcoholism and Alcohol Abuse, the National Institue of Aging and private industry. Most recently we are funded by the National Institute of Aging to examine the effects of age on pilot performance. This study is being conducted to shed light upon the "Age-60 Rule". This controversial FAA rule requires the retirement from pilot-in-command duties of air-transport pilots when they reach age 60.

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  • Neural correlates of Decision Making in Older Pilots (CA)

    Principal Investigator: Maheen M. Adamson, PhD

    Co-Investigator: Anna-Clara Milazzo, PhD

    This project evaluates the role of age-related changes in the frontal brain network on decision-making during performance of a real-world skilled task: a pilot's crucial decision to land or not under difficult weather conditions. The project is currently using a novel landing decision task that simulates real-world risk-taking to evaluate the relationship between the 'aging' frontal brain network and risky decision making. We are also seeking to examine subcortical regions as mediators of the association between frontal network activity and risky decision-making in older pilots.

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  • Eye movements During Landing Decisions Made by Aging Pilots (CA)

    Principal Investigators: Maheen M. Adamson, PhD and Quinn Kennedy, PhD

    The long-term goal of Dr. Yesavage's longitudinal aviator project is to track age-related changes in flight performance among pilots, and to determine moderators and mediators of age-related decline in flight performance, such as flight expertise, cognitive ability, and attention allocation strategy. This project adds the eyetracking technology to detect age and/or flight expertise differences in attention allocation strategies during simulated aviation decision making tasks.

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  • Screening for Memory Studies (CA)

    Principal Investigator: J. Wesson Ashford, MD, PhD

    TThe purpose of this protocol is to advertise, recruit, and do a preliminary screen for various clinical trials. Information collected will be entered in a database available to researchers connected with the Stanford/VA Aging Clinical Research Center, located at VA Palo Alto Health Care System, Palo Alto Division.

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• Complementary and Alternative Medicine

  • Yoga and Mind/Body Therapies for Treatment of War Related Illnesses and Injuries (CA)

    Principal Investigator: Louise Mahoney, MS

    Pilot study looking at stress disorders, back and other joint pain, and fatigue. These are common complaints of post-deployment Veterans and traditional medical treatments have not provided long-term relief for many. This pilot study aims to determine the feasibility of a mind/body therapy program in the VA setting and to determine the real and/or perceived benefits to such a program.

    We have established three class groups - two mat-based classes with one for women only and the other a mixed gender group and a chair-based class. Each class meets one time per week for a total of twelve weeks for a maximum total of 45 Veterans. We are assessing quality of life, pain, post traumatic stress disorder, and fatigue pre and post session. Based on results of this pilot data, we will design controlled studies to determine the effectiveness of yoga in reducing symptoms in one problem area at a time.

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  • Qigong for Symptom Management and Function in Veterans with Fatiguing Illnesses

    Principal Investigator: Anna Rusiewicz, PhD, MS

    Stqatement of Problem: Veterans seen at the WRIISC report higher than expected levels of pain and fatigue. Treatments recommendations for pain and fatigue often include exercise, but these Veterans report difficulty implementing standard exercise programs.

    Goal of Study: The purpose of this study is to compare the effect of two types of physical exercise on the quality of life and health of veterans with chronic multisymptom illness (CMI). The two types of physical exercise will be Standard Exercise and Qigong. Qigong is an ancient form of exercise that is the foundation for tai chi and other forms of martial arts.

    This study is currently on hold.

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• Mood Disorders

  • Divalproex and Placebo, Lithium, or Quetiapine for Mania (CA)

    Principal Investigator: Trisha Suppes, MD, PhD

    The purpose of this study is to compare the use of divalproex ER plus placebo, slow release lithium cabonate, or quetiapine. This research is being conducted because some studies suggest divalproex ER may be effective in the treatment of bipolar I disorder and in combination with either lithium or quetiapine may be even more beneficial for patients with bipolar I disorder with hypomanic or manic episodes.

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  • Bipolar I Disorder (CA)

    Principal Investigator: Trisha Suppes, MD, PhD

    This study is designed to evaluate the efficacy of lurasidone compared with placebo in preventing recurrence of affective symptoms (mania, mixed mania, hypomania and depression) in subjects with bipolar disorder I who have demonstrated a stable response to acute treatment with lurasidone in combination with either lithium or divalproex.

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  • A Randomized, Double-Blind, Placebo-Controlled Study of Ziprasidone in Bipolar Disorder with Comorbid Lifetime Panic or Generalized Anxiety Disorder (CA)

    Principal Investigator: Trisha Suppes, MD, PhD

    The objective of this study is to evaluate functional outcomes for persons with a current diagnosis of bipolar disorder (BDI, BDII, or BDNOS) with co-morbid lifetime panic disorder or generalized anxiety disorder and current at least moderately severe anxiety treated with ziprasidone monotherapy in comparison to placebo.

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  • Bipolar Depression: Lithium, SSRI or the Combination (CA)

    Principal Investigator: Trisha Suppes, MD, PhD

    The objective of this study is to conduct a multi-institutional collaborative research project to investigate the impact of mood stabilizer monotherapy, antidepressant monotherapy and mood stabilizer/antidepressant combination therapy in treating bipolar II depression.

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  • Major Depressive Disorder with Mixed Features (CA)

    Principal Investigator: Trisha Suppes, MD, PhD

    The purpose of this study is to evaluate the efficacy of lurasidone (20, 40, and 60 mg/day, flexibly dosed) compared to placebo for the treatment of subjects with major depressive disorder (MDD) with mixed features.

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• PTSD

  • Post Traumatic Stress Disorder: Research Study Using EEG (CA)

    Principal Investigator: Mageen M. Adamson, PhD

    Co-Investigators: Linda Isaac, PhD and Peter J. Bayley, PhD

    This project is an extension of a Neurocorrelates of cognition in Veterans seen by the WRIISC. The purpose of this study is to better understand the neurophysiological (brain electrical activity) changes that occur after PTSD. This technique may provide critical information that will inform both diagnosis and treatment of PTSD. The goal of this study is to evaluate the brain’s network of neurons in both PTSD and healthy controls.

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  • PTSD, Sleep-Disordered Breathing and APOE Genotype: Effects on Cognition (CA)

    Principal Investigator: Jerome Yesavage, MD

    Co-Investigator: Lisa Kinoshita, PhD

    The study objective is to examine whether sleep-disordered breathing, APOE status, increasing age and their interactions will predict rate of cognitive decline in veterans who have PTSD, a population already at risk for cognitive deficits.

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  • PTSD in Animal Models

    • Studying the Structural and Functional Effects of Fear Extinction in Rat Models for PTSD (CA)

      Principal Investigator: Jahmad Salehi, MD, PHD

      Co-Investigator: Van Dang, PhD

      In collaboration with Dr. Rene Garcia, Chairman of the French PTSD Research-Network and A professor of neurobiology at the University of Nice, France, Dr. Ahmad Salehi of WRIISC-PA continues research on the molecular mechanisms of PTSD in mouse models.

      The new results indicate that stimulation of the pre-frontal cortex-hippocampus pathway can play a significant role in forming new synapses in the hippocampus and improves the rate of fear extinction in mouse models, experiencing a traumatic experience.

      At the present time, Drs. Salehi and Dr. Dang are testing new modalities in stimulating cortical neurons to improve fear extinction in PTSD.

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• Traumatic Brain Injury

  • Social Cognition Rehabilitation in Veterans with TBI and PTSD: Intervention Development (DC)

    Principal Investigator: Kelly McCoy, PsyD

    Psychosocial functioning plays a significant role in both readjustment after brain injury and in recovery from PTSD. This intervention development project focuses on establishing a treatment curriculum for TBI and PTSD that addresses the ability to process and effectively respond to the unpredictable, variable stimuli involved in social interaction. A treatment workbook is in its final stages of preparation and data is being collected on the use of this curriculum in a Polytrauma treatment group.

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• Unexplained Symptoms/Illnesses

  • Prospective Study of Functional Status in Veterans at Risk for Unexplained Illness (HEROES) (NJ)

    Principal Investigator: Lisa McAndrew, PhD

    Funding source: VA HSR&D

    Statement of Problem: The 1991 Gulf War highlighted the importance of unexplained illness and its signature feature, non-specific physical symptoms. Non-specific physical symptoms (NSPS) are a significant problem in civilian and veteran populations with patients who have significant NSPS having twice the healthcare costs. After prior wars combat veterans were especially likely to experience NSPS. Previous research on NSPS was limited by retrospective and cross-sectional designs and by primarily studying treatment seeking populations. This study addressed these methodological problems.

    Goal of Study: 1. To determine pre-deployment and immediate post-deployment factors that predict later physical health symptoms and poor functional status, 2. To improve on previous methodological problems in studies of physical health problems 3. To identify risk factors for declining post-deployment functional status and health problems, 4. To identify protective or resilience factors of post-deployment functional status and health problems.

    Status: Data analysis. The study assessed 790 National Guard and Reserve Army enlisted personnel pre-deployment, immediately post-deployment, 3-months, and 1 year post-deployment.

    Findings:

    • OEF/OIF Veterans report concerns about exposure to multiple potentially toxic environmental exposures while deployed.
    • Both PTSD and Chronic Multisymptom illness are associated with increased mental, physical, and emergency room health care use.

    Products:

    • McAndrew L, Teichman R, Osinubi O, Jasien J, Quigley Q. (In Press). Environmental Exposure and Health of OEF/OIF Veterans. Journal of Occupational and Environmental Medicine.
    • McAndrew LM, D'Andrea EA, Engel C, Yen C, Batorsky B, and Ackerman AJ,; Quigley , KS. (2012). Prospective Longitudinal Study of Health Care Utilization among OEF/OIF Service Members with PTSD and Chronic Multisymptom Illness. HSR&D National Conference.

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• Unique Veteran Studies

  • Clinical Data Collection for Patients Seen in the the War Related Illness and Injury Study Center (CA)

    Principal Investigators: J. Wesson Ashford, MD, PhD and Maheen Adamson, PhD

    The purpose of this on-going project is to study and make recommendations regarding treatment of deployment related injuries and illnesses. One of the objectives of the WRIISC is to evaluate Veterans with multiple unexplained symptoms and/or treatment resistant symptoms and educate other health providers about war related illnesses and injuries. We collect and store data from WRIISC patients for analysis in order to provide information to clinicians treating combat veterans. Stored data includes brain scans, neuropsychological tests, and other information from the patient's clinical evaluation.

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  • The War Related Illness and Injury Study at Washington, DC Data Repository (DC)

    Principal Investigator: Katharine Bloeser, MSW

    This protocol seeks to establish a data repository that would address both the clinical and research mission of the WRIISC. This data repository will consist of clinical, administrative, satisfaction and health care utilization data for Veterans who provide informed consent to include their data in the repository and are seen in the DC WRIISC. Clinically, the compilation of this data will allow the DC WRIISC to systematically collect, organize and view complex clinical data for use by practitioners as they formulate diagnoses and recommendations. Additionally, data analysis will guide continuous quality improvement practices within the DC WRIISC. In terms of research, the establishment of a data repository will help us to better define the health concerns of the Veterans we see. By collecting data about the demographic, clinical, and biomedical findings of Veterans seen at the DC WRIISC, we hope to gain insights into the cause, diagnosis, and treatment of conditions that are difficult to diagnose and treat. With the information gathered from a repository, the DC WRIISC will establish future IRB research protocols designed to improve the post-deployment health of these Veterans.

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  • Interpersonal Psychotherapy (IPT) for Women Veterans Exposed to Trauma (DC)

    Principal Investigator: Matthew Reinhard, PsyD

    The specific aim of this pilot study is to explore the use of IPT as an effective method of treatment for women with PTSD. IPT is a short term individual treatment focusing on symptoms and improvement of current interpersonal functioning.

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  • Retrospective Chart Review of Veterans Seen at the War-Related Illness and Injury Study Center (WRIISC) (NJ)

    Principal Investigator: Helena Chandler, PhD

    Funding Source: WRIISC

    Statement of Problem: Veterans seen in the NJ WRIISC clinical program often have poorer health and worse daily functioning than Veterans who are not seen at the WRIISC, and therefore represent a more homogeneous pool of the larger population of Veterans with deployment-related health concerns. In support of its multiple missions which includes research and clinical service, the WRIISC studies information from the clinical visits to look for trends in health outcomes in Veterans with unexplained physical symptoms and those returning from deployment to Iraq or Afghanistan. All Veterans seen as part of the ongoing clinical program at the WRIISC are eligible for the study. Electronic and paper medical records for each Veteran are reviewed with the period of interest being the 12 months prior to their WRIISC evaluation and for up to 36 months after the visit.

    Goal of Study: The results from this study will provide insights about the emerging health issues and diagnoses of Veterans assessed clinically at the NJ WRIISC, and about the possible causes and treatments for deployment-related health concerns.

    Status: Ongoing

    Findings:

    • Helmer et al, 2007: Veterans reported an average of 4 physical health concerns, and 2.7 exposure concerns. The majority of veterans (55%) had a mental health concern, most commonly, posttraumatic stress disorder. The most frequent exposure concerns were depleted uranium, multiple vaccinations, and poor air quality. Greater proportions of Reserve veterans reported genitourinary concerns and exposure to smoke from burning trash than active duty veterans.
    • Helmer et al, 2009: Chronic widespread pain is a common concern (seen in 29% of the Veterans). Mental health concerns were also frequent (posttraumatic stress 53%, depression 60%, alcohol misuse 63%). The presence of chronic widespread pain has a significant and negative impact on daily functioning in these Veterans that is not explained by age, sex or mental health symptoms.

    Products:

    • Osinubi O, McAndrew L, De Candia V, Chandler H, Santos S, Falca-Dodson M, Teichman R. (In Press). Organizational Psychosocial Factors and Deployment-Related Exposure Concerns in Iraqi/Afghanistan Veterans. Journal of Occupational and Environmental Medicine.
    • Helmer, D., Rossignol, M., Blatt, M., Agarwal, R., Teichman, R., & Lange, G. (2007). Health and Exposure Concerns of Veterans Deployed to Iraq and Afghanistan. Journal of Occupational and Environmental Medicine, 49, 475-479.
    • Helmer, D., Chandler, H.K., Blatt, M., Quigley, K.S., Teichman, R.T., & Lange, G. (2009). Chronic widespread pain, mental health, and physical role function in OEF/OIF veterans. Pain Medicine, 10, 1174-1182.

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  • Role of Cerebral Blood Flow in Nausea and Motion Sickness (NJ)

    Principal Investigator: Jorge Serrador, PhD

    Funding Source: NIH/NIDCD

    Statement of Problem: Motion sickness is a problem that affects many people, including Veterans and military personnel, and can negatively impact job performance in those personnel with frequent exposure to transport (e.g., naval vessels, airplanes, tanks, Humvees, etc.). Participants come to the NJ WRIISC for an assessment of brain blood flow using a non-invasive ultrasound device while they are rotated on a special chair on loan from NASA. Results of this study are expected to help us better understand physiological mechanisms that contribute to symptoms of nausea and motion sickness. Understanding the mechanisms underlying motion sickness will allow us to develop new treatments as well as improve current treatment paradigms.

    Goal of Study: Participants come to the NJ WRIISC for an assessment of brain blood flow using a non-invasive ultrasound device while they are rotated on a special chair on loan from NASA. Results of this study are expected to help us better understand physiological mechanisms that contribute to symptoms of nausea and motion sickness. Understanding the mechanisms underlying motion sickness will allow us to develop new treatments as well as improve current treatment paradigms.

    Status: Data analysis

    Findings: Our findings show a significant decrease in brain blood flow prior to symptoms of motion sickness.

    Products: Abstracts Presented at conferences

    • Blatt M, Falvo MJ, Jasien JJ, Wood SJ and Serrador JM. Cerebral Blood Flow Decreases Prior to Nausea during Off-Vertical Axis Rotation. 7th Congress of the International Society for Autonomic Neuroscience (ISAN) and 22nd Symposium of the American Autonomic Society (AAS). Rio De Janeiro, Brazil, 12-16 Sept 2011.
    • Serrador JM, Black FO, Schlegel TT, Lipsitz LA and Wood SJ. Impaired Vestibular Function affects Orthostatic Cerebral Blood Flow Response. International Academy of Astronautics Humans in Space Symposium. April 11-15, Houston, TX, 2011.
    • Falvo M, Wood SJ, Blatt M, Deegan B, Jasien J and Serrador JM. Role of Otolith Inputs in Cerebral Blood Flow & Blood Pressure Regulation. International Academy of Astronautics Humans in Space Symposium. April 11-15, Houston, TX, 2011.
    • Serrador JM. Post Suborbital Flight Orthostatic Intolerance: A possible health concern. Next-Generation Suborbital Researchers Conference, Orlando, FL 2011.
    • Serrador JM, Falvo M, Blatt M, Deegan B, Jasien J, Wood SJ. Role of Otolith Inputs in Cerebral Blood Flow & Blood Pressure Regulation. Association for Research in Otolaryngology, Baltimore, MD, 2011.
    • Serrador JM, Falvo M, Blatt M, Jasien J, Wood SJ. Cerebral Blood Flow Decreases Prior to Nausea during Off-Vertical Axis Rotation. Eighth Symposium on the Role of the Vestibular Organs in Space Exploration, Houston, TX, 2011.

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