Neuropsychological issues in military deployments: lessons observed in the DoD Gulf War Illnesses Research Program

The U.S. Department of Defense invested $150 M to investigate undiagnosed Gulf War Illnesses (GWI) and twice that amount in post hoc clinical management. No new disease syndrome was identified, but the research produced new understanding and awareness of important psychosocial and neurotoxicological interactions that represented a difficult and relatively untapped frontier in biomedical research, especially concerning chronic multisymptom illnesses. Some specific Gulf War issues such as effects of depleted uranium, Leishmania diagnosis and treatment, and pesticide and prophylactic drug interactions have been intensively investigated; remaining priorities for further investigation include: markers of neurologic change (e.g., neuroimaging, neuropsychological testing), interactions between psychological resilience and neurotoxicity, structure-function relationships of neurotoxins with neurodegenerative disease potential, and predictors of individual susceptibility. The primary conclusions from the program are that no specific neurotoxic chemical has been identified that explains the chronic multisymptom illness observed but wellness of service members in future deployments may be better sustained based on continuing research on preexposure health baselining, fitness and health-damaging behaviors, and stress resilience. The many scientific discoveries and accomplishments of the GWI research effort have advanced military medical science, provided a solid basis on which to build future protections against health and performance risks to the warfighter, and improved the ability to respond to future deployment health issues.