[Vision2020] Veterans and Brain Disease

[Art Deco]

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April 25, 2012
Veterans and Brain Disease By NICHOLAS D.
KRISTOF<http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/nicholasdkristof/index.html?inline=nyt-per>

He was a 27-year-old former Marine, struggling to adjust to civilian life
after two tours in Iraq. Once an A student, he now found himself unable to
remember conversations, dates and routine bits of daily life. He became
irritable, snapped at his children and withdrew from his family. He and his
wife began divorce proceedings.

This young man took to alcohol, and a drunken car crash cost him his
driver’s license. The Department of Veterans Affairs diagnosed him with
post-traumatic stress disorder, or P.T.S.D. When his parents hadn’t heard
from him in two days, they asked the police to check on him. The officers
found his body; he had hanged himself with a belt.

That story is devastatingly common, but the autopsy of this young man’s
brain may have been historic. It revealed something startling that may shed
light on the epidemic of suicides and other troubles experienced by
veterans of wars in Iraq and Afghanistan.

His brain had been physically changed by a disease called chronic traumatic
encephalopathy <http://www.bu.edu/cste/about/what-is-cte/>, or C.T.E.
That’s a degenerative condition best-known for affecting boxers, football
players <http://www.nytimes.com/2011/05/03/sports/football/03duerson.html>and
other athletes who endure repeated blows to the head.

In people with C.T.E., an abnormal form of a protein accumulates and
eventually destroys cells throughout the brain, including the frontal and
temporal lobes. Those are areas that regulate impulse control, judgment,
multitasking, memory and emotions.

That Marine was the first Iraq veteran found to have C.T.E., but experts
have since autopsied a dozen or more other veterans’ brains and have
repeatedly found C.T.E. The findings raise a critical question: Could
blasts from bombs or grenades have a catastrophic impact similar to those
of repeated concussions in sports, and could the rash of suicides among
young veterans be a result?

“P.T.S.D. in a high-risk cohort like war veterans could actually be a
physical disease from permanent brain damage, not a psychological disease,”
said Bennet Omalu<http://www.braininjuryresearchinstitute.org/wp-content/uploads/Bennet-Omalu.pdf>,
the neuropathologist who examined the veteran. Dr. Omalu published an
article <http://www.ncbi.nlm.nih.gov/pubmed/22044102> about the 27-year-old
veteran as a sentinel case in Neurosurgical Focus, a peer-reviewed medical
journal.

The discovery of C.T.E. in veterans could be stunningly important. Sadly,
it could also suggest that the worst is yet to come, for C.T.E. typically
develops in midlife, decades after exposure. If we are seeing C.T.E. now in
war veterans, we may see much more in the coming years.

So far, just this one case of a veteran with C.T.E. has been published in a
peer-reviewed medical journal. But at least three groups of scientists are
now conducting brain autopsies on veterans, and they have found C.T.E.
again and again, experts tell me. Publication of this research is in the
works.

The finding of C.T.E. may help answer a puzzle. Returning Vietnam veterans
did not have sharply elevated suicide rates as Iraq and Afghan veterans do
today. One obvious difference is that Afghan and Iraq veterans are much
more likely to have been exposed to blasts, whose shock waves send the
brain crashing into the skull.

“Imagine a squishy, gelatinous material, surrounded by fluid, and then
surrounded by a hard skull,” explained Robert A. Stern, a C.T.E.
expert<http://www.bu.edu/cste/about/leadership/robert-a-stern-ph-d/>at
Boston University School of Medicine. “The brain is going to move,
jiggle around inside the skull. A helmet cannot do anything about that.”

Dr. Stern emphasized that the study of C.T.E. is still in its infancy. But
he said that his hunch is that C.T.E. accounts for a share — he has no idea
how large — of veteran suicides. C.T.E. leads to a degenerative loss of
memory and thinking ability and, eventually, to dementia. There is also
often a pattern of depression, impulsiveness and, all too often, suicide.
There is now no treatment, or even a way of diagnosing C.T.E. other than
examining the brain after death.

While the sports industry has lagged in
responding<http://www.nytimes.com/2011/12/06/sports/hockey/derek-boogaard-a-brain-going-bad.html?pagewanted=all>to
the discovery of C.T.E., and still does not adequately protect
athletes
from repeated concussions, the military has been far more proactive. The
Defense Department has formed its own unit to autopsy brains and study
whether blasts may be causing C.T.E.

Frankly, I was hesitant to write this column. Some veterans and their
families are at wit’s end. If the problem in some cases is a degenerative
physical ailment, currently incurable and fated to get worse, do they want
to know?

I called Cheryl DeBow, a mother I wrote about
recently<http://www.nytimes.com/2012/04/15/opinion/sunday/kristof-a-veterans-death-the-nations-shame.html>.
She sent two strong, healthy sons to Iraq. One committed suicide, and the
other is struggling. DeBow said that it would actually be comforting to
know that there might be an underlying physical ailment, even if it is
progressive.

“You’re dealing with a ghost when it’s P.T.S.D.,” she told me a couple of
days ago. “Everything changes when it’s something physical. People are more
understanding. It’s a relief to the veterans and to the family. And,
anyway, we want to know.”

•

I invite you to visit my blog, On the
Ground<http://www.nytimes.com/ontheground>.
Please also join me on Facebook <http://www.facebook.com/kristof> and
Google+ <https://plus.google.com/102839963139173448834/posts?hl=en>, watch
my YouTube videos <http://www.youtube.com/nicholaskristof> and follow me on
Twitter <http://twitter.com/nickkristof>.


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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