Although the conflicts in Iraq and Afghanistan dominate today’s headlines, many veterans still struggle with mental health problems stemming from earlier wars. A landmark study to measure those effects over four decades is the National Vietnam Veterans Longitudinal Study, led by Charles R. Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of psychiatry at NYU Langone, and colleagues at Abt Associates. Published in JAMA Psychiatry in July 2015, the study recently surveyed 1,450 veterans who originally participated in the National Vietnam Readjustment Study from 1984 through 1988. More than four decades after the war, Dr. Marmar and his colleagues found, up to 11 percent of male subjects and 9 percent of female subjects showed symptoms of PTSD, suggesting that over 270,000 Vietnam veterans may have the disorder. Among study subjects with PTSD, 36.7 percent also suffered from major depression.
Researchers led by Maria M. Steenkamp, PhD, research assistant professor of psychiatry, further illuminated the scope of the problem in a narrative review published the following month in JAMA. Examining randomized clinical trials of psychotherapies for military-related PTSD over a 35-year period, the team found that about two-thirds of veterans receiving cognitive processing therapy or prolonged exposure therapy—the two most commonly used, evidence-based treatment models—retained their PTSD diagnosis, even if their symptoms improved.
“These studies demonstrate that there are veterans of all wars who are struggling,” says Dr. Marmar. “There’s an urgent need for innovations in treatment to help those men and women and to protect future generations.”
Finding Biomarkers for Brain Trauma
A crucial step toward finding more effective treatments for combat-related neuropsychiatric disorders is to develop improved diagnostic tools. NYU Langone researchers are searching for biomarkers of mild TBI, which is undetectable using conventional medical tests or imaging techniques, but whose symptoms (including cognitive, emotional, and memory problems) can be devastating. According to the Congressional Research Service, about 270,000 Iraq and Afghanistan veterans have suffered this type of injury.
In 2015, Mony J. de Leon, EdD, director of the Center for Brain Health, professor of psychiatry, and an investigator with NYU Langone’s Steven and Alexandra Cohen Veterans Center, launched a study aimed at developing a simple test for TBI. Using new technology 1,000 times more sensitive than conventional immunoassays—the Quanterix single molecule array, or Simoa—Dr. de Leon is searching for traces of tau or other abnormal proteins in the blood of TBI patients. “We know that tau proteins in the cerebrospinal fluid (CSF) are a marker for TBI,” says Dr. de Leon, whose work is supported by a new $3 million grant from Cohen Veterans Bioscience. “But analyzing CSF requires an invasive procedure. A blood or saliva test would allow us to detect a brain injury on the battlefield, without waiting for symptoms to appear. Our preliminary tests with plasma are very encouraging for the detection of tau.”
Meanwhile, two pioneering NYU Langone radiologists are lending their expertise to the Cohen Veterans Center’s biomarker project, providing new insights into both TBI and PTSD. Fernando Boada, PhD, professor of radiology, neurosurgery, and psychiatry and co-director of NYU Langone’s Center for Biomedical Imaging, and Yvonne W. Lui, MD, associate professor of radiology and section chief of neuroradiology, use a variety of novel technologies—including diffusion-weighted imaging and spectrum-weighted imaging, and resting state fMRI—to detect subtle changes in brain structure, connectivity, and metabolism. Among their findings: Iron is processed poorly in the brains of TBI patients, and connectivity is compromised in the precuneus, a region implicated in episodic memory, executive function, and sense of self. Similar, though less severe, changes are seen in the precuneus of PTSD patients. “We still have a lot of work to do,” says Dr. Lui, “but we’re beginning to understand the pathophysiology of these conditions.”
Translating Cutting-Edge Research Into Evidence-Based Care
In July 2015, the Home Depot Foundation donated $1.5 million to help NYU Langone launch the first mental health consortium in New York City dedicated to improving the diagnosis and treatment of PTSD and TBI. With this funding, in collaboration with NY-Presbyterian Hospital, NYU Langone is spearheading the establishment of the Greater New York City Military Family Clinic Consortium Coordinating Center, whose mission is to create a network of academic medical centers providing mental health services to veterans and their families. The consortium will oversee the integration of treatment services, care standardization, and staff training sponsored by member institutions.
At the Steven and Alexandra Cohen Military Family Clinic, veterans and family members receive comprehensive care for mental health conditions free of charge. This past August, the New York City Council awarded a $150,000 grant to the clinic to improve assessment and treatment for TBI. The funds will enable the hiring of a neuropsychologist who specializes in cognitive remediation therapy, which has been shown to be effective in helping TBI patients compensate for deficits. “We serve veterans regardless of their discharge status or deployment history,” explains Amanda Spray, PhD, clinical assistant professor of psychiatry and assistant director of the Military Family Clinic. “As a complementary clinic to the VA NY Harbor Healthcare System, we provide essential adjunctive care for veterans as well as their loved ones.”