IOWA CITY, Iowa -- Cerebral malaria should be considered as seriously as post-traumatic stress disorder (PTSD) or Agent Orange exposure as an underlying cause of long-term medical and psychological problems faced by some Vietnam War veterans, according to a study by a University of Iowa and Veterans Affairs Medical Center (VAMC) psychologist.
In an article published in the November issue of the Journal of Nervous and Mental Disease, Nils R. Varney, UI adjunct professor of psychology and a staff neuropsychologist at the VAMC in Iowa City, and his colleagues report that many cerebral malaria survivors from the Vietnam War have a number of neuropsychiatric symptoms that can persist for years after the acute illness has been treated.
It is estimated that as many as 250,000 Vietnam veterans suffered cerebral malaria. Contracted from mosquitoes, the illness causes an encephalitis, or inflammation of the brain. This can result in damage to cerebral nerve tissue in the frontal-temporal areas of the neocortex.
"Cerebral malaria does a number of different things to a patient's brain that cause a variety of neurological problems," Varney says. "Clinical reports from 500 B.C. through the 20th century noted that patients who survived the illness frequently developed depression, impaired memory loss, personality change and proneness to violence as long-term effects of the disease. These are symptoms that have been reported by many Vietnam veterans for years and are often treated strictly as PTSD."
The researchers compared the neuropsychiatric status of 40 Vietnam combat veterans who contracted cerebral malaria between 1966-1969 with 40 Vietnam veterans with similar wartime experience who suffered gunshot or shrapnel wounds during the same period. The participants underwent numerous tests for sensory, cognitive and behavioral symptoms.
Findings indicated that, when compared to wounded combat veterans who did not contract cerebral malaria during their service, the veterans who had malaria reported more problems with depression, subjective distress, auditory information processing, memory, emotional instability and seizure-like symptoms.
Interestingly, Varney notes, the malaria-related health concerns among Vietnam veterans are similar to what British troops faced in 19th century India during the height of the British Empire. Nineteenth-century physicians documented these cases and considered malaria a leading cause of mental illness in British-occupied regions. "It's well-chronicled in the medical literature from that period, but basically it's been forgotten, since malaria has not been a major problem in industrialized western nations for decades," Varney says.
The study results may offer new hope to many Vietnam veterans with neurological and psychological problems that have not responded to previous treatments. The findings suggest that doctors consider a history of malaria in any medical, psychological or psychiatric workup of Vietnam veterans because a positive response could change diagnosis and treatment. Anticonvulsant medications can be beneficial in treating symptoms that affect cerebral malaria survivors.
"I would suspect that doctors who treat Vietnam veterans with unexplained and untreatable neurological or psychological problems would find a significant number of them with a history of malaria," Varney says. "And that means there's a different way to assess these cases. It's not solely PTSD or Agent Orange exposure that's causing these problems, which are the only explanations these veterans have had to hang their hats on. Now we may be able to move these patients into a category where their problems make sense, what is wrong with them is known and well-documented, and it's treatable."
The study was funded by the U.S. Department of Veterans Affairs.
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