Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study

Neurological dysfunction has been reported in Gulf War Illness (GWI), including abnormal cerebral blood flow (CBF) responses to physostigmine challenge. However, it is unclear whether the CBF response to normal physiological challenges and regulation is similarly dysfunctional. The goal of the present study was to evaluate the CBF velocity response to orthostatic stress (i.e., sit-to-stand maneuver) and increased fractional concentration of carbon dioxide. 23 cases of GWI (GWI+) and 9 controls (GWI) volunteered for this study. Primary variables of interest included an index of dynamic autoregulation and cerebrovascular reactivity. Dynamic autoregulation was significantly lower in GWI+ than GWI-both for autoregulatory index (2.99 +/- 1.5 vs 4.50 +/- 1.5, p = 0.017). In addition, we observed greater decreases in CBF velocity both at the nadir after standing (-18.5 +/- 6.0 vs -9.8 +/- 4.9%, p = 0.001) and during steady state standing (-5.7 +/- 7.1 vs -1.8 +/- 3.2%, p = 0.042). In contrast, cerebrovascular reactivity was not different between groups. In our sample of Veterans with GWI, dynamic autoregulation was impaired and consistent with greater cerebral hypoperfusion when standing. This reduced CBF may contribute to cognitive difficulties in these Veterans when upright.