Veterans returning from active duty endure many challenges to readapt to civilian life. For some there is the added complication of combat stress, which affects their memory, attention span, and other cognitive functions. But how? And for how long?
Neuroscientist Guido van Wingen and colleagues at the Academic Medical Centre (AMC) in Amsterdam monitored a group of soldiers from before their first deployment to Afghanistan until 18 months after their return to civilian life. The idea was to look at how combat stress affects the brain areas supporting cognitive functions such as memory and attention.
The research team used the grid-enabled e-BioInfra Gateway to process and analyze 118 brain scans from 33 soldiers and 26 civilians used as controls. Thanks to a friendly user interface and the computing power of the grid, a workload of several weeks was condensed into two days.
The conclusions, published in the Proceedings of the National Academy of Sciences, show that combat stress impairs cognition by affecting the midbrain and its link with the prefrontal cortex, and that this is largely reversible but could have an impact on future social and cognitive functions.
Monitoring the troops
Severe stress in war zones can lead to long-lasting problems in combat troops. The diagnosis of 'shell shock' used during the first world war has come a long way and post-traumatic stress disorder is now recognized as a major issue with social implications. But even those fortunate enough not to experience trauma report memory loss and decrease in attention span.
The volunteers' brains were scanned with functional magnetic resonance (fMRI) and diffusion tensor imaging (DTI) techniques. The soldiers also completed cognitive memory and attention tests, as well as questionnaires designed to assess their psychological condition. As a control, the team also scanned and tested 26 individuals in non-combat roles.
While in Afghanistan, the soldiers were embedded as part of a NATO mission and exposed to combat situations, enemy fire, and the risk of improvised explosive devices. The tests were repeated shortly after the soldiers' return from deployment and then again 18 months later.
In total, Van Wingen and his colleagues had 118 scans to analyze, which would take approximately 240 hours of computing time. This is not a lot, but "the logistics to organize so many datasets and process them is complex when using a regular computer," he explains.
To make things easier, Van Wingen used the e-BioInfra Gateway to access SURFsara's Dutch e-science grid and analyze the DTI scans with software developed by the AMC's e-Bioscience group led by Silvia Olabarriaga.
"Silvia's group has created an incredibly user-friendly interface to perform the most difficult analyses with several mouse clicks to upload the data and run the analyses," says Van Wingen. "And with the computing power of the grid the analyses that would otherwise require several weeks' time are finished over the weekend."
Long- and short-term consequences
From the psychological evaluation, the team found that combat stress interfered with the soldiers' capacity for sustained attention shortly after their return from Afghanistan. The fMRI scans of their brains during a memory test revealed that this effect was caused by functional changes in the midbrain. The analysis of the DTI images showed that these were accompanied by structural alterations as well.
In the long run, the soldiers returned to their baseline value for attention, which means that the influence of stress on the midbrain's function and structure is reversible.
The team also found long-term changes in the way the midbrain couples with the prefrontal cortex. "Midbrain-prefrontal cortex coupling is an index for communication between these brain regions," explains Van Wingen. "This is known to be important for maintaining information in the working memory, for its evaluation and manipulation in order to make appropriate decisions."
The original, longer version of this article was published as a case study on the European Grid Infrastructure website under the title 'Does combat stress have a long-term effect on attention and memory?'