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3 Characterization of Neurobehavioral Effects
Pages 35-50

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From page 35...
... ." However, the term "neuro­ behavioral effects" was used in the NRC report (2009) to include such neurobehavioral symptoms as fatigue, lack of coordination, sensory disturbances, confusion, depression, tension, trouble concentrating, and headache; alterations in neurobehavioral tests that indicate deficits in attention, reaction time, visuomotor coordination, motor function, digit symbol, and contrast sensitivity; and certain neuropsychological disorders such as learning or behavioral disorders.
From page 36...
... that evaluated neurobehavioral function in 184 adults who had been exposed to TCE-contaminated drinking water many years before testing. Higher exposures were associated with poorer performance on several tests (such as digit symbol substitution test, contrast sensitivity C test, and contrast sensitivity D test)
From page 37...
... Updated Literature The committee identified several new epidemiologic studies that looked at the association between exposure to solvents, particularly TCE and PCE, and neurobehavioral effects such as motor function as well as neurobehavioral symptoms resulting from neurological diseases such as Parkinson's disease. The committee did not assess new toxicological studies on these solvents because they currently would not have clinical applications.
From page 38...
... In the retrospective cohort studies of mortality in the Camp Lejeune and Camp Pendleton populations, the civilian cohort included 4,647 full-time civilian employees with a median age of 58 years who were employed at Camp Lejeune during 1973–1985 (Bove et al., 2014b)
From page 39...
... The committee recommends that VA consider adding Parkinson's disease in the clinical guidance and in algorithm B as a neurobehavioral effect that may result from exposure to contaminated drinking water at Camp Lejeune. IN UTERO AND CHILDHOOD EXPOSURES Although the majority of the diseases listed in the Janey Ensminger Act have been associated with adult exposure to solvents, the act also acknowledges that pregnant women who resided at Camp Lejeune may have ingested the contaminated drinking water and by doing so inadvertently exposed their fetuses.
From page 40...
... Birth Defects Affecting the Nervous System A case-control study was conducted to determine whether children born to mothers with residential exposure to contaminated drinking water at Camp Lejeune during pregnancy were more likely to have childhood hematopoietic cancers, neural tube defects, or oral clefts (Ruckart et al., 2013)
From page 41...
... The committee recommends that VA consider including neurobehavioral effects as a result of neural tube defects to the Camp Lejeune clinical guidance and in algorithm B-1. Neuropsychological Performance Performance on a battery of neuropsychological tests was assessed in a small cohort of 35 adults who had been exposed to PCE at Cape Cod in utero or during early childhood between 1969 and 1983 and also in 28 unexposed subjects (Janulewicz et al., 2012)
From page 42...
... provided enough evidence to warrant a recommendation on the inclusion of these two neurobehavioral effects in the guidance and in the algorithms. Nevertheless, in keeping with the VA policy that "in cases where there is reasonable doubt as to the diagnosis or primary cause for the diagnosis, clinicians should resolve in favor of the Camp Lejeune veteran or family member," the committee recommends that VA consider including adolescent and adult illicit drug use and bipolar disorder as neurobehavioral effects in the Camp Lejeune clinical guidance and in algorithm B-1.
From page 43...
... Nevertheless, the committee finds that the weight of evidence indicates deficits in contrast sensitivity and color discrimination may result from exposure to TCE, PCE, or solvents and are neurobehavioral effects that may result from prenatal, childhood, and adult exposures to solvents in the contaminated drinking water at Camp Lejeune. The committee recommends that problems with contrast sensitivity and color discrimination be included in the clinical guidance and in algorithm B as neurobehavioral effects that may result from exposure to contaminated drinking water at Camp Lejeune, although it recognizes that these are typically subclinical (that is, they are not detectable upon routine examination)
From page 44...
... In Box 4 of the original algorithm B, "Reductions in color discrimination" is also listed as a diagnosed (and TABLE 3-1  Neurobehavioral Effects as Given in Algorithm B and the Revised Algorithm B Algorithm B Revised Algorithm B Identified symptoms include: Delayed reaction times Delayed reaction times Parkinson's disease (added) Problems with Problems with memory Short-term memory Problems with visuomotor function Visual perception Problems with color discrimination Color vision Problems with attention Attention Problems with contrast sensitivity (added)
From page 45...
... Given the inconsistencies between the guidance and algorithm B for neurobehavioral effects in adults following exposure to Camp Lejeune drinking water, the committee recommends that the VA clinical guidance and algorithm B be revised to be consistent and to reflect recent literature. Finally, the committee notes that although the Janey Ensminger Act specifically states that family member includes those who were in utero while at Camp Lejeune, the guidance does not address prenatal exposure and possible subsequent neurobehavioral effects.
From page 46...
... to contaminated drinking water at Camp Lejeune, although not all committee members were in agreement on the addition of illicit drug use and bipolar disorder: • Illicit drug use • Bipolar disorder • Neurobehavioral effects caused by neural tube defects The suggested Algorithm B-1 is presented in Figure 3-2. ANNOTATIONS FOR REVISED ALGORITHM B: ADHD = attention deficit hyperactivity disorder; ALS = amyotrophic lateral sclerosis; OCD = obsessive compulsive disorder; PTSD = posttraumatic stress disorder.
From page 47...
... symptoms or deficits caused by a diagnosed neurologic condition? Neurologic conditions include: Alzheimer's disease or other Yes dementia; ALS; multiple Return to sclerosis; basal ganglia CORE B3 diseases; cerebrovascular disease; genetic color blindness; and primary or metastatic brain tumors No B4 8 Yes Are the neurobehavioral symptoms or deficits caused by a diagnosed psychologic Patient accepted condition?
From page 48...
... ANNOTATIONS FOR ALGORITHM B-1: B1 -- Identified neurobehavioral symptoms include illicit drug use, bipolar disorder, and neurological problems associated with neural tube defects, although not all committee members were in agreement on the inclusion of illicit drug use and bipolar disorder. B2 -- Applicant does not have neurobehavioral symptoms as a covered condition and is not accepted to the Camp Lejeune program at this time.
From page 49...
... 2014b. Mortality study of civilian employees exposed to contaminated drinking water at USMC Base Camp Lejeune: A retrospective cohort study.
From page 50...
... 2013. Evaluation of exposure to contaminated drinking water and specific birth defects and childhood cancers at Marine Corps Base Camp Lejeune, North Carolina: A case-control study.


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