2.4 READ ALS in Military

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What disease did Lou Gehrig give his name to?

Huntington's disease

Amyotrophic lateral sclerosis (ALS) (correct)

Parkinson's disease

Multiple sclerosis

Where did Lou Gehrig deliver his famous speech?

Fenway Park

Wrigley Field

Yankee Stadium (correct)

Dodger Stadium

What commonality did Lou Gehrig share with the men and women serving in the armed forces of the United States?

He was a war hero

He served during the Persian Gulf War

He served in multiple branches of the military

He was at greater risk of developing ALS (correct)

What conclusion does existing evidence support regarding military service and ALS?

Military service increases the risk of developing ALS (B) Signup and view all the answers

What percentage of U.S. persons meeting the case definition for ALS reported service in the military?

23.5% (D) Signup and view all the answers

Why does the fraction of ALS patients reporting military service appear to be disproportionately large?

Because the U.S. veteran population is less than 10% of the total adult population (C) Signup and view all the answers

What did a CDC report published in 2018 demonstrate about men in older age groups affected by ALS?

They are more likely to have a history of military service (B) Signup and view all the answers

What is the main goal of The ALS Association as mentioned in the text?

To raise awareness of the relationship between ALS and military service (A) Signup and view all the answers

What is the impact of ALS on patients as described in the text?

Total paralysis in the later stages of the disease (A) Signup and view all the answers

What is a part of the same neurodegenerative disease spectrum as ALS?

Frontotemporal dementia (FTD) (B) Signup and view all the answers

What is the prognosis for a person diagnosed with ALS?

Death in an average of two to five years (C) Signup and view all the answers

What is the function of Riluzole, a drug approved for the treatment of ALS?

Extending life or the time to mechanical ventilation (B) Signup and view all the answers

What has the current research revealed about Riluzole's effects on ALS?

It has no therapeutic effect on motor function (D) Signup and view all the answers

What does Nuedexta consist of?

A combination of dextromethorphan and quinidine (D) Signup and view all the answers

What should research into ALS and the military NOT be conducted at the expense of?

Other important research into ALS (C) Signup and view all the answers

What is The ALS Association advocating for, according to the text?

Increased funding for ALS research (A) Signup and view all the answers

What are The ALS Association and its local Chapters a central resource for?

Information, assistance, and support for people with ALS and their families. (B) Signup and view all the answers

What does the text imply about the impact of understanding the connection between ALS and military service?

It may yield important clues about ALS that will benefit everyone. (B) Signup and view all the answers

What substances are military personnel more likely to come into contact with, which are thought to be linked to ALS?

Formaldehyde and lead (B) Signup and view all the answers

Which group experienced the greatest risk of ALS according to the study conducted by Ronnie D. Horner, Ph.D.?

Army and Air Force personnel (A) Signup and view all the answers

What was the funding source for the study conducted by Robert Haley, M.D., of the University of Texas Southwestern Medical Center at Dallas?

Perot Foundation (B) Signup and view all the answers

What did the study conducted by Robert Haley, M.D., find about the incidence of ALS in young Gulf War veterans?

It was higher than expected (B) Signup and view all the answers

What did the study led by Ronnie D. Horner, Ph.D., seek to determine?

Whether Gulf War veterans have an elevated rate of ALS (B) Signup and view all the answers

Which factor has been suggested as playing a role in the higher incidence of ALS reported in military personnel?

Repetitive head injury or traumatic brain injuries (TBIs) (D) Signup and view all the answers

What was a key finding of the study conducted by Ronnie D. Horner, Ph.D., regarding ALS risk in military personnel?

Those serving in the Gulf were nearly twice as likely to develop ALS (B) Signup and view all the answers

What age group did the study conducted by Robert Haley, M.D., focus on in relation to ALS occurrence?

<25 and <45 (A) Signup and view all the answers

What does the text suggest about military TBIs in relation to ALS incidence?

>80% of military TBIs occur in non-deployed settings, suggesting they are not a driving force for ALS incidence (A) Signup and view all the answers

"Despite not knowing what increases risk in military populations" - What does this statement suggest about our current understanding?

'Understanding risk factors for ALS is still a work in progress' (D) Signup and view all the answers

What should be considered when attempting to define ALS risk in the military population?

Multi-factorial issues (D) Signup and view all the answers

What did the study by Robert Haley, M.D. find about the observed incidence of ALS in young Gulf War veterans?

It exceeded the expected value (C) Signup and view all the answers

What is the main purpose of Nuedexta, as mentioned in the text?

To improve speech, swallowing, and saliva control in ALS patients (D) Signup and view all the answers

How is Edaravone thought to confer its protective benefits for ALS patients?

By serving as an antioxidant (D) Signup and view all the answers

What is the prevalence of ALS in 2013 and 2014, as mentioned in the text?

5.0/100,000 (C) Signup and view all the answers

What percentage of all ALS cases are hereditary, according to the text?

5%-10% (B) Signup and view all the answers

What aspect of ALS does Edaravone not address, according to the text?

Treating the underlying cause of ALS (A) Signup and view all the answers

What is a recognized risk factor for the development of sporadic ALS?

Increased physical activity (A) Signup and view all the answers

What was the prevalence of ALS in 2004, according to the text?

4.8/100,000 (D) Signup and view all the answers

What is the main purpose of Edaravone, as mentioned in the text?

To slow the progression of functional loss in ALS patients (C) Signup and view all the answers

What is a potential cause for sporadic ALS, as indicated in the text?

Excessive physical activity (A) Signup and view all the answers

What does Nuedexta primarily treat in ALS patients?

Emotional dysfunction (B) Signup and view all the answers

What did the FDA approve Edaravone for?

To slow the progression of functional loss in ALS patients (C) Signup and view all the answers

What organization advised the federal government on public health issues and healthcare policy regarding ALS in veterans?

The Institute of Medicine (C) Signup and view all the answers

When did the IOM issue the finding that the existing evidence supports an increased risk of ALS in veterans?

November 2006 (C) Signup and view all the answers

What did the IOM note about the Harvard study on retrospective cohorts from all eras of service regarding ALS and the military?

It provided some of the strongest evidence to show the connection between ALS and the military. (A) Signup and view all the answers

What did the VA implement regulations for in 2008, two years after the IOM report?

To establish a presumption of service connection for ALS. (B) Signup and view all the answers

How does the presumption for ALS differ from other presumptions issued by the VA?

It applies to veterans diagnosed with ALS at any time following service in the military. (A) Signup and view all the answers

What did the epidemiologists at Harvard's School of Public Health report in their studies published in 2009 and 2015 regarding the risk of ALS in men with a history of military service?

There was a nearly 60% greater risk of ALS in men with a history of military service. (D) Signup and view all the answers

What was one important aspect of the studies conducted by epidemiologists at Harvard’s School of Public Health?

They did not have data on deployment during wartime. (A) Signup and view all the answers

What was the result of the meta-analysis conducted using eight case-control studies and three cohort studies to elucidate the relationship between military service and ALS?

Military service significantly increases the risk of ALS. (B) Signup and view all the answers

What was one limitation mentioned about the meta-analysis conducted using case-control and cohort studies?

Most studies were excluded due to focusing on disorders other than motor neuron disease. (B) Signup and view all the answers

What did the committee appointed by IOM call for after evaluating the existing scientific literature on ALS in the veteran population?

Further studies to investigate aspects of military service contributing to disease etiology. (D) Signup and view all the answers

What prompted the VA to request an independent assessment of the relationship between military service and ALS?

The findings from the ALS Patient Care Database (ALS C.A.R.E) (A) Signup and view all the answers

Which study demonstrated that men who served in the military and were born between 1915-1939 had higher ALS mortality rates?

The study conducted by Harvard University’s School of Public Health (B) Signup and view all the answers

What did the VA establish in 2006 to support research on ALS in veterans?

A brain bank known as VA Biorepository Brain Bank (VABBB) (B) Signup and view all the answers

What is the main purpose of the Genes and Environmental Exposures in Veterans with ALS study (GENEVA)?

To evaluate the joint effects of genetic susceptibility and environmental exposures to the risk of sporadic ALS (C) Signup and view all the answers

What was unique about the ALS C.A.R.E project?

It enrolled 6,000-plus patients from more than 300 clinical sites in the United States (A) Signup and view all the answers

What did Congress mandate in 2008, subsuming the 2003-2007 VA registry?

A National ALS Registry launched by the U.S. Centers for Disease Control and Prevention (CDC) (B) Signup and view all the answers

What did researchers at Harvard University’s School of Public Health seek to assess?

The relationship between military service and ALS mortality in different time periods (D) Signup and view all the answers

What did the VA establish in response to studies linking ALS and service in the Gulf War?

A registry to identify cases of ALS in military veterans (B) Signup and view all the answers

What did researchers note about the increase in ALS mortality among men born between 1915-1939 who had served in the military?

(i.e., World War II, Korea, or Vietnam) (B) Signup and view all the answers

What did studies demonstrate about Gulf War veterans concerning their likelihood to develop ALS?

(p < 0.001) approximately twice as likely to develop ALS compared to veterans who had not served in the Gulf War (B) Signup and view all the answers

What kind of data does the Million Veteran Program aim to provide?

Data addressing possible higher rates of developing sporadic ALS among Gulf War veterans. (A) Signup and view all the answers

What was unique about the findings reported in a 2009 publication regarding male patients with ALS?

Veterans had a similar incidence of lung disease, diabetes mellitus, and depression as non-veterans. (D) Signup and view all the answers

What does the largest analysis to date on the ALS/military link suggest?

Military service is associated with an increased rate of ALS (D) Signup and view all the answers

What did the DVBIC research review find about the association between TBI and ALS?

The association is dependent on the number of TBIs and the proximity to the ALS diagnosis (A) Signup and view all the answers

What did researchers examine in relation to ALS and chronic traumatic encephalopathy (CTE)?

Links between TBI and CTE (D) Signup and view all the answers

Why did the DVBIC authors find the results inconclusive?

The evidence was not strong enough to establish causality between TBI and an ALS diagnosis (A) Signup and view all the answers

What do epidemiologists believe about cohorts with specific toxic exposures, such as veterans with known exposure to burning agents?

They are at increased risk of ALS (C) Signup and view all the answers

What is the Defense and Veterans Brain Injury Center (DVBIC) part of?

U.S. Military Health System (B) Signup and view all the answers

What did recent studies examine in subjects with confirmed ALS from the VA Biorepository Brain Bank?

Links between chronic traumatic encephalopathy (CTE) and ALS (D) Signup and view all the answers

Why are subgroup analyses for military occupational specialty, frequency, duration, duty station, or specific incidents considered appropriate?

They may help broaden the understanding of multi-factorial causes in military populations (A) Signup and view all the answers

What is the main purpose of the information papers published by the Defense and Veterans Brain Injury Center (DVBIC)?

To provide clarification on general topics of interest related to traumatic brain injury (TBI) research (D) Signup and view all the answers

What did recent large population-based case-control studies conducted in Denmark find about employment by the military?

It is associated with a 1.3-fold increased rate of ALS (A) Signup and view all the answers

Why do researchers from the VA want to examine possible links between ALS and chronic traumatic encephalopathy (CTE)?

To examine possible links due to their established association (D) Signup and view all the answers