Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA.
Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA.
Clin Ther. 2020 Jun;42(6):974-982. doi: 10.1016/j.clinthera.2020.02.018. Epub 2020 Mar 14.
Psychological stress is a significant health problem in veterans and their family members. Traumatic brain injury (TBI) and stress lead to the onset, progression, and worsening of several inflammatory and neurodegenerative diseases in veterans and civilians. Alzheimer's disease (AD) is a progressive, irreversible neuroinflammatory disease that causes problems with memory, thinking, and behavior. TBIs and chronic psychological stress cause and accelerate the pathology of neuroinflammatory diseases such as AD. However, the precise molecular and cellular mechanisms governing neuroinflammation and neurodegeneration are currently unknown, especially in veterans. The purpose of this review article was to advance the hypothesis that stress and TBI-mediated immune response substantially contribute and accelerate the pathogenesis of AD in veterans and their close family members and civilians.
The information in this article was collected and interpreted from published articles in PubMed between 1985 and 2020 using the key words stress, psychological stress, Afghanistan war, Operation Enduring Freedom (OEF), Iraq War, Operation Iraqi Freedom (OIF), Operation New Dawn (OND), traumatic brain injury, mast cell and stress, stress and neuroimmune response, stress and Alzheimer's disease, traumatic brain injury, and Alzheimer's disease.
Chronic psychological stress and brain injury induce the generation and accumulation of beta-amyloid peptide, amyloid plaques, neurofibrillary tangles, and phosphorylation of tau in the brain, thereby contributing to AD pathogenesis. Active military personnel and veterans are under enormous psychological stress due to various war-related activities, including TBIs, disabilities, fear, new environmental conditions, lack of normal life activities, insufficient communications, explosions, military-related noise, and health hazards. Brain injury, stress, mast cell, and other immune cell activation can induce headache, migraine, dementia, and upregulate neuroinflammation and neurodegeneration in veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. TBIs, posttraumatic stress disorder, psychological stress, pain, glial activation, and dementia in active military personnel, veterans, or their family members can cause AD several years later in their lives. We suggest that there are increasing numbers of veterans with TBIs and stress and that these veterans may develop AD late in life if no appropriate therapeutic intervention is available.
Per these published reports, the fact that TBIs and psychological stress can accelerate the pathogenesis of AD should be recognized. Active military personnel, veterans, and their close family members should be evaluated regularly for stress symptoms to prevent the pathogenesis of neurodegenerative diseases, including AD.
心理压力是退伍军人及其家庭成员的一个重大健康问题。创伤性脑损伤（TBI）和压力导致退伍军人和平民中几种炎症和神经退行性疾病的发病、进展和恶化。阿尔茨海默病（AD）是一种进行性、不可逆的神经炎症性疾病，可导致记忆、思维和行为问题。TBI 和慢性心理压力导致 AD 等神经炎症性疾病的病理发生和加速。然而，目前尚不清楚导致神经炎症和神经退行性变的确切分子和细胞机制，尤其是在退伍军人中。本文的目的是提出一个假设，即应激和 TBI 介导的免疫反应对退伍军人及其近亲以及平民中 AD 的发病机制有实质性的贡献和加速作用。
本文的信息是通过在 1985 年至 2020 年期间在 PubMed 上发表的文章中收集和解释的，使用的关键词是应激、心理应激、阿富汗战争、持久自由行动（OEF）、伊拉克战争、伊拉克自由行动（OIF）、新黎明行动（OND）、创伤性脑损伤、肥大细胞和应激、应激和神经免疫反应、应激和阿尔茨海默病、创伤性脑损伤和阿尔茨海默病。
慢性心理压力和脑损伤导致β-淀粉样肽、淀粉样斑块、神经原纤维缠结和脑中 tau 的磷酸化的产生和积累，从而促进 AD 的发病机制。现役军人和退伍军人由于各种与战争相关的活动而承受着巨大的心理压力，包括 TBI、残疾、恐惧、新的环境条件、正常生活活动的缺乏、沟通不足、爆炸、与军事相关的噪音和健康危害。脑损伤、应激、肥大细胞和其他免疫细胞的激活可导致头痛、偏头痛、痴呆，并在上个世纪在持久自由行动、伊拉克自由行动和新黎明行动的退伍军人中上调神经炎症和神经退行性变。现役军人、退伍军人或其家庭成员中的 TBI、创伤后应激障碍、心理压力、疼痛、胶质细胞激活和痴呆症可能导致 AD 在他们生命中的几年后出现。我们建议，有越来越多的 TBI 退伍军人和压力退伍军人，如果没有适当的治疗干预，他们可能会在晚年患上 AD。
根据这些已发表的报告，TBI 和心理压力可加速 AD 的发病机制这一事实应得到承认。现役军人、退伍军人及其近亲应定期评估应激症状，以预防包括 AD 在内的神经退行性疾病的发病。
