Imaging and cognitive correlates of blast TBI in OIF/OEF combat veterans

OIF/OEF 退伍军人爆炸性 TBI 的成像和认知相关性

• 批准号: 8195960
• 负责人: Effie M Mitsis
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8195960
• 关键词: Acceleration; Accidents; Activities of Daily Living; Acute; Address; Advisory Committees; Affect; Afghanistan; Age; American; Amnesia; Anatomy; Animals; Anisotropy; Area; Attention; Awareness; Back; Blast Cell; Blast Injuries; Brain; Brain Injuries; Brodmann' s area; Categories; Characteristics; Chicago; Chronic; Clinic; Clinical; Cognitive; Cohort Effect; Communication; Complex; Congresses; Consent; Corpus Callosum; Craniocerebral Trauma; Data; Deceleration; Development; Devices; Diagnosis; Diffuse; Diffusion Magnetic Resonance Imaging; Dimensions; Education; Elderly; Environmental Wind; Event; Exposure to; Fiber; Focal Neurologic Deficits; Freedom; Frequencies; Functional Imaging; Functional Magnetic Resonance Imaging; Glucose; Head; Health; Health Personnel; Healthcare Systems; Hospitals; Image; Imaging Techniques; Impaired cognition; Impairment; Individual; Injury; Institution; Institutional Review Boards; Intervention; Iraq; Knowledge; Laboratories; Lateral; Left; Length; Long-Term Care; MFGE8 gene; Magnetic Resonance Imaging; Mann-Whitney U Test; Maps; Measures; Medical; Medical center; Medicine; Memory; Memory Loss; Metabolic; Methods; Military Personnel; Mining; Nature; Neurobiology; Neuropsychological Tests; Neurosciences; Occupations; Outcome; Patients; Performance; Personal Satisfaction; Physiological; Positron-Emission Tomography; Post-Traumatic Stress Disorders; Preparation; Prevention strategy; Probability; Provider; Quality of life; Quality-of-Life Assessment; Questionnaires; Radiology Specialty; Recruitment Activity; Rehabilitation therapy; Reporting; Role; Sampling; Scanning; Scientific Advances and Accomplishments; Screening procedure; Severities; Sex Education; Sorting - Cell Movement; Staging; Structure; Symptoms; Syndrome; Test Result; Testing; Time; Traumatic Brain Injury; Uncertainty; Unconscious State; United States; United States Department of Veterans Affairs; Validation; Veterans; Work; arm; base; cognitive recovery; cohort; combat; cost; effective therapy; executive function; experience; falls; fluorodeoxyglucose positron emission tomography; functional outcomes; imaging modality; injured; killings; medical schools; mental state; neuropsychological; operation; outcome forecast; pressure; programs; public health relevance; relating to nervous system; sex; shear stress; symposium; treatment planning; uptake; vehicular accident; white matter

DESCRIPTION (provided by applicant): We propose to investigate the impact of blast-related TBI in returning OIF/OEF combat veterans using FDG-PET and diffusion tensor imaging (DTI). The primary objective will be to characterize white matter integrity using DTI, as well as conduct Brodmann analyses and measure glucose metabolic activity using FDG-PET in combat veterans exposed to blast wave with and without a diagnosis of TBI. We will also acquire anatomic MRI for volumetric analysis. The secondary objective will be to examine the relationship between white matter integrity and functional imaging findings to neuropsychological function and to activities of daily living (Functional Assessment Questionnaire and Quality of Living questionnaire). We will also examine in this cohort the effect of PTSD on the imaging and cognitive outcomes. We will recruit a cohort of 16 OEF and OIF combat veterans per year for three years who have sustained mild TBI following blast injury and a group of 16 age, education, and sex matched OIF/OEF veteran controls per year for three years who do not have a diagnosis of mild TBI from blast exposure. This study will help identify for the first time neuropsychological and neural correlates of mild TBI as a result of exposure to blast wave. The use of various types of imaging modalities proposed here will add previously unknown, critically important identification and validation to the diagnosis of TBI and its cognitive consequences in combat veterans exposed to blast. With the growing number of improvised explosive device casualties and resulting TBI diagnoses in OIF/OEF veterans, the full impact of acute and repeated blast exposure on individual performance and long-term health is unknown. Indeed, many OIF/OEF veterans currently presenting to VA hospitals with symptoms consistent with mild TBI were never recognized prior to discharge from the armed forces. While the extent of the problem is not known, it is without doubt substantial and there is a growing concern that blast may produce long-term injury to military personnel. Traumatic brain injury will become an increasingly costly health issue for the US with regard to the escalating cost for federal programs addressing medical treatment and intervention, given the high frequency of blast exposure in returning OIF/OEF veterans. Understanding the neural, cognitive and functional sequelae in these veterans will enable the earliest possible intervention strategies, when treatment may be most effective. Intervention may help to alleviate not only the cognitive problems associated with mild TBI but the functional difficulties (job-related problems, relationship problems) that will certainly reduce costs, but importantly, will prolong quality of life in these veterans. PUBLIC HEALTH RELEVANCE: Little work has been done in veterans on the problem of blast-related TBI, particularly mild TBI, and its association with cognitive decline. Elucidating the neurobiological and neuropsychological aspects, as well as the functional difficulties that arise in many returning veterans as a result of blast-exposure TBI is essential in determining appropriate treatment and long-term care of returning veterans from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) who have sustained head injury during their tours of duty. This study will help identify for the first time neuropsychological and neural correlates of mild TBI as a result of exposure to blast wave. With the growing number of improvised explosive device casualties and resulting mild TBI diagnoses in OIF/OEF veterans, the full impact of acute and repeated blast exposure on individual performance and long-term health is unknown. Indeed, many OIF/OEF veterans currently presenting to VA hospitals with symptoms consistent with mild TBI were never recognized prior to discharge from the armed forces. These cases are only now being recognized as related to single or often multiple blast exposures. While the extent of the problem is not known, it is without doubt substantial and there is a growing concern that blast may produce long-term injury to military personnel. TBI will become an increasingly costly health issue for the US with regard to the escalating cost for federal programs addressing medical treatment and intervention, given the high frequency of head injury in returning OIF/OEF veterans. Understanding the neural, cognitive and functional sequelae in these veterans will enable the earliest possible intervention strategies, when treatment may be most effective to alleviate not only the cognitive sequelae associated with mild TBI but the functional difficulties (job-related problems, relationship problems) that often arise in returning veterans. Delineating the cognitive and neurobiological profile of blast-related TBI in returning OIF/OEF veterans will provide the scientific field with important information with regard to the development of adequate preparation, intervention, treatment, and practical planning. Furthermore, the findings from this study may advance scientific knowledge with regard to the underlying neurobiological underpinnings of the complex interaction of blast-related mild TBI and concomitant cognitive and functional deficits. Intervention and prevention strategies at the earliest possible stage aimed at prolonging well-being, will certainly reduce costs, but importantly, will prolong quality of life in these veterans.

描述（由申请人提供）： 我们建议使用FDG-PET和扩散张量成像（DTI）研究与Blast相关的TBI对返回OIF/OEF战斗退伍军人的影响。主要目标是使用DTI表征白质完整性，并在与TBI诊断的情况下，使用FDG-PET进行Brodmann分析并测量葡萄糖代谢活性。我们还将获得解剖学MRI进行体积分析。次要目标是检查白质完整性与功能成像发现与神经心理学功能以及与日常生活的活动之间的关系（功能评估问卷和生活质量问卷）。我们还将在此队列中检查PTSD对成像和认知结果的影响。我们将每年招募三年的16名OEF和OIF战斗退伍军人队列，他们在爆炸受伤后持续轻度TBI，并且每年16岁，教育和性别匹配的OIF/OEF退伍军人对照组三年，他们在爆炸暴露中均未诊断为轻度TBI。这项研究将有助于首次确定由于暴露于爆炸波的导致轻度TBI的神经心理学和神经相关性。此处提出的各种成像方式的使用将为TBI的诊断及其在暴露于Blast的战斗退伍军人中的诊断及其认知后果增加以前未知的，至关重要的识别和验证。随着OIF/OEF退伍军人的爆炸装置伤亡的数量越来越多，由OIF/OEF退伍军人进行了TBI诊断，急性和反复的爆炸暴露对个人绩效和长期健康的全部影响尚不清楚。实际上，在从武装部队出院之前，从未认识到许多与轻度TBI一致的VA医院的OIF/OEF退伍军人。尽管该问题的程度尚不清楚，但毫无疑问，这是实质性的，并且人们越来越担心爆炸可能会对军事人员造成长期伤害。鉴于返回OIF/OEF退伍军人的爆炸率高，脑损伤将成为美国越来越昂贵的健康问题。当治疗最有效时，了解这些退伍军人中的神经，认知和功能性后遗症将实现最早的干预策略。干预可能不仅有助于减轻与轻度TBI相关的认知问题，而且有助于减轻功能困难（与工作有关的问题，关系问题），这肯定会降低成本，但重要的是，这些退伍军人的生活质量会延长。 公共卫生相关性： 在退伍军人方面，关于爆炸有关的TBI，尤其是轻度TBI及其与认知能力下降的关联的问题很少。阐明神经生物学和神经心理学方面以及由于爆炸暴露TBI而在许多返回退伍军人中产生的功能困难对于确定伊拉克行动自由行动（OIF）的适当治疗和长期护理对在旅行期间遭受头部受伤的经营者（OIF）和长期护理对返回的退伍军人至关重要。这项研究将有助于首次确定由于暴露于爆炸波的导致轻度TBI的神经心理学和神经相关性。随着OIF/OEF退伍军人的简易爆炸装置伤亡人数的越来越多，导致的轻度TBI诊断，急性和反复的爆炸暴露对个人表现和长期健康的全部影响尚不清楚。实际上，在从武装部队出院之前，从未认识到许多与轻度TBI一致的VA医院的OIF/OEF退伍军人。这些案例直到现在才被认为与单个或通常多个爆炸暴露有关。尽管该问题的程度尚不清楚，但毫无疑问，这是实质性的，并且人们越来越担心爆炸可能会对军事人员造成长期伤害。鉴于返回OIF/OEF退伍军人的头部受伤的高频率，TBI将成为美国对解决医疗和干预的联邦计划的不断升级成本的越来越成本的健康问题。当治疗最有效地减轻与轻度TBI相关的认知后遗症，还可以使功能困难（与工作相关的问题，关系问题，关系问题，关系问题，关系问题，关系问题，关系问题）通常最有效地，了解这些退伍军人中的神经，认知和功能性后遗症将实现最早的干预策略。描述与爆炸相关的TBI的认知和神经生物学特征，以返回OIF/OEF退伍军人，将为科学领域提供有关开发适当准备，干预，治疗和实践计划的重要信息。此外，这项研究的发现可能会推进有关基础神经生物学基础的科学知识，这是与爆炸相关的轻度TBI和随之而来的认知和功能缺陷的复杂相互作用的复杂相互作用的基础。旨在延长福利的最早阶段的干预和预防策略肯定会降低成本，但重要的是，这些退伍军人的生活质量将延长成本。