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) 来研究爆炸相关 TBI 对返回 OIF/OEF 退伍军人的影响。主要目标是使用 DTI 表征白质完整性，并使用 FDG-PET 对暴露于爆炸波的退伍军人进行 Brodmann 分析并测量葡萄糖代谢活动，无论是否患有 TBI 诊断。我们还将获取解剖 MRI 以进行体积分析。次要目标是检查白质完整性和功能成像结果与神经心理功能和日常生活活动之间的关系（功能评估问卷和生活质量问卷）。我们还将在该队列中研究 PTSD 对影像和认知结果的影响。我们将每年招募一组 16 名 OEF 和 OIF 战斗退伍军人，为期三年，他们在爆炸受伤后遭受轻度 TBI，并且每年招募一组 16 名年龄、教育程度和性别匹配的 OIF/OEF 退伍军人对照，为期三年，他们没有经历过爆炸损伤。诊断为因爆炸暴露而患有轻度 TBI。这项研究将有助于首次确定因暴露于冲击波而导致的轻度 TBI 的神经心理学和神经相关性。这里提出的各种类型的成像方式的使用将为 TBI 的诊断及其对暴露于爆炸的退伍军人的认知后果增加以前未知的、至关重要的识别和验证。随着简易爆炸装置伤亡人数的不断增加以及由此导致的 OIF/OEF 退伍军人诊断出的 TBI，急性和反复的爆炸暴露对个人表现和长期健康的全面影响尚不清楚。事实上，目前在退伍军人管理局医院就诊的许多 OIF/OEF 退伍军人，其症状与轻度 TBI 一致，但在退伍之前从未被认出。虽然问题的严重程度尚不清楚，但毫无疑问是严重的，而且人们越来越担心爆炸可能对军事人员造成长期伤害。鉴于回国的 OIF/OEF 退伍军人遭受爆炸袭击的频率很高，创伤性脑损伤将成为美国日益昂贵的健康问题，涉及医疗和干预的联邦计划成本不断上升。了解这些退伍军人的神经、认知和功能后遗症将有助于尽早采取干预策略，此时治疗可能最有效。干预不仅有助于缓解与轻度 TBI 相关的认知问题，还有助于缓解功能困难（工作相关问题、人际关系问题），这肯定会降低成本，但更重要的是，将延长这些退伍军人的生活质量。 公共卫生相关性： 对于退伍军人来说，关于爆炸相关的创伤性脑损伤（特别是轻度创伤性脑损伤）及其与认知能力下降的关系的研究还很少。阐明神经生物学和神经心理学方面，以及许多因爆炸暴露 TBI 而返回的退伍军人出现的功能困难，对于确定从伊拉克自由行动 (OIF) 和行动中返回的退伍军人的适当治疗和长期护理至关重要持久自由 (OEF) 在执行任务期间头部受伤。这项研究将有助于首次确定因暴露于冲击波而导致的轻度 TBI 的神经心理学和神经相关性。随着简易爆炸装置造成的伤亡人数不断增加，以及由此导致的 OIF/OEF 退伍军人轻度 TBI 诊断，急性和反复爆炸暴露对个人表现和长期健康的全面影响尚不清楚。事实上，目前在退伍军人管理局医院就诊的许多 OIF/OEF 退伍军人，其症状与轻度 TBI 一致，但在退伍之前从未被识别出来。这些病例直到现在才被认为与单次或经常多次爆炸暴露有关。虽然问题的严重程度尚不清楚，但毫无疑问是严重的，而且人们越来越担心爆炸可能对军事人员造成长期伤害。鉴于返回的 OIF/OEF 退伍军人头部受伤的频率很高，TBI 将成为美国日益昂贵的健康问题，因为联邦医疗和干预计划的成本不断上升。了解这些退伍军人的神经、认知和功能后遗症将使尽早采取干预策略成为可能，此时治疗可能最有效地不仅缓解与轻度 TBI 相关的认知后遗症，而且缓解与轻度 TBI 相关的功能困难（工作相关问题、人际关系问题）。经常出现在退伍军人身上。描述归来的 OIF/OEF 退伍军人与爆炸相关的 TBI 的认知和神经生物学特征，将为科学领域提供有关制定充分准备、干预、治疗和实际计划的重要信息。此外，这项研究的结果可能会增进有关爆炸相关轻度 TBI 和伴随的认知和功能缺陷之间复杂相互作用的神经生物学基础的科学知识。旨在延长福祉的尽早阶段的干预和预防策略肯定会降低成本，但重要的是，将延长这些退伍军人的生活质量。