A longitudinal study of chronic TBI in OEF/OIF/OND Veterans and service members

OEF/OIF/OND 退伍军人和现役军人慢性 TBI 的纵向研究

• 批准号: 9108886
• 负责人: Randall S. Scheibel
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9108886
• 关键词: Acids; Affect; Afghanistan; Alleles; Apolipoprotein E; Archives; Behavior assessment; Behavioral; Blast Cell; Blood; Body Regions; Brain; Brain imaging; Brain region; Brain-Derived Neurotrophic Factor; Caring; Catechol O-Methyltransferase; Cerebrum; Choline; Chronic; Cognition; Cognitive; Comorbidity; Conflict (Psychology); Cross-Sectional Studies; DNA Methylation; Data; Development; Diffuse Axonal Injury; Diffusion Magnetic Resonance Imaging; Educational workshop; Enrollment; Ensure; Episodic memory; Evaluation; Exhibits; Family; Freedom; Future; Genes; Genetic; Genotype; Glutamates; Goals; Head and neck structure; Health; Healthcare; Image; Impaired cognition; Individual; Informed Consent; Injury; Integration Host Factors; Investigation; Iraq; Joints; Knowledge; Late Effects; Life; Link; Lipids; Long-Term Effects; Longitudinal Studies; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Manuals; Measurement; Measures; Mediating; Medical center; Mental Depression; Methods; Mining; Mission; Monitor; Morbidity - disease rate; N-acetylaspartate; Nerve Degeneration; Nervous System Physiology; Nervous System Trauma; Neurocognitive; Neurologic; Neurologic Examination; Neurological status; Neuropsychology; Neurotransmitters; Online Systems; Outcome; Participant; Pathology; Pathway interactions; Perforant Pathway; Performance; Persons; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Procedures; Public Policy; Quality of life; Questionnaires; Recovery; Recruitment Activity; Registries; Rehabilitation therapy; Reporting; Research Personnel; Resources; Rest; Risk; Role; Secondary to; Serum; Severities; Site; Spectrum Analysis; Statistical Data Interpretation; Subgroup; Suggestion; Testing; Thick; Time; Trauma; Traumatic Brain Injury; Veterans; Vietnam; apolipoprotein E-4; associated symptom; cognitive performance; cognitive recovery; cognitive reserve; cognitive task; cognitive testing; cohort; collaborative environment; combat; data management; database design; depressive symptoms; disability; eligible participant; follow up assessment; functional decline; functional outcomes; functional status; genetic variant; health administration; hippocampal atrophy; imaging genetics; longitudinal design; methylation pattern; multimodality; neuroimaging; neuromechanism; operation; promoter; quality assurance; rehabilitation service; screening; service member; tool; two-dimensional; white matter

DESCRIPTION (provided by applicant): Project Background/Rationale. About 15% of service members have sustained a traumatic brain injury (TBI) on one or more occasions while deployed in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). The long-term effects of TBI in civilians and in Vietnam veterans are known to include neurodegenerative conditions. However, little is currently known about TBI sustained during the ongoing conflicts and it is timely to investigate the chronic effects of blast and non-blast-related TBI in OEF/OIF/OND veterans and service members. Project Objectives. The study's broad objective is to characterize the chronic effects of TBI sustained by OEF/OIF/OND veterans and service members, and the specific aims include the evaluation of these effects on cognition, neurologic status, and functional outcome in relation to secondary pathology shown by multimodality brain imaging. Related objectives include an examination of how genetics, cognitive reserve, and brain reserve moderate the chronic effects of TBI on outcome. Project Methods. This dual cohort, longitudinal study would enroll 200 OEF/OIF/OND veterans and service members, including 150 who reported at least one TBI and 50 with an injury to body regions other than the brain or no injury. Participants would be enrolled at the Michael E. De Bakey Veterans Affairs Medical Center (MEDVAMC) and from a coordinated site at Brooke Army Medical Center (BAMC) and Darnall Army Medical Center (DAMC) at Fort Hood. Following informed consent and screening for eligibility, participants who are least two months post-injury would complete a baseline, in-person assessment at the MEDVAMC or BAMC/DAMC that would include cognitive testing, functional status, neurologic examination, and brain imaging. Magnetic resonance imaging (MRI) would be performed to assess brain region and total white matter volumes and cortical thickness, diffusion tensor imaging (DTI) would examine microstructural integrity of white matter tracts, resting state functional connectivity MRI (fcMRI) would measure spontaneous brain activation, and magnetic resonance spectroscopy (MRS) would assess levels of neurotransmitters that are thought to be altered following TBI. A blood draw would provide serum for genotyping. Follow-ups would include web-based assessment of cognition and functional status at six and 18 months after baseline and a second in-person assessment at 12 months that would repeat the outcomes measurement and brain imaging that had been performed at baseline. Data would be archived in an object-oriented database designed for the storage and mining of scientific data in collaborative environments. Data management and statistical analysis would be performed by the senior project statistician at the MEDVAMC in coordination with the other study investigators. Administrative oversight would be provided by subgroups of investigators and project staff organized by their expertise and roles, including Administration, Recruitment and Retention, Imaging, Neuropsychological Assessment, Neurological Examination, Genetics, and Data Management/Analysis. To ensure uniform procedures between the project sites, a workshop would be held and a project manual completed during the first three months. Quality assurance (QA) testing of the similar MRI scanners at the two project sites would ensure high quality image data and audits of the cognitive and behavioral data, including monitoring by neuropsychologists, would provide QA for those measures. Relevance to the VA Health Mission. The chronic effects of single and repetitive TBI sustained by OEF/OIF/OND veterans and service members are poorly understood, but potentially include neurodegenerative conditions that impact the long-term health and quality of life of veterans and their families. This project would enhance the capability of VHA to monitor and identify late effects of TBI, including the use of advanced brain imaging to inform planning of rehabilitation and healthcare resources.

描述（由申请人提供）： 项目背景/理由。在部署在持久的自由/行动中，伊拉克自由/行动新黎明（OEF/OIF/OND）部署在运营中，约有15％的服务成员在一次或多次遭受了脑损伤（TBI）。已知TBI对平民和越南退伍军人的长期影响包括神经退行性条件。但是，目前对正在进行的冲突中持续的TBI知之甚少，并且及时调查爆炸和与非激发与TBI在OEF/OIF/OIF/OND退伍军人和服务成员中的慢性影响。 项目目标。该研究的广泛目标是表征OEF/OIF/OIF/OND退伍军人和服务成员所维持的TBI的慢性影响，具体目的包括评估这些对认知，神经系统状况的影响，以及与多态性脑成像所显示的二级病理有关的影响。相关目标包括研究遗传学，认知储备和大脑储备如何适应TBI对结果的慢性影响。 项目方法。这项双重队列的纵向研究将招募200名OEF/OIF/OND退伍军人和服务成员，其中包括150名报告至少有1个TBI和50名对大脑以外的人体区域受伤或没有受伤的人。参与者将被招募到迈克尔·德·贝基（MedVAMC）的迈克尔·德·贝基（Medvamc），并从布鲁克陆军医疗中心（BAMC）和胡德堡的达纳尔陆军医疗中心（DAMC）招收。经过知情同意并筛选资格，受伤后至少两个月的参与者将在MEDVAMC或BAMC/DAMC上完成基线，面对面评估，其中包括认知测试，功能状态，神经系统检查和脑成像。 将进行磁共振成像（MRI）以评估大脑区域和总白质和皮质厚度，扩散张量成像（DTI）检查白质区域的微结构完整性将静止状态功能连接性MRI（FCMRI）将测量对自发性大脑的范围和磁性的范围（FCMRI），将评估该水平的水平（MR），MRSPECTRASTION SENUR STERRAST STERARS PLESSICER（MR）的水平） TBI。抽血将为基因分型提供血清。随访将包括基于Web的认知和功能状态的评估，在基线后六个月和18个月以及在12个月时进行第二次面对面评估，这将重复在基线时进行的结果测量和大脑成像。数据将在面向对象的数据库中存档，旨在在协作环境中存储和挖掘科学数据。数据管理和统计分析将由MEDVAMC的高级项目统计学家与其他研究调查人员进行协调。 行政监督将由调查人员和项目人员的子组提供，包括其专业知识和角色，包括行政，招聘和保留，成像，神经心理学评估，神经系统检查，遗传学和数据管理/分析。为了确保项目站点之间的统一程序，将在前三个月内举行研讨会和项目手册。对两个项目站点上类似的MRI扫描仪的质量保证（QA）测试将确保高质量的图像数据以及对认知和行为数据的审核，包括神经心理学家的监视，将为这些措施提供质量检查。 与VA健康任务有关。众所周知，OEF/OIF/OND退伍军人和服务成员所维持的单一和重复的TBI的慢性效应尚不清楚，但可能包括影响退伍军人及其家人的长期健康和生活质量的神经退行性条件。 该项目将增强VHA监测和确定TBI的后期影响的能力，包括使用先进的脑成像为康复和医疗保健资源的规划提供信息。