CENC - Clinical and Neuroimaging Correlates of Neurodegeneration in Military mTBI

CENC - 军事 mTBI 中神经变性的临床和神经影像学相关性

• 批准号: 9812776
• 负责人: Nicholas David Davenport
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-11-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812776
• 关键词: Address; Alcohol dependence; Attention; Behavioral; Behavioral Symptoms; Biological; Biological Factors; Biological Markers; Blood; Blood specimen; Brain; Brain Concussion; Brain Injuries; Caring; Characteristics; Chronic; Clinical; Cognition; Cognitive; Comorbidity; Craniocerebral Trauma; Data; Deterioration; Diagnosis; Diagnostic; Diffuse; Documentation; Education; Electroencephalography; Elements; Equilibrium; Event; Frequencies; Goals; Headache; Health; Individual; Inflammation; Injury; Intervention; Interview; Long-Term Care; Long-Term Effects; MMPI; Magnetic Resonance Imaging; Measurement; Measures; Medical; Memory; Mental Depression; Methods; Military Personnel; Monitor; Nerve Degeneration; Neurologic Signs; Outcome; Participant; Pathology; Patient Self-Report; Personality; Phase; Population; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Prevention; Procedures; Process; Provider; Psychological Factors; Psychopathology; Radial; Recording of previous events; Reporting; Research; Research Design; Resistance; Risk; Sampling; Sleeplessness; Soldier; Source; Sports; Structure; Symptoms; Testing; Time; Training; Translations; Veterans; base; chronic traumatic encephalopathy; cognitive function; combat; cost; experience; high risk; improved; in vivo; instrument; member; mild traumatic brain injury; neuroimaging; neuropathology; outcome forecast; protein expression; psychologic; psychological outcomes; relating to nervous system; service member

Background: Mild traumatic brain injury (mTBI) is common among military service members returning from OEF/OIF deployments. While a history of military mTBI has been demonstrated to be associated with increased risk of negative psychological outcomes (e.g., PTSD, depression, alcohol dependence), as well as disrupted brain connectivity, it is unknown how these conditions relate to neurodegenerative conditions, such as chronic traumatic encephalopathy (CTE). Therefore, it would be of high clinical utility to identify markers, especially in vivo biological markers, that are present early in the neurodegenerative course, reliably predict further decline, and can be distinguished from confounding factors. Objective/Hypothesis: The overall goal of the proposed research is to better understand biological and psychological factors contributing to progressive functional deterioration among veterans with a history of military concussion. In particular, the methods described are intended to identify veterans demonstrating evidence of worsening cognitive disruption and/or neural degeneration. Improved characterization of long-term, ongoing damage associated with mTBI among active duty service members and veterans may improve the diagnostic and monitoring procedures used in these populations, reduce clinical costs, and improve long-term veteran health outcomes. Specific Aims: The proposed research will address two critical elements: Aim 1: Test several psychological and biological measures for utility as markers of mTBI-related neurodegeneration. (Specific Aims 1-4) Aim 2: Characterize the utility and limitations of self-report measures in the context of mTBI and comorbid psychopathology. (Specific Aims 5-6) Study Design: Participants will be 180 of the 276 OEF/OIF military service members who provided a blood sample as well as complete clinical, cognitive, self-report, and neuroimaging data during participation in one of two prior studies. All participants completed combat deployments as part of OEF or OIF, and the majority endorsed a history of mTBI and/or PTSD. Longitudinal data will be collected on the measures acquired in the prior (i.e., baseline) studies, including clinical interviews of psychopathology (SCID, CAPS) and mTBI, self- report measures of psychopathology (BDI, PCL-M) and personality (MPQ, MMPI-2), neuroimaging (MRI, EEG), and blood-based protein expression. Additional data from these instruments will be collected to specifically inform characterization of reliability. Impact: Given the high rates of mTBI during OEF/OIF deployments, along with high rates of civilian mTBI (e.g., contact sports, high risk recreational activities) among members of the military, better understanding of the long-term effects of mTBI, especially progressive neurodegenerative effects, would be of utility to the identification of soldiers at increased risk, diagnosis and intervention in early stages, and ultimately prevention efforts. The results of the proposed research may have implications for the assessment and documentation of mTBI during deployment, education of soldiers and military medical providers, long-term monitoring of service members who sustain mTBI, and enable more efficient provision of long-term care. Therefore, there are clear potential benefits for active duty military as well as for veteran care.

背景：轻度创伤性脑损伤（MTBI）在兵役中很常见 OEF/OIF部署。虽然已经证明了军事MTBI的历史 负面心理结局的风险增加（例如PTSD，抑郁，酒精依赖），以及 破坏了大脑连通性，尚不清楚这些条件与神经退行性条件如何相关， 作为慢性创伤性脑病（CTE）。因此，识别标记物，很高的临床实用性是很高的 特别是在神经退行性过程中早期存在的体内生物学标记物，可靠地预测 进一步下降，可以与混杂因素区分开。 客观/假设：拟议研究的总体目标是更好地了解生物学和 心理因素导致具有历史的退伍军人的渐进式功能恶化 军事脑震荡。特别是，所描述的方法旨在识别退伍军人证明 认知破坏和/或神经变性恶化的证据。长期表征的改善， 现役军人和退伍军人之间与MTBI相关的持续损害可能会改善 这些人群中使用的诊断和监测程序，降低临床成本并改善长期 资深健康成果。 具体目的：拟议的研究将解决两个关键要素： AIM 1：测试几种与MTBI相关的标记的效用的心理和生物学测量 神经变性。 （特定目标1-4） 目的2：在MTBI和合并症的背景下表征自我报告措施的效用和局限性 心理病理学。 （具体目标5-6） 研究设计：参与者将是276名OEF/OIF兵役成员中的180名，他们提供了血液 参与其中一项的样本以及完整的临床，认知，自我报告和神经影像学数据 两项先前的研究。所有参与者作为OEF或OIF的一部分完成了战斗部署，大多数 认可MTBI和/或PTSD的历史。纵向数据将根据在 先验（即基线）研究，包括心理病理学（SCID，CAPS）和MTBI的临床访谈，自我 报告心理病理学（BDI，PCL-M）和人格（MPQ，MMPI-2）的报告量度（MRI， EEG）和基于血液的蛋白质表达。这些乐器的其他数据将收集到 特别告知可靠性的表征。 影响：鉴于OEF/OIF部署期间的MTBI率很高，并且平民MTBI率高 （例如，联系体育，高风险娱乐活动）在军事成员中，更好地理解 MTBI的长期影响，尤其是进行性神经退行性效应，对 在早期的风险，诊断和干预中识别士兵，并最终预防 努力。拟议研究的结果可能对评估和文档有影响 MTBI在部署期间，士兵和军事医疗提供者的教育，长期监控服务 维持MTBI的成员，并可以更有效地提供长期护理。因此，有清晰的 现役军人以及退伍军人护理的潜在好处。