Validating Cases of Dementia and Mild Cognitive Impairment in OEF/OIF Veterans

验证 OEF/OIF 退伍军人的痴呆症和轻度认知障碍病例

• 批准号: 9198736
• 负责人: Mary Jo Pugh
• 金额: --
• 依托单位: SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198736
• 关键词: Accounting; Address; Adult; Afghanistan; Age; Algorithms; Awareness; Blast Cell; Brain Concussion; Brain Injuries; Caring; Case-Control Studies; Characteristics; Chronic; Clinic; Clinical; Comorbidity; Craniocerebral Trauma; Data; Data Collection; Dementia; Development; Diagnosis; Early Diagnosis; Early identification; Elderly; Ensure; Epidemiology; Epilepsy; Future; Goals; Health Services Research; Healthcare Systems; High Prevalence; Impaired cognition; Individual; Injury; Inpatients; Interdisciplinary Study; Iraq; Knowledge; Link; Literature; Long-Term Effects; Manufactured football; Medical; Memory; Mental Health; Methods; Movement Disorders; Nerve Degeneration; Nervous System Trauma; Neurology; Neuropsychology; Observational Study; Outcome; Outpatients; Patients; Pharmacy facility; Physical Medicine; Population; Population Research; Population Study; Population trends; Process; Quality of Care; Research; Resources; Risk; Risk Factors; Severities; Stroke; Telephone Interviews; Traumatic Brain Injury; United States; Validation; Veterans; War; Work; clinical care; clinically relevant; cognitive function; cohort; diagnosis evaluation; disability; early onset; epidemiology study; experience; innovation; mild cognitive impairment; mild traumatic brain injury; physical conditioning; public health relevance; service member; wound

 DESCRIPTION (provided by applicant): Traumatic brain injury (TBI), particularly mild TBI, has been identified as a signature wound of the wars in Iraq and Afghanistan and concern has been raised about the long-term effects of these injuries on our Veterans. While moderate to severe brain injury has been linked with conditions such as dementia, epilepsy, and movement disorders, the evidence linking mild TBI to neurodegenerative conditions is limited. More recently, studies of football players and boxers have shown long-term effects of concussions and repetitive mild head injuries on cognitive function. This growing awareness of the chronic effects of neurotrauma has led to an urgent need to study the Iraq/Afghanistan Veterans (IAV) who have suffered these types of injuries, including multiple blast related mild TBI. While cognitive dysfunction such as dementia and mild cognitive impairment (MCI) is a significant and growing problem in older adults, it is rare in adults in the age range of IAV (mean age ~36 years), but remains a significant concern due to the high prevalence of mild TBI in the IAV population. To date, observational studies have not been powered to examine the link between mild TBI and rare conditions such as dementia and MCI in younger individuals, and population-based studies using existing data from VA clinical encounters have been limited by concern for the validity of these diagnoses. The National Research Action Plan emphasized the need to understand the association of mild TBI with long-term outcomes such as dementia and MCI so that the Department of Veterans Affairs can plan for the needs of our Iraq/Afghanistan Veterans and provide high quality of care. The long-term goal of the proposed line of research is to address these concerns using a case-control study employing DoD data, VA data and telephone interviews to identify the risk of dementia and MCI among those with deployment-related mild TBI, accounting for lifetime TBI exposure, deployment and non-deployment experiences, and other comorbid conditions such as stroke. However before such a study can be effectively conducted, validation of diagnoses of dementia and MCI in this younger VA population is needed. To address this knowledge gap, we convened an interdisciplinary team with expertise in epidemiology, neuropsychology, neurology, physiatry, and health services research to validate diagnoses of early onset dementia (EOD) and MCI in Iraq/Afghanistan Veterans, and develop algorithms for use in population-based studies of EOD/MCI. We will also describe patient characteristics associated with validated EOD/MCI diagnoses. We hypothesize that among those with diagnoses indicative of EOD/MCI individuals with moderate to severe TBI will be more likely to have validated EOD/MCI diagnoses than similar IAV with mild TBI. This study will develop a cohort that can be used in a larger epidemiological study to examine the impact of deployment related mild TBI on EOD/MCI while controlling for lifetime TBI exposures. Moreover, the process used in this study will allow for development of reliable algorithms for identification of EOD/MCI for population- based research. Findings from these lines of research will inform DoD and VA healthcare systems regarding future resources that will be needed to provide high quality care.

 描述（由申请人提供）： 创伤性脑损伤（TBI），尤其是轻度TBI，已被确定为伊拉克和阿富汗战争的标志性伤口，并且对这些伤害对我们退伍军人的长期影响提出了关注。尽管中度至重度脑损伤与痴呆症，癫痫和运动障碍等疾病有关，但将轻度TBI与神经退行性疾病联系起来的证据是有限的。最近，对足球运动员和拳击手的研究显示了咨询和重复轻度头部受伤对认知功能的长期影响。人们对神经瘤的慢性影响的越来越多，迫切需要研究遭受此类损伤的伊拉克/阿富汗退伍军人（IAV），包括多种相关的爆炸性轻度TBI。尽管痴呆症和轻度认知障碍（MCI）等认知功能障碍是老年人的重大问题，但在IAV年龄范围内的成年人（平均年龄〜36岁）中很少见，但由于IAV人群中轻度TBI的高度流行，这仍然是一个重大关注的问题。迄今为止，观察性研究尚未用于研究年轻个体中轻度TBI与痴呆症和MCI等少数疾病之间的联系，以及使用VA临床相遇中现有数据的基于人群的研究受到对这些诊断有效性的关注的限制。国家研究行动计划强调，有必要了解温和的TBI与痴呆症和MCI等长期成果的关联，以便退伍军人事务部可以计划伊拉克/阿富汗退伍军人的需求并提供高质量的护理。拟议的研究系列的长期目标是通过使用DOD数据，VA数据和电话访谈的病例对照研究来解决这些问题，以确定与部署相关的轻度TBI的痴呆症和MCI的风险，这考虑了终身TBI的暴露，部署，非部署和非部署体验以及其他comorbid条件，以及其他Comorbid条件。但是，在有效进行此类研究之前，需要在该年轻的VA种群中验证痴呆症和MCI的诊断。为了解决这一知识差距，我们召集了一个跨学科团队，具有在伊拉克/阿富汗退伍军人中的早期发作痴呆症（EOD）和MCI的诊断，具有流行病学，神经心理学，神经病学，生理学和健康服务研究方面的专业知识，以及在基于人群基于EOD/MCI的基于人群研究中使用的ALGORITH的诊断。我们还将描述与经过验证的EOD/MCI诊断相关的患者特征。我们假设，在具有诊断性的人中，与使用轻度TBI的类似IAV相比，具有中度至重度TBI的EOD/MCI个体的EOD/MCI患者更有可能已验证EOD/MCI诊断。这项研究将开发一个队列，该队列可以在更大的流行病学研究中使用，以检查与部署相关的轻度TBI对EOD/MCI的影响，同时控制终身TBI暴露。此外，本研究中使用的过程将允许开发可靠的算法，以识别EOD/MCI用于基于人群的研究。这些研究的发现将为DOD和VA医疗保健系统提供有关提供高质量护理所需的未来资源的信息。