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)，特别是轻度 TBI，已被确定为伊拉克和阿富汗战争的标志性创伤，人们对这些损伤对退伍军人的长期影响表示担忧，而中度至重度脑损伤则已引起人们的关注。尽管脑外伤与痴呆、癫痫和运动障碍等疾病有关，但将轻度创伤性脑损伤与神经退行性疾病联系起来的证据有限。最近，对足球运动员和拳击手的研究表明，脑震荡和重复性轻度头部损伤对认知能力有长期影响。人们越来越认识到神经创伤的慢性影响，因此迫切需要研究遭受此类伤害的伊拉克/阿富汗退伍军人 (IAV)，其中包括多发性爆炸相关的轻度 TBI，以及痴呆和轻度认知功能障碍。认知障碍（MCI）是老年人中一个重要且日益严重的问题，在 IAV 年龄范围（平均年龄约 36 岁）的成年人中很少见，但由于 IAV 中轻度 TBI 的高患病率，仍然是一个重大问题人口。迄今为止，观察性研究尚未有能力检验轻度 TBI 与年轻个体中的痴呆和 MCI 等罕见疾病之间的联系，并且使用 VA 临床经验的现有数据进行的基于人群的研究因对这些诊断有效性的担忧而受到限制国家研究行动计划强调需要了解轻度 TBI 与痴呆和 MCI 等长期后果的关联，以便退伍军人事务部能够针对伊拉克/阿富汗退伍军人的需求进行规划并提供高质量的护理。 .长期拟议研究的目标是通过病例对照研究解决这些问题，该研究采用国防部数据、退伍军人事务部数据和电话访谈，以确定患有与部署相关的轻度 TBI 的人患痴呆症和 MCI 的风险，并考虑到终生 TBI 暴露，然而，在有效进行此类研究之前，需要对年轻退伍军人群体中的痴呆症和轻度认知障碍进行诊断，以解决这一知识差距。与...组队我们还将利用流行病学、神经心理学、神经病学、生理学和卫生服务研究方面的专业知识来验证伊拉克/阿富汗退伍军人的早发性痴呆 (EOD) 和 MCI 的诊断，并开发用于基于人群的 EOD/MCI 研究的算法。描述与经验证的 EOD/MCI 诊断相关的患者特征，我们认为，在那些具有 EOD/MCI 诊断的患者中，患有中度至重度 TBI 的个体更有可能经过验证。 EOD/MCI 诊断与轻度 TBI 的类似 IAV 相比，本研究将开发一个队列，可用于更大规模的流行病学研究，以检查部署相关的轻度 TBI 对 EOD/MCI 的影响，同时控制终生 TBI 暴露。这项研究中使用的方法将有助于开发可靠的算法来识别 EOD/MCI，以进行基于人群的研究。这些研究结果将为国防部和退伍军人管理局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。

项目成果

Validity of early-onset dementia diagnoses in VA electronic medical record administrative data.

VA 电子病历管理数据中早发性痴呆诊断的有效性。

• 发表时间: 2020
• 作者: Marceaux, Janice C;Soble, Jason R;O'Rourke, Justin J F;Swan, Alicia A;Wells, Margaret;Amuan, Megan;Sagiraju, Hari Krishna Raju;Eapen, Blessen C;Pugh, Mary Jo
• 通讯作者: Pugh, Mary Jo