VA-DoD Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC): Epidemiology Study

VA-DoD 军事相关脑损伤联盟 (LIMBIC) 的长期影响：流行病学研究

• 批准号: 10426048
• 负责人: Kristine Yaffe
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426048
• 关键词: Age; Brain Injuries; Caring; Characteristics; Chronic; Clinical; Complex; Data; Data Pooling; Data Set; Data Sources; Databases; Dementia; Diagnosis; Epidemiology; Ethnic Origin; Evolution; Gender; Goals; Healthcare Systems; Image; Individual; Intervention; Investigation; Long-Term Effects; Medical; Medical center; Mental Health; Military Personnel; Modeling; Nerve Degeneration; Nervous System Trauma; Neurodegenerative Disorders; Outcome; Patients; Pharmaceutical Preparations; Phenotype; Positioning Attribute; Post-Traumatic Stress Disorders; Prevention; Public Health; Race; Research Personnel; Resources; Risk; Risk Factors; Socioeconomic Status; Subgroup; Substance abuse problem; Time; Translating; Traumatic Brain Injury; Update; Veterans; Work; adverse outcome; care systems; clinical care; comorbidity; cost; data repository; dementia risk; early onset; epidemiology study; follow-up; health care service utilization; improved; longitudinal course; mild traumatic brain injury; military service; mortality; neurosensory; novel; physical conditioning; prognostic model; prognostication; prospective; repository; resilience; risk stratification; tool

The primary objective of this project is to utilize a variety of existing data sources by integrating and analyzing them in novel ways to answer key questions related to the long-term effects of mild traumatic brain injury (mTBI) in veterans over time. Although prior studies have found that moderate and severe TBI are associated with a variety of adverse clinical outcomes, the effects of mTBI are less well understood. We propose to build on our past several years of work within The Chronic Effects of Neurotrauma Consortium (CENC - Epidemiology Study) in which we have assembled a very large or “mega” data repository of nearly 2 million veterans (including all veterans with a TBI diagnosis) that comprises multiple different national synthesized databases. We are extremely well positioned to capitalize on this national resource to continue to maximally study veterans with mTBI. Specifically, we now have the unprecedented ability to follow these veterans prospectively as they are embedded within the VA national care system and we can investigate both the course and outcomes of TBI. We propose to investigate mTBI and its long-term outcomes through four complementary Specific Aims under the three Objectives of LIMBIC. In Objective 1 Aim 1 we propose to maintain, augment, and refine our current repository, including creating and refining new variables associated with TBI. In Objective 2 Aim 1 we will identify subgroups at the greatest risk and resilience for mental health and neurogenerative outcomes after mTBI, including very-early onset dementia. In Objective 2 Aim 2 we propose to examine and elucidate the complex associations between mTBI and comorbidities such as substance abuse, PTSD, etc. In Objective 3 Aim 1 we will develop prognostic models to determine which veterans decline versus sustain/improve after mTBI. Our overall goal is to investigate how mTBI is interwoven with other comorbidities, especially mental health factors, and how these other factors may be synergistic or additive, how mTBI remote adverse outcomes evolve over time and what predicts this evolution. Furthermore, we will translate our findings to develop prognostic models that will guide clinician and researchers toward better care and prevention of mTBI and associated outcomes.

该项目的主要目标是通过集成和 以新颖的方式分析它们，以回答与轻度肥胖的长期影响有关的关键问题。 创伤性脑损伤（mTBI）在退伍军人随着时间的推移。尽管先前的研究发现， 和严重TBI与各种不良临床结果相关，mTBI的影响是 不太了解。我们建议在过去几年的工作基础上， 神经创伤联盟（CENC -流行病学研究）的影响，我们已经组装了一个 包含近200万退伍军人（包括所有TBI退伍军人）的超大型或“巨型”数据存储库 诊断），包括多个不同的国家综合数据库。我们非常好 定位利用这一国家资源，继续最大限度地研究退伍军人与mTBI。 具体来说，我们现在有了前所未有的能力来前瞻性地跟踪这些退伍军人， 嵌入VA国家护理系统，我们可以调查过程和结果 关于TBI我们建议通过四个互补的方法来研究mTBI及其长期结果。 LIMBIC三大目标下的具体目标。在目标1中，我们提议维持， 扩充和完善我们当前的存储库，包括创建和完善新的相关变量 关于TBI在目标2和目标1中，我们将确定精神疾病风险和恢复力最大的亚组。 mTBI后的健康和神经生成结果，包括极早发作的痴呆症。目标2 目的2：我们建议检查和阐明mTBI和 合并症，如药物滥用，创伤后应激障碍等。在目标3目标1中，我们将制定预后 模型来确定哪些退伍军人在mTBI后下降与维持/改善。我们的总体目标是 研究mTBI如何与其他合并症交织在一起，特别是心理健康因素， 这些其他因素如何协同或相加，mTBI远程不良结局如何演变 以及是什么预测了这种进化。此外，我们将把我们的发现转化为发展 预测模型，将指导临床医生和研究人员更好地护理和预防mTBI 以及相关的结果。