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

该项目的主要目标是通过集成和 以新颖的方式分析它们，以回答与轻度药物长期疗效相关的关键问题 随着时间的推移，退伍军人的创伤性脑损伤(MTBI)。尽管先前的研究发现，适度的 而严重的颅脑损伤与各种不良的临床结局有关，mTBI的影响是 不太为人所知。我们建议在过去几年工作的基础上，在慢性 神经创伤联盟的影响(CENC-流行病学研究)，我们在其中组建了一个 近200万名退伍军人(包括所有患有脑外伤的退伍军人)的非常大或“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 准备利用这一国家资源，继续最大限度地研究患有mTBI的退伍军人。 具体地说，我们现在拥有前所未有的能力，能够前瞻性地跟踪这些退伍军人 嵌入退伍军人管理局国家保健系统，我们可以调查过程和结果 TBI的。我们建议通过四个互补的方法来研究mTBI及其长期结果 边缘的三个目标下的具体目标。在目标1目标1中，我们建议维持， 扩充和改进我们当前的存储库，包括创建和改进相关的新变量 使用TBI。在目标2目标1中，我们将确定精神疾病风险和恢复力最高的亚群 MTBI后的健康和神经生成结果，包括极早发病的痴呆。在目标2中 目的2我们建议检查和阐明mTBI和mTBI之间的复杂联系。 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，以确定哪些退伍军人在mTBI后下降或维持/改善。我们的总体目标是 调查mTBI如何与其他共病，特别是精神健康因素交织在一起，以及 这些其他因素可能是如何协同或相加的，mTBI的远程不良后果是如何演变的 随着时间的推移，以及是什么预测了这种演变。此外，我们将把我们的发现转化为 将指导临床医生和研究人员更好地护理和预防mTBI的预后模型 以及相关的结果。

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.