Objective Diagnosis of Mild Blast-Induced TBI

摘要 与在中东部署有关的轻微创伤在我们的士兵中十分猖獗。兰德 该公司估计，我们的士兵中可能有32万人至少经历过轻微的脑外伤。 即使是占所有脑外伤病例80%的轻度脑损伤，也会导致大脑损伤，从而导致 显著的行为和认知变化。退伍军人经常报告个性发生了变化，包括 易怒和攻击性、记忆力丧失和效率丧失。这些问题通常是 永久的。 轻度颅脑损伤的诊断非常具有挑战性，因为没有明显的神经学症状 结果，就像瘫痪。轻度颅脑损伤的诊断也很复杂，因为这种疾病 通常与创伤后应激障碍(PTSD)的症状一起发生，包括 焦虑和抑郁，分别出现在44%和27%的轻度脑外伤士兵中。 创伤后应激障碍和抑郁症可以独立地降低认知和行为表现，而且它们 可同时加重主观抱怨和客观认知缺陷在轻度到 中度脑外伤。因此，这些心理因素可能很难与 身体损伤对大脑本身的影响。这种错综复杂的因素大大增加了 诊断不准确的风险，特别是当使用纯粹主观的报告来评估状态时 心理健康的问题。未能建立正确的残疾状况会给受影响的士兵 没有对他们的残疾作出充分解释，阻碍了适当的医疗服务。 这项提议寻求开发一种新的便携式眼动测试，该测试有可能 为颅脑损伤的诊断提供了客观的方法。有大量证据表明这种类型的眼睛 运动试验将被证明在诊断较轻微的颅脑损伤方面特别有价值，这种情况可能 否则就不会被人认出。这组眼动测试将被给予对照受试者和 退伍军人已经被波士顿退伍军人管理局的神经认知科学家诊断出患有脑外伤。这个 这项拨款中提议的临床研究试图确定这种新测试的程度 预测脑损伤的存在和暴露于爆炸的严重程度。 如果有机会开发这种新的测试仪器，我们的长期目标是使用这种新的和 便携式眼动测试作为一种筛查工具，将在 与其他基本体检同时进行。然后进行同样的测试 “部署后”是指那些暴露在爆炸中的士兵。之前和之后的某些差异 部署后试验可能提供一个客观参数来证实BLAST的临床诊断。 诱发颅脑损伤。

Summary Mild TBI related to deployment in the Middle East is rampant among our soldiers. The RAND Corporation has estimated that 320,000 of our soldiers may have experienced at least mild TBI. Even in mild TBI, which accounts for 80% of all TBI cases, causes damage to the brain that results in significant behavioral and cognitive changes. Veterans often report changes in personality, including irritability and aggression, loss of memory and loss of effectiveness. These problems are often permanent. The diagnosis of mild TBI is very challenging because there are no grossly evident neurological findings, like paralysis. The diagnosis of mild TBI is also complicated because this disorder frequently occurs together with the symptoms of post-traumatic stress disorder (PTSD), which include anxiety and depression, which are present in 44 and 27%, respectively, in soldiers with mild TBI. PTSD and depression can independently degrade cognitive and behavioral performance, and they can both exacerbate both the subjective complaints and objective cognitive deficits in mild to moderate TBI. Consequently, these psychological factors can be difficult to separate from the consequences of physical injury to the brain itself. This tangle of factors substantially increases the risk of diagnostic imprecision, particularly when purely subjective reports is used to assess the state of psychological health. Failure to establish the correct profile of disabilities leaves affected soldiers without a full explanation for their disabilities and hinders appropriate delivery of medical care. This proposal seeks to develop a new and portable eye movement test that has the potential to provide an objective method to diagnose TBI. There is substantial evidence that this type of eye movement test will prove especially valuable in the diagnosis of the milder cases of TBI which could otherwise go unrecognized. This battery of eye movement tests will be given to control subjects and veterans who have been diagnosed with TBI by the Neuro-Cognitive scientists at the Boston VA. The clinical study that is proposed in this grant seeks to determine the degree to which this new test predicts the presence of TBI and the severity of exposure to blasts. Given the opportunity to develop this new test instrument, our long-range goal is to use this new and portable eye movement test as a screening tool that would be administered "pre-deployment" at the same time as other basic medical examinations are being given. The same test would then be given "post-deployment" for those soldiers who were exposed to a blast. Certain differences in the pre- vs. post-deployment test might provide an objective parameter to corroborate a clinical diagnosis of blast- induced TBI.