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

 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伤口，并对这些伤害对我们的退伍军人的长期影响提出了担忧。虽然中度至重度脑损伤与痴呆、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功能有长期影响。这种对神经创伤慢性影响的日益认识导致迫切需要研究遭受这些类型伤害的伊拉克/阿富汗退伍军人（IAV），包括多次爆炸相关的轻度TBI。虽然认知功能障碍如痴呆和轻度认知障碍（MCI）是老年人中一个重要且日益严重的问题，但在IAV年龄范围内的成年人（平均年龄约36岁）中很少见，但由于IAV人群中轻度TBI的高患病率，因此仍然是一个重要的问题。到目前为止，观察性研究还没有能力检查轻度TBI与年轻人中的痴呆和MCI等罕见疾病之间的联系，并且使用VA临床遭遇的现有数据进行的基于人群的研究受到这些诊断有效性的限制。国家研究行动计划强调需要了解轻度TBI与痴呆和MCI等长期结果的关系，以便退伍军人事务部能够为我们的伊拉克/阿富汗退伍军人的需求制定计划，并提供高质量的护理。拟议研究的长期目标是使用病例对照研究解决这些问题，该研究采用DoD数据，VA数据和电话访谈，以确定部署相关轻度TBI患者中痴呆和MCI的风险，考虑终身TBI暴露，部署和非部署经验，以及其他共病条件，如中风。然而，在有效地进行这样的研究之前，需要在这个年轻的VA人群中验证痴呆和MCI的诊断。为了解决这一知识差距，我们召集了一个具有流行病学，神经心理学，神经学，物理学和卫生服务研究专业知识的跨学科团队，以验证伊拉克/阿富汗退伍军人中早发性痴呆（EOD）和MCI的诊断，并开发用于EOD/MCI人群研究的算法。我们还将描述与经验证的EOD/MCI诊断相关的患者特征。我们假设，在那些诊断为EOD/MCI的中重度TBI患者中，与类似的IAV轻度TBI患者相比，EOD/MCI诊断更有可能得到验证。本研究将开发一个队列，可用于更大的流行病学研究，以检查部署相关的轻度TBI对EOD/MCI的影响，同时控制终身TBI暴露。此外，本研究中使用的程序将有助于为基于人口的研究开发识别爆炸物/MCI的可靠算法。这些研究的结果将告知国防部和退伍军人管理局医疗保健系统未来提供高质量护理所需的资源。

 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.