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

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SUMMARY The Chronic Effects of Neurotrauma Consortium (CENC) has been a highly productive, coordinated, multicenter, basic science-to-bedside, research collaboration jointly funded since 2013 by the Department of Defense and the Veterans Administration (VA). CENC linked basic, translational, epidemiologic, and clinical neuroscience researchers from the VA, military, academia, and private sector to effectively address the diagnostic challenges and therapeutic ramifications of mild traumatic brain injury (mTBI) and its potential long- term effects. Experienced and proven researchers from the CENC comprise the LIMBIC team at the level of Consortium Leadership, Core Facilities, and Research Study Directors. This proven team of leaders, infrastructure supporters and researchers will initiate targeted, expanded research studies that extend CENC research findings, address all priorities (required and secondary research elements) detailed in the program announcement, and will produce deliverables for the clinicians in the field. The Neuroimaging Core is one of four coordinated Core efforts that support the longitudinal observational and other studies in this proposal. These Cores (Biomarkers, Neuroimaging, Data and Biostatistics, Clinical Studies) will work in concert to accomplish three overarching, interrelated aims: Aim 1. Transition and expand CENC to LIMBIC -- Enroll and expand sizes of relevant cohorts of Veterans (Vs) and Service Members (SMs); expand data points collected; collect data in accordance with established guidelines; and identify and describe key characteristics of populations to guide rigorous studies on the nature and degree of mTBI late effects in combat Vs/SMs over time. Aim 2. Comorbidities & neurologic sequela -- Determine prevalence and associations of mTBI with important comorbidities and neurologic sequela, such as dementia and neurodegenerative disease, pain, psychological health including PTSD, and neurosensory deficits, and determine nature and degree of mTBI late effects over time. Specific to the Neuroimaging Core, we will examine findings from conventional and more advanced magnetic resonance imaging (MRI) to elucidate imaging-related findings most predictive of associated outcomes, biomarkers and neurodegenerative disease or functional decline. Aim 3. Phenotypes -- Identify characteristics (e.g., repetitive mTBI, deployment-only mTBI, frequent low level blast or other subconconcussive head/brain impact exposure, baseline neurocognitive deficits, presence of neurologic signs, presence of symptoms), pathophysiology, biomarkers, and subpopulations (e.g., women) that serve as risk or protective factors for long-term outcomes such as neurodegeneration, symptom burden and health economics. The Neuroimaging Core will assist in exploration of the utility of neuroimaging in clinical diagnosis, prognosis, injury/disease course monitoring, individualized treatment planning and evaluation of treatment response in Veterans and Service Members with TBI. Additionally, the Neuroimaging Core will seek to identify neuroimaging signatures that may be predictive of long-term outcomes and healthcare utilization. LIMBIC will continue the mission and lines of research begun by CENC, which has Veterans, Service Members, and their family members at the center of the work performed, to develop, deploy, and disseminate patient-centered health care tools and strategies. Work conducted to date has expanded knowledge in the areas of chronic pain, sleep, sensory disorders, psychological health, and return to work. Knowledge translation underway includes improving both care and systems of care to the population, translatable to both military and the general public populations. We are poised to achieve LIMBIC’s intent to “improve acute TBI care and subsequent support systems for chronic care following mTBI”.