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

VA-DoD 军事相关脑损伤联盟 (LIMBIC) 的长期影响：神经影像核心

• 批准号: 10001813
• 负责人: Elisabeth A Wilde
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 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/10001813
• 关键词: Academia; Acute; Address; Area; Basic Science; Biological Markers; Biometry; Brain; Brain Injuries; Caring; Characteristics; Chronic; Chronic Care; Clinical; Clinical Research; Cognitive; Collaborations; Collection; Core Facility; Data; Dementia; Department of Defense; Development; Diagnostic; Diffusion; Disease; Elements; Enrollment; Epidemiology; Evaluation; Family member; Functional disorder; Funding; General Population; Guidelines; Head; Healthcare; Image; Imaging Techniques; Infrastructure; Injury; Knowledge; Late Effects; Leadership; Link; Long-Term Effects; Magnetic Resonance Imaging; Mental Health; Military Personnel; Mission; Monitor; NIH Program Announcements; Nature; Nerve Degeneration; Nervous System Trauma; Neurocognitive Deficit; Neurodegenerative Disorders; Neurologic; Neurologic Signs; Neurosciences; Outcome; Pain; Phenotype; Population; Population Characteristics; Post-Traumatic Stress Disorders; Prevalence; Private Sector; Research; Research Personnel; Risk Factors; Sensory Disorders; Sleep; Support System; Symptoms; Therapeutic; Time; United States Department of Veterans Affairs; Veterans; Woman; Work; care systems; chronic pain; clinical Diagnosis; cohort; combat; comorbidity; experience; functional decline; functional outcomes; health care service utilization; health economics; improved; individualized medicine; knowledge translation; mild traumatic brain injury; neuroimaging; neurosensory; outcome forecast; patient oriented; perfusion imaging; protective factors; research study; service member; tool; treatment planning; treatment response

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”.

摘要 神经创伤联合会(CENC)的慢性影响一直是一个高效、协调、 多中心、基础科学到床边的研究合作，自2013年以来由新闻部共同资助 国防和退伍军人管理局(VA)。CENC将基础、翻译、流行病学和临床联系起来 来自退伍军人事务部、军方、学术界和私营部门的神经科学研究人员有效地解决 轻度创伤性脑损伤(MTBI)的诊断挑战和治疗后果及其潜在的长期 期限效应。来自CENC的经验丰富和久经考验的研究人员组成了一个级别为 财团领导力、核心设施和研究项目总监。这支久经考验的领导团队， 基础设施支持者和研究人员将启动有针对性的、扩展的研究，以扩展CENC 研究结果，解决计划中详细说明的所有优先事项(必需的和次要的研究要素) 宣布，并将为该领域的临床医生提供交付成果。神经成像核心是 四项协调的核心工作，支持本提案中的纵向、观察性和其他研究。 这些核心(生物标记物、神经成像、数据和生物统计学、临床研究)将协同工作 实现三个相互关联的首要目标： 目标1.向边缘过渡和扩大CENC--招募和扩大退伍军人(V)相关队列的规模 和服务成员(短信)；扩展收集的数据点；按照既定的标准收集数据 指导方针；确定和描述人口的主要特征，以指导对自然的严格研究 以及随着时间的推移，mTBI在战斗中对VS/SMS的迟发影响程度。 目的2.合并症和神经系统后遗症--确定mTBI的患病率及其与重要的 合并症和神经后遗症，如痴呆症和神经退行性疾病，疼痛，心理 健康，包括创伤后应激障碍和神经感觉障碍，并确定mTBI后遗症的性质和程度 时间到了。具体到神经成像核心，我们将检查来自常规和更高级的发现 磁共振成像(MRI)阐明与成像相关的最具预测性的相关发现 结果、生物标志物和神经退行性疾病或功能衰退。 目标3.表型--确定特征(例如，重复的mTBI、仅部署的mTBI、频繁的低水平 冲击波或其他亚缩性头部/脑撞击暴露，基线神经认知障碍，存在 神经学体征、症状的存在)、病理生理学、生物标志物和亚群(例如，女性) 作为长期结果的风险或保护因素，如神经变性、症状负担和 健康经济学。神经成像核心将有助于探索神经成像在临床上的应用 诊断、预后、损伤/病程监测、个体化治疗计划和评估 退伍军人和军人合并脑外伤的治疗反应。此外，神经成像核心将寻求 以确定可能预测长期结果和医疗保健利用的神经成像特征。 Limbic将继续由CENC开始的使命和研究路线，CENC拥有退伍军人服务 成员及其在工作中处于中心地位的家庭成员，开发、部署和传播 以患者为中心的保健工具和策略。到目前为止进行的工作扩大了对 慢性疼痛、睡眠、感觉障碍、心理健康和重返工作岗位。知识 正在进行的翻译包括改善对人口的护理和护理系统，两者都可以翻译 军队和普通民众。我们已经做好准备，要实现利贝克的意图，即“改善急性脑外伤 MTBI后的慢性护理和后续支持系统“。