Web-based Visual and Cognitive Screening Battery for Rural OEF/OIF/OND Veterans

该提案旨在开发一种新的基于网络的筛选电池来测试视觉和认知功能。 列举了五项测试对比敏感度、视觉处理速度、注意力、执行功能的任务， 和记忆，拟议的电池将1）解决几个重要的知识差距， OEF/OIF/OND退伍军人的认知功能，包括视觉和视觉功能缺陷的协变， 认知领域和潜在的地理差异和2）提供一个具有成本效益的方法来筛选 美国农村地区的退伍军人，为这些服务不足的人群改善医疗服务。 本提案的培训部分也将促进申请人的长期职业目标， 一个全职的完全资助的独立调查员在退伍军人事务部，利用基础科学研究领域的视野 科学和神经心理学，并将这些发现转化为新的筛选方法， 在远程医疗中实施，以改善农村和城市地区所有退伍军人的医疗保健服务。 培训目标包括：1）最先进的视觉功能和认知心理测量评估培训， 2）神经心理学培训，以了解视觉和 认知缺陷与OEF/OIF/OND退伍军人的心理和身体健康问题有关，3）增加 候选人的国家的最先进的基于Web的编程技术的熟练程度，和4）允许候选人 通过成功地通过竞争择优资助， VA或其他非VA融资机会（即，NIH）。 设计与方法：第一阶段的建议（目标1）涉及开发和主办的筛选 基于网络的认知测试平台TestMyBrain上的电池，将从 超过15，000名美国志愿者（全球约50，000人）沿着WHODAS调查，以评估功能性残疾 在六个领域和人口统计问题评估目前的军事或退伍军人地位和访问 保健服务。在该提案的第二阶段（目标2），我们将招募和测试120名自由行动部队/自由行动部队/国家国防部 来自VA波士顿社区的退伍军人将组成三个群体：视力缺陷的退伍军人，退伍军人 有认知缺陷的人和对照组的退伍军人这些参与者将完成电池四次 两次在我们的实验室里，两次在他们自己的家里。来自拟定试验和其他试验的数据 将使用神经心理学测量来评估筛选测量的可靠性和有效性。 最后，分析了农村和城市参与者以及退伍军人与平民之间的地理差异， 与会者将在这一数据集上完成初步需求评估（目标3）。 目标1：开发一个基于网络的视觉和认知测试软件程序， 标准的年龄价值观。假设1a：基于网络的寿命趋势和峰值性能年龄 测量值将与相应临床评估的已发表值相匹配。假设1b：经方差调整 视觉和认知评估的表现将与测量的功能结果相关， 在WHODAS问卷上。假设1c：将视觉和视觉上的表现指标结合起来， 认知领域预测功能结果的能力要优于单独使用这两个领域中的任何一个。 目的2：比较基于网络和基于实验室的测试，以评估基于网络的测试的信度和效度。 措施假设2a：测量在时间和环境上具有高可靠性（可靠性> 0.7）。 假设2b：与标准筛查工具类似，测量的诊断准确性> 0.6， 将退伍军人组分类（对照组、视觉缺陷组、认知缺陷组）。目标3：区域特征 性能差异以及与功能结局和医疗保健可及性的关系。假设三： 在平民中，经性别调整的性能指标将显示与功能结果的更强相关性， 生活在农村地区的退伍军人。这种相关性将通过自我报告的获得医疗保健来介导。

This proposal aims to develop a novel web-based screening battery to test visual and cognitive functioning. Incorporating five tasks that test contrast sensitivity, visual processing speed, attention, executive functioning, and memory, the proposed battery will 1) address several important knowledge gaps regarding visual and cognitive functioning in OEF/OIF/OND Veterans, including covariation in deficits across the visual and cognitive domains and potential geographical disparities and 2) provide a cost-effective approach to screen Veterans in rural regions of the United States, improving healthcare services for this under-served population. The training portion of this proposal will also facilitate the applicant’s long-term career goal of becoming a full-time fully funded independent investigator at the VA, utilizing basic science research in the fields of vision science and neuropsychology and translating these findings into novel screening methods that can be implemented within telemedicine to improve healthcare access for all Veterans, both in rural and urban regions. The training aims include: 1) training in state of the art visual function and cognitive psychometric assessments, and services and implementation research 2) training in neuropsychology to understand how visual and cognitive deficits relate to OEF/OIF/OND Veteran’s mental and physical health issues , 3) Increasing the candidate’s proficiency in state-of-the-art web-based programming techniques, and 4) allowing the candidate to progress to an independent investigator status through successfully competing for merit funding through the VA or other non-VA funding opportunities (i.e., NIH). DESIGN & METHOD: The first phase of the proposal (Aim 1) involves developing and hosting the screening battery on the web-based cognitive testing platform TestMyBrain where normative data will be collected from over 15,000 U.S. volunteers (~50,000 worldwide) along with the WHODAS survey to asses functional disability across six domains and demographic questions assessing current military or veteran status and access to healthcare services. In the second phase of the proposal (Aim 2) we will recruit and test 120 OEF/OIF/OND Veterans from the VA Boston community who will make up three groups: Veterans with visual deficit, Veterans with cognitive deficits, and a control group of Veterans. These participants will complete the battery four times over two months, twice in our laboratory and twice in their own homes. Data from the proposed tests and other neuropsychological measures will be used to assess the reliability and validity of the screening measures. Finally, geographical disparities analyses between rural and urban participants and Veteran vs. civilian participants will be completed on this dataset for preliminary needs assessment (Aim 3). OBJECTIVES: Aim 1: Develop a web-based visual and cognitive testing software program and determine normative age-based values. Hypothesis 1a: Lifespan trends and age-of-peak performance on our web-based measures will match published values from corresponding clinical assessments. Hypothesis 1b: Age-adjusted performance on the visual and cognitive assessments will be correlated with functional outcomes as measured on the WHODAS questionnaire. Hypothesis 1c: Combining performance measures across the visual and cognitive domains will predict functional outcomes better than performance measures in either domain alone. Aim 2: Compare web-based to lab-based testing to assess the reliability and validity of the web-based measures. Hypothesis 2a: Measurements will have high reliability across time and setting (reliability > 0.7). Hypothesis 2b: Similar to standard screening tools, measurements will have diagnostic accuracy > 0.6 in classifying the Veteran group (Control, Visual Deficit, Cognitive Deficit). Aim 3: Characterize regional differences in performance and relationship to functional outcomes and healthcare access. Hypothesis 3: Age-adjusted performance measures will show stronger correlations with functional outcomes in civilians and Veterans living in rural regions. This correlation will be mediated by self-reported access to healthcare.