Neural and Cognitive Sequelae of Blast-Induced Traumatic Brain Injury

描述（由申请人提供）： 摘要：创伤性脑损伤（Traumatic brain injury，TBI）是伊拉克战争中最常见的损伤，随着简易爆炸装置使用的增加，大部分战争相关脑损伤是爆炸引起的闭合性脑损伤。bTBI患者中与压力相关的精神共病（特别是PTSD和抑郁症）的高发病率为诊断提出了独特的挑战。轻度创伤性脑损伤和压力相关的精神症状导致相似的临床表现以及相似的认知神经心理障碍。重叠的神经和精神疾病对神经心理和功能结果的影响仍然不清楚，更好地了解他们的个人贡献和相互作用是至关重要的，为遭受冲击伤的患者制定最佳的干预策略。 扩散张量成像（DTI）是一种测量白色物质功能完整性的神经成像技术，已被证明对轻度非冲击波TBI后的细微变化特别敏感。在这里，我们使用DTI作为一种手段，量化爆炸暴露造成的神经损伤，并评估其效用在解开的贡献轻度bTBI和精神科共病的星座认知和功能缺陷的军事人员与爆炸伤。 拟议研究的具体目标有四个方面。首先，本研究旨在描述与轻度bTBI相关的白色物质异常，无论是原发性冲击波还是继发性/三级损伤，并评估是否存在弥散异常是TBI唯一诊断标志物的区域，而不是精神症状。其次，本研究旨在评估所观察到的微结构白色物质异常的功能意义。我们假设注意力/执行功能、记忆力和精神速度领域的表现与TBI相关的弥散异常有关，并且认知表现与这些白色物质异常之间的关系将受到精神共病的存在的调节。第三，该研究旨在揭示bTBI后认知功能和生活质量的最佳预测因素，同时考虑到bTBI相关扩散异常和精神共病的贡献可能因爆炸负荷和其他损伤相关变量而异。最后，该研究旨在研究弥散异常和精神共病与长期认知和功能结局的关系，并在9个月随访时进行评估。 这项研究不仅有可能为与bTBI相关的神经变化提供敏感的诊断标志物，而且还可以大大提高我们对神经和精神异常对与爆炸伤相关的认知和功能障碍的贡献的理解。

DESCRIPTION (provided by applicant): Abstract: Traumatic brain injury (TBI) is the most common injury of the Iraq war, and with the increased use of improvised explosive devices, a majority of war-related brain injuries are closed head injuries that result from blast. The high incidence of stress-related psychiatric co-morbidities (in particular, PTSD and depression) in individuals with bTBI raises unique challenges for diagnosis. Mild TBI and stress-related psychiatric symptoms lead to similar clinical presentations as well as to similar cognitive neuropsychological impairments. The impact of overlapping neurologic and psychiatric conditions on neuropsychological and functional outcome remains unclear and a better understanding of their individual contributions and interactions is critical to the development of optimal intervention strategies for patients who suffered blast injury. Diffusion tensor imaging (DTI), a neuroimaging technique that measures the functional integrity of white matter, has proven to be especially sensitive to the subtle changes following mild non-blast TBI. Here we use DTI as a means of quantifying neural injury resulting from blast exposure and evaluate its utility in disentangling the contribution of mild bTBI and psychiatric co-morbidities to the constellation of cognitive and functional deficits seen in military personnel with blast injury. The specific goals of the proposed research are four-fold. First, this study aims to characterize the white matter abnormalities associated with mild bTBI, whether from primary blast or secondary/tertiary injury, and to evaluate whether there are regions in which diffusion abnormalities are unique diagnostic markers of TBI, and not of psychiatric symptoms. Second, this study aims to evaluate the functional significance of the observed microstructural white matter abnormalities. We hypothesize that performance in the domains of attention/executive function, memory, and psychomotor speed will be related to TBI-associated diffusion abnormalities, and that the relationship between cognitive performance and these white matter abnormalities will be moderated by the presence of psychiatric co-morbidities. Third, the study aims to uncover optimal predictors of cognitive functioning and quality of life following bTBI, taking into account that the contribution of bTBI-associated diffusion abnormalities and psychiatric co-morbidities may differ as a function of blast load and other injury-related variables. Finally, the study aims to examine how diffusion abnormalities and psychiatric co-morbidities are related to long-term cognitive and functional outcome, assessed at 9-month follow-up. This research has the potential not only to provide a sensitive diagnostic marker for neural changes associated with bTBI, but also to greatly enhance our understanding of the contributions of neural and psychiatric abnormalities to the cognitive and functional impairments associated with blast injury.