Executive Functioning in OEF/OIF Veterans with Traumatic Brain Injury

描述(由申请人提供)： 项目摘要/摘要创伤性脑损伤是从伊拉克和阿富汗返回的大量军事人员的一个严重的健康问题。不幸的是，许多因暴露在爆炸或其他事故中而导致轻微创伤性脑损伤的人，由于其损伤的微妙性质，没有得到适当的评估和治疗。此外，与轻度创伤性脑损伤相关的大脑变化通常无法用标准的脑成像技术发现。其他问题，如共存的情绪障碍、可能的精神残疾的耻辱、他们的年轻，以及对这种认知变化的缺乏认识，都可能影响结果并使康复进一步复杂化。目前的研究建议对患有轻度创伤性脑损伤的退伍军人进行一系列全面的测试，以记录推理和解决问题等认知技能的障碍。当我们的老病人试图重返工作和学校时，这些能力是至关重要的。此外，我们将使用一种最近开发的MRI脑成像形式，称为扩散张量成像，它可以识别标准MRI扫描无法检测到的细微大脑变化。通过这种方式，我们将能够识别认知缺陷及其与脑损伤的关系。这项研究将帮助我们理清由其他共存症状引起的困难，如情绪障碍，以及那些直接源于大脑创伤的问题。我们迫切需要改进对患有创伤性脑损伤的退伍军人的诊断和治疗。这项研究的数据将提供有关轻度创伤性脑损伤患者的特征认知特征的重要信息，并为VA系统内的适当诊断和治疗程序提供指导。此外，这项研究的发现将澄清这一患者组认知缺陷的大脑基础。 公共卫生相关性： 项目简介目前的研究旨在确定和描述从伊拉克和阿富汗返回的退伍军人在经历爆炸和其他事故后遭受轻微创伤性脑损伤的缺陷范围。由于与轻度创伤性脑损伤相关的缺陷的微妙程度，患者往往没有得到充分的评估或诊断。当他们试图重返工作或学校时，我们的许多退伍军人都会因为记忆力、注意力和其他思考能力的丧失而遇到困难。由于这一组患者传统上使用的许多标准化任务对他们缺陷的微妙性质不敏感，我们将使用更类似于日常任务的新测试来测试患者。此外，我们将使用一种名为扩散张量成像的新形式的MRI脑成像，它将使我们能够检测到这一患者组中用标准临床扫描无法检测到的细微脑变化。通过这种方式，我们可以帮助确定轻度创伤性脑损伤退伍军人缺陷的神经学基础，并将这些神经学原因与其他心理原因(如情绪变化)分开。这项研究的数据将可直接翻译到临床领域，因为它将提供有关轻度创伤患者的特征认知特征的关键信息，并为VA系统内的适当诊断和治疗程序提供指导。这项研究的实验结果可以直接用于帮助轻度创伤患者设计新的康复策略。这些发现将为最终提高患者解决问题和多任务处理能力的策略提供基础，这反过来将促进他们重返工作和学校的能力。这项研究的脑成像结果将为改进退伍军人管理局轻度创伤性脑损伤的诊断提供基础，并澄清这一患者组认知缺陷的大脑基础。

DESCRIPTION (provided by applicant): Project Summary/Abstract Traumatic brain injury is a significant health problem in a large number of military personnel returning from Iraq and Afghanistan. Unfortunately, many individuals with mild traumatic brain injuries stemming from exposure to blasts or other accidents do not get properly evaluated and treated, due to the subtle nature of their injuries. Moreover, the brain changes associated with mild traumatic brain injury often go undetected with standard brain imaging. Other issues, such as coexisting emotional disorders, the stigma of a possible mental disability, their young age, and the lack of awareness of such cognitive changes, can each affect outcome and further complicate recovery. The current study proposes to conduct a comprehensive battery of tests in returning veterans with mild traumatic brain injury in order to document impairments in cognitive skills, such as reasoning and problem solving. Such abilities are critical as our veteran patients attempt to return to work and school. In addition, we will use a recently developed form of MRI brain imaging, known as diffusion tensor imaging, which can identify subtle brain changes that are not detected with standard MRI scans. In this way, we will be able to identify cognitive deficits and their relationship to brain injury in this patient group. This study will help us to disentangle difficulties stemming from other co-existing symptoms, such as emotional disorders, versus those problems stemming directly from trauma to the brain. Improved diagnostics and treatment for our veteran patients with traumatic brain injury is critically needed. Data from this study will provide important information regarding the characteristic cognitive profile of patients with mild traumatic brain injury and provide direction for proper diagnostic and treatment procedures within the VA system. Moreover, findings from this study will clarify the brain basis of cognitive deficits in this patient group. PUBLIC HEALTH RELEVANCE: Project Narrative The current study is aimed at identifying and characterizing the range of deficits experienced by veterans returning from Iraq and Afghanistan who have sustained mild traumatic brain injuries following exposure to blasts and other accidents. Due to the subtlety of deficits associated with mild traumatic brain injury, patients are often not adequately evaluated or diagnosed. When they attempt to return to work or school, many of our veterans experience difficulty due to lapses in memory, concentration, and other thinking skills. Since many of the standardized tasks traditionally used with this patient group are not sensitive to the subtle nature of their deficits, we will test patients on newer tests that are more similar to everyday tasks. In addition, we will use a new form of MRI brain imaging, called diffusion tensor imaging, that will allow us to detect subtle brain changes in this patient group that cannot be detected with standard clinical scans. In this way, we can help identify the neurologic basis of deficits in veterans with mild traumatic brain injury and disentangle these neurologic causes from other psychological causes, such as emotional changes. Data from this study will be directly translatable into the clinical realm, as it will provide critical information regarding the characteristic cognitive profile of patients with mild traumatic injury and provide direction for proper diagnostic and treatment procedures within the VA system. Experimental findings from this study can be directly used to aid in devising new strategies for rehabilitation in patients with mild traumatic injury. The findings will provide a basis for strategies to ultimately improve our patients' problem solving and multi-tasking abilities, which will in turn facilitate their ability to return to work and school. Brain imaging findings from this study will provide the basis for improved diagnostics for mild traumatic brain injury at the VA, as well as clarify the brain basis of cognitive deficits in this patient group.