Objective Diagnosis of Mild Blast-Induced TBI

总结 与中东部署有关的轻度TBI在我们的士兵中很猖獗。兰德公司 公司估计，我们的320,000名士兵可能经历了至少轻微的TBI。 即使在轻度TBI（占所有TBI病例的80%）中，也会对大脑造成损伤，导致 显著的行为和认知变化。退伍军人经常报告性格的变化，包括 易怒和侵略性，记忆力丧失和效率丧失。这些问题往往 永久的 轻度TBI的诊断非常具有挑战性，因为没有明显的神经系统损害。 比如瘫痪轻度TBI的诊断也很复杂，因为这种疾病 经常与创伤后应激障碍（PTSD）的症状一起发生，其中包括 焦虑和抑郁，分别出现在44%和27%的轻度TBI士兵中。 PTSD和抑郁症可以独立地降低认知和行为表现， 在轻度至中度的患者中， 中度脑外伤因此，这些心理因素可能很难与 对大脑本身的物理损伤的后果。这一错综复杂的因素大大增加了 诊断不精确的风险，特别是当使用纯粹主观的报告来评估状态时 心理健康。由于未能建立正确的残疾状况， 在没有充分解释其残疾的情况下，并妨碍适当提供医疗服务。 该提案旨在开发一种新的便携式眼动测试， 为TBI的诊断提供了客观的方法。有大量证据表明这种眼睛 运动试验将被证明在诊断较轻的TBI病例中特别有价值， 否则就无法识别。将对对照受试者进行这组眼动测试， 退伍军人谁已被诊断为创伤性脑损伤的神经认知科学家在波士顿弗吉尼亚州。的 这项拨款中提出的临床研究旨在确定这种新测试的程度 预测TBI的存在和暴露于爆炸物的严重程度。 鉴于有机会开发这种新的测试仪器，我们的长期目标是使用这种新的， 便携式眼动测试作为一种筛查工具，将在部署前进行 与其他基本体检同时进行。同样的测试也会在 “部署后”的那些士兵谁是暴露在爆炸。前与后的某些差异。 部署后测试可提供客观参数，以证实爆炸的临床诊断， 诱发TBI。

Summary Mild TBI related to deployment in the Middle East is rampant among our soldiers. The RAND Corporation has estimated that 320,000 of our soldiers may have experienced at least mild TBI. Even in mild TBI, which accounts for 80% of all TBI cases, causes damage to the brain that results in significant behavioral and cognitive changes. Veterans often report changes in personality, including irritability and aggression, loss of memory and loss of effectiveness. These problems are often permanent. The diagnosis of mild TBI is very challenging because there are no grossly evident neurological findings, like paralysis. The diagnosis of mild TBI is also complicated because this disorder frequently occurs together with the symptoms of post-traumatic stress disorder (PTSD), which include anxiety and depression, which are present in 44 and 27%, respectively, in soldiers with mild TBI. PTSD and depression can independently degrade cognitive and behavioral performance, and they can both exacerbate both the subjective complaints and objective cognitive deficits in mild to moderate TBI. Consequently, these psychological factors can be difficult to separate from the consequences of physical injury to the brain itself. This tangle of factors substantially increases the risk of diagnostic imprecision, particularly when purely subjective reports is used to assess the state of psychological health. Failure to establish the correct profile of disabilities leaves affected soldiers without a full explanation for their disabilities and hinders appropriate delivery of medical care. This proposal seeks to develop a new and portable eye movement test that has the potential to provide an objective method to diagnose TBI. There is substantial evidence that this type of eye movement test will prove especially valuable in the diagnosis of the milder cases of TBI which could otherwise go unrecognized. This battery of eye movement tests will be given to control subjects and veterans who have been diagnosed with TBI by the Neuro-Cognitive scientists at the Boston VA. The clinical study that is proposed in this grant seeks to determine the degree to which this new test predicts the presence of TBI and the severity of exposure to blasts. Given the opportunity to develop this new test instrument, our long-range goal is to use this new and portable eye movement test as a screening tool that would be administered "pre-deployment" at the same time as other basic medical examinations are being given. The same test would then be given "post-deployment" for those soldiers who were exposed to a blast. Certain differences in the pre- vs. post-deployment test might provide an objective parameter to corroborate a clinical diagnosis of blast- induced TBI.