Validating Cases of Dementia and Mild Cognitive Impairment in OEF/OIF Veterans

 描述(由申请人提供)： 创伤性脑损伤(TBI)，特别是轻微的脑损伤，已被确定为伊拉克和阿富汗战争的标志性创伤，人们对这些损伤对退伍军人的长期影响表示关注。虽然中度到重度脑损伤与痴呆症、癫痫和运动障碍等疾病有关，但将轻度脑损伤与神经退行性疾病联系起来的证据有限。最近，对足球运动员和拳击手的研究表明，脑震荡和反复的轻微头部损伤对认知功能有长期影响。随着人们对神经创伤慢性影响的认识日益增强，迫切需要研究伊拉克/阿富汗退伍军人(IAV)，他们遭受了这些类型的伤害，包括与多发爆炸相关的轻度脑外伤。虽然认知功能障碍，如痴呆症和轻度认知障碍(MCI)在老年人中是一个严重且日益严重的问题，但在IAV的年龄范围内(平均年龄~36岁)的成年人中这种问题很少见，但由于IAV人群中轻度TBI的高患病率，这仍然是一个令人严重关注的问题。到目前为止，观察性研究还没有被提供动力来检查轻度脑外伤与较年轻个体的罕见疾病(如痴呆症和MCI)之间的联系，而基于人群的研究由于对这些诊断的有效性的担忧而受到限制，这些研究使用了VA临床接触的现有数据。国家研究行动计划强调，需要了解轻度脑外伤与痴呆和MCI等长期后果的关联，以便退伍军人事务部能够为我们伊拉克/阿富汗退伍军人的需求制定计划，并提供高质量的护理。建议的研究路线的长期目标是通过使用国防部数据、退伍军人事务部数据和电话访谈的病例对照研究来解决这些问题，以确定与部署相关的轻度脑损伤患者中痴呆和MCI的风险，考虑终生脑损伤暴露、部署和非部署经历以及其他共病情况，如中风。然而，在有效地进行这样的研究之前，需要对这一年轻的退伍军人群体中的痴呆症和MCI的诊断进行验证。为了解决这一知识差距，我们召集了一个具有流行病学、神经心理学、神经学、生理学和卫生服务研究专业知识的跨学科团队，以验证伊拉克/阿富汗退伍军人中早发性痴呆(EOD)和MCI的诊断，并开发用于EOD/MCI基于人群的研究的算法。我们还将描述与有效的EOD/MCI诊断相关的患者特征。我们推测，在那些诊断为EOD/MCI的患者中，中到重度脑外伤患者比类似的IAV轻度脑损伤患者更有可能确诊为EOD/MCI。这项研究将开发一个队列，可用于更大的流行病学研究，以检查部署相关的轻度脑损伤对EOD/MCI的影响，同时控制终生脑损伤暴露。此外，这项研究中使用的程序将为以人口为基础的研究开发确定EOD/MCI的可靠算法。这些研究结果将向国防部和退伍军人管理局医疗保健系统通报提供高质量医疗保健所需的未来资源。

 DESCRIPTION (provided by applicant): Traumatic brain injury (TBI), particularly mild TBI, has been identified as a signature wound of the wars in Iraq and Afghanistan and concern has been raised about the long-term effects of these injuries on our Veterans. While moderate to severe brain injury has been linked with conditions such as dementia, epilepsy, and movement disorders, the evidence linking mild TBI to neurodegenerative conditions is limited. More recently, studies of football players and boxers have shown long-term effects of concussions and repetitive mild head injuries on cognitive function. This growing awareness of the chronic effects of neurotrauma has led to an urgent need to study the Iraq/Afghanistan Veterans (IAV) who have suffered these types of injuries, including multiple blast related mild TBI. While cognitive dysfunction such as dementia and mild cognitive impairment (MCI) is a significant and growing problem in older adults, it is rare in adults in the age range of IAV (mean age ~36 years), but remains a significant concern due to the high prevalence of mild TBI in the IAV population. To date, observational studies have not been powered to examine the link between mild TBI and rare conditions such as dementia and MCI in younger individuals, and population-based studies using existing data from VA clinical encounters have been limited by concern for the validity of these diagnoses. The National Research Action Plan emphasized the need to understand the association of mild TBI with long-term outcomes such as dementia and MCI so that the Department of Veterans Affairs can plan for the needs of our Iraq/Afghanistan Veterans and provide high quality of care. The long-term goal of the proposed line of research is to address these concerns using a case-control study employing DoD data, VA data and telephone interviews to identify the risk of dementia and MCI among those with deployment-related mild TBI, accounting for lifetime TBI exposure, deployment and non-deployment experiences, and other comorbid conditions such as stroke. However before such a study can be effectively conducted, validation of diagnoses of dementia and MCI in this younger VA population is needed. To address this knowledge gap, we convened an interdisciplinary team with expertise in epidemiology, neuropsychology, neurology, physiatry, and health services research to validate diagnoses of early onset dementia (EOD) and MCI in Iraq/Afghanistan Veterans, and develop algorithms for use in population-based studies of EOD/MCI. We will also describe patient characteristics associated with validated EOD/MCI diagnoses. We hypothesize that among those with diagnoses indicative of EOD/MCI individuals with moderate to severe TBI will be more likely to have validated EOD/MCI diagnoses than similar IAV with mild TBI. This study will develop a cohort that can be used in a larger epidemiological study to examine the impact of deployment related mild TBI on EOD/MCI while controlling for lifetime TBI exposures. Moreover, the process used in this study will allow for development of reliable algorithms for identification of EOD/MCI for population- based research. Findings from these lines of research will inform DoD and VA healthcare systems regarding future resources that will be needed to provide high quality care.