VA-DoD Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC): Neuroimaging Core

总结 神经创伤慢性效应联盟（CENC）是一个高效，协调， 自2013年以来，多中心，基础科学到床边，研究合作由美国医学部联合资助。 国防和退伍军人管理局（VA）。CENC将基础、转化、流行病学和临床 来自退伍军人事务部、军方、学术界和私营部门的神经科学研究人员， 轻度创伤性脑损伤（mTBI）的诊断挑战和治疗后果及其潜在的长期 长期影响。来自CENC的经验丰富和久经考验的研究人员组成了LIMBIC团队， 联盟领导、核心设施和研究负责人。这支久经考验的领导团队， 基础设施支持者和研究人员将启动有针对性的、扩大的研究， 研究结果，解决方案中详细说明的所有优先事项（必需和次要研究要素） 公告，并将为该领域的临床医生提供可交付成果。神经影像学核心是 四项协调的核心工作，支持本提案中的纵向观察和其他研究。 这些核心（生物标志物、神经影像学、数据和生物统计学、临床研究）将协同工作， 实现三个相互关联的总体目标： 目标1.过渡和扩大CENC到LIMBIC -招募和扩大相关退伍军人队列的规模 和服务成员（SM）;扩大收集的数据点;根据既定的 确定和描述种群的主要特征，以指导对自然的严格研究 以及随着时间的推移，在战斗V/SM中的mTBI晚期效应的程度。 目标2.共病和神经系统后遗症-确定mTBI的患病率和与重要 合并症和神经系统后遗症，如痴呆和神经退行性疾病，疼痛，心理 健康，包括创伤后应激障碍，和神经感觉缺陷，并确定性质和程度的mTBI后期影响超过 时间具体到神经影像学核心，我们将检查结果从传统的和更先进的 磁共振成像（MRI），以阐明最能预测相关 结果、生物标志物和神经退行性疾病或功能衰退。 目标3：表型-确定特征（例如，重复性mTBI、仅部署mTBI、频繁低水平 冲击波或其他亚震荡性头部/脑部撞击暴露，基线神经认知缺陷， 神经学体征，症状的存在），病理生理学，生物标志物，和亚群（例如，妇女）， 作为长期结果的风险或保护因素，如神经退行性变、症状负担和 卫生经济学。神经影像学核心将有助于探索神经影像学在临床中的应用。 诊断、预后、损伤/病程监测、个体化治疗计划和评估 TBI的退伍军人和服务人员的治疗反应。此外，神经影像学核心将寻求 以识别可能预测长期结果和医疗保健利用的神经影像学特征。 LIMBIC将继续CENC开始的使命和研究路线，CENC拥有退伍军人，服务 成员和他们的家庭成员在中心的工作执行，开发，部署和传播 以患者为中心的医疗保健工具和策略。迄今为止开展的工作扩大了对 慢性疼痛、睡眠、感觉障碍、心理健康和重返工作领域。知识 正在进行的转化包括改善对人口的护理和护理系统， 军队和普通民众。我们准备实现LIMBIC的意图，“改善急性TBI mTBI后慢性护理的护理和后续支持系统”。

SUMMARY The Chronic Effects of Neurotrauma Consortium (CENC) has been a highly productive, coordinated, multicenter, basic science-to-bedside, research collaboration jointly funded since 2013 by the Department of Defense and the Veterans Administration (VA). CENC linked basic, translational, epidemiologic, and clinical neuroscience researchers from the VA, military, academia, and private sector to effectively address the diagnostic challenges and therapeutic ramifications of mild traumatic brain injury (mTBI) and its potential long- term effects. Experienced and proven researchers from the CENC comprise the LIMBIC team at the level of Consortium Leadership, Core Facilities, and Research Study Directors. This proven team of leaders, infrastructure supporters and researchers will initiate targeted, expanded research studies that extend CENC research findings, address all priorities (required and secondary research elements) detailed in the program announcement, and will produce deliverables for the clinicians in the field. The Neuroimaging Core is one of four coordinated Core efforts that support the longitudinal observational and other studies in this proposal. These Cores (Biomarkers, Neuroimaging, Data and Biostatistics, Clinical Studies) will work in concert to accomplish three overarching, interrelated aims: Aim 1. Transition and expand CENC to LIMBIC -- Enroll and expand sizes of relevant cohorts of Veterans (Vs) and Service Members (SMs); expand data points collected; collect data in accordance with established guidelines; and identify and describe key characteristics of populations to guide rigorous studies on the nature and degree of mTBI late effects in combat Vs/SMs over time. Aim 2. Comorbidities & neurologic sequela -- Determine prevalence and associations of mTBI with important comorbidities and neurologic sequela, such as dementia and neurodegenerative disease, pain, psychological health including PTSD, and neurosensory deficits, and determine nature and degree of mTBI late effects over time. Specific to the Neuroimaging Core, we will examine findings from conventional and more advanced magnetic resonance imaging (MRI) to elucidate imaging-related findings most predictive of associated outcomes, biomarkers and neurodegenerative disease or functional decline. Aim 3. Phenotypes -- Identify characteristics (e.g., repetitive mTBI, deployment-only mTBI, frequent low level blast or other subconconcussive head/brain impact exposure, baseline neurocognitive deficits, presence of neurologic signs, presence of symptoms), pathophysiology, biomarkers, and subpopulations (e.g., women) that serve as risk or protective factors for long-term outcomes such as neurodegeneration, symptom burden and health economics. The Neuroimaging Core will assist in exploration of the utility of neuroimaging in clinical diagnosis, prognosis, injury/disease course monitoring, individualized treatment planning and evaluation of treatment response in Veterans and Service Members with TBI. Additionally, the Neuroimaging Core will seek to identify neuroimaging signatures that may be predictive of long-term outcomes and healthcare utilization. LIMBIC will continue the mission and lines of research begun by CENC, which has Veterans, Service Members, and their family members at the center of the work performed, to develop, deploy, and disseminate patient-centered health care tools and strategies. Work conducted to date has expanded knowledge in the areas of chronic pain, sleep, sensory disorders, psychological health, and return to work. Knowledge translation underway includes improving both care and systems of care to the population, translatable to both military and the general public populations. We are poised to achieve LIMBIC’s intent to “improve acute TBI care and subsequent support systems for chronic care following mTBI”.