EValuation Of Longitudinal outcomes in mild TBI Active-Duty Military and VEterans 10-Year

项目摘要/摘要- PI：C。Mac Donald - EVOLVE-10研究 战时受伤的长期临床影响仍然没有完全描述1，2。先前的研究 主要基于自我报告和筛选工具3-6来定义TBI，而不是直接的临床评估。 在受伤时确定并进行前瞻性研究的队列。作为我们先前努力的一部分， 成功完成了直接招募现役美军的前瞻性、观察性、纵向研究 在阿富汗战区，并在0-7天后医疗后送至德国的Landstuhl （中位数4）17、18、0-30天（中位数7-9）19、20和0-90天（中位数14）21-23天，在1- 到目前为止，18-22年和5年24，25的结果。我们仍然是迄今为止唯一的研究， 现役美军从战斗中直接脑震荡损伤到高级MR的长期结局 成像和临床评价。我们将在当前提案中利用这一特征明确的队列， 研究在部署期间持续的轻度震荡性创伤性脑损伤（TBI）的长期影响， 美国军事人员使用先进的磁共振成像和临床结果的措施。我们将把这些 前瞻性采集的纵向成像和临床数据的急性，亚急性， 早期慢性阶段后战斗脑震荡收集这些科目的一部分，我们以前的努力。我们 假设战斗脑震荡将不同地影响服务人员，我们将能够 确定那些处于持续下滑高风险的国家，而不是那些通过利用 已经在这些患者中收集了大量的早期临床和成像数据，将其与计划的 10-年评价。 具体目标#1：评估10年的神经学、神经心理学和精神病学临床结局， 利用先前获得的纵向数据识别美国军事人员的战斗脑震荡 长期临床结果的预测因素。 具体目标#2：检查战斗后服务人员的10年高级神经成像数据 利用先前获得的纵向数据确定美国军事人员脑震荡的预测因素 长期影像学结果。 具体目标#3：使用潜在生长模型探索受伤后第一个十年的功能轨迹， 了解心理健康症状、认知功能、神经行为症状的演变或解决方案 和脑震荡后的神经影像学检查

Project Summary/Abstract – PI: C. Mac Donald – EVOLVE-10 Study The long-term clinical impact of war-time injuries remains incompletely described 1,2. Previous studies have been based largely on self-report and screening tools 3-6 to define TBI, rather than direct clinical assessments in cohorts identified at the time of injury and prospectively studied. As part of our prior efforts, we have successfully completed prospective, observational, longitudinal studies enrolling active-duty US military directly in the combat theatre in Afghanistan and following medical evacuation to Landstuhl, Germany at 0-7 days (median 4) 17,18, 0-30 days (median 7-9) 19,20, and 0-90 days (median 14) 21-23 post-injury with evaluation at 1- year 18-22 and 5-year 24,25 outcome to date. We remain the only study to date that has prospectively followed active-duty US military from concussive brain injury directly in combat to long-term outcome with advanced MR imaging and clinical evaluation. We will leverage this well characterized cohort in the current proposal to investigate the long-term effects of mild-concussive traumatic brain injury (TBI) sustained during deployment in US military personnel using advanced MR imaging and clinical outcome measures. We will relate these findings to the prospectively acquired longitudinal imaging and clinical data from the acute, sub-acute, and early chronic stages following combat concussion collected on these subjects as part of our prior efforts. We hypothesize that combat concussion will differentially impact service members and that we will be able to identify those at high risk of continued decline verses those with a trajectory of recovery by leveraging the extensive early clinical and imaging data already collected in these very same patients linking it to the planned 10-year evaluation. Specific Aim #1: Assess 10-year neurological, neuropsychological, and psychiatric clinical outcomes of combat concussion in US military personnel leveraging previously acquired longitudinal data to identify predictors of long-term clinical outcome. Specific Aim #2: Examine 10-year advanced neuroimaging data in service members following combat concussion in US military personnel leveraging previously acquired longitudinal data to identify predictors of long-term imaging outcome. Specific Aim #3: Explore functional trajectories over this first decade post-injury using latent growth models to understand evolution or resolution of mental health symptoms, cognitive function, neurobehavioral symptoms and neuroimaging measures following combat concussion.