Neuropsychological Screening of OEF/OIF Veterans in VA Primary Care Mild TBI (mTBI) and mental health disorders have both been associated with cognitive symptoms that may lead to poor functioning and community reintegration in OEF/OIF veterans. Whereas the military is implementing pre-deployment neurocognitive screening of soldiers using the computer-administered Automated Neuropsychological Assessment Metrics (ANAMTM) battery, the VA has no systematic mechanism to detect post-deployment cognitive impairment in returned combat veterans. The 4-item VA TBI screen includes questions about "memory problems," but the screen has never been validated and most veterans are not asked about cognitive problems because the screen terminates and is "negative" if antecedent items are not endorsed. Further, many OEF/OIF veterans with positive TBI screens are lost-to-follow-up and many of those who follow-up are found to have "false-positive" screens because instead of a history of mTBI, many are found to have mental health problems. Thus, a high proportion of OEF/OIF veterans with cognitive problems likely go undetected or results are misattributed to mTBI which may mitigate opportunities for appropriate risk communication, triage and early targeted interventions, potentially increasing risk for prolonged disability. Our long-term goal is to promote early accurate detection and triage for current physical, cognitive, and mental health symptoms in OEF/OIF veterans to prevent long-term disability. The short-term goal of this proposal is to investigate the extent to which the VA TBI screening process may fail to detect or accurately identify the source of cognitive dysfunction and other postconcussive symptoms, limiting VA clinicians'ability to optimally communicate, triage and provide targeted services for OEF/OIF veterans. Through secondary data analyses of VA national-level data , we will test the following hypotheses: (1) Cognitive symptoms, namely memory deficits, are among the most frequently reported postconcussive symptoms in veterans with positive TBI screens;(2) Veterans who endorse current "memory problems" in the context of a positive TBI screen will be more likely to have diagnoses of PTSD or depression with or without mTBI than mTBI alone on second-level evaluation and (3) A minority of veterans that screens positive for mTBI attends second-level neurological evaluation and lack of follow-up is independently associated with individual and system-level factors. We will also conduct a cross-sectional study of 250 OEF/OIF veterans seeking VA primary care who do and do not screen positive for TBI on first-level VA TBI screen and who complete standard post-deployment mental health assessments. We hypothesize that in addition to mental health assessment that: (1) It is feasible to administer the brief 22-item Neurobehavioral Symptom Inventory (NSI) and the ANAMTM to OEF/OIF veterans seeking VA primary care;(2) At least 20% of veterans who screen negative for TBI on the first-level TBI screen will report cognitive symptoms on the NSI and/or will demonstrate cognitive dysfunction on the ANAM or traditional neuropsychological testing;(3) ANAMTM test results have a sufficiently high correlation with traditional neuropsychological test results to be used as a screening tool for objective cognitive impairment in primary care patients with concerning cognitive symptoms, and (4) Cognitive symptoms and objective cognitive dysfunction are independently associated both with a history of mTBI and mental health disorders and mediate the relationship of each with daily functioning and community reintegration. If successful, results from this study may be applied in translation to the VA primary care setting to improve VA's ability to efficiently and accurately assess and triage OEF/OIF veterans.

Public Health Relevance

Neuropsychological Screening of OEF/OIF Veterans in VA Primary Care Mild traumatic brain injury (mTBI), mental health disorders and deployment have been associated with cognitive dysfunction which may lead to poor functioning and community reintegration in OEF/OIF veterans. Our long- term goal is to promote early accurate detection and appropriate triage for postconcussive symptoms in OEF/OIF veterans to prevent long-term disability. The short-term goal of this proposal is to investigate the extent to which the VA TBI screening process may fail to detect or accurately identify the source of cognitive dysfunction and other post-concussive symptoms, limiting VA clinicians'ability to optimally communicate, triage and provide targeted services for OEF/OIF veterans. We will assess the feasibility of conducting integrated primary care-based screening for a history of mTBI, postconcussive symptoms using the Neurobehavioral Symptom Inventory and objective cognitive dysfunction using the brief, computer-administered Automated Neurocognitive Assessment MetricsTM in conjunction with post-deployment mental health screening.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Type
Non-HHS Research Projects (I01)
Project #
5I01HX000277-03
Application #
8600185
Study Section
HSR-2 Determinants of Patient Response to Care (HSR2)
Project Start
2010-10-01
Project End
2014-09-30
Budget Start
2012-10-01
Budget End
2013-09-30
Support Year
3
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Veterans Affairs Medical Center San Francisco
Department
Type
DUNS #
078763885
City
San Francisco
State
CA
Country
United States
Zip Code
94121