The primary objective of this project is to utilize a variety of existing data sources by integrating and analyzing them in novel ways to answer key questions related to the long-term effects of mild traumatic brain injury (mTBI) in veterans over time. Although prior studies have found that moderate and severe TBI are associated with a variety of adverse clinical outcomes, the effects of mTBI are less well understood. We propose to build on our past several years of work within The Chronic Effects of Neurotrauma Consortium (CENC - Epidemiology Study) in which we have assembled a very large or ?mega? data repository of nearly 2 million veterans (including all veterans with a TBI diagnosis) that comprises multiple different national synthesized databases. We are extremely well positioned to capitalize on this national resource to continue to maximally study veterans with mTBI. Specifically, we now have the unprecedented ability to follow these veterans prospectively as they are embedded within the VA national care system and we can investigate both the course and outcomes of TBI. We propose to investigate mTBI and its long-term outcomes through four complementary Specific Aims under the three Objectives of LIMBIC. In Objective 1 Aim 1 we propose to maintain, augment, and refine our current repository, including creating and refining new variables associated with TBI. In Objective 2 Aim 1 we will identify subgroups at the greatest risk and resilience for mental health and neurogenerative outcomes after mTBI, including very-early onset dementia. In Objective 2 Aim 2 we propose to examine and elucidate the complex associations between mTBI and comorbidities such as substance abuse, PTSD, etc. In Objective 3 Aim 1 we will develop prognostic models to determine which veterans decline versus sustain/improve after mTBI. Our overall goal is to investigate how mTBI is interwoven with other comorbidities, especially mental health factors, and how these other factors may be synergistic or additive, how mTBI remote adverse outcomes evolve over time and what predicts this evolution. Furthermore, we will translate our findings to develop prognostic models that will guide clinician and researchers toward better care and prevention of mTBI and associated outcomes.

Public Health Relevance

It is estimated that up to 20% of young veterans have had a traumatic brain injury (TBI), yet little is known about the impact of TBI over the long term. This project aims to utilize medical information obtained through VA medical centers to investigate the long-term effects of TBI. We have assembled a database of nearly 2 million veterans (including all veterans with a TBI), and plan to expand and use this resource to study various TBI outcomes such as neurodegenerative disease and mental health diagnoses. We also plan to develop models that will guide clinicians toward better care and prevention of TBI associated outcomes. This line of investigation is vital not only to anticipate and plan for individual, VA, and U.S. public health burden from military-service related problems, but also to inform VA and other healthcare systems about how to best use resources and target interventions to improve the care of veterans and to reduce the risk of long-term consequences.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Brain Injury (RRDB)
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Veterans Affairs Medical Center San Francisco
San Francisco
United States
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