This proposal aims to develop a novel web-based screening battery to test visual and cognitive functioning. Incorporating five tasks that test contrast sensitivity, visual processing speed, attention, executive functioning, and memory, the proposed battery will 1) address several important knowledge gaps regarding visual and cognitive functioning in OEF/OIF/OND Veterans, including covariation in deficits across the visual and cognitive domains and potential geographical disparities and 2) provide a cost-effective approach to screen Veterans in rural regions of the United States, improving healthcare services for this under-served population. The training portion of this proposal will also facilitate the applicant?s long-term career goal of becoming a full-time fully funded independent investigator at the VA, utilizing basic science research in the fields of vision science and neuropsychology and translating these findings into novel screening methods that can be implemented within telemedicine to improve healthcare access for all Veterans, both in rural and urban regions. The training aims include: 1) training in state of the art visual function and cognitive psychometric assessments, and services and implementation research 2) training in neuropsychology to understand how visual and cognitive deficits relate to OEF/OIF/OND Veteran?s mental and physical health issues , 3) Increasing the candidate?s proficiency in state-of-the-art web-based programming techniques, and 4) allowing the candidate to progress to an independent investigator status through successfully competing for merit funding through the VA or other non-VA funding opportunities (i.e., NIH). DESIGN & METHOD: The first phase of the proposal (Aim 1) involves developing and hosting the screening battery on the web-based cognitive testing platform TestMyBrain where normative data will be collected from over 15,000 U.S. volunteers (~50,000 worldwide) along with the WHODAS survey to asses functional disability across six domains and demographic questions assessing current military or veteran status and access to healthcare services. In the second phase of the proposal (Aim 2) we will recruit and test 120 OEF/OIF/OND Veterans from the VA Boston community who will make up three groups: Veterans with visual deficit, Veterans with cognitive deficits, and a control group of Veterans. These participants will complete the battery four times over two months, twice in our laboratory and twice in their own homes. Data from the proposed tests and other neuropsychological measures will be used to assess the reliability and validity of the screening measures. Finally, geographical disparities analyses between rural and urban participants and Veteran vs. civilian participants will be completed on this dataset for preliminary needs assessment (Aim 3). OBJECTIVES:
Aim 1 : Develop a web-based visual and cognitive testing software program and determine normative age-based values. Hypothesis 1a: Lifespan trends and age-of-peak performance on our web-based measures will match published values from corresponding clinical assessments. Hypothesis 1b: Age-adjusted performance on the visual and cognitive assessments will be correlated with functional outcomes as measured on the WHODAS questionnaire. Hypothesis 1c: Combining performance measures across the visual and cognitive domains will predict functional outcomes better than performance measures in either domain alone.
Aim 2 : Compare web-based to lab-based testing to assess the reliability and validity of the web-based measures. Hypothesis 2a: Measurements will have high reliability across time and setting (reliability > 0.7). Hypothesis 2b: Similar to standard screening tools, measurements will have diagnostic accuracy > 0.6 in classifying the Veteran group (Control, Visual Deficit, Cognitive Deficit).
Aim 3 : Characterize regional differences in performance and relationship to functional outcomes and healthcare access. Hypothesis 3: Age-adjusted performance measures will show stronger correlations with functional outcomes in civilians and Veterans living in rural regions. This correlation will be mediated by self-reported access to healthcare.

Public Health Relevance

Visual and cognitive deficits have a high occurrence in OEF/OIF/OND Veterans. Yet, availability of healthcare resources is not geographically homogenous, and factors such as mobility can limit an individual?s ability to utilize available healthcare resources. Recent developments in web-based testing capabilities and telemedicine applications provide opportunities to address these disparities and develop novel and cost- effective solutions to increase access to healthcare screening. The proposed research will address these issues by developing and employing a web-based visual and cognitive screening battery. We will further obtain normative measurements of visual and cognitive functioning across a nationally representative sample of volunteers, including both Veterans and non-Veterans, and assess the reliability of the screening measures across time and setting. This screening battery has the potential to substantially improve quality of care for under-served OEF/OIF/OND Veterans. .

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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Career Development Program - Panel II (RRD9)
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VA Boston Health Care System
United States
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