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BACKGROUND/RATIONALE:
Consequences of brain injuries from blast exposure and other war related injuries are poorly understood. The interplay of TBI and cognitive and affective symptoms in OIF/OEF veterans over time has not been adequately explored. Mild TBI and neuropsychological symptoms may not become evident until after military personnel return home. Evidence-based guidelines for diagnosis and treatment are limited. The current project, conducted in cooperation with the PT/BRI-QUERI and the Polytrauma Research Consortium, began as a clinical initiative in VISN 2. Our goal is to provide evidence-based understanding of cognitive and affective correlates of TBI in OIF/OEF veterans, symptom relationship to health care utilization and quality of life factors, and the evolution of the phenomena over time.
OBJECTIVE(S):
(1) Describe war related cognitive and affective symptoms and patterns of substance abuse in OEF/OIF veterans.
(2) Construct cognitive and affective profiles of OEF/OIF veterans over time.
(3) Describe the temporal relationship between the composite stress index and the cognitive profiles of OEF/OIF veterans.
(4) Describe the temporal relationships among TBI, cognitive symptoms (attention, memory and executive functioning), patient outcomes (quality of life and community participation), and health services outcomes (VA health care utilization), controlling for patient and deployment characteristics.
METHODS:
This four-year prospective cohort study of OIF/OEF veterans will include descriptive and multivariate techniques. Power analysis for the most complex research question (Q4) required a sample size of 106. The study includes profile analysis via multidimensional scaling (PAMS) and longitudinal examination of profile data with MDS latent growth curve models. TBI profiles will illuminate clinically meaningful patterns of deficits related to injury status, which will be used as predictors of community participation and quality of life with hierarchical set regression analyses. 500 OIF/OEF veterans will be recruited VISN-wide from the OIF/OEF registry, allowing for 40% attrition at each step. Initial contact will be made by mail, followed by telephone screening. The TBI diagnostic interview and neuropsychological evaluations will be completed at five sites across the network: Buffalo, Rochester/Canandaigua, Bath, Syracuse, and Albany. Assessment will be conducted by licensed psychologists and trained research assistants (supervised by licensed psychologists). Patient outcomes will be predicted by the cognitive profiles. Covariates include socio-demographics, deployment characteristics, co-morbid health conditions, and pre-military factors. Health care utilization data will be retrieved from the National Patient Database. Participants will be assessed on four occasions: baseline and 6, 12, and 18 month intervals.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The purpose of this project is to describe cognitive, affective, and substance abuse symptoms associated with deployment and TBI in OIF/OEF veterans and symptom impact on VA health care utilization, community participation, and quality of life. We will examine changes in cognitive and affective symptoms at four time points, six months apart. Impact on health care will be informed by clarification of health care utilization and QoL factors based on TBI status, cognitive and affective symptoms, and intra- and extra-individual variables.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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