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Traumatic Brain Injury (TBI)


Introduction

The Centers for Disease Control and Prevention (CDC) define a traumatic brain injury (TBI) as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury." In addition, service members and Veterans potentially have the additional exposures to blast, both from combat and from training.

After a TBI and depending on the severity, the person may experience a change in consciousness that can range from becoming dazed and confused to loss of consciousness. The person may also have a loss of memory for the time immediately before or after the event that caused the injury.

Due to improved diagnostics and increased vigilance, the Department of Defense (DOD) estimates that 22 percent of all combat casualties from Iraq and Afghanistan are brain injuries, compared with 12 percent of Vietnam-related combat casualties. TBI and its associated co-morbidities are a significant cause of disability outside of military settings, most often as the result of assaults, falls, automobile accidents, or sports injuries.

TBI can include a range of comorbidities, from headaches, irritability, and sleep disorders to memory problems, slower thinking, and depression. These symptoms often lead to long-term mental and physical health problems that impair Veterans' employment and family relationships, and their reintegration into their communities.

The severity of the TBI is determined at the time of the injury and is based on evidence of a positive computed tomography (CT) scan (evidence of brain bleeding, bruising, or swelling), the length of the loss or alteration of consciousness, the length of memory loss, and how responsive the individual was after the injury.

Most TBI injuries are considered mild, but even mild cases can involve serious long-term effects on areas such as thinking ability, memory, mood, and focus. Other symptoms may include headaches, endocrine, vision, and hearing problems.

Mild TBI (mTBI), also known as concussion, is usually more difficult to identify than severe TBI, because there may be no observable head injury, even on imaging, and because some of the symptoms are similar to symptoms from other problems that also follow combat trauma, such as posttraumatic stress disorder (PTSD).

While most people with mTBI have symptoms that resolve within hours, days, or weeks, a minority may experience persistent symptoms that last for several months or longer.

Treatment typically includes a mix of cognitive, physical, speech, and occupational therapy, along with medication to control specific symptoms such as headaches or anxiety.

Another often overlooked factor is the lifetime accumulation of TBI events. Having multiple mTBIs has been associated with greater risk of psychological health conditions. The association with neurodegenerative disease and repetitive mTBI has been a frequent topic in the news media, and there is some evidence in epidemiological studies (studies that use clinical diagnostic codes and/or health records) of a link between the two

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Selected Major Accomplishments

  • 2008: Established a Brain Bank to collect and study post-mortem human brain and spinal cord tissue to better understand the effects of trauma on the human nervous system
  • 2012: Discovered chronic traumatic encephalopathy, a degenerative disease linked to repeated head traumas such as concussion, in the brains of four Veterans after their deaths
  • 2013:
  • Along with the Department of Defense, funded two research consortia to improve treatment for PTSD and mTBI: the Consortium to Alleviate PTSD and Chronic Effects of Neurotrauma Consortium
  • Showed that, in mice, an artificial communication link inserted in the brain can restore functions lost as a result of TBI
  • 2016: Identified the cerebellum as particularly vulnerable to repeated blast exposures
  • 2017: Found that treatment with UCH-L1, a protein expressed in high levels in neurons, has the potential to improve cognitive function when given weeks or months after a TBI
  • 2018: Discovered that functional brain networks that actively interfere with pain perception are disrupted by mTBI in post-911 Veterans and service members with and without chronic pain

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New, Ongoing, and Published Research

VA research related to TBI is wide-ranging. Among the goals of VA researchers working in this field are to shed light on brain changes in TBI, improve screening methods and refine tools for diagnosing the condition, and develop ways to treat brain injury or limit its severity when it first occurs.

Researchers are also designing improved methods to assess the effectiveness of treatments and learning the best ways to help family members cope with the effects of TBI and support their loved ones.

VA's TBI Model System (TBIMS), a cross-agency collaboration with the National Institute on Disability, Independent Living, and Rehabilitation Research, is a longitudinal multicenter research program that examines the recovery course and outcomes of Veterans and active duty service members with TBI following comprehensive inpatient rehabilitations. The goal of the system is to conduct research that contributes to evidence-based rehabilitation interventions and practice guidelines that improve the lives of people with TBI.

Improved Understanding of Medical and Psychological Needs in Veterans and Service Members with TBI (IMAP) is an extension of TBIMS. The goals of IMAP are to examine types of long-term physical and psychological health conditions in persons with TBI, the impact of those health conditions on recovery, and chronic rehabilitation needs including accessibility of needed services.

The VA's Translational Research Center for TBI and Stress Disorders (TRACTS) promotes multidisciplinary research aimed at improving the understanding of the complex cognitive and emotional problems faced by Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans. TRACTS is co-located at VA Boston Healthcare System and the Michael E. DeBakey VA Medical Center in Houston. The center focuses on innovations in the diagnosis of mTBI and in the development of treatments that target the combined effects of TBI and stress-related disorders. VA hopes to accomplish this in part with an extensive longitudinal cohort study that includes advanced neuroimaging techniques, genetics, and data that will lead to the development of a deep characterization of the clinical characteristics that affect this generation of Veterans.

The Brain Rehabilitation Research Center (BRRC) in Gainesville, Florida, has been funded since 1999 by the VA Rehabilitation Research and Development (RR&D) Service. The mission of the BRRC is to develop and test treatments that harness neuroplasticity, the brain’s ability to form new neural connections, to substantially improve or restore motor, cognitive, and emotional functions impaired by neurologic disease or injury.

VA's War Related Illness and Injury Study Center, located at the VA medical centers in Palo Alto, California; Washington, D.C.; and East Orange, New Jersey, develops and provide post-deployment health expertise to Veterans and their health care providers through clinical programs, research, education, and risk communication. VA's Office of Public Health directs the center.

VA's Polytrauma System of Care is an integrated network of specialized rehabilitation programs dedicated to serving Veterans and service members with TBI and multiple, complex, severe injuries, which is termed polytrauma. (Click here to see a map of sites within the VHA Polytrauma/TBI system of care.)

The Defense and Veterans Brain Injury Center (DVBIC) is a DOD program that serves active duty military, their beneficiaries, and Veterans with TBI through state of-the-art clinical care, innovative clinical research initiatives and educational programs, and support for force health protection services. DVBIC interacts with VA at the five Polytrauma Rehabilitation Centers, where it provides staff and expertise for those with deployment-related TBIs.

For more information on TBI, visit our Depression, Mental Health, Suicide Prevention, Substance Use Disorders, and Posttraumatic Stress Disorder topic pages.

If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study information page.

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➤ The National Research Action Plan

In 2013, VA, DOD, and the Department of Health and Human Services developed a wide-reaching plan to improve access to mental health services for Veterans, service members, and military families.

The National Research Action Plan (NRAP) is improving scientific understanding of TBI, PTSD, various conditions related to both TBI and PTSD, and suicide. Other goals of the plan include providing effective treatments for these conditions and reducing their occurrence.

Among the highlights of the plan is the establishment of two joint DOD/VA research consortia at a combined investment of $107 million. These include the Consortium to Alleviate PTSD, a collaboration led by the University of Texas Health Science Center-San Antonio, and the Chronic Effects of Neurotrauma Consortium (CENC), led by Virginia Commonwealth University.

The CENC serves as the comprehensive research network for DOD and VA that focuses on the long-term effects of combat-related and military-relevant TBI. The CENC is designed to conduct research that provides clinically relevant answers and interventions for current service members and Veterans and to develop long-term solutions to the chronic effects of TBI. The CENC is identifying and characterizing the anatomic, molecular, and physiological mechanisms of chronic injury from TBI and potential neurodegeneration; investigating the relationship of comorbidities (psychological, neurological, sensory, motor, pain, cognitive, neuroendocrine) of trauma and combat exposure to TBI with neurodegeneration; and assessing the efficacy of existing and novel treatment and rehabilitation strategies for chronic effects and neurodegeneration following TBI.

CENC has been funded for another five years through the "Long-term Impact of Military-relevant Brain Injury Consortium" (LIMBIC) program. The program will continue to follow over 1,800 Veterans and service members who have enrolled already in the study, with the goal of increasing the study population.

All three NRAP participating federal agencies are collaborating with academia and not-for-profit foundations. They are standardizing, integrating, and sharing data as appropriate; building new tools and technologies; and maximizing the impact of existing research.

The agencies are working together to explore genetic markers that may demonstrate an association between gene and elevated risk for poorer brain health outcomes. They are also working to identify possible changes in brain circuitry, confirm potential biomarkers for TBI and PTSD, and establish new data-sharing agreements.

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➤ Brain changes in TBI

TBI can result in brain damage that is sometimes subtle. This damage can result in changes in memory, attention, thinking, personality, and behavior that are difficult to diagnose and treat. VA researchers are refining ways to reliably diagnose TBI and to predict Veterans' outcomes and care needs.

Brain agingA 2015 study led by researchers from the Translational Research Center for TBI and Stress Disorders (TRACTS) found that Veterans who were near bomb blasts in Iraq and Afghanistan appear to experience faster brain aging.

The team studied 195 Veterans who had been exposed to bomb blasts within 100 feet, and 56 who had not. Study participants were an average age of 33 years. The team learned that even in blasts that do not necessarily lead to concussion, those exposed to bomb blasts showed aging in brain images designed to detect the "leakiness" and fraying of the white matter in the brain.

Consequences of this potentially premature brain aging could be increased rehabilitation time and an earlier need for health care for issues such as dementia.

Problems with daily livingAnother 2015 TRACTS study found that Veterans with a combination of depression, PTSD, and military-related TBI had the greatest difficulties of all Iraq and Afghanistan Veterans in getting around, communicating and getting along with others, handling self-care, and accomplishing other daily tasks.

According to the research team, many Iraq and Afghanistan Veterans require highly integrative treatment approaches, and their health problems need to be dealt with in a comprehensive and coordinated manner.

Cerebellum issuesA 2016 study by researchers with the VA Puget Sound Health Care System and the University of Washington identified the cerebellum as particularly vulnerable to repeated blast exposures. The cerebellum, an area of the brain, coordinates and regulates muscle activity.

The investigators looked at brain scans from Veterans who had experienced an average of 21 mTBIs each as a result of explosions. The more blasts they were exposed to, the more likely they were to show lower levels of glucose metabolism in the cerebellum. Glucose metabolism is a marker of brain activity.

The research team also created "shock tubes" to test similar blast effects in miceand found that repeated explosions ruptured part of the blood-brain barrier and led to the loss of neurons in the cerebellum. They also revealed the buildup of proteins associated with dementia and Alzheimer's disease.

Chronic traumatic encephalopathy and TBIIn 2012, an international team including researchers from the Boston VA Healthcare System discovered chronic traumatic encephalopathy (CTE) in the brains of four Veterans after their deaths, including three who had survived explosions from improvised explosive devices. The fourth had suffered multiple concussions in and out of service.

CTE is a degenerative disease thought to be linked to repeated head traumas such as concussions, and has been identified in the brains of football players who have committed suicide. It is possible that some of the symptoms of PTSD and other mental health conditions in Veterans are caused by CTE.

A follow-up study by the team analyzed brain tissue from 85 people with histories of repetitive mTBI. They found evidence of CTE in 68 of them. Of the 85 people studied, 64 were athletes and 21 were Veterans, although 86 percent of the Veterans also were athletes. This study should be reviewed with the understanding that the brains in these cases were donated by families who were concerned by the condition of their family member and were not randomly sampled from either Veteran or athletic populations. Prospective longitudinal studies, such as CENC and TRACTS, will be crucial in determining the causative and susceptibility link between repetitive brain injury and CTE in the future.

Another study by the team, published in 2017, found that a protein found in the brain, CCL11, might be used as a biomarker to potentially allow CTE to be diagnosed in living people. By analyzing recently deceased athletes, the team found that those with CTEbut not those without dementia or Alzheimer's disease—had significantly elevated levels of CCL11 in their spinal fluid, which creates the possibility that CC11t can also be measured in living people, and a determination can be made whether they have CTE. Previously, CTE could only be correctly diagnosed, and distinguished from Alzheimer's disease, after death.

VA, along with Boston University and the Concussion Legacy Foundation, established a Brain Bank in 2008 to collect and study post-mortem human brain and spinal cord tissue to better understand the effects of trauma on the human nervous system. The Brain Bank has both Veteran and non-Veteran/athlete brain samples and has been at the forefront in research neurodegenerative disease that could be linked to lifetime TBI exposure.

In 2016, VA hosted "Brain Trust: Pathways to InnoVAtion," a two-day public-private partner event that brought together many important leaders in the area of brain health to identify and advance solutions together for mTBI and PTSD. Among those present were representatives from DOD, the sports industry, other federal and private agencies, Veterans Service Organizations, and community partners.

Brain damage in Veterans without TBI symptomsVeterans exposed to blasts from bombs, grenades, and other devices may still have brain damage even if they have no symptoms of TBI, according to a 2015 study by researchers at VA's Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC) in Durham, North Carolina, and Duke University. The results of the study suggested that a lack of symptoms of TBI after a blast may not indicate the extent of brain damage caused by the blast, and that TBI symptoms such as headache, dizziness, nausea, memory problems, and irritability may eventually develop in blast-exposed Veterans who appear not to have had even a mTBI as a result of their exposure.

To be able to study the chronic effects of repeated blast exposures, VA is funding the startup of an open field blast core facility in Columbia, Missouri. This core facility will work with VA investigators around the country to develop Veteran-centric research in preclinical models in order to understand chronic mechanisms in blast-related TBI. Understanding these mechanisms will help VA to accelerate diagnostic and treatment research to improve the lives of Veterans with TBI.

Electroencephalograms and mTBImTBI and PTSD often carry similar symptoms such as irritability, restlessness, hypersensitivity to stimulation, memory loss, fatigue, and dizziness. In 2016, a team of researchers from the DVBIC used electroencephalograms (EEGs) to learn there were patterns of brain activities at different locations on the scalp for mTBI and PTSD in Iraq and Afghanistan Veterans.

This finding can reduce the possibility these conditions can be confused with each other, thereby improving diagnosis and treatment. It also shows that electrical activity in the brain appears to be affected long after combat-related mTBI, suggesting long term changes in the signaling between cells in the nervous system.

Another study, published in 2017, found that a technique called magnetoencephalography can map activity in the brains of patients with PTSD and mTBI, and that in PTSD, but not mTBI, alpha brain waves measured using that technique showed reductions in network structure (the interconnected symptoms of neurons in the brain), thereby providing another way for clinicians to differentiate between the two conditions.

Tracking mTBI over decadesA federally funded study is in the process of enrolling at least 1,200 service members and Veterans who fought in Iraq and Afghanistan to learn more about mTBI and how it can best be evaluated and perhaps prevented and treated. The researchers, under the auspices of CENC, hope to follow the cohort for 20 years or more to better understand the long-term neurological effects of mTBI and other deployment-related conditions. Methods and procedures for the study were described in a 2016 article.

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➤ Other body changes in TBI

Sensory issuesSensory problems are common among Veterans who have had TBI. In 2012, VA researchers reported on a study of 21,000 Veterans evaluated for TBI in VA outpatient clinics. They found that 9.9 percent of them reported vision problems, 31.3 percent reported hearing impairments, and 34.6 percent reported both vision and hearing issues.

A 2014 VA Evidence Synthesis Review of the literature concluded that while visual dysfunction diagnosed in U.S. service members treated in military health care settings is uncommon, occurring in less than 1 percent of individuals for most non-TBI-related disorders, studies of Veterans with TBI history and who are treated in TBI rehabilitation clinics report much higher frequencies, often over 50 percent for many types of visual dysfunctions.

Hearing supportA 2015 study by VA's National Center for Rehabilitative Auditory Research (NCRAR) looked at 99 Veterans who were exposed to blasts in Iraq or Afghanistan. All 99 had clinically normal hearing, but all reported problems hearing in difficult listening situations.

The research team asked study participants to participate in 10 performance-based tests that have been shown to uncover problems in processing hearing signals. They found that many of the participants had difficulty in one or more of the tests, compared with non–blast-exposed Veterans, although they may have performed well in other tests.

The team concluded that auditory processing symptoms may vary among Veterans exposed to blasts, but that blast injuries can and do result in damage to the central auditory system.

RNA molecule deficienciesIn 2015, researchers at the James J. Peters VA Medical Center in the Bronx and VA's War-Related Illness and Injury Study Center in East Orange, New Jersey, learned that four specific RNA molecules, known by the designations ACA48, U35, U55, and U83A, were found at lower-than-normal levels in Veterans who had TBIs along with PTSD.

RNA, or ribonucleic acid, is a nucleic acid present in all living cells. Its main role is to act as a messenger carrying instructions from DNA for controlling the synthesis of proteins.

The researchers tested blood samples from 58 Iraq and Afghanistan Veterans. Some of the Veterans had a combination of TBI and PTSD, some had only one of the conditions, and others had neither.

Veterans with only PTSD had significantly lower levels of only the U55 RNA molecule, and Veterans who only had a TBI and not PTSD had normal levels of all four molecules.

The team hopes that their study will eventually result in a simple blood test to help diagnose the two issues in Veterans.

TBI and epilepsyIn 2015, researchers at the VA South Texas Health Care System and the University of Texas reported that Iraq and Afghanistan Veterans with m TBIs were about 28 percent more likely to have developed epilepsy than those without TBIs.

The researchers also showed that Veterans who suffered penetrating or severe TBIs had the highest risk of developing epilepsy. The study looked at 256,284 Iraq and Afghanistan Veterans who received either inpatient or outpatient care at VA in fiscal years 2009 and 2010.

Previous studies of Veterans from World War II and the Korean War have shown a link between combat-related head injury and epilepsy. The research team concluded that because war-related epilepsy in Vietnam Veterans continued 35 years after the war, a detailed, prospective study is needed to understand the long-term relationship between epilepsy and TBI severity in Iraq and Afghanistan Veterans.

Currently, VA investigators in Philadelphia are working with Citizens United for Research in Epilepsy and the DOD to study the increased risk of epilepsy onset following an mTBI. They are evaluating circuitry changes over time after injury in the hippocampus, a vulnerable brain area in both epilepsy and trauma. The research team hopes to understand how these alterations lead to epileptic activity after injury. The research team is also testing interventions that block inflammatory processes contributing to circuit dysfunction in the hippocampus. Establishing a mechanistic link between repetitive concussions and epilepsy would be a powerful way to reduce the number of new epilepsy cases.

TBI and suicidePsychiatric conditions may add to the relationship between TBI and suicide, according to a 2017 study by researchers with the VA Boston Healthcare System. The researchers looked at data for more than 270,000 Veterans deployed to Iraq and Afghanistan, and found that Veterans with a TBI had an increased rate of a suicide attempt. In addition, 83 percent of those with TBI who attempted suicide also had a psychiatric condition. Veterans with these conditions should be closely monitored for suicidal behavior, according to the researchers.

TBI and returning to workFew service members and Veterans with moderate to severe TBI return to work one year after their injury, according to a 2017 VA Polytrauma Rehabilitation Centers study. Those who were older, minorities, or had a more severe TBI were more likely to be unemployed. Of the 293 Veterans and service members in the study, 85 percent of subjects with severe TBI were unemployed, while 63 percent with moderate TBI were unemployed. The results will help VA plan rehabilitation services for these patients.

TBI and endocrine dysfunctionThe work at the VA Puget Sound Health Care System has demonstrated that Veterans with repetitive mTBI have a risk of developing growth hormone deficiency. Having growth hormone deficiency can lead to increased body mass index (BMI), fatigue, and symptoms of depression. These symptoms can then lead to decreases in sleep hygiene, self-esteem, psychological health, cognition, and quality of life. The Puget Sound investigators are in the process of proposing a multisite clinical trial that will investigate the efficacy of growth hormone replacement in those with TBI and growth hormone deficiency.

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➤ Diagnosing TBI

Value of TBI screening questionnaireBecause individuals who have persistent symptoms after an mTBI may need targeted intervention, VA established a system-wide screening and assessment procedure in 2007 to identify mTBI in Veterans as quickly as possible.

The tool consists of questions VA health care professionals must ask all Iraq and Afghanistan Veterans when they come in for care. Veterans who screen positive are offered follow-up evaluations with specialists. VA researchers collaborated in the development of this screening tool.

In 2012, researchers from the VA Boston Healthcare System published a study documenting that this TBI screening process helps clinicians refer patients with current symptoms to appropriate care. More than 90 percent of Veterans who were evaluated received further VA health care, and evaluations that confirmed a diagnosis of mTBI were associated with significantly higher health care use.

Little research on blast versus nonblast TBIA 2017 review of existing studies by researchers at the Minneapolis VA Health Care System found that little information is available about outcomes for TBIs caused by blasts versus those caused by other factors. The available research showed that blast and nonblast TBI groups had similar rates of depression, sleep disorders, alcohol use, vision loss, balance problems, and functional status.

Results were inconsistent about PTSD, headache, hearing loss, and neurocognitive functions. More research is needed, according to the researchers, on the differences between blast and nonblast TBI, along with consistent definitions of blast exposure.

Postconcussive symptoms after deploymentIn a 2017 study by DVBIC, nearly half of soldiers who had an mTBI while serving in Afghanistan or Iraq had postconcussive symptoms such as sleep problems, forgetfulness, irritability, and headaches three months after their deployment. According to the researchers, this suggests that m TBI is associated with continuing problems for longer than has been generally recognized in the active duty population.

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➤ Investigating Treatments for TBI

VA researchers are studying the effectiveness of various existing and potential treatments for TBI and symptoms such as headaches, anxiety, and mood swings.

LithiumLithium is a mood stabilizing drug that has been used since the 19th century. In 2016, a team of researchers from the VA Pittsburgh Healthcare System found that lithium modestly improved cognitive performance in rats when they were tested 14 days after receiving a TBI. The research also found that lithium does not reduce motor impairment or brain tissue loss following a TBI. Other VA researchers are studying lithium in a cooperative study (CSP #590) to determine whether the drug can be used to prevent suicide.

Headaches and magnetic stimulationA 2015 study involving Veterans with headaches related to mTBI found positive results from a treatment called repetitive transcranial magnetic stimulation.

The treatment involves taking an electromagnet (a wire wrapped around a solid coil), charging it with electricity, and applying it to specific points on the skull to target the underlying brain area. The result is a powerful magnetic field that can affect brain cells.

Researchers at the VA San Diego Healthcare System looked at 24 Veterans who had persistent daily headaches as the result of head trauma. Each Veteran received either three real or sham treatments within a week. In assessments one week later, about 58 percent of the real-treatment group had at least a 50 percent reduction in headache intensity, versus only 17 percent in the shame group. After four weeks, the real-treatment group still showed greater improvements than the sham group.

The Food and Drug Administration approved this kind of treatment for refractory (treatment-resistant) depression in 2008.

Protein treatment may protect against TBI damageA 2017 study by researchers at the VA Pittsburgh Healthcare System found that treatment with UCH-L1, a protein expressed in high levels in neurons, combined with other proteins, has the potential to improve cognitive function when given weeks or months after a TBI. The protein was injected into mice with TBIs, and those treated with the protein showed better brain function than others who were not. Neuron cell survival was also improved.

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➤ Coping strategies for Veterans and their families

Caregiver healthA 2015 study done in part by researchers at the Edward Hines, Jr., VA Hospital in Hines, Illinois, found that blame and anger associated with the grief of caring for a loved one with a TBI may be related to elevations in tumor necrosis factor alpha—a substance associated with inflammation and chronic disease. High levels of TNF-alpha have been associated with certain inflammatory-related diseases, like heart disease and chronic obstructive pulmonary disease. The study examined grief and its association with inflammation in 40 wives or partners of Veterans with TBIs.

Study participants completed written measures of grief, perceived stress, and symptoms of depression. They also provided morning saliva samples to measure TNF-alpha.

The caregivers collectively reported levels of grief comparable to that of individuals who had lost a loved one. That grief was not associated with TNF-alpha or inflammation in general. However, higher levels of TNF-alpha were found in those caregivers who reported high levels of blame and anger associated with their grief.

High levels of TNF-alpha are related to a variety of inflammatory-related health issues, and may be an important indicator of which caregivers may be at risk for developing chronic health problems such as heart disease.

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➤ Ongoing large-scale TBI research

VA researchers are continually working to better understand TBI and to improve therapies for the condition. Ongoing large-scale initiatives designed to improve the health of Veterans with TBI include the Traumatic Brain Injury Veterans Health Registry and the "New Generation" study.

The TBI Veterans Health Registry, begun in 2009 by VA's Office of Public Health (OPH), is providing military and civilian researchers with data on a large number of well-documented cases of TBI from the wars in Iraq and Afghanistan. The registry helps evaluate and compare different therapeutic options and outcomes; compares war-related TBI with TBI in civilian patients; and examines the association of TBI with other medical conditions, including PTSD, depression, memory loss, sensory loss, and seizure.

VA's National Health Study for a New Generation of U.S. Veterans is another OPH project. Investigators are assessing 60,000 Iraq and Afghanistan Veterans, half of whom were deployed to combat areas. Some members of that group will participate in the MIND (Markers for the Identification, Norming, and Differentiation of TBI and PTSD) study. Researchers are analyzing health information from Veterans who have symptoms of TBI or PTSD and a comparison group of Veterans. They will use what they've learned to build objective and consistent diagnostic criteria for both conditions.

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More on Our Website

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Selected Scientific Articles by Our Researchers

Pilot investigation of a novel white matter imaging technique in Veterans with and without history of mild traumatic brain injury. Jurick SM, Hoffman SN, Sorg S, Keller AV, Evangelista ND, DeFord NE, Sanderson-Cimino M, Bangen KJ, Delano-Wood L, Deoni S, Jak AJ. Using a novel myelin-sensitive MRI technique, Veterans in the post-acute period following mTBI showed a limited and uneven distribution of myelin water fraction (MWF) changes. Researchers found that a lower MWF was significantly related to processing speed on a neuropsychological assessment. Brain Inj. 2018 Oct;32(10):1255-1264.

Assessment of quantitative magnetic resonance imaging metrics in the brain through the use of a novel phantom. Wilde EA, Provenzale JM, Taylor BRA, Boss M, Zuccolotto RH, Pathak S, Tate DF, Abildskov TJ, Schneider W. This study compared the results of diffusion tensor imaging (DTI) across four scanners using a human and novel phantom developed in conjunction with the Chronic Effect of Neurotrauma consortium. The human tissue and phantom showed similar fractional anisotropy (FA) ranges, high linearity, and large within-device effect sizes.

Brain Inj. 2018 Oct;32(10):1265-1275.

Functional brain connectivity and cortical thickness in relation to chronic pain in post-911 veterans and service members with mTBI. Newsome MR, Wilde EA, Bigler ED, Liu Q, Mayer AR, Tayler BA, Steinberg JL, Tate DF, Abildskov TJ, Scheibel RS, Walker WC, Levin HS. Study participants with a history of mild TBI who reported more severe pain interference had less functional connectivity between certain brain regions. The cortical thickness of specific brain regions was positively related to severity of pain interference. Brain Inj. 2018 Oct;32(10):1235-1243.

Sensory dysfunction and traumatic brain injury severity among deployed post-9/11 veterans: a Chronic Effects of Neurotrauma Consortium study. Swan AA, Nelson JT, Pogoda TK, Amuan ME, Akin FW, Pugh MJ. Sensory problems affect a substantial number of deployed Post-9/11 Veterans and are more common among those with TBI or with exposure to deployment-related blast exposure. Brain Inj. 2018 Oct;32(10):1197-1207.

Do postconcussive symptoms from traumatic brain injury in combat veterans predict risk for receiving opioid therapy for chronic pain? Bertenthal D, Yaffe K, Barnes DE, Byers AL, Gibson CJ, Seal KH; Chronic Effects of Neurotrauma Consortium Study Group. Increased opioid prescribing in Veterans with self-reported, severe, persistent postconcussive symptoms indicates a need to educate prescribers and make non-opioid pain management options available for veterans with TBI. Brain Inj. 2018 Oct;32(10):1188-1196.

Longitudinal changes in neuroimaging and neuropsychiatric status of post-deployment veterans: a CENC pilot study. Martindale SL, Rowland JA, Shura RD, Taber KH. Preliminary data on longitudinal changes in Iraq and Afghanistan combat Veterans following blast exposure found MRI changes were not associated with changes in psychiatric diagnoses or symptom burden but were associated with severity of blast exposure. Brain Inj. 2018 Oct;32(10):1208-1216.

Exploring the factor structure of a battery of neuropsychological assessments among the CENC cohort. Hirsch S, Belanger HG, Levin H, Eggleston BS, Wilde EA, McDonald SD, Brearly TW, Tate DF. Study results provided reasonable evidence that data collected from the CENC neuropsychological battery can be reduced to five clinically useful factors enabling investigators to use them for further study on the impact of concussion on neurodegeneration. Brain Inj. 2018 Oct;32(10):1226-1235.

Longitudinal evaluation of ventricular volume changes associated with mild traumatic brain injury in military service members. Davenport ND, Gullickson JT, Grey SF, Hirsch S, Sponheim SR; Chronic Effects of Neurotrauma Consortium. In this longitudinal sample of deployed Veterans, mTBI was not associated with gross brain atrophy as reflected by an abnormally high ventricle-brain ratio (VBR) or abnormal increases in VBR over time. Brain Inj. 2018 Oct;32(10):1245-1255.

Impact of age on acute post-TBI neuropathology in mice expressing humanized tau: a Chronic Effects of Neurotrauma Consortium study. Mouzon B, Saltiel N, Ferguson S,Ojo J, Lungmus C, Lynch C, Algamal M, Morin A, Carper B, Bieler G, Mufson E, Stewart W, Mullan M, Crawford F. The findings in this study suggest that polypathology is more severe in older than younger mice during the acute phase following repetitive, mild traumatic brain injury (r-mTBI). Brain Inj. 2018 Oct;32(10):1285-1294.

Is balance performance reduced after mild traumatic brain injury?: Interim analysis from chronic effects of neurotrauma consortium (CENC) multi-centre study. Walker WC, Nowak KJ, Kenney K, Franke LM, Eapen BC, Skop K, Levin H, Agyemang AA, Tate DF, Wilde EA, Hinds S, Nolen TL. Repeated mTBI partially mediated by pain may lead to later balance disturbances among military combatants. Brain Inj. 2018 Oct;32(10):1156-1168.

Understanding the impact of mild traumatic brain injury on veteran service-connected disability: results from Chronic Effects of Neurotrauma Consortium. Dismuke-Greer CE, Nolen TL, Nowak K, Hirsch S, Pogoda TK, Agyemang AA, Carlson KF, Belanger HG, Kenney K, Troyanskaya M, Walker WC. Mild TBI, especially blast related, is associated with higher VA service-connected disability ratings with each additional mTBI increasing percent SCD. Brain Inj. 2018 Oct;32(10):1178-1187.

Higher exosomal phosphorylated tau and total tau among veterans with combat-related repetitive chronic mild traumatic brain injury. Kenney K, Qu BX, Lai C, Devoto C, Motamedi V, Walker WC, Levin HS, Nolen T, Wilde EA, Diaz-Arrastia R, Gill J; CENC Multisite Observational Study Investigators. Repetitive TBI is associated with elevations of exosomal p-tau, suggesting that blood-based exosomes may provide a peripheral source of centrally derived biomarkers in remote mTBI, and may contribute to chronic neuropsychological symptoms. Brain Inj. 2018 Oct;32(10):1276-1284.

Pain and chronic mild traumatic brain injury in the US military population: a Chronic Effects of Neurotrauma Consortium study. Hoot MR, Levin HS, Smith AN, Goldberg G, Wilde E, Walker WC, Eapen BC, Nolen T, Pugh NL. Mild TBI is strongly associated with pain intensity and pain interference in this sample. However, the effect appears to be mediated by other common mTBI comorbidities: PTSD, depression, anxiety, and sleep disturbance. Brain Inj. 2018 Oct;32(10):1169-1177.

Sleep Disturbances in Traumatic Brain Injury: Associations with Sensory Sensitivity. Elliott JE, Opel RA, Weymann KB, Chau AQ, Papesh MA, Callahan ML, Storzbach D, Lim MM. Veterans with TBI reported sleep disturbances that were significantly correlated with the severity of their sensory sensitivity and associated with posttraumatic stress disorder (PTSD). J Clin Sleep Med. 2018 Jul 15;14(7):1177-1186.

Telephone-Based Progressive Tinnitus Management for Persons with and Without Traumatic Brain Injury: A Randomized Controlled Trial. Henry JA, Thielman EJ, Zaugg TL, Kaelin C, McMillan GP, Schmidt CJ, Myers PJ, Carlson KF. A randomized controlled trial to assess the efficacy of teaching coping skills using Progressive Tinnitus Management by telephone (Tele-PTM), showed significantly better outcomes than the control group. Results provide strong support for the use of this intervention for people with tinnitus, regardless of whether they also have TBI symptoms. Ear Hear. 2018 May 29.

Window to Hope: A Randomized Controlled Trial of a Psychological Intervention for the Treatment of Hopelessness Among Veterans With Moderate to Severe Traumatic Brain Injury. Brenner LA, Forster JE, Hoffberg AS, Matarazzo BB, Hostetter TA, Signoracci G, Simpson GK. A psychological intervention to reduce hopelessness among Veterans with traumatic brain injury (TBI) was found to make a significant difference between treatment and control groups on postintervention scores on the Beck Hopelessness Scale. J Head Trauma Rehabil. 2018 Mar/Apr;33(2):E64-E73.

Employment Stability in Veterans and Service Members With Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model Systems Study. Dillahunt-Aspillaga C, Pugh MJ, Cotner BA, Silva MA, Haskin A, Tang X, Saylors ME, Nakase-Richardson R. Over half of Veterans and military service members diagnosed with TBI in this study had stable employment as of the first date of competitive employment. At follow-up, those with stable employment had higher scores on motor and cognitive functional independence measures (FIM). Arch Phys Med Rehabil. 2018 Feb;99(2S):S23-S32.

Associations between traumatic brain injury history and future headache severity in Veterans: a longitudinal study. Suri P, Stolzmann K, Iverson KM, Williams R, Meterko M, Yan K, Gormley K, Pogoda TK. Headache outcomes are poor in Veterans who receive VA TBI evaluations, but significantly worse in those with a history of moderate or severe TBI. No association was found between mild TBI and future headache severity. Arch Phys Med Rehabil. 2017 Nov;98(11):2118-2125.

Traumatic brain injury may not increase the risk of Alzheimer disease. Weiner MW, Crane PK, Montine TJ, Bennett DA, Veitch DP. Recent studies have failed to confirm the relationship of TBI to the development of Alzheimer’s disease, dementia, or pathologic changes and suggest that other neurodegenerative processes might be linked to TBI. Neurology. 2017 Oct 31;89(18):1923-1925.

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Traumatic Brain Injury Fact Sheet

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