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Understanding the Impacts of Traumatic Brain Injury Post-Military Service

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Traumatic brain injury, or TBI, is a common occurrence among military service members. The damage ranges from mild to severe and can have both short- and long-term impacts—many of which are debilitating. Fortunately, those in health care research are working to better understand the effects of TBI and have been awarded the funding to find the answers.

VCU received a $62 million Chronic Effects of Neurotrauma Consortium (CENC) grant in 2013, and based on its success, received a new $50 million grant to lead a continuation research project called the Long-term Impact of Military-relevant Brain Injury Consortium (LIMBIC-CENC).

CENC: Looking at Recovery

The CENC team has been studying the short- and long-term effects of repeated combat concussions in service members and veterans of the Iraq and Afghanistan conflicts for the past six years.

“We’re looking at the effects of one, two, three or many more concussions and how they impact the soldiers and veterans short-term — let’s say in the first three months to a year — as well as how they impact them long-term — in five years, 20 years or even longer,” states David Cifu, M.D., the principle investigator on both of VCU’s national studies. “We’re trying to identify just how folks recover after these events. If there is good short-term recovery, are there long-term problems that perhaps aren’t seen at first or may develop after many years? Or, if they don’t have good early recovery and continue to have some difficulties, what will happen to them after a decade or more?”

The CENC program recruited more than 2,300 individuals who sustained concussions in a combat setting. Cifu reports that approximately two-thirds of this group are doing “extremely well.” They are working, have families, and participate in hobbies or other activities. These individuals may have some ongoing difficulties – the most common being headaches, diminished attention span and occasional high-level thinking problems – but they consider themselves fully functional.

Unfortunately, the remaining one-third of individuals are not as lucky and experience a high dose of ongoing difficulties. “They may be employed or married. They may have lives outside of their injuries. But, they feel so weighed down by their symptoms that they really aren’t at the level of performance they were before they went to war,” notes Cifu.

The good news is, this latter group is accessing healthcare – predominately within the VA but also outside the VA. They are following up with their physicians and other healthcare workers. “They aren’t being over-tested, over-treated or over-medicated for the problems they still have,” says Cifu. “For example, we find no higher opioid use than in folks who were not in the war. They are connected with appropriate mental health professionals to address post-traumatic stress disorder or depression and they have primary care clinicians that are helping them deal with their day-to-day symptoms.”

LIMBIC-CENC: The Long-Term Effects

LIMBIC-CENC represents a pivot from the initial CENC program that covered 11 independent studies, to a more focused project involving only two major studies. The first new major study involves long-term tracking of 3,000-5,000 service members and veterans recruited and followed at 11 sites across the country.

While 80 percent of these individuals will have had one or more combat concussions, a control group of 20 percent will have been exposed to a combat environment but never suffered a concussion. “That way, we can identify if it is just being a service member in a combat setting that causes difficulties, or if the added burden of a traumatic brain injury contributes, as well,” says Cifu. “These are individuals we are going to be following for the long-term, as we look to identify evidence of decline in function. Specifically, issues like Parkinson’s disease and dementia.”

The second major study of LIMBIC-CENC includes a mega-data set of two million veterans and service members who have received care in the military and/or VA health system. Their medical, administrative, pharmacy, benefits and military records have been collected from nine separate data sets and merged into one database.

“We’re using this big data to look at associations and trends. Do they have a higher incidence of dementia, suicide attempt, opioid use, Parkinson’s or depression? Are there specific treatments that are or aren’t helping some but not others? Which health care services are being used more or less?” says Cifu. “Initial analysis of the information has demonstrated that in fact this concussed group of service members and veterans do have higher rates of dementia, Parkinson’s disease, chronic pain, opioid usage, and suicide risk. But, it takes that many individuals in a research study to look for it.”

The researchers’ next steps will be to link findings from this epidemiologic study with the longitudinal study of the 3,000-5,000 individuals who are followed annually for life, and then see what can be done to reduce their risks, improve their functioning and give them back their lives.

Looking to the Future

The goal of LIMBIC-CENC is to add a series of rapidly executed clinical trials in the next five years using innovative interventions on targeted groups to try to both treat their active symptoms and prevent future ones. With the larger group of two million, the goal is to track them electronically.

“We’re very excited about this phase, because even we academicians don’t just want to write papers and give lectures. We actually want to have people that we’re working with in our clinics and those who we’re providing care for or supporting… we want them to get well and to have a feeling that they're going to have a good long-term outcome,” shares Cifu.

To learn more about these initiatives, please visit www.cencstudy.org. To get information on all brain injury rehabilitation care offered at VCU Health, please go to www.vcuhealth.org.

Listen to a full interview with David Cifu on this topic by clicking here.  For more episodes, find the Healthy with VCU Health podcast on any major streaming platform or by visiting the VCU Health Podcast library at vcuhealth.org/podcasts.