Chronic Effects of Neurotrauma Consortium (CENC) multicentre study interim analysis: Differences between participants with positive versus negative mild TBI histories

ABSTRACT

Objectives: Compare characteristics and outcomes of combat-exposed military personnel with positive versus negative mild traumatic brain injury (mTBI) histories.

Setting: Recruitment was from registration lists and ambulatory clinics at four veterans administration hospitals.

Participants: Consented veterans and service members completing initial evaluation by September 2016 (n = 492).

Design: Observational with cross-sectional analyses.

Main measures: Multimodal assessments including structured interviews, record review, questionnaires, neuroendocrine labs and neurocognitive and sensorimotor performance.

Results: In unadjusted comparisons to those absent lifetime mTBI, the mTBI positive group (84%) had greater combat exposure, more potential concussive events, less social support and more comorbidities, including asthma, sleeping problems and post-traumatic stress disorder. They also fared worse on all sensory and pain symptom scores and self-reported functional and global outcomes. They had poorer scores on Wechsler Adult Intelligence Scale-IV coding (processing speed), TMT-B (visual-motor integration and executive function) and two posturography subtests, but were otherwise equal to TBI negative participants on neurocognitive and sensorimotor testing and neuroendocrine levels.

Conclusions: Although differences in characteristics exist which were not adjusted for, participants with historical mTBI have greater symptomatology and life functioning difficulties compared with non-TBI. Performance measures were less dissimilar between groups. These findings will guide further research within this accruing cohort.

KEYWORDS:

• Traumatic brain injury
• concussion
• veterans
• military deployment
• neuropsychological test
• post-concussion syndrome
• cohort study

Acknowledgments

The CENC Observational Study Site PIs or co-PIs also include: Heather Belanger PhD (Tampa), Carlos Jaramillo MD (San Antonio), Ajit Pai MD (Richmond), Melissa Geurra MD (Fort Belvoir), Randall Scheibel PhD (Houston), Terri Pogoda PhD (Boston), Scott Sponheim PhD (Minneapolis), Kathleen Carlson PhD (Portland). We also acknowledge the efforts of the entire CENC Observational Study Leadership Working Group and Core Team members who besides the authors also include: Justin Alicea, Jessica Berumen, Cody Blankenship, Jennifer Boyce, Linda Brunson, Katrina Burson, Julia Christensen, Margaret Clarke, Sureyya Dikmen, Esra Doud, Connie Duncan, Stephanie Edmunds, Robyn Endsley, Elizabeth Fogleman, Laura M. Franke, Katelyn Gormley, Brenda Hair, Jim Henry, Nancy Hsu, Cheryl Ford-Smith, George Gitchel, Col. Sidney Hinds (Consortium Co-PI), Caitlin Jones, Kimbra Kenney, Sunchai Khemalaap, Valerie Larson, Tiffany Lewis, Scott McDonald, Tamara McKenzie-Hartman, Lauren Nagusuki, Frank Mierzwa, Alison Molitor, Joe Montanari, Johnnie Mortenson, Nicholas Pastorek, Judy Pulliam, Risa Richardson, Callie Riggs, Rachel Rosenfield, Sara Salkind, James K. Sickinger, Taylor Swankie, Nancy Temkin, Doug Theriaque, Maya Troyanskaya, Rodney Vanderploeg and Carmen Vasquez.

This material is based upon work supported with resources and the use of facilities at: Hunter Holmes McGuire Veterans Affairs Medical Center (VAMC) in Richmond, VA; James A. Haley Veterans Hospital (VH), Tampa, FL; Michael E. DeBakey VAMC, Houston, TX; Audie L. Murphy Memorial VH, San Antonio, TX; and is based upon work supported in part by the Defense and Veterans Brain Injury Center, US Army Medical Research and Material Command (USAMRMC).

Declaration of interest

This work was supported by grant funding from Department of Defense, Chronic Effects of Neurotrauma Consortium (CENC) Award W81XWH-13-2-0095 and Department of Veterans Affairs CENC Award I01 CX001135. The authors have no conflicts of interest to disclose.

Disclaimer

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Veterans Affairs or Department of Defense position, policy, or decision unless so designated by other official documentation.