Harnessing the Power of VHA EHR Data to Examine Synergistic Associations Between TBI History and Other Risk Factors on AD/ADRD in Military Veterans
Abstract
Study Rationale: Traumatic brain injury (TBI) has been identified as a risk factor for dementia— specifically Alzheimer’s disease (AD) and AD-related dementias (ADRD)—by several research groups. However, other investigators have determined that TBI history is not strongly associated with AD/ADRD. Notwithstanding these conflicting findings, we know that there is not a one-to-one relationship between TBI and AD/ADRD—that is, not everyone with a history of TBI develops AD/ADRD and not everyone with AD/ADRD has a history of TBI, suggesting that the relationship between TBI and AD/ADRD is complex, nuanced, and influenced by a multitude of factors. Beyond TBI, several other risk factors have been associated with AD/ADRD including sociodemographic characteristics (e.g., age, sex, race/ethnicity), lifestyle and environmental factors (e.g., smoking and alcohol use, degree of social connectedness), and other medical conditions (e.g., high blood pressure, high cholesterol, diabetes, heart conditions). However, the extent to which TBI history interacts with these other variables to increase AD/ADRD risk is not well understand. More research is therefore needed to improve understanding of the complex relationship between TBI, AD/ADRD, and other risk variables so that more timely and targeted prevention and intervention strategies can be offered. Objective and Focus Area: The overall objective of our study is to determine the combination of factors that increase risk for AD/ADRD, with the ultimate goal being to develop a risk score calculator that can be disseminated to clinicians to assist with determining an individual’s risk for AD/ADRD. As such, our proposal addresses two of the Fiscal Year 2022 Peer Reviewed Alzheimer’s Research Program Investigator-Initiated Research Award focus areas: (1) diagnostic, environmental, and prognostic factors and (2) foundational research. To accomplish our overall study objective, we will utilize pre-existing data routinely collected during clinical care (i.e., electronic health record data) from across the Department of Veterans Affairs (VA) Health System, which has data for over 14 million Veterans. The specific patient population will be military Veterans enrolled in the VA Health System with a documented TBI diagnosis (cases) and a comparison sample of military Veterans without a TBI diagnosis (controls). After determining the cohort of eligible Veterans, we will review medical record data and extract the following variables of interest: AD/ADRD diagnostic status; cognitive screening and neuropsychological assessment scores; and other risk variables (i.e., sociodemographics, lifestyle and environmental factors, medical comorbidities, lab values). After extracting all relevant data, we will examine associations between TBI history, other risk variables, and AD/ADRD diagnostic status. Finally, we will develop and validate an AD/ADRD risk score calculation tool. Clinical Application, Scientific Contribution, and Timeline: This research is novel in that we will utilize multiple sources of routinely collected clinical data to more carefully define TBI and AD/ADRD diagnoses, an advancement from existing research. Moreover, unlike previous studies, we will examine numerous risk factors simultaneously to understand the combination of factors (in the presence and absence of TBI) that increase AD/ADRD risk. Another strength of our proposal is having access to a large and diverse sample of Veterans from across the nation; this will result in greater generalizability of findings. Finally, we will translate our results into a usable tool for clinicians both within and outside of the VA through the development and validation of an AD/ADRD risk score calculator. As such, data from this large-scale investigation of TBI, AD/ADRD, and other risk factors can be used to better tailor treatments to the individual, potentially altering the recovery process following TBI and mitigating negative health consequences
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310230
Entities
People
- Victoria C Merritt
Organizations
- United States Army
- Veterans Medical Research Foundation of San Diego