Long-Term Vascular-Related Cognitive Decline After Traumatic Brain Injury
Abstract
Background: Traumatic brain injury (TBI) in the United States is common, affecting approximately 23 million civilians and over 400,000 military active-duty and Veteran Service Members. It has become increasingly recognized that the consequences of TBI are long-lasting. Indeed, TBI has been associated with increased risk for the development of mild cognitive impairment and dementia. Vascular risk factors, such as diabetes and high blood pressure, are also associated with increased mild cognitive impairment and dementia risk. TBI is characterized by vascular injury, which may be a link between TBI and the later development of mild cognitive impairment and dementia. However, it remains unknown if vascular risk factors such as diabetes and high blood pressure are associated with poor cognition after TBI. Since vascular injury secondary to TBI and vascular risk factors are often preventable and treatable, it is critical to determine if TBI, in combination with vascular risk factors, is associated with poor cognition after TBI. It is important to note that studies of cognition are expensive and complex because of the long-term follow-up that is needed as well as loss to follow-up leading to incomplete data. In order to obtain unbiased results in studies of post-TBI related cognitive impairment, careful statistical techniques are needed. Objectives/Hypotheses: The overall objective of this proposal is to use rigorously developed sophisticated statistical methods to unbiasedly determine if individuals with TBI and vascular risk factors have greater cognitive impairment compared to individuals with TBI without vascular risk factors and compared to controls. The overarching hypothesis of this proposal is that individuals with TBI and vascular risk factors will have greater decline in cognitive function over 5 years than individuals with TBI without vascular risk factors and controls. Further, we hypothesize that individuals with TBI and greater severity of vascular risk factors will have greater decline in cognitive function over 5 years than individuals with TBI and lower severity of vascular risk factors or no vascular risk factors and controls. Research Strategy: This proposed project uses data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study, which is one of the largest longitudinal studies of TBI and is funded by NIH/NINDS (2010-2011: RC2 NS069409; 2013-2019: U01 NS086090), DoD (2014-2019: W81XWH-14-0176), and multiple philanthropic sources, including the National Football League. The TRACK-TBI study was designed to characterize the acute and long-term clinical, neuroimaging, and blood biomarker features of TBI. The TRACK-TBI Study has nearly 2,700 participants with TBI and nearly 600 control participants without TBI that were enrolled from 18 Level 1 trauma centers in the United States. Participants are currently being followed up to 5 years for outcomes and have undergone cognitive testing at multiple time points over the course of the study. We propose to develop and validate statistical models to unbiasedly determine if participants with a combination of TBI and vascular risk factors such as diabetes and high blood pressure have greater decline in cognitive function after TBI compared to participants with TBI alone and to control participants without TBI. We will also investigate the role of the severity of vascular risk factors (e.g., uncontrolled versus controlled diabetes) on post-TBI cognitive function. Impact/Innovation: The proposed project is clearly aligned with FY20 PRARP Convergence Science Research Award’s intent, vision, and mission. The proposal directly addresses the paucity of epidemiological and clinical research and focuses on vascular dementia. This proposed work has the potential to generate the following innovative deliverables: (1) identifying vascular risk factor reduction as a high-priority target for dementia prevention strategies and clinical
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110590
Entities
People
- Andrea Schneider
Organizations
- United States Army
- University of Pennsylvania