Veterans w/ TBI at Risk for dementia, aggression, memory loss, depression, & symptoms similar to those of Parkinson's disease

Today the U.S. Institute of Medicine released the following announcement:Contacts: Christine Stencel, Media Relations OfficerAlison Burnette, Media Relations AssistantOffice of News and Public Information202-334-2138; e-mail <news@nas.edu>Date: Dec. 4, 2008

FOR IMMEDIATE RELEASEMilitary Personnel With Traumatic Brain Injury at Risk for Serious Long-Term Health ProblemsMilitary personnel who suffer severe or moderate traumatic brain injury(TBI) face an increased risk for developing several long-term healthproblems, says a new report from the Institute of Medicine thatevaluates the evidence on long-term consequences of TBI.These conditions include Alzheimer's-like dementia, aggression, memoryloss, depression, and symptoms similar to those of Parkinson's disease.Even mild TBI is associated with some of these adverse consequences,noted the committee that wrote the report.In addition, the report notes that brain injuries sustained as a resultof exposure to the force of an explosion without a direct strike to thehead -- one of the most common perils for soldiers in Iraq andAfghanistan -- may be underdiagnosed due to the lack of research onblast injury. It calls for the U.S. Department of Defense and the U.S.Department of Veterans Affairs to step up clinical and animal studies ofblast-induced neurotrauma (BINT)."Explosive devices and other weaponry have become more powerful anddevastating throughout the wars in Iraq and Afghanistan, and we areseeing much higher rates of nonpenetrating traumatic brain injury andblast-induced injury among military personnel who have served in thesecountries than in earlier wars," said George W. Rutherford, professor ofepidemiology and preventive medicine and vice chair, department ofepidemiology and biostatistics, School of Medicine, University ofCalifornia, San Francisco, and chair of the committee that wrote thereport. "It is important to identify and understand any long-termhealth effects of these injuries so that wounded service members do notlose valuable time for therapy and rehabilitation."As of January, more than 5,500 military personnel have suffered TBIsduring the conflicts in Iraq and Afghanistan, according to DOD. Theprolific use of explosive weaponry in Iraq has made blast-relatedinjuries the signature wound of the war, with many service membershaving been exposed to multiple explosions.Although recent clinical findings and military experience have shownthat short-term and long-term neurologic deficits may result fromexposure to the energy of a blast without a direct blow to the head, theprevailing opinion among neurological professionals had been that blast-related impairments were rare because the skull adequately shields thebrain. The report recommends that VA and DOD support research on BINTand the development of a good animal model of BINT, which is currentlylacking. Without good research data, neurological and behavioralchanges in blast victims may be underestimated and undiagnosed, andthese individuals may not get timely needed treatment, the report notes.TBI can be mild, moderate, or severe. The committee's review of theresearch on TBI at all levels of severity determined that there issufficient evidence that brain injuries resulting from severe, skull-piercing wounds can cause unprovoked seizures and premature death.Seizures can also be caused by severe, nonpenetrating TBI as well asmore moderate brain injury.Studies link both moderate and severe TBI with other long-termconsequences, including increased risk for Alzheimer's-like dementia,symptoms similar to those of Parkinson's disease, and diminishedabilities to maintain social relationships. Other data links mild TBIto increased risk for PTSD among Gulf War veterans. The evidence inthese cases shows an association, but it is not sufficient to concludethat TBI causes these problems. Likewise, TBI at any level of severity-- even mild -- appears to be associated with increased risk foraggressive behavior, depression, and memory and concentration problems.TBI may be associated with certain other potential consequences, but theevidence is only suggestive of a link. For example, moderate and severeTBI may put individuals at greater risk for developing diabetesinsipidus and psychosis, but the evidence is limited. Some data suggestthat mild TBI accompanied by loss of consciousness is linked to thedevelopment of symptoms similar to Alzheimer's and Parkinson's diseaseas well as vision problems and seizures, but the data have significantshortcomings. Likewise, TBI at all levels of severity may be linked toreduced alcohol and drug use within the first few years following theinjury, but there is inadequate evidence to be certain.Due to insufficient evidence, it is not possible to say whether mild TBIcan result in neurocognitive deficits or loss of ability to functionsocially. Also, the evidence does not indicate whether mild TBI thatwas not accompanied by loss of consciousness could lead to thedevelopment of Alzheimer's-like dementia, or whether any TBI is linkedto mania, bipolar disorder, multiple sclerosis, or amyotrophic lateralsclerosis.To develop a fuller picture of the effects of TBI and blast injuries,the committee recommended that DOD conduct pre-deployment neurocognitivetests of all military personnel to establish a baseline for identifyingpost-injury consequences and that the VA include uninjured servicemembers and other comparison groups in the Traumatic Brain InjuryVeterans Health Registry which it is building.The study was sponsored by the U.S. Department of Veterans Affairs.Established in 1970 under the charter of the National Academy ofSciences, the Institute of Medicine provides independent, objective,evidence-based advice to policymakers, health professionals, the privatesector, and the public. The National Academy of Sciences, NationalAcademy of Engineering, Institute of Medicine, and National ResearchCouncil make up the National Academies. A committee roster follows.Copies of Gulf War and Health: Long-Term Consequences of TBI areavailable from the National Academies Press; tel. 202-334-3313 or1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters mayobtain a copy from the Office of News and Public Information (contactslisted above).