- Email: [email protected]
Clinical profile of older veterans with remote tbi
Podium Presentations: Thursday, July 23, 2015 O5-03-05
CLINICAL PROFILE OF OLDER VETERANS WITH REMOTE TBI
Kristine Yaffe1, Carrie Peltz2, Raquel C. Gardner3, Kimbra Kenney4, Joel Kramer5, Ramon Diaz-Arrastia4, 1University of California, San Francisco, San Francisco, CA, USA; 2NCIRE-The Veterans Health Research Institute, San Francisco, CA, USA; 3UCSF and SFVAMC, San Francisco, CA, USA; 4Uniformed Services University of the Health Sciences, Rockville, MD, USA; 5University of California San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: History of traumatic brain injury (TBI) is highly prev-
alent in older veterans. TBI is associated with cognitive impairment and psychiatric comorbidities, but the long-term consequences are not well-characterized. Our objective was to describe the neuropsychological and neuropsychiatric profile of older veterans with TBI history. Methods: Participants were 146 independently living residents from the Armed Forces Retirement Home, Washington, DC, and the Veterans Home of California-Yountville. TBI diagnosis, defined as head injury resulting in medical care or hospitalization, was determined by the Ohio State University TBI Questionnaire. 75 participants with TBI history and 71 non-TBI controls self-reported psychiatric history, completed depression and post-traumatic stress disorder (PTSD) scales, and received a comprehensive neuropsychological battery. We calculated composite z-scores for three cognitive domains (learning/memory, language, and processing speed/executive functioning). Regression analyses (adjusting for age, gender, race, education, diabetes, and site) were used to compare outcomes between TBI and control participants. Results: Veterans were, on average, 78 years old, had completed 14 years of education, and were mostly male. Within the TBI group, 72% reported loss of consciousness (LOC), and of those, 32% had LOC>30 minutes. Mean interval from first TBI to study visit was 51 years. Veterans with TBI were less likely to be minority (p¼0.01), but did not differ from the control group on age, gender, education, or years in military (all p>0.05). In adjusted analyses, TBI participants were more likely to have a history of substance abuse, and higher current depression and PTSD scores (all p<0.05). Modified Mini-Mental State Examination scores were slightly higher in controls than TBI (28.2 vs. 27.5; p<0.05). Learning/memory and language composite scores did not differ between the groups (learning/memory z-scores, control:-0.01, TBI:0.02; language z-scores, control:0.05, TBI:-0.02), but processing speed/executive functioning composite score was significantly lower in participants with TBI (control:0.12, TBI:0.15; p<0.01). This association persisted after additionally adjusting for psychiatric comorbidities (p<0.05). Conclusions: Our results suggest that older veterans with a distant TBI history have a unique
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neuropsychiatric profile with high rates of behavioral symptoms and deficits in executive functioning. The clinical course and underlying pathology of these individuals warrants further study.
O5-03-06
THE UNITE STUDY: UNDERSTANDING CHRONIC TRAUMATIC ENCEPHALOPATHY THROUGH CLINICO-PATHOLOGICAL CORRELATION — METHODS AND INSTRUCTIVE CASES
Jesse Mez, Todd M. Solomon, Daniel Daneshvar, Philip Montenigro, Lauren Murphy, Patrick Kiernan, Joshua Kriegel, Thor Stein, Douglas I. Katz, Robert Cantu, Neil W. Kowall, Robert A. Stern, Ann McKee, Boston University School of Medicine, Boston, MA, USA. Contact e-mail: [email protected] Background: UNITE, a recently NIH-funded U01 examines the neuropathology and clinical presentation of brain donors “at risk” for chronic traumatic encephalopathy (CTE). We present methodology for examining clinicopathological correlation and two cases highlighting similarities and differences between CTE and Alzheimer’s disease (AD). Methods: Over the next four years, we will analyze the brain and spinal cord of 300 deceased subjects who have a history of repetitive brain trauma from contact sports or military service. Clinical data will be collected through retrospective family interviews and medical record review. Comprehensive neuropathological assessment for neurodegenerative disease including CTE will be made using published criteria (including McKee 2013) blinded to the clinical data. At a clinicopathological conference, an expert panel of physicians and neuropsychologists reach a clinical consensus diagnosis blinded to the neuropathological data, using published criteria including proposed clinical research criteria for CTE (Montenigro 2014). The clinical and pathological analyses are subsequently reconciled. Results: Case 1: A 66 y.o. man who played American football for seventeen years including six years in the NFL as a center, had a progressive course that included angry outbursts beginning in his late twenties, memory impairment beginning in his fifties, depression and visuospatial dysfunction beginning in his early sixties and parkinsonism in his last year of life. Case 2: An 82 y.o. man who played American football for sixteen years including nine years in the NFL as a wide receiver had a progressive course that included memory, executive function and visuospatial deficits beginning in his mid-sixties, functional impairment beginning in his early seventies and severe dementia prior to death. While the clinical consensus diagnosis for Case 1 was CTE and Case 2 was AD, both cases met pathological criteria for CTE, but not for AD (Montine 2012). Conclusions: CTE can present strikingly similar to or different from typical AD.
CLINICAL PROFILE OF OLDER VETERANS WITH REMOTE TBI
Kristine Yaffe1, Carrie Peltz2, Raquel C. Gardner3, Kimbra Kenney4, Joel Kramer5, Ramon Diaz-Arrastia4, 1University of California, San Francisco, San Francisco, CA, USA; 2NCIRE-The Veterans Health Research Institute, San Francisco, CA, USA; 3UCSF and SFVAMC, San Francisco, CA, USA; 4Uniformed Services University of the Health Sciences, Rockville, MD, USA; 5University of California San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: History of traumatic brain injury (TBI) is highly prev-
alent in older veterans. TBI is associated with cognitive impairment and psychiatric comorbidities, but the long-term consequences are not well-characterized. Our objective was to describe the neuropsychological and neuropsychiatric profile of older veterans with TBI history. Methods: Participants were 146 independently living residents from the Armed Forces Retirement Home, Washington, DC, and the Veterans Home of California-Yountville. TBI diagnosis, defined as head injury resulting in medical care or hospitalization, was determined by the Ohio State University TBI Questionnaire. 75 participants with TBI history and 71 non-TBI controls self-reported psychiatric history, completed depression and post-traumatic stress disorder (PTSD) scales, and received a comprehensive neuropsychological battery. We calculated composite z-scores for three cognitive domains (learning/memory, language, and processing speed/executive functioning). Regression analyses (adjusting for age, gender, race, education, diabetes, and site) were used to compare outcomes between TBI and control participants. Results: Veterans were, on average, 78 years old, had completed 14 years of education, and were mostly male. Within the TBI group, 72% reported loss of consciousness (LOC), and of those, 32% had LOC>30 minutes. Mean interval from first TBI to study visit was 51 years. Veterans with TBI were less likely to be minority (p¼0.01), but did not differ from the control group on age, gender, education, or years in military (all p>0.05). In adjusted analyses, TBI participants were more likely to have a history of substance abuse, and higher current depression and PTSD scores (all p<0.05). Modified Mini-Mental State Examination scores were slightly higher in controls than TBI (28.2 vs. 27.5; p<0.05). Learning/memory and language composite scores did not differ between the groups (learning/memory z-scores, control:-0.01, TBI:0.02; language z-scores, control:0.05, TBI:-0.02), but processing speed/executive functioning composite score was significantly lower in participants with TBI (control:0.12, TBI:0.15; p<0.01). This association persisted after additionally adjusting for psychiatric comorbidities (p<0.05). Conclusions: Our results suggest that older veterans with a distant TBI history have a unique
P321
neuropsychiatric profile with high rates of behavioral symptoms and deficits in executive functioning. The clinical course and underlying pathology of these individuals warrants further study.
O5-03-06
THE UNITE STUDY: UNDERSTANDING CHRONIC TRAUMATIC ENCEPHALOPATHY THROUGH CLINICO-PATHOLOGICAL CORRELATION — METHODS AND INSTRUCTIVE CASES
Jesse Mez, Todd M. Solomon, Daniel Daneshvar, Philip Montenigro, Lauren Murphy, Patrick Kiernan, Joshua Kriegel, Thor Stein, Douglas I. Katz, Robert Cantu, Neil W. Kowall, Robert A. Stern, Ann McKee, Boston University School of Medicine, Boston, MA, USA. Contact e-mail: [email protected] Background: UNITE, a recently NIH-funded U01 examines the neuropathology and clinical presentation of brain donors “at risk” for chronic traumatic encephalopathy (CTE). We present methodology for examining clinicopathological correlation and two cases highlighting similarities and differences between CTE and Alzheimer’s disease (AD). Methods: Over the next four years, we will analyze the brain and spinal cord of 300 deceased subjects who have a history of repetitive brain trauma from contact sports or military service. Clinical data will be collected through retrospective family interviews and medical record review. Comprehensive neuropathological assessment for neurodegenerative disease including CTE will be made using published criteria (including McKee 2013) blinded to the clinical data. At a clinicopathological conference, an expert panel of physicians and neuropsychologists reach a clinical consensus diagnosis blinded to the neuropathological data, using published criteria including proposed clinical research criteria for CTE (Montenigro 2014). The clinical and pathological analyses are subsequently reconciled. Results: Case 1: A 66 y.o. man who played American football for seventeen years including six years in the NFL as a center, had a progressive course that included angry outbursts beginning in his late twenties, memory impairment beginning in his fifties, depression and visuospatial dysfunction beginning in his early sixties and parkinsonism in his last year of life. Case 2: An 82 y.o. man who played American football for sixteen years including nine years in the NFL as a wide receiver had a progressive course that included memory, executive function and visuospatial deficits beginning in his mid-sixties, functional impairment beginning in his early seventies and severe dementia prior to death. While the clinical consensus diagnosis for Case 1 was CTE and Case 2 was AD, both cases met pathological criteria for CTE, but not for AD (Montine 2012). Conclusions: CTE can present strikingly similar to or different from typical AD.