Chronic Effects of Neurotrauma Consortium

Last updated
Chronic Effects of Neurotrauma Consortium (CENC)
Founded2013 (2013)
TypeResearch Consortium
Location
Coordinates 37°32′48″N77°27′12″W / 37.546615°N 77.453255°W / 37.546615; -77.453255
Area served
United States
Website cenc.rti.org

The Chronic Effects of Neurotrauma Consortium (CENC) is a federally funded research project devised to address the long-term effects of mild traumatic brain injury in military service personnel (SMs) and Veterans. Announced by President Barack Obama on August 20, 2013, the CENC was one of two major initiatives developed in response to the injuries incurred by U.S. service personnel during Operation Enduring Freedom and Operation Iraqi Freedom. [1] [2] [3] The project is jointly funded in the amount of $62.175 million by the Department of Defense (DoD) and the Department of Veterans Affairs (VA). The CENC is led by Dr. David X. Cifu of the Virginia Commonwealth University. [4] [5] [6] [7] [ unreliable source? ] [8] [9] [ unreliable source? ] [10]

Contents

Background

In short, critical gaps exist in the literature, with a paucity of prospective, controlled studies on late-life outcomes and neurodegeneration after mTBI and related basic science research. These research gaps are particularly prominent in the injuries and difficulties seen in combat-exposed populations. The existing research, although suggestive, is not rigorous or robust enough to allow for a clear understanding of the relationships, risks, and potential effective interventions for mTBI, chronic symptoms, and neurodegeneration. To date, no controlled prospective longitudinal study has examined the late-life cognitive, behavioral, systemic, and functional effects of TBI of any severity. Given the absence of prospective studies, the association between TBI and early neurodegeneration is merely theoretical, and the actual risk factors and rate/extent of physiologic and clinical decline over time are unknown. It is also unclear whether a single TBI may be enough to begin a degenerative cascade in select individuals or whether a critical number (dose threshold) of TBIs is needed to “prime” the central nervous system for degeneration. As the majority of TBIs in the military are mild, prospective studies of cognitive outcomes from mild injury are necessary to determine the long-term risks posed to SMs and Veterans. The potential link between mTBI and the development of early dementia is a significant concern for not only at-risk SMs, Veterans, and their families, but also for DoD and VA resource planning, given the high service utilization in the DoD and VA health systems associated with dementia. [11]

Given these gaps in scientific research and knowledge, the military- and Veteran-specific issues involved, and the importance of a uniform approach to this critical set of problems, the Department of Defense and the Department of Veterans Affairs jointly issued a request for proposals to fund a 5-year, $62.175 million project to address these concerns. After a competitive application process, a consortium led by Virginia Commonwealth University prevailed and was announced as the recipient of the award by President Obama on August 20, 2013. [4] [5] [6] [8] [9] [10] At the time of the award, this was the single largest grant ever awarded to Virginia Commonwealth University. [6]

The Consortium

The mission of the CENC is to fill the gaps in knowledge about the basic science of mild TBI (also termed concussion), to determine its effects on late-life outcomes and neurodegeneration, to identify service members most susceptible to these effects, and to identify the most effective treatment strategies. [4] [5] [6] [12] The CENC is a multi-center collaboration linking premiere basic science, translational, and clinical neuroscience researchers from the DoD, VA, academic universities, and private research institutes to effectively address the scientific, diagnostic, and therapeutic ramifications of mild TBI and its long-term effects. [6] [7] [10] [8] [9]

Oversight

The CENC has oversight from a Government Steering Committee (GSC). Members of the GSC are DoD/VA appointed and is composed of both government representatives and non-government subject matter experts. The GSC approves all studies to be conducted, recommends new studies, and identifies existing and new requirements as they arise. The GSC is the overall main governing and management committee for the project and the committee through which the DoD and VA interact and collaborate with the CENC. The GSC determines all major scientific decisions, and clinical studies proposed by the Consortium Committee proceed into the implementation stage only with the approval of the GSC. [13] [14]

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Concussion</span> Type of traumatic brain injury

A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin immediately, or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

<span class="mw-page-title-main">Traumatic brain injury</span> Injury of the brain from an external source

A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumatic brain injury. TBI can also be characterized based on mechanism or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

<span class="mw-page-title-main">Chronic traumatic encephalopathy</span> Neurodegenerative disease caused by head injury

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia.

Polytrauma and multiple trauma are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury in addition to a serious burn. The term is defined via an Injury Severity Score (ISS) equal to or greater than 16. It has become a commonly applied term by US military physicians in describing the seriously injured soldiers returning from Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in Afghanistan. The term is generic, however, and has been in use for a long time for any case involving multiple trauma.

<span class="mw-page-title-main">Madigan Army Medical Center</span> Hospital in Washington, United States

The Madigan Army Medical Center, located on Joint Base Lewis-McChord just outside Lakewood, Washington, is a key component of the Madigan Healthcare System and one of the largest military hospitals on the West Coast of the United States.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Primary and secondary brain injury are ways to classify the injury processes that occur in brain injury. In traumatic brain injury (TBI), primary brain injury occurs during the initial insult, and results from displacement of the physical structures of the brain. Secondary brain injury occurs gradually and may involve an array of cellular processes. Secondary injury, which is not caused by mechanical damage, can result from the primary injury or be independent of it. The fact that people sometimes deteriorate after brain injury was originally taken to mean that secondary injury was occurring. It is not well understood how much of a contribution primary and secondary injuries respectively have to the clinical manifestations of TBI.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) is a United States Department of Defense (DoD) organization that provides guidance across DoD programs related to psychological health (PH) and traumatic brain injury (TBI) issues. The organization's official mission is to "improve the lives of our nation’s service members, families and veterans by advancing excellence in psychological health and traumatic brain injury prevention and care."

The National Center for Telehealth & Technology (T2) is one of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), a part of the Military Health System (MHS). T2 was originally established to lead the integration of behavioural sciences with technology to provide solutions for psychological health and traumatic brain injury (TBI). T2 is a principal coordinator of United States Department of Defense (DoD) initiatives involving telehealth, online health tools, suicide surveillance and prevention, and information technology.

<span class="mw-page-title-main">Childhood acquired brain injury</span> Medical condition

Childhood acquired brain injury (ABI) is the term given to any injury to the brain that occurs during childhood but after birth and the immediate neonatal period. It excludes injuries sustained as a result of genetic or congenital disorder. It also excludes those resulting from birth traumas such as hypoxia or conditions such as foetal alcohol syndrome. It encompasses both traumatic and non-traumatic injuries.

Traumatic brain injury modeling replicates aspects of traumatic brain injury (TBI) as a method to better understand what physically happens to the brain. Researchers use a variety of models for this process, with different models able to replicate certain aspects of TBI while also producing their own limitations.

<span class="mw-page-title-main">Veterans Traumatic Brain Injury Care Improvement Act</span>

The Veterans Traumatic Brain Injury Care Improvement Act is a bill introduced in the 113th U.S. Congress that would extend medical treatment and rehabilitation services to U.S. military veterans suffering from traumatic brain injuries.

Ibolja Cernak is an American researcher in blast wave injury. Cernak concluded in the 1990s that soldiers who had been subjected to blasts were suffering from traumatic brain injury (TBI), while most still considered their invisible injuries to be Post Traumatic Stress Syndrome (PTSD), and to be psychological rather than physical. Cernak is Chair of Military and Veterans’ Clinical Rehabilitation at the Faculty of Rehabilitation at the University of Alberta.

K. Drorit "Dee" Gaines is a neuropsychologist specializing in diagnostic evaluations, brain injury, trauma, and public education. She is most known for her work with United States veterans, and serves as an authority on the physical brain's effects on behavior and cognitive functioning.

Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of patients with TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI specifically develop insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.

Inga Katharina Koerte is a German neuroradiologist. She currently holds a dual affiliation as Professor of Biological Research in Child and Adolescent Psychiatry at Ludwig-Maximilians-University (LMU), Munich, Germany and as lecturer in psychiatry at Harvard Medical School (HMS), Boston, USA. Since 2018 she is associate faculty member of the Graduate School of Systemic Neuroscience (GSN) in Munich. Her research focusses on the effects of brain trauma on the brain's structure and function, as well as the development of diagnostic markers that can be used for the purpose of both therapeutic, and preventative interventions.

<span class="mw-page-title-main">Jessica Gill (nurse)</span> American nurse scientist

Jessica M. Gill is an American nurse scientist working as a Bloomberg Distinguished Professor of Trauma Recovery Biomarkers in the department of neurology at the Johns Hopkins School of Nursing and School of Medicine since 2021. She was the acting deputy director of the National Institute of Nursing Research from 2019 to 2020 and deputy director of the Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of the Health Sciences until 2021.

Ramon Diaz-Arrastia is an American neurologist and clinical investigator. He is the John McCrae Dickson, MD Presidential professor of Neurology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Director of Clinical Traumatic Brain Injury Research, and Attending Neurologist at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center.

References

  1. ↑ "Obama Introduces New PTSD and Education Programs". Military.com. 12 August 2013. Retrieved 2 May 2014.
  2. ↑ "Obama administration to research TBI, PTSD in new efforts Read more: Chronic Effects of Neurotrauma Consortium - FierceGovernment". Fiercegovernment.com. Archived from the original on 2 May 2014. Retrieved 2 May 2014.
  3. ↑ "DoD, VA Establish Two Multi-Institutional Consortia to Research PTSD and TBI". United States Department of Veterans Affairs. 10 August 2013. Retrieved 2 May 2014.
  4. 1 2 3 "Fact Sheet: The Obama Administration's Work to Honor Our Military Families and Veterans". whitehouse.gov . 10 August 2013. Retrieved 2 May 2014– via National Archives.
  5. 1 2 3 Buckley, Anne (12 August 2013). "Fact Sheet: VCU will lead $62 million study of traumatic brain injuries in military personnel". Virginia Commonwealth University . Retrieved 2 May 2014.
  6. 1 2 3 4 5 Buckely, Anne (13 August 2013). "Fact Sheet: Largest federal grant in VCU's history". Virginia Commonwealth University . Retrieved 2 May 2014.
  7. 1 2 "RTI to research mild traumatic brain injury effects in US soldiers". Army-Technology.com. 21 August 2013. Retrieved 2 May 2014.
  8. 1 2 3 Smith, Tammie; Strong, Ted (12 August 2013). "VCU to lead major study of concussions". Richmond Times-Dispatch. Archived from the original on 3 May 2014. Retrieved 2 May 2014– via grpva.com.
  9. 1 2 3 Baker, Berenice (10 March 2014). "Brain trust - the US consortia tacking military PTSD and brain injury". Army-Technology.com. Retrieved 2 May 2014.
  10. 1 2 3 Crown, Ellen (16 August 2013). "DOD partners to combat brain injury". United States Army . Retrieved 2 May 2014.
  11. ↑ Taber KH, Warden DL, Hurley RA: Blast-Related Traumatic Brain Injury: What Is Known? J Neuropsychiatr Clin Neurosci 2006;18:141-145
  12. ↑ "Goals and Mission". Chronic Effects of Neurotrauma Consortium. Archived from the original on 2 May 2014. Retrieved 2 May 2014.
  13. ↑ "Government Steering Committee". Chronic Effects of Neurotrauma Consortium. Archived from the original on 2 May 2014. Retrieved 2 May 2014.
  14. ↑ "FY12 Chronic Effects of Neurotrauma Consortium (CENC) Government Steering Committee". Congressionally Directed Medical Research Programs. Retrieved 2 May 2014.
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