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|Issue 150||March 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Traumatic Brain Injury and Dementia
Traumatic brain injury (TBI) is a common condition among both civilian and military populations. While some TBIs cause acute symptoms that resolve over several weeks or months, evidence accumulated over nearly three decades suggests that TBI may lead to chronic neurodegenerative diseases such as dementia. More public awareness about TBI in active-duty service members as a risk factor for earlier onset of dementia and/or of Chronic Traumatic Encephalopathy (CTE) has increased the urgency to better understand these potential links. In particular, a better understanding of the link between TBI and dementia among Veterans could help VA develop and provide guidance on new screening, diagnosis, and treatment efforts in the future.
In 2017, the DoD reported 15,000 new TBI diagnoses among military service members, and researchers have estimated that 10-20% of Veterans experience a TBI during deployment. Most military service members who experience a TBI, experience more than one.
The aim of this rapid review was to summarize the best evidence on the comparative prevalence of dementia between Veterans and civilians, and to assess whether certain risk factors (i.e., previous TBIs, era of conflict, and combat exposure) affect the risk and timing of dementia onset among Veterans. Investigators with VA's Evidence Synthesis Coordinating Center in Portland, OR reviewed the literature including: MEDLINE®, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar. Investigators identified 40 studies that were used in this review, which builds on previous evidence synthesis work by focusing on Veteran populations and adding a few key studies including Veterans that were either not yet published or that used a broader range of analytic methods (i.e., hazard ratio, prevalence rates).
Summary of Findings
Dementia prevalence appears similar in Veteran and non-Veteran populations.
No studies were found that addressed whether the prevalence of dementia in Veterans varies based on combat deployment history, era of conflict, mode of injury (blast vs non-blast), or number of injuries.
Implications for VHA Practice/Policy
In the interim, clinical recommendations should encourage the incorporation of healthy lifestyle habits (i.e., healthy diet, regular exercise, sleep hygiene, avoidance of alcohol and drugs, etc.) to improve overall health. For detailed guidance on managing all the post-concussion symptoms, providers may access the full Clinical Practice Guidelines package from 2016 (Management of Concussion-mild Traumatic Brain Injury). These guidelines identify the science behind and practical approaches to managing the 20+ symptoms commonly seen following combat (and all) concussions. Additionally, the Chronic Effects of Neurotrauma Consortium (CENC) has established a knowledge translation core to disseminate all CENC findings to the public, service members and Veterans, as well as clinicians and researchers.
Please feel free to forward this information to others!
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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