The seventh in a series of congressionally mandated reports on Gulf War veterans health, this volume evaluates traumatic brain injury (TBI) and its association with long-term health affects.

That many returning veterans have TBI will likely mean long-term challenges for them and their family members. Further, many veterans will have undiagnosed brain injury because not all TBIs have immediately recognized effects or are easily diagnosed with neuroimaging techniques.

In an effort to detail the long term consequences of TBI, the committee read and evaluated some 1,900 studies that made up its literature base, and it developed criteria for inclusion of studies to inform its findings. It is clear that brain injury, whether penetrating or closed, has serious consequences. The committee sought to detail those consequences as clearly as possible and to provide a scientific framework to assist veterans as they return home.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON GULF WAR AND HEALTH: BRAIN INJURY IN VETERANS AND LONG-TERM HEALTH OUTCOMES
• REVIEWERS
• PREFACE
• SUMMARY
• 1. INTRODUCTION
  • BACKGROUND
  • TRAUMATIC BRAIN INJURY
  • OPERATION ENDURING FREEDOM AND OPERATION IRAQI FREEDOM
  • CHARGE TO THE COMMITTEE
  • SCOPE OF THE REPORT
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. BIOLOGY OF TRAUMATIC BRAIN INJURY
  • PATHOBIOLOGY OF TRAUMATIC BRAIN INJURY
  • TRADITIONAL CLASSIFICATIONS OF TRAUMATIC BRAIN INJURY
  • CLASSIFICATION ACCORDING TO EXTENT OF PATHOLOGY
  • CLASSIFICATION ACCORDING TO BIOMECHANICS OF INJURY
  • THERAPEUTICS AND TRAUMATIC BRAIN INJURY
  • SUMMARY OF PATHOBIOLOGY OF TRAUMATIC BRAIN INJURY
  • TRAUMATIC BRAIN INJURIES RELEVANT TO THE MILITARY
  • BASIC MECHANISMS OF EXPLOSIVE INJURIES
  • SEVERITY SCORING OF BLAST INJURIES AND TRAUMATIC BRAIN INJURY
  • REFERENCES
• 3. EPIDEMIOLOGY OF ADULT TRAUMATIC BRAIN INJURY
  • Scales and Scoring Systems Used to Describe Traumatic Brain Injury
  • Gross Severity of Traumatic Brain Injury
  • Outcome Scores and Predictors
  • INCIDENCE OF TRAUMATIC BRAIN INJURY
  • BRAIN INJURY SEVERITY
  • RISK FACTORS FOR TRAUMATIC BRAIN INJURY
  • RECURRENT TRAUMATIC BRAIN INJURY
  • TRAUMATIC BRAIN INJURY AND SHORT-TERM OUTCOMES
  • SUMMARY
  • REFERENCES
• 4. CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE
  • IDENTIFICATION OF THE LITERATURE
  • TYPES OF EVIDENCE
  • INCLUSION CRITERIA
  • CONSIDERATIONS IN ASSESSING THE STRENGTH OF EVIDENCE
  • LIMITATIONS OF STUDIES
  • REFERENCES
• 5. MAJOR COHORT STUDIES
  • GENERAL LIMITATIONS OF COHORT STUDIES
  • ORGANIZATION OF THE CHAPTER
  • MILITARY STUDIES
  • POPULATION-BASED STUDIES
  • OTHER COHORT STUDIES
  • STUDIES OF SPORTS-RELATED TRAUMATIC BRAIN INJURY
  • REFERENCES
• 6. NEUROCOGNITIVE OUTCOMES
  • PENETRATING BRAIN INJURY
  • CLOSED HEAD INJURY
  • REFERENCES
• 7. NEUROLOGIC OUTCOMES
  • SEIZURE DISORDERS
  • POSTCONCUSSION SYMPTOMS
  • OCULAR AND VISUAL MOTOR DETERIORATION
  • ENDOCRINE DISORDERS
  • NEURODEGENERATIVE DISEASES
  • DEMENTIA OF THE ALZHEIMER TYPE
  • DEMENTIA PUGILISTICA
  • PARKINSONISM
  • MULTIPLE SCLEROSIS
  • AMYOTROPHIC LATERAL SCLEROSIS
  • REFERENCES
• 8. PSYCHIATRIC OUTCOMES
  • MOOD DISORDERS
  • SUICIDE
  • ANXIETY DISORDERS
  • OTHER PSYCHIATRIC OUTCOMES
  • AGGRESSIVE BEHAVIORS
  • DRUG AND ALCOHOL ABUSE DISORDERS
  • PSYCHOTIC DISORDERS
  • REFERENCES
• 9. SOCIAL FUNCTIONING
  • PRIMARY STUDIES OF MILITARY POPULATIONS
  • PRIMARY STUDIES OF CIVILIAN POPULATIONS
  • SECONDARY STUDIES
  • SUMMARY AND CONCLUSIONS
  • REFERENCES
• 10. OTHER HEALTH OUTCOMES
  • MORTALITY AND TRAUMATIC BRAIN INJURY PRIMARY STUDIES
  • SECONDARY STUDIES
  • SUMMARY AND CONCLUSIONS
  • BRAIN TUMORS AND TRAUMATIC BRAIN INJURY
  • PRIMARY STUDIES
  • SECONDARY STUDIES
  • SUMMARY AND CONCLUSIONS
  • REFERENCES
• 11. CONCLUSIONS AND RECOMMENDATIONS
  • QUALITY OF THE STUDIES
  • OVERVIEW OF HEALTH OUTCOMES
  • RECOMMENDATIONS

This study was supported by Contract V101(93) P-2136, Task Order 8 between the National Academy of Sciences and Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2009. Gulf War and Health, Volume 7: Long-term Consequences of Traumatic Brain Injury. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.