William C Walker1, Justin O'Rourke2, Elisabeth Anne Wilde3, Mary Jo Pugh4, Kimbra Kenney5, Clara Libby Dismuke-Greer6, Zhining Ou7, Angela P Presson7, J Kent Werner8, Jacob Kean9,10, Deborah Barnes11, Amol Karmarkar1, Kristine Yaffe12, David Cifu1. 1. Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, and Central Virginia VA Healthcare System, Richmond, Virginia, USA. 2. Traumatic Brain Injury Model Systems, Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, Texas, USA. 3. VA Salt Lake City Health Care System, Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. 4. VA Salt Lake City Health Care System, Department of Medicine, IDEAS Center of Innovation, University of Utah School of Medicine, Salt Lake City, Utah, USA. 5. Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 6. Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, California, USA. 7. Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah Hospital, Salt Lake City, Utah, USA. 8. Department of Neurology, School of Medicine, Uniformed Services University, Bethesda, Maryland, USA. 9. Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA. 10. VA Informatics and Computing Infrastructure, Salt Lake City, Utah, USA. 11. Departments of Psychiatry and Behavioral Sciences and Epidemiology & Biostatistics, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA. 12. Departments of Psychiatry and Behavioral Science, Neurology, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA.
Abstract
OBJECTIVE: Describe dementia cases identified through International Classification of Diseases (ICD) coding in the Long-term Impact of Military-relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) multicenter prospective longitudinal study (PLS) of mild traumatic brain injury (mTBI). DESIGN: Descriptive case series using cross-sectional data. METHODS: Veterans Affairs (VA) health system data including ICD codes were obtained for 1563 PLS participants through the VA Informatics and Computing Infrastructure (VINCI). Demographic, injury, and clinical characteristics of Dementia positive and negative cases are described. RESULTS: Five cases of dementia were identified, all under 65 years old. The dementia cases all had a history of blast-related mTBI and all had self-reported functional problems and four had PTSD symptomatology at the clinical disorder range. Cognitive testing revealed some deficits especially in the visual memory and verbal learning and memory domains, and that two of the cases might be false positives. CONCLUSIONS: ICD codes for early dementia in the VA system have specificity concerns, but could be indicative of cognitive performance and self-reported cognitive function. Further research is needed to better determine links to blast exposure, blast-related mTBI, and PTSD to early dementia in the military population.
OBJECTIVE: Describe dementia cases identified through International Classification of Diseases (ICD) coding in the Long-term Impact of Military-relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) multicenter prospective longitudinal study (PLS) of mild traumatic brain injury (mTBI). DESIGN: Descriptive case series using cross-sectional data. METHODS: Veterans Affairs (VA) health system data including ICD codes were obtained for 1563 PLS participants through the VA Informatics and Computing Infrastructure (VINCI). Demographic, injury, and clinical characteristics of Dementia positive and negative cases are described. RESULTS: Five cases of dementia were identified, all under 65 years old. The dementia cases all had a history of blast-related mTBI and all had self-reported functional problems and four had PTSD symptomatology at the clinical disorder range. Cognitive testing revealed some deficits especially in the visual memory and verbal learning and memory domains, and that two of the cases might be false positives. CONCLUSIONS: ICD codes for early dementia in the VA system have specificity concerns, but could be indicative of cognitive performance and self-reported cognitive function. Further research is needed to better determine links to blast exposure, blast-related mTBI, and PTSD to early dementia in the military population.
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