Report focuses on long-term effects of battlefield brain injuries

Washington -- Military personnel who have a severe or moderate traumatic brain injury are at heightened risk for a range of long-term health problems, including Alzheimer's-like dementia, aggression, memory loss, depression, inability to maintain social relationships and symptoms similar to those of Parkinson's disease, according to an Institute of Medicine report released Dec. 4, 2008.

As of January 2008, more than 5,500 military personnel had received such injuries during the conflicts in Iraq and Afghanistan, according to the Dept. of Defense. The widespread use of explosive weaponry in Iraq has made blast-related injuries the signature wound of the war, with many service members having been exposed to multiple explosions, said the report's authors.

"Explosive devices and other weaponry have become more powerful and devastating throughout the wars in Iraq and Afghanistan, and we are seeing much higher rates of nonpenetrating traumatic brain injury and blast-induced injury among military personnel who have served in these countries than in earlier wars," said George W. Rutherford, MD, professor of epidemiology and preventive medicine and vice chair of the Dept. of Epidemiology and Biostatistics at the University of California, San Francisco, School of Medicine. Dr. Rutherford chaired the panel that drafted the report, "Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury." More information about the document is available online (link).

Although recent clinical findings and military experience have shown that short-term and long-term neurologic deficits may result from exposure to the energy of a blast without a direct blow to the head, an "outdated dogma" persists that neurologic impairments caused by primary blasts are rare because the skull provides protection for the brain, said the report's authors. As a result, such injuries are often undiagnosed.

Traumatic brain injuries may also be associated with other consequences, such as diabetes insipidus and psychosis, although the evidence is only suggestive, according to the report.

The panelists urged the Dept. of Veterans Affairs, which sponsored the study, and the Defense Dept. to step up research efforts and develop an animal model to study such injuries.