Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury

Casey S Gilmore; Kelvin O Lim; Mona K Garvin; Jui-Kai Wang; Johannes Ledolter; Alicia L Fenske; Carolyn L Gentz; Julie Nellis; Michael T Armstrong; Randy H Kardon

doi:10.1001/jamanetworkopen.2020.30824

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Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury

Journal article

Open access

Peer reviewed

Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury

Casey S Gilmore, Kelvin O Lim, Mona K Garvin, Jui-Kai Wang, Johannes Ledolter, Alicia L Fenske, Carolyn L Gentz, Julie Nellis, Michael T Armstrong and Randy H Kardon

JAMA network open, Vol.3(12), pp.e2030824-e2030824

12/01/2020

DOI: 10.1001/jamanetworkopen.2020.30824

PMID: 33351088

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Abstract

Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. Change over time of retinal nerve fiber layer (RNFL) thickness. A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] μm/y vs -0.31 [0.32] μm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.

United States - epidemiology

Visual Field Tests - methods

Visual Field Tests - statistics & numerical data

Brain Concussion - physiopathology

Neurodegenerative Diseases - etiology

Neurodegenerative Diseases - psychology

Humans

Middle Aged

Neurodegenerative Diseases - diagnosis

Male

Brain Concussion - complications

Cognition

Functional Status

Tomography, Optical Coherence - methods

Neuropsychological Tests - statistics & numerical data

Veterans Health - statistics & numerical data

Female

Chronic Disease

Longitudinal Studies

Details

Title: Subtitle: Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury
Creators: Casey S Gilmore - Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
Kelvin O Lim - Department of Psychiatry, University of Minnesota, Minneapolis
Mona K Garvin - Department of Electrical and Computer Engineering, University of Iowa, Iowa City
Jui-Kai Wang - Department of Electrical and Computer Engineering, University of Iowa, Iowa City
Johannes Ledolter - Department of Business Analytics and Department of Statistics and Actuarial Science, University of Iowa, Iowa City
Alicia L Fenske - Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
Carolyn L Gentz - Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
Julie Nellis - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
Michael T Armstrong - Defense and Veterans Brain Injury Center, Minneapolis, Minnesota
Randy H Kardon - Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
Resource Type: Journal article
Publication Details: JAMA network open, Vol.3(12), pp.e2030824-e2030824
DOI: 10.1001/jamanetworkopen.2020.30824
PMID: 33351088
NLM abbreviation: JAMA Netw Open
ISSN: 2574-3805
eISSN: 2574-3805
Publisher: United States
Language: English
Date published: 12/01/2020
Academic Unit: Statistics and Actuarial Science; Electrical and Computer Engineering; Iowa Neuroscience Institute; Business Analytics; Ophthalmology and Visual Sciences
Record Identifier: 9984070720902771

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