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July 2017

Functional Decline 5 Years After Blast Traumatic Brain InjurySounding the Alarm for a Wave of Disability?

Author Affiliations
  • 1Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Department of Neurology, University of Tennessee Health Science Center, Memphis
  • 4Department of Pediatrics, University of Tennessee Health Science Center, Memphis
  • 5Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
  • 6Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis
  • 7Department of Neurology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
JAMA Neurol. 2017;74(7):763-764. doi:10.1001/jamaneurol.2017.0176

The long-term outcomes associated with wartime traumatic brain injury (TBI) and general combat exposure remain poorly understood as they relate to service members from recent military conflicts. Most of the research on mild TBI (mTBI) has been conducted on athletes and civilians; these studies suggest that a majority of individuals experience complete recovery within a few weeks or months after injury. The effects of combat on long-term health and aging have been studied among individuals who served during World War II or in the Korean and Vietnam War eras, and the results are somewhat mixed. Some studies report poorer overall health with aging among veterans compared with nonveterans,1,2 particularly for those who experienced combat.3,4 However, other studies seem to support what has been called the “healthy soldier effect,”5 suggesting that service members continue to be healthier than their nonveteran peers for decades after military service.5,6 Research on blast mTBI has been growing since mTBI was labeled one of the signature injuries of the recent wars. Studies examining military breachers, who conduct dynamic entry into buildings often using planned explosive blasts, have shown that chronic exposure to low-level blasts can lead to clinical sequelae.7 A recently published study revealed the presence of astroglial scarring on the surface of the brain after blast TBI, suggesting that blast mTBI is different from routine sports concussion and also may explain some of the clinical sequelae seen after blast mTBI.8