"Studying injured minds" - the Vietnam head injury study and 40 years of brain injury research

Vanessa Raymont, Andres M Salazar, Frank Krueger, Jordan Grafman, Vanessa Raymont, Andres M Salazar, Frank Krueger, Jordan Grafman

Abstract

The study of those who have sustained traumatic brain injuries (TBI) during military conflicts has greatly facilitated research in the fields of neuropsychology, neurosurgery, psychiatry, neurology, and neuroimaging. The Vietnam Head Injury Study (VHIS) is a prospective, long-term follow-up study of a cohort of 1,221 Vietnam veterans with mostly penetrating brain injuries, which has stretched over more than 40 years. The scope of this study, both in terms of the types of injury and fields of examination, has been extremely broad. It has been instrumental in extending the field of TBI research and in exposing pressing medical and social issues that affect those who suffer such injuries. This review summarizes the history of conflict-related TBI research and the VHIS to date, as well as the vast range of important findings the VHIS has established.

Keywords: brain imaging; brain injury; brain lesion; neuropsychology.

Figures

Figure 1
Figure 1
Predictive formula for the risk of developing PTE.
Figure 2
Figure 2
Pre- and PH2 Armed Forces Qualification Test (AFQT) scores in head injured subject (filled circles, r = −0.32) and controls (open circles, r = −0.44). Plot of pre- to PH2 AFQT differences (D-AFQT) by preinjury AFQT deciles.
Figure 3
Figure 3
Mean change in AFQT scores from Phase 2 to Phase 3 in subjects with TBI.
Figure 4
Figure 4
Lesion difference analysis. A healthy adult brain is shown on the left. The lesion difference analysis for the corresponding slices is shown on the right. The color of each voxel indicates the difference between the number of veterans with damage to that voxel that developed PTSD and did not develop PTSD. The colors blue and green indicate the most negative values – areas where damage was relatively infrequently associated with PTSD. Top row, sagittal views of negative value clusters in prefrontal cortex. The left hemisphere (x = −10) is on the left and the right hemisphere (x = 16) is on the right. Second row, coronal views of negative value clusters in bilateral prefrontal cortex. Slices are arranged with the anterior most slice on the left (y = 66, y = 56, y = 36, respectively). In each coronal slice, the right hemisphere is on the reader’s left (radiological convention). Third row, coronal views of negative value clusters in bilateral anterior temporal lobe (y = 14, y = 8, y = 2, y = −4, respectively). Fourth row, coronal views of posterior temporal lobe (y = −10, y = −16, y = −22, y = −28, respectively).
Figure 5
Figure 5
Logistic regression analysis outcomes for predictive factors of variation in work status.
Figure 6
Figure 6
Vietnam Head Injury Study, percent working by disability score. The disability score represents the number of disabilities present (1–7).

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