Day Two - May 3, 2024

Continental Breakfast

Chairperson's Opening Remarks

Andreas Jeromin, Ph.D., Chief Scientific Officer, ALZ Path

Sex-specific Associations Between Traumatic Brain Injury and Non-fatal Drug Overdose in Young Adult Post-9/11 Veterans

Evidence is mounting that veterans with a history of traumatic brain injury (TBI) have a disproportionately higher risk for overdose, yet information on sex-specific associations is lacking. The present study evaluated whether there are sex-specific differences in the association between TBI and non-fatal overdose in a national prospective cohort of US post-9/11 veterans receiving care at the Department of Veterans Affairs. We examined two overdose outcomes; any drug overdose, and the subset of drug overdoses that were opioid-related. Furthermore, we estimated both the multiplicative and additive interactions between TBI and sex. Finally, we determined whether psychiatric disorders (posttraumatic stress disorder, mood disorders, and anxiety disorders) and substance use disorders (alcohol use disorder, opioid use disorder, and other substance use disorder) mediated the sex-specific association between TBI and each overdose outcome.

Jennifer Fonda, Ph.D., Assistant Professor, Chobanian & Avedisian School of Medicine, Department of Psychiatry, Boston University

Substance Use following Traumatic Brain Injury: Evidence of Substance Use Treatment Disparities and Adverse Consequences

Dr. Adams will provide a brief overview of the risk for excessive substance use following traumatic brain injury (TBI). In the context of the opioid and overdose epidemic, she will describe the "perfect storm" theory which posits that numerous risk factors may converge for people with TBI, placing them at increased risk for opioid use, misuse, substance use treatment disparities, and devastating consequences. Dr. Adams will highlight new studies which found that among people with opioid use disorder, people with a history of TBI experienced substance use treatment disparities compared to people without TBI, revealing health inequities. She will conclude her talk by synthesizing evidence for risk for adverse morbidity and mortality following TBI among people with substance use disorders.

Rachel Sayko Adams, Ph.D., MPH, Research Associate Professor, Dept. of Health, Law, Policy & Management, Boston University School of Public Health

Multi-domain TBI Sequelae: Methodological and Conceptual Considerations

Kristen Dams-O'Connor, Ph.D., Vice Chair of Research, Director, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai

Track Follow Up Discussion & Question/Answer Session

An Update and Lessons Learned from HeadSMART II (HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma II)

Damon Kuehl, MD, Vice Chair Research & Academic Affairs, Carilion Clinic, Virginia Tech University

Refreshment Break/Exhibit Viewing/Poster Session

Brain Impact of Repetitive Subconcussive Blast Exposure in Special Operator Heavy Weapons Training: The INVICTA Study (INVestigating traIning assoCiated blasT pAthology)

INVICTA is a 5-year prospective controlled longitudinal study assessing blast overpressure, and the corresponding impact on a wide range of measures of brain function, during Special Operator Heavy Weapons Training. INVICTA targets 200 exposed Special Operators and Range Safety Officers, as well as 100 active duty controls, and is nearly completed at this time. This talk will cover the results obtained from blast gauges placed on the head, shoulder, and chest of participants, as well as measures demonstrating acute adverse (but reversible) impact on blood biomarkers, cognitive function, gait, tactile discrimination, and oculomotor function.

Michael J. Roy, MD, MPH, Colonel (Retired), U.S. Army, Director, Division of Military Internal Medicine, Professor of Medicine, Deputy Director, Military Traumatic Brain Injury Initiative, Uniformed Services University

Clinical Research Track - Track Chair's Opening Remarks

Ramon Diaz-Arrastia, MD, Ph.D., John McCrea Dickson M.D. Presidential Professor, Department of Neurology, University of Pennsylvania

Spreading Depolarizations: a Clinical Target for Neuroprotection?

Dr. Hartings will review the pathophysiology of spreading depolarizations, their occurrence in the human brain after severe injury, and how they are measured by electrocorticography. He will review evidence from observational studies that depolarizations are a mechanism of secondary injury associated with worse outcomes. Finally, he will review current thoughts on treatments and how depolarization monitoring might allow a precision-medicine approach to neuroprotection.

Jed Hartings, Ph.D., Professor, Department of Neurosurgery, University of Cincinnati

Prevention of Post-TBI Chronic Neurodegenerative Disease

The transition of acute TBI into chronic neurodegenerative disease, including increased risk for developing earlier and more severe Alzheimer's disease, is an important problem that is poorly understood in the field. This talk will discuss mechanisms and therapeutic opportunities related to this problem.

Andrew Pieper, MD, Ph.D., Professor, Department of Neurosciences, Investigator, Case Western Reserve University, Harrington Discovery Institute

Pig Model of TBI for Development of Individualized Treatment Strategies

In this talk, Dr. Shin will talk about how two different pig models of TBI (contusion injury and acceleration injury) leads to different biomarker, diffusion imaging, and histological profile. He will also delve into how these clinically relevant large animal models with biomarker data that is directly translatable to human TBI can be used for development of individualized therapy in TBI.

Samuel Shin, MD, Ph.D., Assistant Professor of Neurology, University of Pennsylvania


Track Follow Up Discussion & Question/Answer Session

Predicting Neurodegeneration after Neurotrauma

Neil Graham, MD, Clinical Lecturer, Faculty of Medicine, Department of Brain Sciences, Imperial College London

Patterns of Traumatic Brain Injury-Related Cognitive Decline and Dementia: Insights from Epidemiology

Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality, especially among older individuals. In this presentation, the current epidemiology of traumatic brain injury will be presented. Leveraging data with over 30 years of follow-up, data presented herein will quantify the population-level burden of TBI and the dose-dependent long-term consequences of TBI (including data on cognitive decline and dementia risk) in comprehensive manner. Data will also be presented showing how epidemiological study design and biostatistical methods can provide insights into mechanisms underlying observed associations. The robust and dose-dependent associations of TBI with adverse outcomes underscore the importance of public health measures aimed at preventing head injuries and targeted clinical interventions to reduce morbidity and mortality after head injury.

Andrea Schneider, MD, Ph.D., Assistant Professor, Department of Neurology, Division of Neurocritical Care, University of Pennsylvania School of Medicine

The Spectrum of Downstream Neurodegenerative and Clinical Outcomes of Repetitive Head Trauma

Exposure to repetitive head impacts (RHI) from activities like contact/collision sports, military service, assaults, and other sources increases the risk for later-life neurodegenerative disease. Patterns have begun to emerge linking RHI to certain diseases and types of symptoms, some of which seem highly specific to prior RHI while others more commonly are described in individuals without known RHI. This presentation will discuss how the combination of fluid biomarkers, neuroimaging, and a thorough clinical assessment can help inform the presence of a neurodegenerative condition and the likelihood that prior RHI has played a role in current brain health.

Breton Asken, Ph.D., ATC, Assistant Professor, Department of Clinical and Health Psychology, University of Florida

Bidirectional Association Between TBI and Neurodegeneration

In this presentation, Dr. Gardner will discuss risk of dementia associated with TBI, role of pre-injury cognitive reserve/neurodegeneration on post-TBI cognitive outcome, and prevalence of pre-injury MCI/dementia in an ongoing prospective cohort study of older adults with acute TBI.

Raquel Gardner, MD, Principal Investigator and Director of Clinical Research, Joseph Sagol Neuroscience Center, Sheba Medical Center

Track Follow Up Discussion & Question/Answer Session

End of Conference

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