0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment

Anlys Olivera, PhD1; Natasha Lejbman, BS1; Andreas Jeromin, PhD2; Louis M. French, PsyD3,4; Hyung-Suk Kim, PhD1; Ann Cashion, PhD1; Vincent Mysliwiec, MD5; Ramon Diaz-Arrastia, MD, PhD4,6; Jessica Gill, RN, PhD1
[+] Author Affiliations
1National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
2Quanterix Corporation, Lexington, Massachusetts
3Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, Maryland
4Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
5Madigan Army Medical Center, Tacoma, Washington
6Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA Neurol. 2015;72(10):1109-1116. doi:10.1001/jamaneurol.2015.1383.
Text Size: A A A
Published online

Importance  Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated.

Objectives  To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations.

Design, Setting, and Participants  Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included.

Main Outcomes and Measures  Concentration of total tau in peripheral blood.

Results  Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported TBI compared with the 28 controls (mean [SD], 1.13 [0.78] vs 0.63 [0.48] pg/mL, respectively; F1,97 = 4.97; P = .03). Within the self-reported TBI cases, plasma total tau concentrations were significantly associated with having a medical record of TBI compared with self-reported TBI only (mean [SD], 1.57 [0.92] vs 0.85 [0.52] pg/mL, respectively; F1,69 = 6.15; P = .02) as well as reporting the occurrence of 3 of more TBIs during deployment compared with fewer than 3 TBIs (mean [SD], 1.52 [0.82] vs 0.82 [0.60] pg/mL, respectively; F1,69 = 8.57; P = .008). The severity of total postconcussive symptoms correlated with total tau concentrations in the self-reported TBI group (r = 0.37; P = .003).

Conclusions and Relevance  Military personnel who report multiple TBIs have long-term elevations in total tau concentration. The total tau concentration relates to symptoms of postconcussive disorder.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Plasma Total Tau Concentration

A, Plasma total tau concentration was higher in military personnel with self-reported traumatic brain injury (TBI) compared with control samples (F1,97 = 4.97; P = .03). B, Plasma total tau concentration was higher in the group with a medical record of TBI compared with those with self-reported TBI only (F1,69 = 6.15; P = .02). C, Plasma total tau concentration was associated with the number of TBIs (F1,69 = 8.57; P = .008). Horizontal lines indicate means.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Specificity of Tau in Traumatic Brain Injuries (TBIs) and Associated Chronic Postconcussive Disorder Symptoms

A, Receiver operating characteristic analyses showed modest accuracy of plasma tau concentration for the identification of self-report of TBI (area under the receiver operating characteristic curve = 0.74; 95% CI, 0.61-0.86; P = .007), a medically documented TBI (area under the receiver operating characteristic curve = 0.69; 95% CI, 0.51-0.89; P = .007), and a report of 3 or more TBIs (area under the receiver operating characteristic curve = 0.73; 95% CI, 0.61-0.86; P = .003). B, Plasma total tau concentration is associated with Neurobehavioral Symptom Inventory (NSI) score for chronic postconcussive disorder symptoms (r = 0.37; P = .003).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,940 Views
7 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();