Impact of repeated blast exposure on active-duty United States Special Operations Forces

United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a resul...

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Published in:	Proceedings of the National Academy of Sciences - PNAS Vol. 121; no. 19; p. e2313568121
Main Authors:	Gilmore, Natalie, Tseng, Chieh-En J, Maffei, Chiara, Tromly, Samantha L, Deary, Katryna B, McKinney, Isabella R, Kelemen, Jessica N, Healy, Brian C, Hu, Collin G, Ramos-Llordén, Gabriel, Masood, Maryam, Cali, Ryan J, Guo, Jennifer, Belanger, Heather G, Yao, Eveline F, Baxter, Timothy, Fischl, Bruce, Foulkes, Andrea S, Polimeni, Jonathan R, Rosen, Bruce R, Perl, Daniel P, Hooker, Jacob M, Zürcher, Nicole R, Huang, Susie Y, Kimberly, W Taylor, Greve, Douglas N, Mac Donald, Christine L, Dams-O'Connor, Kristen, Bodien, Yelena G, Edlow, Brian L
Format:	Journal Article
Language:	English
Published:	United States National Academy of Sciences 07-05-2024
Subjects:	Adult Biological Sciences Blast Injuries - diagnostic imaging Brain Brain - diagnostic imaging Brain - metabolism Brain injury Cognition - physiology Cognitive ability Cortex (cingulate) Diagnostic systems Executive function Exposure Female Functional magnetic resonance imaging Head injuries Humans Magnetic Resonance Imaging Male Medical imaging Military Personnel Neural networks Neuroimaging Overpressure Positron emission Positron emission tomography Proteomics Quality of life Special forces Tau protein Thickness Training Traumatic brain injury United States Young Adult United States United States > US traumatic brain injury Special Operations Forces blast overpressure
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Summary:	United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [ C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [ F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 2Y.G.B. and B.L.E. contributed equally to this work. Edited by Marcus Raichle, Washington University in St. Louis School of Medicine, St. Louis, MO; received August 22, 2023; accepted March 22, 2024 1N.G., C.-E.J.T., and C.M. contributed equally to this work.
ISSN:	0027-8424 1091-6490
DOI:	10.1073/pnas.2313568121