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Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed. Additional studies are needed to clarify the factors that increase risk for later life cognitive decline, define the mechanistic link between these factors and dementia, and provide empirically supported interventions to mitigate the impact of TBI on cognition across the life span.

CME Educational Objectives 1. Review diagnostic challenges and risks associated with traumatic brain injury (TBI), related injury processes, comorbidities, and persistent symptoms and sequelae. 2. Review the evidence related to undiagnosed neurotrauma, and particularly mild TBI, as a potential contributor to physical, cognitive, emotional, and behavioral dysfunction. 3. Discuss the incidence and risks of multiple injury scenarios, especially those involving sensory system injuries, and related efforts to advance the integrated study and management of polytrauma/TBI. What prepared us? … Almost every hospital has a surgeon or nurse or medic with battlefield experience, sometimes several. … We’ve learned, and we’ve absorbed. Atul Gawande, MD, “Why Boston’s Hospitals Were Ready” ( The New Yorker , April 17, 2013). Traumatic brain injury (TBI) has been described as “the beginning of an ongoing, perhaps lifelong process.” 1 Even when classified as mild, TBI can pose significant long-term challenges to health, well-being, and functionality. TBI also increases the risk for psychiatric disturbance such as depression and stress-related disorder. 2 The inherent complexity of TBI is complicated further in the context of multiple injuries (polytrauma) to other body structures, organs, and systems including vision, hearing, and mental health. Although unfortunately common in combat and blast exposure (see Figure 1 , page 309), polytraumatic scenarios are by no means limited to the military environment.

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability, and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.

Traumatic brain injury (TBI) is a common event in the current extended conflicts by American service members, with estimates that as many as 300,000 have sustained combat-related concussions during Operation Iraqi Freedom and Operation Enduring Freedom. The limited ecological validity of traditional neuropsychological assessment measures presents a challenge to effective postconcussion evaluation of service members in relation to fitness-for-duty decisions or rehabilitation needs. Virtual reality (VR) technology offers a promising opportunity to advance the field of functional assessment for TBI. This article reviews the current professional literature on VR applications for TBI assessment, with special emphasis on those that are particularly relevant to U.S. service members. VR affords several advantages for clinical use. These include assessment of complex sets of cognitive and behavioral functions rather than the isolated components assessed by traditional measures; more precise control over the standardized presentation of task stimuli and the recording of response data; and enhanced ecological validity that can lead to more useful assessment data in the applied contexts faced by the U.S. military.

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. The most recent statistics from the Centers for Disease Control and Prevention document that an estimated 1.7 million people sustain a TBI annually. Nearly 80 % of these individuals will be treated in the ER and released, and a significant majority of these injuries are estimated to be of mild severity. Falls and motor vehicle accidents are the two most common causes of injury with males showing greater rates of TBI than females. Additional risk factors for TBI include age, socioeconomic status, race/ethnicity, and previous injury history. TBI results in significant economic burden to the individual and society and can have long-lasting and devastating effects on an individual’s ability to return to family, social, and occupational roles. This chapter will review the epidemiology and societal impact of TBI with particular focus on the epidemiology of TBI in the general population, in the military, and in sports-related events.

ANAM measures were based on procedures used in both clinical and performance assessment. This paper reviews data from studies designed to delineate specific neurocognitive functions assessed by more commonly used ANAM measures. Data are brought together from both exploratory and confirmatory analyses. Current findings support the use of these measures for assessing aspects of attention, processing efficiency, and working memory. Recommendations for further research include the need for larger samples and the inclusion of specific marker variables.

This paper describes the development and ongoing validation of the ANAM-sports medicine battery (ASMB) for use in concussion surveillance and management. A review of previous research utilizing the ASMB highlights current issues in concussion surveillance including: tracking cognitive recovery, effect of previous concussion history on acute concussion presentation, and clinical decision making using computerized measures. ASMB interpretation using reliable change indices or impairment indices is highlighted. Future development of the ASMB is discussed as it relates to interpretation of ASMB, development of appropriate norms, and defining adequate baseline assessment. This includes the definition of practice effects, the effects of maturation on test performance and definition of adequate baseline assessment that clearly defines a subject's normal cognitive performance level. ASMB is ready for cautious introduction into clinical practice for use by neuropsychologists with experience in both sports concussion and computerized testing.