William P. Milberg - US grants

DESCRIPTION (Adapted from the Investigator's Abstract): A series of 18 experiments are designed to systematically characterize neglect patients ability to process visual information within their neglected field. These studies are based on a convergence between recent empirical evidence of preserved visual information processing in the contralateral field of patients with neglect, and recent theories and data regarding attention and the binding of information in normal vision. Ninety patients with neglect, 45 patients with hemianopsia and 90 matched control subjects will be tested with four sets of studies that are designed 1) to assess processing of visual features and their binding into objects; 2) the processing of space and its binding to features and objects; 3) the processed involved in preparing a response an binding it to objects; and 4) the process involved in preparing a response and binding it to specific spatial locations. The results will be relevant to clinical evidence of object versus spatially centered neglect and attentional versus intentional neglect. Examining each of these processes independently will allow further specification of the information processing deficit in neglect and help fit the disorder more clearly within the taxonomy of perceptual and attentional processes developed in normals. The experiments include variations of previously developed yoked implicit and explicit paradigms that have been used with neglect patients in the PI's laboratory, as well as novel procedures extensively piloted in normal subjects. The data should provide a new understanding of the clinical phenomenon of neglect as well as basic information about the neuropsychology of attention and higher visual processes. The data should also have relevance to understanding normal operations of these processes.

CORE B. DATA MANAGEMENT AND ANALYSIS (DAMA) The primary responsibilities of the Data Management and Analysis (DAMA) Core are to manage the data obtained by members of the Clinical Assessment Core and all research projects;to make these data accessible to all P30 investigators;to provide statistical and methodological assistance and guidance in the design of studies and in analysis and interpretation of data;and to provide information about the various research projects to professionals through our website and other educational offerings. To meet its responsibilities, the DAMA Core encompasses three domains: (1) Data Management includes maintenance, modification, extension, and documentation of our database, as well as continuing development and maintenance of our computer network;(2) Design and Analysis includes assistance to investigators with methodological and research design questions, data analysis, power analysis, and review of papers being prepared for publication;(3) Training and Education involves weekly seminars and monthly tutorials on selected topics in research design and methodology. These seminars and tutorials illustrate the appropriate use of statistical and graphical techniques for analyzing current and previously collected HGARC data and improving presentation of data and results using state of the art graphical and research design methods. The DAMA Core conducts developmental research to illustrate new methods for broader application and uses P30 data to maximal advantage in order to address cross-cutting questions not considered by individual research projects. The DAMA Core uses our website to educate the general public, professionals, and stroke survivors and their families about aphasia and the various research projects affiliated with our Center. During the next grant cycle the P30 Core Center, through its DAMA Core, will establish the country's first nationwide Virtual Community for Aphasia and Aphasia Related Disorders Researchers.

It is increasingly recognized that returning Veterans and Service Members of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) suffer from co-occurring psychological and physical conditions that produce complex patterns of cognitive, psychological, and physical symptoms that impede reintegration and make efficient and effective treatment planning difficult, if not impossible. Preliminary findings from our laboratory based on the analyses of two existing databases supports the idea that some patterns of co-occurring symptoms or diagnoses that include a history of mTBI are predictive of poor functional outcome, even more so than the effects of any individual diagnostic category including mTBI itself. Using factor analysis we have empirically identified three injury profiles that may represent biologically relevant unique clinical phenotypes related to deployment trauma. Using the TRACTS data repository, the first profile consists of PTSD, Major Depressive Disorder (MDD) with a history of mTBI, and we have called this the Deployment Trauma Phenotype (DTP). We have have shown that DTP is more predictive of substantial disability than other potential combinations of common diagnoses. Further preliminary evidence indicates that DTP may have a unique neural signature evident on high-resolution diffusion weighted neuroimaging. We have also identified two other prevalent coherent patterns of diagnoses: PTSD with Major Depression (PTSD/MDD) and mTBI with co-occurring pain and sleep disorder (somatic mTBI). In the current application, we proposed to use the TRACTS data repository to further examine the underlying neurologic basis and functional impact of the injury profiles we have defined (DTP, somatic mTBI, and PTSD/MD). This dataset will allow us to examine patient characteristics at longer time frames after TBI, as all TRACTS participants are assessed months to years following TBI. We also propose to examine the prevalence and functional outcome (employment, healthcare utilization) of these profiles using the TBI national dataset. This proposal will, for the first time, combine the advantages of a tightly managed and sophisticated cohort- based database (TRACTS data repository) and a much larger population-based medical database (TBI national database) to test and validate hypotheses about the effects of multiple deployment trauma based pathologies. It represents the first attempt to apply the whole brain morphometry-based multivariate modeling approaches to the question of differentiating potential biomarkers associated with deployment trauma based clinical phenotypes.