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Review of the Scientific Evidence of Using Population Normative Values for Post-Concussive Computerized Neurocognitive Assessments

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Technical Report

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Defense Health Agency/Defense Health Board Falls Church United States

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The recent conflicts in Iraq and Afghanistan have raised concerns about the invisible wounds of war1 endured by Service members following deployments. Mild traumatic brain injury mTBI, also referred to as concussion, is among those injuries and remains difficult to evaluate and manage. The long-term effects of mTBI can leave Service members with insomnia, anxiety, emotional distress, and impaired cognitive functioning. As of March 2015, there have been more than 320,344 diagnosed cases of traumatic brain injury TBI in theater and in garrison in the U.S. military since 2000.2 In response to the large number of TBIs, Congress included a provision in the 2008 National Defense Authorization Act NDAA stating that the Secretary of Defense shall develop and implement a comprehensive policy on consistent neurological cognitive assessments of members of the Armed Forces before and after deployment.3 The Department of Defense DoD implemented this requirement through a DoD Instruction that requires all Service members who deploy to undergo baseline neurocognitive testing within 12months prior to deployment.4 The Automated Neuropsychological Assessment Metrics 4 ANAM4, a computerized neurocognitive assessment tool NCAT developed by the U.S. Army to assess the cognitive function of Service members, was selected to support this effort. The individual baseline measurements baselines obtained using ANAM4 were intended to provide a basis for comparison and evaluation in the event that a Service member experienced an mTBI during his or her deployment. As of September 2015, more than 1.8 million baselines have been completed. An initial normative database a reference set of baseline tests from the population of interest was created in 2008 with 107,000 tests stratified by age and sex. There are efforts currently underway to expand the normative database, and to date approximately 1.1 millionANAM4 test results have been selected for analysis and inclusion in the

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