Research Reports - Peripheral total tau in military personnel who sustain traumatic brain injuries during deployment

JAMA Neurol. 2015 Oct 1;72(10):1109-16. doi: 10.1001/jamaneurol.2015.1383.

Olivera A(1), Lejbman N(1), Jeromin A(2), French LM(3), Kim HS(1), Cashion A(1),
Mysliwiec V(4), Diaz-Arrastia R(5), Gill J(1).

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

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