![]() Undoubtedly, the “invisible” nature of mTBI, notably the lack of any external physical evidence of damage to the head or brain, has been a major factor contributing to the impression of inconsequentiality. Despite their frequency, the acute and long-term effects of mTBI have been a relatively unexplored area of medical inquiry until very recently. Estimates of the prevalence of mTBI among returning service members range from 15.2% to 22.8%, affecting as many as 320,000 troops. forces deployed to Afghanistan and Iraq in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), blast exposure is the leading cause of mTBI, although service members are also susceptible to concussions. In military settings, most traumatic brain injuries (TBIs) are mild TBIs (mTBIs). Chronic traumatic encephalopathy has clinical and pathological features that overlap with postconcussion syndrome and posttraumatic stress disorder, suggesting that the three disorders might share some biological underpinnings. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus septal abnormalities and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. ![]() mTBI is the most common traumatic brain injury affecting military personnel however, it is the most difficult to diagnose and the least well understood. Mild traumatic brain injury (mTBI) includes concussion, subconcussion, and most exposures to explosive blast from improvised explosive devices.
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