U.S. Troops To Get Cognitive Screening

U.S. Troops To Get Cognitive Screening

By LISA CHEDEKEL | Courant Staff Writer
June 25, 2008
The military will begin giving cognitive tests this summer to troops heading to war, in an effort to get a baseline measure of their reaction time, memory, concentration and other brain functions, which could be referenced in case they are injured.

The introduction of the neuropsychological screening comes in response to pressure from Congress and veterans' advocates. They have been pushing the military to assess the cognitive functioning of all deploying troops so symptoms of mild traumatic brain injury, dubbed the "signature injury" of the Iraq war, can be detected more easily during and after combat.

Assistant Defense Secretary S. Ward Casscells recently directed military leaders to begin pre-deployment screening of troops by late-July, using a computer-based test known as the Automated Neuropsychological Assessment Metrics, or ANAM, a Department of Defense spokeswoman confirmed in written responses to The Courant.

The testing, which takes about 15 to 20 minutes, will "allow for greater levels of accuracy when making assessments following injury," said the spokeswoman, Cynthia Smith.



Some veterans' advocates have complained that the military has moved too slowly in identifying and addressing mild traumatic brain injury, or TBI, a common injury among troops in Iraq and Afghanistan who are exposed to blasts of improvised explosive devices. While shrapnel from the devices can penetrate the skull, the blasts also can cause neurological injuries that are hard to detect.

A study this year by the RAND Corporation estimated that close to one in five deployed service members — or about 320,000 — may have experienced a traumatic brain injury. In Connecticut, TBI is emerging as a problem among returning troops, with the preliminary findings of a survey sent to 1,000 veterans indicating that about 19 percent met criteria indicating they are at risk of TBI.

Smith said the new testing is not intended as a diagnostic tool for mild traumatic brain injury, but instead would enable clinicians "to compare a person to their own 'norms' or baseline scores" in the event of an injury.

She also said troops who fail the screening, or who test positive for cognitive problems, would not be automatically excluded from deploying.

"If a person screens positive for [mild TBI] before deploying AND has symptoms, they will be referred to a provider for further evaluation," she said in her written response. Similar referrals will occur if a service member scores low on the testing, she said.

The military has no policy barring service members with mild TBI from going to war or staying in combat.

In fact, in a report released earlier this year, a military task force on traumatic brain injury found disparities in how TBI is detected and treated within the combat zone, and noted that troops who sustain a brain injury may be "returned to [the combat] theater unless co-morbidities exist that preclude return to duty."

The task force recommended instituting baseline testing of a soldier's mental functions using the ANAM. Congress also has passed legislation requiring the defense department to develop systems for screening troops for both cognitive function and TBI, before and after they are deployed.

The military already has expanded its screening for troops returning home to include questions about possible TBI symptoms, such as memory lapses, dizziness and headaches.

Soldiers' advocates have been pushing the military for years to improve its pre-deployment health screening of troops, which now is based largely on a self-reported questionnaire.

Congress in 1997 passed legislation requiring the military to conduct medical examinations, including an assessment of mental health, on all service members heading to combat, in an effort to ensure that their medical conditions are accurately recorded before they deploy. That mandate grew out of the first Gulf War, when returning troops reported mysterious illnesses that military officials insisted were unrelated to combat.

Some veterans' advocates said the new cognitive testing is a step in the right direction, but does not go far enough.

"We still stand by our very firm belief that every service member needs to be fully physically and mentally examined, before and after deployment," said Paul Sullivan, executive director of Veterans for Common Sense. "Here we are, seven years into a war, and the military is still doing everything possible to avoid putting a service member in front of a doctor."

Sullivan said screening for TBI symptoms was long overdue, given that brain injuries had emerged as a major concern early in the war.

"It's like designing a lock for the barn door after 90 percent of the horses have fled," he said.

Garry Augustine, deputy national service director of Disabled American Veterans, said he had questions about how the new testing would be used.

"On one level, it's great to see they are acknowledging [TBI] and trying to determine the severity of it," he said. "But what we don't know is how things like this are going to be utilized. With pre-emptive testing, you want to make sure it doesn't come back and haunt the veteran later," when he or she seeks compensation for a disability.

The ANAM was developed by the Army and already has been used to assess the cognitive functioning of about 50,000 soldiers, according to a recent report by the U.S. Government Accountability Office, the investigative arm of Congress.

Smith said preliminary data show that most soldiers screened using the ANAM perform well on the tests, with very few testing positive for TBI or other cognitive difficulties.

Contact Lisa Chedekel at lchedekel@courant.com.

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