The patient history is an electronic record that will be integrated with the neuropsychological and physiological data. It can be a modified version of a standard document (DoD/VA). If the system is utilized in a clinical study, the electronic history can be the FDA-negotiated Case Report Form (CRF).

Integrated Analysis will include biomarker data (e.g. blood/plasma components, cerebral spinal fluid components, and genomic information) and quantitative results from imaging studies when these data elements are available.

The Neurological and Psychiatric Assessment Instruments module contains electronic versions of standard instruments, for example Combat Exposure Scale, Mayo Classification for Traumatic Brain Injury, Rivermead Post-Concussion Symptom Scale, Short Form Health Survey, Symptom Checklist-90-Revised, Beck Depression Inventory, and PTSD Checklist [1]. There are hundreds of possibilities. Choices can be made based on the patient population and the objectives of the study. Licensing is required for proprietary instruments.

The Neuropsychological Evaluation module includes standard NeuroCognitive Assessment Tests (NCAT) such as the DoD’s ANAM (Automated Neuropsychological Assessment Metrics) which is a large collection of neuropsychological tests, as well as the Simon and Flanker Arrow Tasks. The INAS extends this with (1) improved timing accuracy, (2) enhanced mathematical analysis of reaction time data, (3) introduction of more demanding neuropsychological tasks, and (4) introduction of perithreshold (subliminal) stimuli. The orange analysis band of the system architecture diagram indicates the addition of conditional accuracy functions and delta analysis to the reaction time analysis section.

The electrophysiology subsystem now includes electrocardiology (heart rate variability) and electroencephalography (quantitative EEG and event related potentials). Eye tracking is scheduled for the next system iteration. The implementation of an electromyography capability is not yet in the engineering schedule.

Heart rate variability provides a noninvasive means of assessing autonomic nervous system integrity. The technology implemented here focuses on using HRV to assess psychological resilience. The HRV assessment places an emphasis on differential measures of HRV in rest and during cognitive stress Differential values (between state differences) and, most particularly, the rate of recovery from acute stress are hypothesized to be clinically disclosing when absolute values of HRV (within state values) alone are nondisclosing. In our operationalization, psychological resilience is not the absence of a response to stress. It is the ability to recover quickly from a stressful event. We argue that the derivative of a multivariate measure of heart rate variability during the recovery period will provide a physiological measure of psychological resilience generically applicable to a broad range of psychiatric presentations, and may be a prodrome of delayed onset disorders.