目的:评估创伤性脑损伤(TBI)的特征,受伤年龄,或损伤的近期可预测神经认知功能下降的过程和/或增加向轻度认知障碍(MCI)或痴呆的转化率。
方法:数据来自国家阿尔茨海默氏症协调中心,参与者年龄50-85岁,2015年至2022年有3-5次就诊,有或没有TBI病史(TBI+=508;TBI-=2,382)。根据自我报告的TBI病史对各组进行分层(即,单个TBI没有意识丧失[LOC],带LOC的单个TBI,没有LOC的多个TBI,和多个带LOC的TBI),最近TBI的年龄,和最近的TBI。混合线性模型比较了神经心理学复合轨迹(执行功能/注意力/速度,语言,记忆,和全球),随着年龄的变化,性别,教育,载脂蛋白E4状态,种族/民族,和基线诊断(正常老化n=1,720,MCIn=749或痴呆n=417)。Logistic二元回归分析MCI/痴呆转化率。
结果:在具有多个TBI的患者中,MCI/痴呆的频率略高(有和没有LOC的患者为50%至60%,与无TBI的39%相比),但是纵向轨迹相似。TBI历史,受伤年龄,或损伤的近期没有影响神经认知轨迹或MCI/痴呆的转换率(所有p/s>.01).
结论:TBI历史,无论损伤特征如何,受伤年龄,或最近受伤,没有恶化神经认知功能减退或MCI/痴呆转换。需要在具有更广泛TBI严重程度的更多样化队列中进行其他纵向研究,以评估TBI可能增加痴呆风险的具体因素和可能机制。
OBJECTIVE: Evaluate whether traumatic brain injury (TBI) characteristics, age of injury, or recency of injury predicts the course of neurocognitive decline and/or increases conversion rates to mild cognitive impairment (MCI) or dementia.
METHODS: Data were obtained from the National Alzheimer\'s Coordinating Center for participants 50-85 years old with 3-5 visits from 2015 to 2022, with or without TBI history (TBI+ = 508; TBI- = 2,382). Groups were stratified by self-reported TBI history (i.e., single TBI without loss of consciousness [LOC], single TBI with LOC, multiple TBI without LOC, and multiple TBI with LOC), age of most recent TBI, and recency of TBI. Mixed linear models compared neuropsychological composite trajectories (executive functioning/attention/speed, language, memory, and global), co-varying for age, gender, education, apolipoprotein E4 status, race/ethnicity, and baseline diagnosis (normal aging n = 1,720, MCI n = 749, or dementia n = 417). Logistic binary regression examined MCI/dementia conversion rates.
RESULTS: There was a slightly higher frequency of MCI/dementia in those with multiple TBIs (50% to 60% with and without LOC, compared to 39% with no TBI) at baseline, but longitudinal trajectories were similar. TBI history, age of injury, or recency of injury did not impact neurocognitive trajectories or conversion rates to MCI/dementia (all p\'s > .01).
CONCLUSIONS: TBI history, regardless of injury characteristics, age of injury, or recency of injury, did not worsen neurocognitive decline or MCI/dementia conversion. Additional longitudinal research in more diverse cohorts with a wider range of TBI severity is needed to evaluate the specific factors and possible mechanisms in which TBI may increase dementia risk.