Traumatic brain injury in the prodromal period of Parkinson's disease: A large epidemiological study using medicare data.
Traumatic brain injury in the prodromal period of Parkinson's disease: A large epidemiological study using medicare data.
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DOI：
10.1002/ana.25074
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发表时间：
2017-11
影响因子：
11.2
通讯作者：
Racette BA
中科院分区：
文献类型：
--
作者：
Camacho-Soto A;Warden MN;Searles Nielsen S;Salter A;Brody DL;Prather H;Racette BA
研究表明，创伤性脑损伤（TBI）后发生帕金森病（PD）的风险更大，但在PD的前驱期发生TBI的风险可能更大。我们的目的是检查时间TBI PD患者在他们的前驱期相比，基于人口的控制。2009年，我们使用医疗保险索赔数据确定了89，790例事件PD病例和118，095例可比较的对照组> 65岁。使用过去五年的数据，我们比较了前驱期PD患者与对照组的TBI时间。我们通过考克斯回归估计了TBI的风险比（HR）和95%置信区间（CI），同时调整了年龄、性别、种族、改良Charlson共病指数、吸烟和饮酒。在所有年龄和性别组中，PD患者在前驱期的TBI风险更大，HR随着接近PD诊断而持续增加。HR范围为诊断前5年的1.64（95% CI 1.52，1.77）至前一年的3.93（95% CI 3.74，4.13）。PD、TBI和时间之间的相互作用主要观察到归因于福尔斯的TBI。运动功能障碍和认知障碍，建议相应的ICD-9代码，部分介导的PD-TBI协会。在PD的前驱期，PD和最近的TBI之间有很强的关联。这种关联随着PD诊断的临近而加强，可能是未检测到的非运动和运动症状的结果，但需要确认。
Studies suggest a greater risk of Parkinson disease (PD) after traumatic brain injury (TBI), but it is possible that the risk of TBI is greater in the prodromal period of PD. We aimed to examine the time-to-TBI in PD patients in their prodromal period compared to population-based controls. We identified 89,790 incident PD cases and 118,095 comparable controls > 65 years of age in 2009 using Medicare claims data. Using data from the preceding five years, we compared time-to-TBI in PD patients in their prodromal period to controls. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for TBI in a Cox regression, while adjusting for age, sex, race/ethnicity, modified Charlson comorbidity index, smoking, and alcohol use. Risk of TBI was greater in PD patients in their prodromal period across all age and sex groups, with HRs consistently increasing with proximity to PD diagnosis. HRs ranged from 1.64 (95% CI 1.52, 1.77) five years prior to diagnosis to 3.93 (95% CI 3.74, 4.13) in the year prior. The interaction between PD, TBI, and time was primarily observed for TBI attributed to falls. Motor dysfunction and cognitive impairment, suggested by corresponding ICD-9 codes, partially mediated the PD-TBI association. There is a strong association between PD and a recent TBI in the prodromal period of PD. This association strengthens as PD diagnosis approaches and may be a result of undetected non-motor and motor symptoms, but confirmation will be required.