Traumatic brain injury and risk of dementia in older veterans
Traumatic brain injury and risk of dementia in older veterans
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DOI：
10.1212/wnl.0000000000000616
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发表时间：
2014-07-22
期刊：
影响因子：
9.9
通讯作者：
Yaffe, Kristine
中科院分区：
文献类型：
--
作者：
Barnes, Deborah E.;Kaup, Allison;Yaffe, Kristine
目的：创伤性脑损伤 (TBI) 在军事人员中很常见，人们越来越关注 TBI 对大脑的长期影响；方法：我们对 188,764 名 55 岁或以上的美国退伍军人进行了一项回顾性队列研究，这些退伍军人在基线 (2000-2003) 和随访 (2003-2012) 期间至少接受过一次住院或门诊治疗，并且在基线时没有诊断出痴呆。 TBI 和痴呆症诊断是使用电子病历中的 ICD-9 代码确定的。细灰色比例风险模型用于确定 TBI 是否与更大的痴呆风险相关，考虑了死亡的竞争风险并调整了人口统计、医疗合并症和精神疾病。结果：退伍军人的基线平均年龄为 68 岁。在 9 年的随访期间，16% 的 TBI 患者发展为痴呆，而未患 TBI 的患者这一比例为 10%（调整后风险比，1.57；95% 置信区间：1.35-1.83）。有证据表明，TBI 与其他与痴呆风险相关的疾病之间存在累加关联。结论：在考虑了竞争风险和潜在混杂因素后，老年退伍军人的 TBI 与 9 年内患痴呆风险增加 60% 相关。我们的研究结果表明，老年退伍军人的创伤性脑损伤可能会导致症状性痴呆，并引起人们对年轻退伍军人和平民创伤性脑损伤的潜在长期后果的担忧。
Objectives: Traumatic brain injury (TBI) is common in military personnel, and there is growing concern about the long-term effects of TBI on the brain; however, few studies have examined the association between TBI and risk of dementia in veterans.Methods: We performed a retrospective cohort study of 188,764 US veterans aged 55 years or older who had at least one inpatient or outpatient visit during both the baseline (2000-2003) and follow-up (2003-2012) periods and did not have a dementia diagnosis at baseline. TBI and dementia diagnoses were determined using ICD-9 codes in electronic medical records. Fine-Gray proportional hazards models were used to determine whether TBI was associated with greater risk of incident dementia, accounting for the competing risk of death and adjusting for demographics, medical comorbidities, and psychiatric disorders.Results: Veterans were a mean age of 68 years at baseline. During the 9-year follow-up period, 16% of those with TBI developed dementia compared with 10% of those without TBI (adjusted hazard ratio, 1.57; 95% confidence interval: 1.35-1.83). There was evidence of an additive association between TBI and other conditions on risk of dementia.Conclusions: TBI in older veterans was associated with a 60% increase in the risk of developing dementia over 9 years after accounting for competing risks and potential confounders. Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of TBI in younger veterans and civilians.