Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study
Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study
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DOI：
10.1016/j.apmr.2020.12.019
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发表时间：
2021-06-02
影响因子：
4.3
通讯作者：
Kamdar, Neil
中科院分区：
文献类型：
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作者：
Mahmoudi, Elham;Lin, Paul;Kamdar, Neil
目的：创伤性脊髓损伤(TSCI)是一种改变生活的事件，最常导致永久性肢体残疾。对患有TSCI的中老年人患阿尔茨海默病和相关痴呆症(ADRD)的风险知之甚少。评估ADRD的诊断和调整风险的时间。设计：队列研究。设置：使用来自Optom Clinformatics Data Mart的2007-2017年索赔数据，我们确定了诊断为TSCI的成年人(45+)(n=7019)。未诊断为TSCI的成人作为对照(n=916,516)。使用年龄、性别、种族/民族、心脏代谢、心理和肌肉骨骼慢性病、美国人口普查部门和社会经济变量，我们对患有和不患有TSCI的患者进行了倾向评分匹配(n=6083)。比较了入选4年后ADRD的发病率估计。用生存模型对ADRD事件的未调整、完全调整和倾向匹配的未调整和调整风险比(HR)进行量化。参与者：有和没有TSCI的成年人(N=6083)。干预：不适用。主要结果指标：ADRD的诊断。结果：在45-和65岁以上的不匹配队列中，中老年人TSCI的ADRD发生率均高于未发生TSCI的人(0.5%比0.2%和11.7%比3.3%)，在45岁的和65岁以上的匹配队列中，分别为0.5%和0.3%和10.6%和6.2%。全校正生存模型显示，成人TSCI患者发生ADRD的危险性较大(45~64岁年龄组：未匹配HR：3.19[95%可信区间，95%CI，2.30~4.44]，匹配HR：1.93[95%CI，1.06~3.51]；65岁以上成人：未匹配HR：1.90[95%CI，1.77~2.04]，匹配HR：1.77[1.55~2.02])。改善临床筛查和旨在保护认知功能的早期干预对这一患者队列至关重要。美国康复医学大会物理医学和康复档案2021；102：1147-54(C)2021
Objective: Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed.Design: Cohort study.Setting: Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD.Participants: Adults with and without TSCI (N=6083).Intervention: Not applicable.Main Outcomes Measures: Diagnosis of ADRD.Results: Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]).Conclusions: Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.Archives of Physical Medicine and Rehabilitation 2021;102:1147-54(c) 2021 by the American Congress of Rehabilitation Medicine