Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity.
Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity.
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DOI：
10.1001/jamaneurol.2014.2668
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发表时间：
2014-12
期刊：
影响因子：
29
通讯作者：
Yaffe, Kristine
中科院分区：
文献类型：
--
作者：
Gardner, Raquel C.;Burke, James F.;Nettiksimmons, Jasmine;Kaup, Allison;Barnes, Deborah E.;Yaffe, Kristine
关于创伤性脑损伤（TBI）作为痴呆症风险因素的重要性，流行病学证据相互矛盾。以前很少有研究使用非TBI创伤（骨折）患者作为对照，并调查年龄和TBI严重程度的影响。与骨折的成年人相比，量化近期TBI的成年人痴呆的风险。2005年1月至2011年12月的回顾性队列研究（随访5 - 7年）。加州全州急诊科（艾德）和住院患者就诊的行政卫生数据库。2005-2006年诊断为TBI或骨折的所有年龄≥55岁且基线无痴呆且住院期间未死亡的患者（n= 164，661）。使用ICD-9代码疾病控制中心（CDC）定义诊断的轻度与中度/重度TBI。使用ICD-9代码诊断的骨折，不包括头/颈骨折。初次TBI或骨折后≥1年发生艾德/住院诊断为痴呆（ICD-9代码）。采用考克斯比例风险模型，在调整常见痴呆预测因子和潜在混杂因素前后，评估TBI和痴呆风险之间的关联。我们还根据TBI严重程度和年龄类别（年龄55-64，65-74，75-84和85+）进行分层。51，799例（31%）创伤患者患有TBI。其中，4，361人（8.4%）发展为痴呆，而骨折患者为6，610人（5.9%）（p<0.001）。TBI与痴呆风险增加相关（风险比（HR）= 1.46; 95%置信区间（CI）1.41-1.52）。除年龄类别调整外，协变量调整几乎没有影响（完全调整模型HR=1.26; 95% CI 1.21-1.32）。在分层校正分析中，中/重度TBI与所有年龄段的痴呆风险增加相关（55-64岁：HR = 1.72; 95%CI 1.40-2.10 vs. 65-74岁：HR = 1.46; 95%CI 1.30-1.64），而轻度TBI可能是随着年龄增加的更重要的风险因素（年龄55-64 HR = 1.11; 95%CI.80-1.53对比年龄65-74 HR = 1.25; 95%CI 1.04-1.51）（年龄相互作用p<0.0001）。在艾德或住院环境中评估的患者中，年龄≥55岁的中度/重度TBI或年龄≥65岁的轻度TBI会增加发生痴呆的风险。年轻的成年人可能比老年人更能适应近期轻度TBI的影响。
There is conflicting epidemiological evidence regarding the importance of traumatic brain injury (TBI) as a risk factor for dementia. Few prior studies have used non-TBI trauma (fracture) patients as controls and investigated the influence of age and TBI severity. To quantify risk of dementia among adults with recent TBI compared to adults with fractures. Retrospective cohort study from January 2005 to December 2011 (follow-up 5 to 7 years). California statewide administrative health database of emergency department (ED) and inpatient visits. All patients aged ≥55 diagnosed with TBI or fracture in 2005–2006 without baseline dementia and who did not die during hospitalization (n=164,661). Mild versus moderate/severe TBI diagnosed using ICD-9 code Center for Disease Control (CDC) definitions. Fracture diagnosed using ICD-9 codes excluding fractures of head/neck. Incident ED/inpatient diagnosis of dementia (ICD-9 codes) ≥1 year after initial TBI or fracture. The association between TBI and risk of dementia was estimated using Cox proportional hazard models before and after adjusting for common dementia predictors and potential confounders. We also stratified by TBI severity and age-category (age 55–64, 65–74, 75–84, and 85+). 51,799 (31%) trauma patients had TBI. Of these, 4,361 (8.4%) developed dementia compared to 6,610 (5.9%) of fracture patients (p<0.001). TBI was associated with increased dementia risk (hazard ratio (HR) = 1.46; 95% confidence-interval (CI) 1.41–1.52). Adjustment for covariates had little impact except adjustment for age category (fully adjusted model HR=1.26; 95% CI 1.21–1.32). In stratified adjusted analyses moderate/severe TBI was associated with increased risk of dementia across all ages (age 55–64: HR = 1.72; 95% CI 1.40–2.10 vs. age 65–74: HR = 1.46; 95% CI 1.30–1.64), while mild TBI may be a more important risk factor with increasing age (age 55–64 HR = 1.11; 95% CI .80–1.53 vs. age 65–74 HR = 1.25; 95% CI 1.04–1.51) (age interaction p<0.0001). Among patients evaluated in ED or inpatient settings, moderate/severe TBI at age ≥55 or mild TBI at age ≥65 increases risk for developing dementia. Younger adults may be more resilient to effects of mild recent TBI than older adults.
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影响因子：
9.9
作者：
Burke, James F.;Stulc, Jessica L.;Morgenstern, Lewis B.
通讯作者：
Morgenstern, Lewis B.
影响因子：
1.9
作者：
Helmes, Edward;Ostbye, Truls;Steenhuis, Runa E.
通讯作者：
Steenhuis, Runa E.
影响因子：
5.7
作者：
MOLGAARD, CA;STANFORD, EP;GOLBECK, AL
通讯作者：
GOLBECK, AL
影响因子：
9.9
作者：
Mehta, KM;Ott, A;Breteler, MMB
通讯作者：
Breteler, MMB
老年人患有轻度创伤性脑损伤的老年人死亡率较高：一项全国范围的研究。
DOI：
10.1186/1757-7241-22-7
发表时间：
2014-01-28
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Cheng PL;Lin HY;Lee YK;Hsu CY;Lee CC;Su YC
通讯作者：
Su YC