Clinical implications of head trauma in frontotemporal dementia and primary progressive aphasia.

IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY
Breton M Asken, Jessica M Bove, Russell M Bauer, Jeremy A Tanner, Kaitlin B Casaletto, Adam M Staffaroni, Lawren VandeVrede, Michael L Alosco, Jesse B Mez, Robert A Stern, Bruce L Miller, Lea T Grinberg, Adam L Boxer, Maria Luisa Gorno-Tempini, Howie J Rosen, Gil D Rabinovici, Joel H Kramer
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引用次数: 0

Abstract

Background: Traumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications.

Methods: We studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education).

Results: Years of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p = .008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p = .003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p = .03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p = .009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p = .02, d = 1.1).

Conclusions: Lifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms.

头部创伤对额颞叶痴呆症和原发性进行性失语症的临床影响。
背景:创伤性脑损伤(TBI)和重复性头部撞击(RHI)与多种类型的神经退行性疾病风险增加、痴呆风险升高和痴呆症状发病年龄提前有关,这表明它们对晚年大脑健康具有跨诊断影响。额颞叶痴呆(FTD)和原发性进行性失语(PPA)代表了神经病理学上多种多样的临床表型。FTD/PPA 的诊断带来了独特的挑战,因为它们具有复杂的认知和行为症状,而且过多地表现为早发性痴呆(65 岁以前)。与健康对照组相比,我们对 FTD 和 PPA 患者终生暴露于头部创伤的情况进行了详细描述,以研究终生 TBI 和 RHI 的频率以及相关的临床影响:我们研究了 132 名 FTD/PPA(年龄为 68.9 ± 8.1,65% 为男性)和 132 名性别匹配的健康对照组(HC;年龄为 73.4 ± 7.6)。我们比较了 FTD/PPA 和 HC 之前的 TBI 和 RHI(接触/碰撞运动)比率(卡方、逻辑回归、方差分析)。在 FTD/PPA 中,我们评估了与症状发作年龄的关系(方差分析)。在行为变异型 FTD 中,我们评估了与认知功能和神经精神症状的关联(线性回归,控制年龄、性别和受教育年限):结果:对于任何接触/碰撞运动(8.5 ± 6.7 年 vs. 5.3 ± 4.5 年,p = .008)和美式足球(6.2 ± 4.3 年 vs. 3.1 ± 2.4 年,p = .003),FTD/PPA 的参与年限均高于 HC。在 FTD/PPA 中,TBI(0 TBI:62.1±8.1,1 TBI:59.9±6.9,2 + TBI:57.3±8.4;p = .03)和美式足球年限(0 年:62.2±8.7,1-4 年:59.7±7.0,5 + 年:55.9±6.3;p = .009)与较早出现症状的年龄存在剂量依赖关系。在bvFTD中,踢美式足球的人记忆力较差(z分数:-2.4 ± 1.2 vs. -1.4 ± 1.6,p = .02,d = 1.1):结论:终生头部创伤可能是导致 FTD/PPA 的一个可预防的环境风险因素。TBI或RHI暴露的剂量依赖性会影响FTD/PPA症状的发作和bvFTD的记忆功能。需要进行临床病理学研究,以更好地了解RHI或创伤性脑损伤与FTD/PPA发病和症状之间的神经病理学相关性。
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来源期刊
Alzheimer's Research & Therapy
Alzheimer's Research & Therapy 医学-神经病学
CiteScore
13.10
自引率
3.30%
发文量
172
审稿时长
>12 weeks
期刊介绍: Alzheimer's Research & Therapy is an international peer-reviewed journal that focuses on translational research into Alzheimer's disease and other neurodegenerative diseases. It publishes open-access basic research, clinical trials, drug discovery and development studies, and epidemiologic studies. The journal also includes reviews, viewpoints, commentaries, debates, and reports. All articles published in Alzheimer's Research & Therapy are included in several reputable databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, MEDLINE, PubMed, PubMed Central, Science Citation Index Expanded (Web of Science) and Scopus.
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