Dementia Risk Due to Traumatic Brain Injury in Subtypes of Dementia in the Welsh Population.

IF 8.5 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-08-12 Epub Date: 2025-07-03 DOI:10.1212/WNL.0000000000213866

Emily Simmonds, Jun Han, George Kirov, David J Sharp, Thomas H Massey, Valentina Escott-Price

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引用次数: 0

Abstract

Background and objectives: Traumatic brain injury (TBI) can increase vulnerability to neurodegenerative disorders. The association between TBI and dementia has been previously reported, but studies have relied on self-reporting of TBI and often do not appropriately adjust for relevant risk factors or cover enough time to include both individuals at age of highest TBI risk and age of dementia onset. This study uses electronic health records, which include over 20 years of data and 1.7 million individuals with hospital or general practitioner diagnoses of dementia and TBI. Therefore, the aim of this study was to assess the association between TBI and dementia and between TBI and dementia subtypes (Alzheimer disease [AD], vascular dementia [VaD], and unspecified dementia).

Methods: We performed a population-based study using Welsh (UK) electronic health records to estimate effect of TBI on the risk of dementia for individuals aged between 30 and 65 years in 1999 without a previous dementia diagnosis. The long-term risk of dementia after TBI was established using Cox proportional hazard models adjusting for sex, social deprivation, and other comorbidities. The effect of the time between TBI and dementia was investigated with time-stratified analyses. We assessed separately the risks of AD, VaD, and unspecified dementia related to TBI.

Results: Our study investigated 42,974 individuals with dementia (mean diagnosis age of 70 [SD = 10.5]), 10,164 individuals with a history of TBI, and 1,737,480 controls (mean age of 62 [SD = 11.9]). 49% of all individuals were female. TBI was associated with increased risk of dementia (hazard ratio [HR] = 2.32, 95% CI [1.88-2.85], p = 3.8 × 10^-15), with the risk increasing for multiple TBIs (HR = 1.22, 95% CI [1.08-1.38], p = 1.8 × 10^-03). The effect size of association between TBI and dementia was higher in people diagnosed with VaD (HR = 1.71, 95% CI [1.06-2.75], p = 0.027) and unspecified dementia (HR = 1.90, 95% CI [1.29-2.80], p = 0.0011) compared with the AD group (HR = 1.44, 95% CI [0.84-2.48], p = 0.189).

Discussion: Our study confirms that TBI increases dementia risk. We have shown a higher risk of VaD and unspecified dementia in those with a TBI, compared with AD. This study will direct future research into which biological mechanisms drive the association between TBI and dementia.

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威尔士人群中痴呆症亚型中创伤性脑损伤导致的痴呆风险。

背景和目的：创伤性脑损伤（TBI）可增加神经退行性疾病的易感性。TBI和痴呆之间的关联此前已有报道，但研究依赖于TBI的自我报告，通常没有适当调整相关风险因素，或覆盖足够的时间，以包括最高TBI风险年龄和痴呆发病年龄的个体。这项研究使用了电子健康记录，其中包括20多年的数据和170万被医院或全科医生诊断为痴呆症和脑外伤的人。因此，本研究的目的是评估TBI与痴呆之间以及TBI与痴呆亚型（阿尔茨海默病[AD]、血管性痴呆[VaD]和未指明的痴呆）之间的关系。方法：我们使用威尔士（英国）的电子健康记录进行了一项基于人群的研究，以估计1999年年龄在30至65岁之间没有先前痴呆诊断的个体脑外伤对痴呆风险的影响。使用Cox比例风险模型，调整性别、社会剥夺和其他合并症，建立脑外伤后痴呆的长期风险。用时间分层分析研究脑外伤与痴呆之间时间的影响。我们分别评估了与TBI相关的AD、VaD和未指明痴呆的风险。结果：我们的研究调查了42974名痴呆患者（平均诊断年龄为70岁[SD = 10.5]）， 10164名TBI病史患者，以及1737480名对照组（平均年龄为62岁[SD = 11.9]）。49%的个体是女性。TBI与痴呆风险增加相关（风险比[HR] = 2.32, 95% CI [1.88-2.85], p = 3.8 × 10-15），多发TBI的风险增加（HR = 1.22, 95% CI [1.08-1.38], p = 1.8 × 10-03）。与AD组（HR = 1.44, 95% CI [0.84-2.48], p = 0.189）相比，被诊断为VaD （HR = 1.71, 95% CI [1.06-2.75], p = 0.027）和未指定痴呆（HR = 1.90, 95% CI [1.29-2.80], p = 0.0011）的患者TBI和痴呆之间的关联效应量更高。讨论：我们的研究证实脑外伤增加痴呆风险。我们已经表明，与阿尔茨海默氏症相比，脑外伤患者患VaD和未指明痴呆的风险更高。这项研究将指导未来关于脑外伤和痴呆之间的生物学机制的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.