Mehta K M, Ott A, Kalmijn S, Slooter A J, van Duijn C M, Hofman A, Breteler M M
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Neurology. 1999 Dec 10;53(9):1959-62. doi: 10.1212/wnl.53.9.1959.
To investigate the relation between head trauma and incidence of dementia in a prospective population-based study.
Whether head trauma increases the risk of dementia and AD remains controversial. It has been suggested that the risk might be particularly increased for carriers of the APOE-epsilon4 allele.
The study population included 6645 participants of the prospective population-based Rotterdam Study, aged 55 years or older, who were free of dementia at baseline. Head trauma with loss of consciousness was measured at baseline by a self-report to a physician and detailed the number of head traumas, time since head trauma, and duration of loss of consciousness. The cohort was followed for incident dementia that was diagnosed according to international criteria. Logistic regression was used to calculate the risk of dementia after adjusting for age, gender, and education.
No increased risk of dementia or AD was found for persons with a history of head trauma with loss of consciousness (relative risk [RR] for dementia = 1.0, 95% CI, 0.5-2.0; RR for AD = 0.8, 95% CI, 0.4-1.9). Multiple head traumas, time since head trauma, and duration of unconsciousness did not significantly influence the risk of dementia. In addition, the APOE-epsilon4 allele did not modify the relationship.
This study suggests that mild head trauma is not a major risk factor for dementia or AD in the elderly. In addition, this study does not concur with previous cross-sectional studies suggesting an interaction with the APOE genotype.
在一项基于人群的前瞻性研究中调查头部创伤与痴呆发病率之间的关系。
头部创伤是否会增加患痴呆症和阿尔茨海默病（AD）的风险仍存在争议。有人认为，对于载脂蛋白E-ε4等位基因携带者，这种风险可能会特别增加。
研究人群包括鹿特丹前瞻性人群研究中的6645名参与者，年龄在55岁及以上，基线时无痴呆症。通过向医生自我报告在基线时测量有昏迷的头部创伤，并详细记录头部创伤的次数、头部创伤后的时间以及昏迷持续时间。对该队列进行随访，以诊断根据国际标准确诊的新发痴呆症。使用逻辑回归在调整年龄、性别和教育程度后计算患痴呆症的风险。
有昏迷头部创伤史的人患痴呆症或AD的风险没有增加（痴呆症的相对风险[RR]=1.0，95%可信区间[CI]，0.5-2.0；AD的RR=0.8，95%CI，0.4-1.9）。多次头部创伤、头部创伤后的时间以及昏迷持续时间对痴呆症风险没有显著影响。此外，APOE-ε4等位基因并未改变这种关系。
这项研究表明，轻度头部创伤不是老年人患痴呆症或AD的主要危险因素。此外，本研究与之前表明与APOE基因型存在相互作用的横断面研究结果不一致。
