Plassman B L, Havlik R J, Steffens D C, Helms M J, Newman T N, Drosdick D, Phillips C, Gau B A, Welsh-Bohmer K A, Burke J R, Guralnik J M, Breitner J C
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Neurology. 2000 Oct 24;55(8):1158-66. doi: 10.1212/wnl.55.8.1158.
The association between antecedent head injury and AD is inconsistent.
To examine the association between early adult head injury, as documented by military hospital records, and dementia in late life; and to evaluate the interaction between head injury and APOE epsilon4 as risk factors for dementia.
The study had a population-based prospective historical cohort design. It included men who were World War II Navy and Marine veterans, and were hospitalized during their military service with a diagnosis of either a nonpenetrating head injury or another unrelated condition. In 1996 to 1997, military medical records were abstracted to document the occurrence and details of closed head injury. The entire sample was then evaluated for dementia and AD using a multistage procedure. There were 548 veterans with head injury and 1228 without head injury who completed all assigned stages of the study. The authors estimated risk of dementia, specifically AD, using proportional hazards models.
Both moderate head injury (hazard ratio [HR] = 2.32; CI = 1.04 to 5.17) and severe head injury (HR = 4.51; CI = 1.77 to 11.47) were associated with increased risk of AD. Results were similar for dementia in general. The results for mild head injury were inconclusive. When the authors stratified by the number of APOE epsilon4 alleles, they observed a nonsignificant trend toward a stronger association between AD and head injury in men with more epsilon4 alleles.
Moderate and severe head injuries in young men may be associated with increased risk of AD and other dementias in late life. However, the authors cannot exclude the possibility that other unmeasured factors may be influencing this association.
既往头部损伤与阿尔茨海默病（AD）之间的关联并不一致。
研究军事医院记录所记载的成年早期头部损伤与晚年痴呆之间的关联；并评估头部损伤与载脂蛋白Eε4（APOE epsilon4）作为痴呆风险因素之间的相互作用。
本研究采用基于人群的前瞻性历史队列设计。研究对象包括第二次世界大战期间的海军和海军陆战队退伍军人，他们在服役期间因非穿透性头部损伤或其他无关疾病住院。1996年至1997年，提取军事医疗记录以记录闭合性头部损伤的发生情况和细节。然后采用多阶段程序对整个样本进行痴呆和AD评估。共有548名头部受伤的退伍军人和1228名未头部受伤的退伍军人完成了研究的所有指定阶段。作者使用比例风险模型估计痴呆尤其是AD的风险。
中度头部损伤（风险比[HR]=2.32；可信区间[CI]=1.04至5.17）和重度头部损伤（HR=4.51；CI=1.77至11.47）均与AD风险增加相关。总体痴呆的结果相似。轻度头部损伤的结果尚无定论。当作者按APOE epsilon4等位基因数量进行分层时，他们观察到在携带更多epsilon4等位基因的男性中，AD与头部损伤之间的关联有更强的趋势，但无统计学意义。
年轻男性的中度和重度头部损伤可能与晚年AD及其他痴呆的风险增加有关。然而，作者不能排除其他未测量因素可能影响这种关联的可能性。
