BaylorScott&White Health, Temple, TX, USA; Texas A&M University Health Sciences, Temple, TX, USA.
Northshore Health System, Evanston, IL, USA.
Alzheimers Dement. 2014 Jun;10(3 Suppl):S188-95. doi: 10.1016/j.jalz.2014.04.002.
Population-based studies have supported the hypothesis that a positive history of traumatic brain injury (TBI) is associated with an increased incidence of neurological disease and psychiatric comorbidities, including chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. These epidemiologic studies, however, do not offer a clear definition of that risk, and leave unanswered the bounding criteria for greater lifetime risk of neurodegeneration. Key factors that likely mediate the degree of risk of neurodegeneration include genetic factors, significant premorbid and comorbid medical history (e.g. depression, multiple head injuries and repetitive subconcussive impact to the brain, occupational risk, age at injury, and severity of brain injury). However, given the often-described concerns in self-report accuracy as it relates to history of multiple TBIs, low frequency of patient presentation to a physician in the case of mild brain injuries, and challenges with creating clear distinctions between injury severities, disentangling the true risk for neurodegeneration based solely on population-based studies will likely remain elusive. Given this reality, multiple modalities and approaches must be combined to characterize who are at risk so that appropriate interventions to alter progression of neurodegeneration can be evaluated. This article presents data from a study that highlights uses of neuroimaging and areas of needed research in the link between TBI and neurodegenerative disease.
基于人群的研究支持这样一种假设，即创伤性脑损伤（TBI）的阳性病史与神经退行性疾病和精神共病的发病率增加有关，包括慢性创伤性脑病、阿尔茨海默病、帕金森病和肌萎缩侧索硬化症。然而，这些流行病学研究并没有对该风险提供明确的定义，也没有回答神经退行性病变终生风险更高的边界标准。可能介导神经退行性病变风险程度的关键因素包括遗传因素、显著的发病前和合并症病史（例如抑郁、多次头部受伤和对大脑的反复亚震荡影响、职业风险、受伤时的年龄和脑损伤的严重程度）。然而，鉴于多次 TBI 相关的自我报告准确性常常存在问题、轻度脑损伤患者就诊医生的频率低以及在区分损伤严重程度方面存在挑战，仅基于人群研究来确定神经退行性病变的真正风险可能仍然难以捉摸。鉴于这一现实情况，必须结合多种模式和方法来确定谁有风险，以便评估改变神经退行性病变进展的适当干预措施。本文介绍了一项研究的数据，该研究强调了神经影像学在 TBI 和神经退行性疾病之间联系中的应用和需要研究的领域。
