Dams-O'Connor Kristen, Gibbons Laura E, Landau Alexandra, Larson Eric B, Crane Paul K
Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, Washington.
J Am Geriatr Soc. 2016 Apr;64(4):844-8. doi: 10.1111/jgs.14014. Epub 2016 Mar 1.
To evaluate whether indices of preinjury health and functioning are associated with risk of incident traumatic brain injury (TBI) with loss of consciousness (LOC) and to evaluate health-related factors associated with mortality in individuals with incident TBI.
Prospective community cohort study.
Group Health, Seattle, Washington.
Individuals aged 65 and older with no self-reported prior TBI with LOC (N = 3,363) were enrolled and followed every 2 years for an average of 7.5 years (range 0-18 years).
Weibull survival models were used to evaluate baseline and time-varying predictors of incident TBI with LOC, including measures of depression, activities of daily living (ADLs), cerebrovascular disease, and disease comorbidity.
In an adjusted multivariate model, baseline depression symptoms as measured according to Center for Epidemiologic Studies Depression Scale (CES-D) score (hazard ratio (HR) for 4 points = 1.23, 95% confidence interval (CI) = 1.02-1.49, P = .03) and baseline activity of daily living (ADL) impairment (HR = 2.37, 95% CI = 1.24-4.53, P = .009) were associated with incident TBI. In a model that included time-dependent covariates, cerebrovascular disease at the previous visit (HR = 2.28, 95% CI = 1.37-3.78, P < .001), CES-D score the previous visit (HR for 4 points = 1.23, 95% CI = 1.02-1.49, P < .04) and baseline ADL impairment (HR 2.14, 95% CI = 1.11-4.13, P = .02) predicted incident TBI. Of factors considered, cerebrovascular disease and ADL impairment were associated with earlier mortality in participants with incident TBI with LOC.
Indices of health, mood, and functional status predict incident TBI with LOC in older adults. These findings may have implications for injury prevention and postinjury clinical management.
评估伤前健康和功能指标是否与创伤性脑损伤（TBI）伴意识丧失（LOC）的发病风险相关，并评估与TBI患者死亡率相关的健康因素。
前瞻性社区队列研究。
华盛顿州西雅图市的Group Health。
65岁及以上且无自我报告的既往TBI伴LOC病史的个体（N = 3363）入组，每2年随访一次，平均随访7.5年（范围0 - 18年）。
使用威布尔生存模型评估TBI伴LOC的基线和随时间变化的预测因素，包括抑郁测量、日常生活活动（ADL）、脑血管疾病和疾病共病情况。
在调整后的多变量模型中，根据流行病学研究中心抑郁量表（CES - D）评分测量的基线抑郁症状（4分的风险比（HR）= 1.23，95%置信区间（CI）= 1.02 - 1.49，P = 0.03）和基线日常生活活动（ADL）功能障碍（HR = 2.37，95% CI = 1.24 - 4.53，P = 0.009）与TBI发病相关。在一个包含时间依赖性协变量的模型中，上次随访时的脑血管疾病（HR = 2.28，95% CI = 1.37 - 3.78，P < 0.001）、上次随访时的CES - D评分（4分的HR = 1.23，95% CI = 1.02 - 1.49，P < 0.04）和基线ADL功能障碍（HR = 2.14，95% CI = 1.11 - 4.13，P = 0.02）可预测TBI发病。在考虑的因素中，脑血管疾病和ADL功能障碍与TBI伴LOC患者的早期死亡率相关。
健康、情绪和功能状态指标可预测老年人TBI伴LOC的发病情况。这些发现可能对损伤预防和伤后临床管理具有启示意义。
