Gardner Raquel C, Peltz Carrie B, Kenney Kimbra, Covinsky Kenneth E, Diaz-Arrastia Ramon, Yaffe Kristine
Memory and Aging Center, Department of Neurology, University of California San Francisco.
San Francisco Veterans Affairs Medical Center, California.
J Gerontol A Biol Sci Med Sci. 2017 Sep 1;72(9):1233-1238. doi: 10.1093/gerona/glw341.
Traumatic brain injury (TBI) has been identified as a risk factor for Parkinson's disease (PD). Motor dysfunction among TBI-exposed elders without PD has not been well characterized. We sought to determine whether remote TBI is a risk factor for motor dysfunction on exam and functionally relevant motor dysfunction in day-to-day life among independently living elders without PD.
This is a cross-sectional cohort study of independently living retired military veterans aged 50 or older with (n = 78) and without (n = 85) prior TBI-all without diagnosed PD. To characterize multidimensional aspects of motor function on exam, the Unified Parkinson's Disease Rating Scale (UPDRS) Motor Examination was performed by a board-certified neurologist and used to calculate a modified UPDRS (mUPDRS) global motor score and four domain scores (tremor, rigidity, bradykinesia, and posture/gait). Functionally relevant motor dysfunction was assessed via self-report of falls within the past year.
In analyses adjusted for demographics and comorbidities that differed between groups, compared with veterans without TBI, those with moderate-to-severe TBI were more likely to have fallen in past year (33% vs. 14%, risk ratio 2.5 [95% confidence interval 1.1-5.4]), had higher (worse) mUPDRS global motor (p = .03) and posture/gait scores (p = .02), but not higher tremor (p = .70), rigidity (p = .21), or bradykinesia scores (p = .22). Mild TBI was not associated with worse motor function.
Remote moderate-to-severe TBI is a risk factor for motor dysfunction-defined as recent falls and impaired posture/gait-among older veterans. TBI-exposed older adults may be ideal candidates for aggressive fall-screening and prevention strategies.
创伤性脑损伤（TBI）已被确定为帕金森病（PD）的一个风险因素。在无帕金森病的TBI暴露老年人中，运动功能障碍尚未得到充分表征。我们试图确定既往创伤性脑损伤是否是独立生活的无帕金森病老年人在体格检查时运动功能障碍以及日常生活中与功能相关的运动功能障碍的一个风险因素。
这是一项横断面队列研究，研究对象为年龄在50岁及以上、有（n = 78）或无（n = 85）既往创伤性脑损伤的独立生活的退休退伍军人——均未被诊断为帕金森病。为了在体格检查中表征运动功能的多维度方面，由一名获得委员会认证的神经科医生进行统一帕金森病评定量表（UPDRS）运动检查，并用于计算改良UPDRS（mUPDRS）总体运动评分和四个领域评分（震颤、强直、运动迟缓以及姿势/步态）。通过自我报告过去一年内的跌倒情况来评估与功能相关的运动功能障碍。
在对两组之间不同的人口统计学和合并症进行校正的分析中，与无创伤性脑损伤的退伍军人相比，中重度创伤性脑损伤的退伍军人在过去一年中更有可能跌倒（33%对14%，风险比2.5 [95%置信区间1.1 - 5.4]），mUPDRS总体运动评分（p = 0.03）和姿势/步态评分更高（更差）（p = 0.02），但震颤评分（p = 0.70）、强直评分（p = 0.21）或运动迟缓评分（p = 0.22）没有更高。轻度创伤性脑损伤与更差的运动功能无关。
既往中重度创伤性脑损伤是老年退伍军人运动功能障碍的一个风险因素，运动功能障碍定义为近期跌倒和姿势/步态受损。有创伤性脑损伤的老年人可能是积极的跌倒筛查和预防策略的理想对象。
