Department of Psychiatry.
Department of Pathology.
Neuropsychology. 2018 May;32(4):410-416. doi: 10.1037/neu0000423. Epub 2018 Feb 1.
To evaluate whether a history of traumatic brain injury (TBI) with reported loss of consciousness (LOC) is a risk factor for earlier onset of Alzheimer's disease (AD) in an autopsy-confirmed sample.
Data from 2,133 participants with autopsy-confirmed AD (i.e., at least Braak neurofibrillary tangle stages III to VI and CERAD neuritic plaque score moderate to frequent) were obtained from the National Alzheimer's Coordinating Center (NACC). Participants were categorized by presence/absence of self-reported remote (i.e., >1 year prior to their first Alzheimer's Disease Center visit) history of TBI with LOC (TBI+ vs. TBI-). Analyses of Covariance (ANCOVA) controlling for sex, education, and race compared groups on clinician-estimated age of symptom onset and age of diagnosis.
Average age of onset was 2.34 years earlier (p = .01) for the TBI+ group (n = 194) versus the TBI- group (n = 1900). Dementia was diagnosed on average 2.83 years earlier (p = .002) in the TBI+ group (n = 197) versus the TBI- group (n = 1936). Using more stringent neuropathological criteria (i.e., Braak stages V-VI and CERAD frequent), both age of AD onset and diagnosis were 3.6 years earlier in the TBI+ group (both p's < .001).
History of TBI with reported LOC appears to be a risk factor for earlier AD onset. This is the first study to use autopsy-confirmed cases, supporting previous investigations that used clinical criteria for the diagnosis of AD. Further investigation as to possible underlying mechanisms of association is needed. (PsycINFO Database Record
评估有报告意识丧失（LOC）的创伤性脑损伤（TBI）病史是否是尸检确诊样本中阿尔茨海默病（AD）发病较早的危险因素。
从国家阿尔茨海默病协调中心（NACC）获得了 2133 名尸检确诊 AD 患者（即至少 Braak 神经纤维缠结阶段 III 至 VI 和 CERAD 神经原纤维缠结评分中度至频繁）的数据。参与者根据是否有（即在他们第一次去阿尔茨海默病中心就诊前 1 年以上）有报告的远程（即，在他们第一次去阿尔茨海默病中心就诊前 1 年以上）TBI 伴有 LOC（TBI+与 TBI-）的病史进行分类。采用协方差分析（ANCOVA），控制性别、教育和种族，比较两组患者的临床医生估计的发病年龄和诊断年龄。
TBI+组（n=194）的平均发病年龄比 TBI-组（n=1900）早 2.34 年（p=0.01）。TBI+组（n=197）比 TBI-组（n=1936）平均早 2.83 年被诊断为痴呆（p=0.002）。使用更严格的神经病理学标准（即 Braak 阶段 V-VI 和 CERAD 频繁），TBI+组的 AD 发病年龄和诊断年龄均早 3.6 年（均 p<0.001）。
有报告 LOC 的 TBI 病史似乎是 AD 发病较早的危险因素。这是第一项使用尸检确诊病例的研究，支持了先前使用 AD 临床标准进行诊断的研究。需要进一步研究可能的潜在关联机制。
