From the San Francisco Veterans Affairs Medical Center (R.C.G., A.L.B., D.E.B., Y.L., J.B., K.Y.), and Departments of Neurology (R.C.G., K.Y.), Psychiatry (A.L.B., D.E.B., K.Y.), Epidemiology & Biostatistics (D.E.B., J.B., K.Y.), and Medicine (J.B.), University of California, San Francisco.
Neurology. 2018 May 15;90(20):e1771-e1779. doi: 10.1212/WNL.0000000000005522. Epub 2018 Apr 18.
Our aim was to assess risk of Parkinson disease (PD) following traumatic brain injury (TBI), including specifically mild TBI (mTBI), among care recipients in the Veterans Health Administration.
In this retrospective cohort study, we identified all patients with a TBI diagnosis in Veterans Health Administration databases from October 2002 to September 2014 and age-matched 1:1 to a random sample of patients without TBI. All patients were aged 18 years and older without PD or dementia at baseline. TBI exposure and severity were determined via detailed clinical assessments or ICD-9 codes using Department of Defense and Defense and Veterans Brain Injury Center criteria. Baseline comorbidities and incident PD more than 1 year post-TBI were identified using ICD-9 codes. Risk of PD after TBI was assessed using Cox proportional hazard models adjusted for demographics and medical/psychiatric comorbidities.
Among 325,870 patients (half with TBI; average age 47.9 ± 17.4 years; average follow-up 4.6 years), 1,462 were diagnosed with PD during follow-up. Compared to no TBI, those with TBI had higher incidence of PD (no TBI 0.31%, all-severity TBI 0.58%, mTBI 0.47%, moderate-severe TBI 0.75%). In adjusted models, all-severity TBI, mTBI, and moderate-severe TBI were associated with increased risk of PD (hazard ratio [95% confidence interval]: all-severity TBI 1.71 [1.53-1.92]; mTBI 1.56 [1.35-1.80]; moderate-severe TBI 1.83 [1.61-2.07]).
Among military veterans, mTBI is associated with 56% increased risk of PD, even after adjusting for demographics and medical/psychiatric comorbidities. This study highlights the importance of TBI prevention, long-term follow-up of TBI-exposed veterans, and the need to determine mechanisms and modifiable risk factors for post-TBI PD.
我们旨在评估退伍军人健康管理局（Veterans Health Administration）中护理接受者发生创伤性脑损伤（TBI）后（包括特定的轻度 TBI [mTBI]）发生帕金森病（PD）的风险。
在这项回顾性队列研究中，我们从 2002 年 10 月至 2014 年 9 月期间，在退伍军人健康管理局的数据库中确定了所有患有 TBI 诊断的患者，并按照年龄与没有 TBI 的随机患者样本进行了 1：1 匹配。所有患者均为 18 岁及以上，基线时没有 PD 或痴呆。TBI 暴露和严重程度通过详细的临床评估或 ICD-9 代码确定，这些代码使用了国防部和国防与退伍军人脑损伤中心的标准。使用 ICD-9 代码确定 TBI 后 1 年以上的基线合并症和新发 PD。使用 Cox 比例风险模型评估 TBI 后发生 PD 的风险，该模型调整了人口统计学和医疗/精神合并症因素。
在 325870 名患者中（一半患有 TBI；平均年龄 47.9±17.4 岁；平均随访 4.6 年），有 1462 名患者在随访期间被诊断为 PD。与没有 TBI 相比，患有 TBI 的患者 PD 发生率更高（无 TBI 为 0.31%，所有严重程度的 TBI 为 0.58%，mTBI 为 0.47%，中重度 TBI 为 0.75%）。在调整后的模型中，所有严重程度的 TBI、mTBI 和中重度 TBI 与 PD 风险增加相关（危险比[95%置信区间]：所有严重程度的 TBI 为 1.71[1.53-1.92]；mTBI 为 1.56[1.35-1.80]；中重度 TBI 为 1.83[1.61-2.07]）。
在退伍军人中，即使在调整了人口统计学和医疗/精神合并症因素后，mTBI 也与 PD 风险增加 56%相关。这项研究强调了 TBI 预防、对暴露于 TBI 的退伍军人进行长期随访以及确定 TBI 后 PD 的机制和可改变的危险因素的重要性。
