1 Research Service, San Francisco VA Health Care System and Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.
2 Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts.
J Neurotrauma. 2019 Jan 15;36(2):338-347. doi: 10.1089/neu.2018.5695. Epub 2018 Sep 4.
Traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and depressive symptoms each increase the risk for cognitive impairment in older adults. We investigated whether TBI has long-term associations with cognition in late middle-aged men, and examined the role of current PTSD/depressive symptoms. Participants were 953 men (ages 56-66) from the Vietnam Era Twin Study of Aging (VETSA), who were classified by presence or absence of (1) history of TBI and (2) current elevated psychiatric symptoms (defined as PTSD or depressive symptoms above cutoffs). TBIs had occurred an average of 35 years prior to assessment. Participants completed cognitive testing examining nine domains. In mixed-effects models, we tested the effect of TBI on cognition including for interactions between TBI and elevated psychiatric symptoms. Models adjusted for age, pre-morbid cognitive ability assessed at average age 20 years, apolipoprotein E genotype, and substance abuse; 33% (n = 310) of participants had TBI, mostly mild and remote; and 23% (n = 72) of those with TBI and 18% (n = 117) without TBI had current elevated psychiatric symptoms. TBI and psychiatric symptoms had interactive effects on cognition, particularly executive functioning. Group comparison analyses showed that men with both TBI and psychiatric symptoms demonstrated deficits primarily in executive functioning. Cognition was largely unaffected in men with either risk factor in isolation. Among late middle-aged men, the combination of even mild and very remote TBI with current elevated psychiatric symptoms is associated with deficits in executive function and related abilities. Future longitudinal studies should investigate how TBI and psychiatric factors interact to impact brain aging.
创伤性脑损伤（TBI）、创伤后应激障碍（PTSD）和抑郁症状都会增加老年人认知障碍的风险。我们研究了 TBI 是否与中老年男性的认知功能有长期关联，并探讨了当前 PTSD/抑郁症状的作用。参与者为来自越南时代双胞胎衰老研究（VETSA）的 953 名男性（年龄 56-66 岁），他们根据是否存在（1）TBI 史和（2）当前升高的精神症状（定义为 PTSD 或抑郁症状超过临界值）进行分类。TBI 发生在评估前平均 35 年。参与者完成了九项认知测试。在混合效应模型中，我们测试了 TBI 对认知的影响，包括 TBI 和升高的精神症状之间的相互作用。模型调整了年龄、20 岁平均年龄时的预先存在的认知能力、载脂蛋白 E 基因型和物质滥用；33%（n=310）的参与者有 TBI，主要是轻度和远程；310 名有 TBI 的参与者中有 23%（n=72）和 117 名没有 TBI 的参与者中有 23%（n=72）有当前升高的精神症状。TBI 和精神症状对认知有相互作用，特别是执行功能。组间比较分析表明，同时患有 TBI 和精神症状的男性在执行功能方面表现出缺陷。在单独存在任何一种风险因素的男性中，认知功能基本不受影响。在中老年男性中，即使是轻度和非常远程的 TBI 与当前升高的精神症状相结合，与执行功能和相关能力的缺陷有关。未来的纵向研究应探讨 TBI 和精神因素如何相互作用，影响大脑老化。
