From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle.
Neurology. 2018 Oct 23;91(17):e1611-e1618. doi: 10.1212/WNL.0000000000006391. Epub 2018 Sep 26.
To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D).
We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old between January 1, 1996, and September 30, 2015. Dementia and TBI diagnoses throughout the study period were abstracted from medical records. Cox proportional hazards models estimated associations between time-dependent TBI and dementia adjusting for demographics, HbA1c, nephropathy, neuropathy, stroke, peripheral artery disease, depression, and dysglycemic events. Fine and Gray regression models evaluated the association between baseline TBI and dementia risk accounting for competing risk of death.
A total of 178 individuals (4.4%) experienced a TBI and 212 (5.2%) developed dementia. In fully adjusted models, TBI was associated with 3.6 times the dementia risk (hazard ratio [HR] 3.64; 95% confidence interval [CI] 2.34, 5.68). When accounting for the competing risk of death, TBI was associated with almost 3 times the risk of dementia (HR 2.91; 95% CI 1.29, 5.68).
This study demonstrates a marked increase in risk of dementia associated with TBI among middle-aged and elderly people with T1D. Given the complexity of self-care for individuals with T1D, and the comorbidities that predispose them to trauma and falls, future work is needed on interventions protecting brain health in this vulnerable population, which is now living to old age.
在患有 1 型糖尿病（T1D）的中年和老年人群队列中，研究创伤性脑损伤（TBI）与痴呆风险之间的关联。
我们评估了 1996 年 1 月 1 日至 2015 年 9 月 30 日期间在一个综合性医疗保健系统中患有 T1D 且年龄≥50 岁的 4049 名患者。在整个研究期间，从病历中提取痴呆症和 TBI 诊断。使用 Cox 比例风险模型，根据人口统计学、HbA1c、肾病、神经病、中风、外周动脉疾病、抑郁和血糖异常事件，调整时间依赖性 TBI 与痴呆症之间的关联。精细和灰色回归模型评估了基线 TBI 与痴呆风险之间的关联，同时考虑了死亡的竞争风险。
共有 178 人（4.4%）发生 TBI，212 人（5.2%）发生痴呆症。在完全调整的模型中，TBI 与痴呆风险增加 3.6 倍（风险比[HR]3.64；95%置信区间[CI]2.34，5.68）。当考虑到死亡的竞争风险时，TBI 与痴呆风险增加近 3 倍相关（HR 2.91；95% CI 1.29，5.68）。
这项研究表明，在患有 T1D 的中年和老年人群中，TBI 与痴呆风险显著增加。鉴于 T1D 患者自我护理的复杂性，以及使他们易患创伤和跌倒的合并症，需要开展未来的工作，以研究针对这一脆弱人群的大脑健康保护干预措施，因为这群人现在已经长寿。
