Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Alzheimers Dis. 2018;66(2):717-723. doi: 10.3233/JAD-180586.
Traumatic brain injury (TBI) with loss of consciousness (LOC) has been associated with earlier onset of mild cognitive impairment, frontotemporal dementia, Parkinson's disease, and Alzheimer's disease (AD), but has not been examined as a risk factor for earlier onset of dementia with Lewy bodies (DLB).
The purpose of this study was to assess the association between a history of TBI and the age of onset of DLB.
Data from 576 subjects with a clinical diagnosis of DLB were obtained from the National Alzheimer's Coordinating Center (NACC). Analyses of Covariance examined whether self-reported history of remote TBI with LOC (i.e., >1 year prior to the first Alzheimer's Disease Center visit) was associated with earlier DLB symptom onset.
Controlling for sex, those with a history of remote TBI had an approximately 1.5-year earlier clinician-estimated age of onset (F = 0.87, p = 0.35) and 0.75-years earlier age of diagnosis (F = 0.14, p = 0.71) of DLB compared to those without a history of TBI, though the differences did not reach statistical significance. Analysis of subjects with autopsy-confirmed diagnoses was underpowered due to the low number of TBI+ subjects.
Remote TBI with LOC was not significantly associated with DLB onset, despite being a significant risk factor for cognitive decline and earlier age of onset in other neurodegenerative conditions. Replication of these results using a larger cohort of DLB subjects with and without a TBI history who have undergone autopsy is indicated, as our TBI+ subjects did show a slightly earlier onset of about 1.5 years. Further investigations into other potential DLB risk factors are also warranted.
伴有意识丧失（LOC）的创伤性脑损伤（TBI）与轻度认知障碍、额颞叶痴呆、帕金森病和阿尔茨海默病（AD）的更早发病有关，但尚未作为路易体痴呆（DLB）更早发病的危险因素进行研究。
本研究旨在评估 TBI 病史与 DLB 发病年龄之间的关联。
从国家阿尔茨海默病协调中心（NACC）获得了 576 名临床诊断为 DLB 的受试者的数据。协方差分析检验了是否存在伴有 REMOTE LOC 的 TBI 病史（即，在首次阿尔茨海默病中心就诊前>1 年）与 DLB 症状更早发作有关。
在控制了性别因素后，有 TBI 病史的患者其临床医生估计的 DLB 发病年龄大约提前了 1.5 年（F=0.87，p=0.35），诊断年龄提前了 0.75 年（F=0.14，p=0.71），但差异无统计学意义。由于 TBI+患者数量较少，因此对经尸检证实诊断的受试者进行分析的效能不足。
尽管 TBI 伴有 LOC 是认知能力下降和其他神经退行性疾病更早发病的重要危险因素，但与 DLB 发病并无显著相关性。使用具有 TBI 病史和无 TBI 病史的更大 DLB 受试者队列重复这些结果是必要的，因为我们的 TBI+受试者确实表现出大约 1.5 年的稍早发病。还需要进一步调查其他潜在的 DLB 危险因素。
