Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Division of Rheumatology, Department of Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Rheumatology, Department of Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
World Neurosurg. 2019 May;125:e563-e574. doi: 10.1016/j.wneu.2019.01.133. Epub 2019 Feb 1.
The role of maxillofacial trauma in dementia risk is not well established. The aim of this study was to evaluate the association between craniofacial trauma, including facial bone fracture and traumatic brain injury (TBI), and dementia.
Using Taiwan's National Health Insurance Research Database, we identified 501,889 adults who had had ≥1 medical record of craniofacial trauma between 2000 and 2010 and did not have a dementia diagnosis at baseline. Diagnoses of craniofacial trauma, including facial bone fracture and TBI, and dementia were made using International Classification of Diseases, Ninth Revision codes. The standardized incidence ratio was used to determine whether craniofacial trauma was associated with a greater risk of incident dementia compared with the general population. The Cox proportional hazards model was used to predict the risk of dementia among the trauma cohort by comparing the patients with and without comorbidities.
A total of 501,889 patients with craniofacial trauma were included, of which 1.5% (n = 7804) developed dementia. Facial bone fracture (standardized incidence ratio, 1.58; 95% confidence interval, 1.25-2.00) was shown to be associated with an increased dementia risk compared with the general population. In addition, craniofacial trauma accompanied with postinjury comorbidities was associated with an increased risk of dementia during follow-up periods compared with the group without comorbidities.
Craniofacial traumas, especially facial bone fracture, were associated with an increased risk of subsequent dementia. Maintaining a high index of suspicion for associated TBIs in all patients with facial trauma is crucial, even if no obvious initial signs and symptoms of brain injury are observed.
颌面外伤与痴呆风险的关系尚未明确。本研究旨在评估颅面外伤（包括面骨骨折和创伤性脑损伤[TBI]）与痴呆之间的关系。
利用台湾全民健康保险研究数据库，我们确定了 501889 名在 2000 年至 2010 年期间至少有 1 次颅面外伤医疗记录且基线时无痴呆诊断的成年人。使用国际疾病分类，第 9 版代码来诊断颅面外伤，包括面骨骨折和 TBI 以及痴呆。使用标准化发病比来确定颅面外伤与一般人群相比是否与更高的痴呆发病风险相关。通过比较伴有和不伴有合并症的患者，Cox 比例风险模型来预测外伤队列中的痴呆风险。
共纳入 501889 名颅面外伤患者，其中 1.5%（n=7804）发生了痴呆。与一般人群相比，面骨骨折（标准化发病比，1.58；95%置信区间，1.25-2.00）与痴呆风险增加相关。此外，与无合并症的患者相比，颅面外伤伴有外伤后合并症与随访期间痴呆风险增加相关。
颅面外伤，尤其是面骨骨折，与随后发生痴呆的风险增加相关。对面部外伤的所有患者均保持对相关 TBI 的高度警惕至关重要，即使没有明显的初始脑损伤迹象和症状。
