Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA.
J Alzheimers Dis. 2019;67(4):1277-1289. doi: 10.3233/JAD-181039.
It is presently unknown whether military service members are at risk for chronic traumatic encephalopathy (CTE) or Alzheimer's disease (AD) pathology, due to traumatic brain injury (TBI). Studies with respect to AD have had mixed results with respect to mild TBI, although an increased risk of clinical AD with moderate and severe TBI is more consistently demonstrated. No studies to date have demonstrated a longitudinal progression from TBI to autopsy. We therefore initiated a cross-sectional survey of former military service members. 18 brain specimens have been examined to date, with a mean age of 68.9±16 years (range 32-94). Twelve had a history of psychiatric problems; 10 had a history of PTSD specifically. Five had neurological problems including stroke and seizures. One subject had early-onset AD. Two subjects had a history of TBI and two had a history of blast exposure. Age-related proteinopathy, ranging from AD neuropathologic change A0B1C0 to A3B3C3 by NIA-AA guidelines, was identified. None of the cases showed changes specific for CTE pathology. There was no relationship between p-tau in the amygdala and psychiatric signs. There was no significant difference in phosphorylated tau (p-tau) or amyloid-β burden compared to age-matched controls. These preliminary data suggest that military service per se is not a risk factor for CTE pathology or neurodegenerative proteinopathy. More research is needed to study the relationship, if any, between TBI and neurodegenerative proteinopathy.
由于创伤性脑损伤（TBI），目前尚不清楚军人是否存在慢性创伤性脑病（CTE）或阿尔茨海默病（AD）病理的风险。关于 AD 的研究在轻度 TBI 方面结果不一，尽管中度和重度 TBI 导致临床 AD 的风险增加更为一致。迄今为止，尚无研究表明 TBI 会导致尸检的纵向进展。因此，我们开始对前军人进行横断面调查。迄今为止，已经检查了 18 个大脑标本，平均年龄为 68.9±16 岁（范围 32-94）。12 人有精神病史；10 人有 PTSD 病史。5 人有神经系统问题，包括中风和癫痫。1 名受试者有早发性 AD。2 名受试者有 TBI 病史，2 名受试者有爆炸暴露史。根据 NIA-AA 指南，确定了年龄相关蛋白病，范围从 AD 神经病理变化 A0B1C0 到 A3B3C3。没有病例显示出特定的 CTE 病理变化。杏仁核中的 p-tau 与精神症状之间没有关系。与年龄匹配的对照组相比，磷酸化 tau（p-tau）或淀粉样β负荷没有显著差异。这些初步数据表明，军人身份本身并不是 CTE 病理或神经退行性蛋白病的风险因素。需要进一步研究 TBI 与神经退行性蛋白病之间的关系（如果有的话）。
