From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA.
Neurology. 2020 Aug 18;95(7):e793-e804. doi: 10.1212/WNL.0000000000010040. Epub 2020 Jun 26.
To test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition.
This cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group.
A total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36-2.12), TBI without LOC (β, 0.43; 95% CI, 0.31-0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59-0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001-0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002-0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, -0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition.
RHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.
为了验证重复性头部撞击（RHI），如接触性运动和创伤性脑损伤（TBI），会产生长期的神经精神和认知后果这一假设，我们比较了报告有 RHI 和/或 TBI 病史与没有该病史的中年和老年参与者，评估他们的抑郁和认知情况。
这项横断面研究包括来自脑健康登记处的 13323 名参与者（平均年龄 61.95 岁；72.5%为女性），他们完成了在线评估，包括俄亥俄州立大学 TBI 识别方法、老年抑郁量表（GDS-15）、CogState 简明电池和 Lumos 实验室神经认知表现测试。采用考虑年龄、性别、种族/民族和教育的逆概率加权线性回归，比较 RHI 和 TBI 与非 RHI/TBI 组的影响。
共有 725 名参与者报告有 RHI 暴露（主要是接触性运动和滥用），7277 名参与者报告有 TBI（n=2604 名有意识丧失[LOC]）。RHI（β，1.24；95%CI，0.36-2.12）、无 LOC 的 TBI（β，0.43；95%CI，0.31-0.54）和有 LOC 的 TBI（β，0.75；95%CI，0.59-0.91）与更高的 GDS-15 评分相对应。虽然 LOC 伴 TBI 与最多的神经心理学关联相关，但无 LOC 的 TBI 对 CogState 识别（β，0.004；95%CI，0.001-0.01）和 CogState 1 次回溯测试（β，0.004；95%CI，0.0002-0.01）有负面影响。RHI 预测 CogState 1 次回溯测试的分数更差（β，0.02；95%CI，-0.01 至 0.05）。RHI 和 TBI 之间存在交互作用，对几个神经心理学测试都有影响，而那些既有 RHI 又有 LOC 伴 TBI 的参与者，抑郁症状最严重，认知能力最差。
RHI 和 TBI 独立导致中年后神经精神和认知功能恶化。
