Iacono Diego, Raiciulescu Sorana, Olsen Cara, Perl Daniel P
Department of Defense/Uniformed Services University (DoD/USU) Brain Tissue Repository & Neuropathology Program, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States.
Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States.
Front Neurol. 2021 May 12;12:573401. doi: 10.3389/fneur.2021.573401. eCollection 2021.
We aimed to detect the possible accelerating role of previous traumatic brain injury (TBI) exposures on the onset of later cognitive decline assessed across different brain diseases. We analyzed data from the National Alzheimer's Coordinating Center (NACC), which provide information on history of TBI and longitudinal data on cognitive and non-cognitive domains for each available subject. At the time of this investigation, a total of 609 NACC subjects resulted to have a documented history of TBI. We compared subjects with and without a history of previous TBI (of any type) at the time of their first cognitive decline assessment, and termed them, respectively, TBI+ and TBI- subjects. Three hundred and sixty-one TBI+ subjects (229 male/132 female) and 248 TBI- subjects (156 male/92 female) were available. The analyses included TBI+ and TBI- subjects with a clinical diagnosis of Mild Cognitive Impairment, Alzheimer's disease, Dementia with Lewy bodies, Progressive supranuclear palsy, Corticobasal degeneration, Frontotemporal dementia, Vascular dementia, non-AD Impairment, and Parkinson's disease. The data showed that the mean age of TBI+ subjects was lower than TBI- subjects at the time of their first cognitive decline assessment (71.6 ± 11.2 vs. 74.8 ± 9.5 year; < 0.001). Moreover, the earlier onset of cognitive decline in TBI+ vs. TBI- subjects was independent of sex, race, attained education, APOE genotype, and importantly, clinical diagnoses. As for specific cognitive aspects, MMSE, Trail Making Test part B and WAIS-R scores did not differ between TBI+ and TBI- subjects, whereas Trail Making Test part A ( = 0.013) and Boston Naming test ( = 0.008) did. In addition, data showed that neuropsychiatric symptoms [based on Neuropsychiatry Inventory (NPI)] were much more frequent in TBI+ vs. TBI- subjects, including AD and non-AD neurodegenerative conditions such as PD. These cross-sectional analyses outcomes from longitudinally-assessed cohorts of TBI+ subjects that is, subjects with TBI exposure before the onset of cognitive decline in the contest of different neurodegenerative disorders and associated pathogenetic mechanisms, are novel, and indicate that a previous TBI exposure may act as a significant "" factor on the onset of cognitive decline in either AD and non-AD conditions independently of demographic factors, education, APOE genotype, and current or upcoming clinical conditions.
我们旨在检测既往创伤性脑损伤（TBI）暴露对不同脑部疾病中评估的后期认知衰退发作可能具有的加速作用。我们分析了来自国家阿尔茨海默病协调中心（NACC）的数据，该中心为每个可用受试者提供了TBI病史信息以及认知和非认知领域的纵向数据。在本次调查时，共有609名NACC受试者有记录在案的TBI病史。我们比较了首次认知衰退评估时有无既往TBI（任何类型）病史的受试者，并分别将他们称为TBI +和TBI -受试者。有361名TBI +受试者（229名男性/132名女性）和248名TBI -受试者（156名男性/92名女性）可供分析。分析纳入了临床诊断为轻度认知障碍、阿尔茨海默病、路易体痴呆、进行性核上性麻痹、皮质基底节变性、额颞叶痴呆、血管性痴呆、非AD性认知障碍和帕金森病的TBI +和TBI -受试者。数据显示，在首次认知衰退评估时，TBI +受试者的平均年龄低于TBI -受试者（分别为71.6±11.2岁和74.8±9.5岁；P<0.001）。此外，TBI +受试者与TBI -受试者相比，认知衰退的更早发作与性别、种族、受教育程度、APOE基因型无关，重要的是，与临床诊断无关。至于具体的认知方面，TBI +和TBI -受试者之间的简易精神状态检查表（MMSE）、连线测验B部分和韦氏成人智力量表修订版（WAIS-R）得分没有差异，而连线测验A部分（P = 0.013）和波士顿命名测验（P = 0.008）存在差异。此外，数据显示神经精神症状[基于神经精神科问卷（NPI）]在TBI +受试者中比TBI -受试者中更为常见，包括AD以及PD等非AD神经退行性疾病。这些来自对TBI +受试者纵向评估队列的横断面分析结果，即不同神经退行性疾病及其相关发病机制背景下认知衰退发作前有TBI暴露的受试者，是新颖的，表明既往TBI暴露可能独立于人口统计学因素、教育程度、APOE基因型以及当前或即将出现的临床状况，在AD和非AD情况下的认知衰退发作中起重要的“”作用。
