Raj Rahul, Kaprio Jaakko, Jousilahti Pekka, Korja Miikka, Siironen Jari
From the Department of Neurosurgery (R.R., M.K., J.S.), Helsinki University Hospital and University of Helsinki; Institute for Molecular Medicine Finland (J.K.), University of Helsinki; and Department of Public Health and Welfare (P.J.), Finnish Institute for Health and Welfare, Helsinki, Finland.
Neurology. 2022 Jun 6;98(23):e2377-e2386. doi: 10.1212/WNL.0000000000200290.
Traumatic brain injury (TBI) is considered a potential modifiable dementia risk factor. We aimed to determine whether TBI actually increases the risk of dementia when adjusting for other relevant dementia risk factors.
This was a national prospective longitudinal cohort study that included random and representative population samples from different parts of Finland of patients 25 through 64 years of age from 1992 to 2012. Major TBI was defined as a diagnosis of traumatic intracranial hemorrhage and hospital length of stay (LOS) ≥3 days and minor TBI was defined as a diagnosis of concussion and hospital LOS ≤1 day. Dementia was defined as any first hospital contact with a diagnosis of dementia, first use of an antidementia drug, or dementia as an underlying or contributing cause of death. Follow-up was until death or end of 2017.
Of 31,909 participants, 288 were hospitalized due to a major TBI and 406 were hospitalized due to a minor TBI. There was a total of 976 incident dementia cases during a median follow-up of 15.8 years. After adjusting for age and sex, hospitalization due to major TBI (hazard ratio [HR] 1.51, 95% CI 1.03-2.22), but not minor TBI, increased the risk of dementia. After additional adjustment for educational status, smoking status, alcohol consumption, physical activity, and hypertension, the association between major TBI and dementia weakened (HR 1.30, 95% CI 0.86-1.97). The risk factors most strongly attenuating the association between major TBI and dementia were alcohol consumption and physical activity.
There was an association between hospitalized major TBI and incident dementia. The association was diluted after adjusting for confounders, especially alcohol consumption and physical activity. Hospitalization due to minor TBI was not associated with an increased risk of dementia.
This study provides Class I evidence that major TBI is associated with incident dementia.
创伤性脑损伤（TBI）被认为是一种潜在的可改变的痴呆风险因素。我们旨在确定在调整其他相关痴呆风险因素后，TBI是否真的会增加患痴呆症的风险。
这是一项全国性前瞻性纵向队列研究，纳入了1992年至2012年芬兰不同地区年龄在25至64岁的随机且具有代表性的人群样本。重度TBI定义为创伤性颅内出血诊断且住院时间（LOS）≥3天，轻度TBI定义为脑震荡诊断且住院LOS≤1天。痴呆定义为首次因痴呆诊断而住院、首次使用抗痴呆药物或痴呆作为潜在或促成死亡原因。随访至死亡或2017年底。
在31909名参与者中，288人因重度TBI住院，406人因轻度TBI住院。在中位随访15.8年期间，共有976例新发痴呆病例。在调整年龄和性别后，因重度TBI住院（风险比[HR]1.51，95%CI 1.03 - 2.22），而非轻度TBI，增加了患痴呆症的风险。在进一步调整教育程度、吸烟状况、饮酒量、身体活动和高血压后，重度TBI与痴呆之间的关联减弱（HR 1.30，95%CI 0.86 - 1.97）。最能减弱重度TBI与痴呆之间关联的风险因素是饮酒量和身体活动。
因重度TBI住院与新发痴呆之间存在关联。在调整混杂因素后，尤其是饮酒量和身体活动，这种关联被削弱。因轻度TBI住院与痴呆风险增加无关。
本研究提供了I类证据，表明重度TBI与新发痴呆有关。
