Gardner R C, Barnes D E, Li Y, Boscardin J, Peltz C, Yaffe K
Raquel C. Gardner, MD, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 52621, Email:
J Prev Alzheimers Dis. 2023;10(2):244-250. doi: 10.14283/jpad.2023.16.
Traumatic brain injury (TBI) is a risk factor for dementia and is common, especially among Veterans. It is unknown whether TBI exposure moderates the effect of other common medical/psychiatric comorbidities that are also risk factors for dementia. If treatable or preventable risk factors have a different impact on TBI-exposed Veterans, then this may have important public health implications for dementia prevention.
Determine prevalence of common medical/psychiatric comorbidities and associated risk of dementia in Veterans with versus without TBI.
Observational cohort.
Nationwide Veterans Health Administrative data 2001-2019.
After excluding baseline dementia, Veterans age ≥55 years with TBI (N=95,139) were age/sex/race-matched 1:2 with Veterans without TBI (N=190,278).
We compared prevalence of hypertension, coronary artery disease (CAD), diabetes, cerebrovascular disease (CVD), epilepsy, depression, and post-traumatic stress disorder (PTSD) among Veterans with and without TBI. We calculated risk of incident dementia associated with each comorbidity using multivariable hazard ratios (HR) with Fine-Grey competing risk of death adjusted for baseline demographics. We estimated population attributable fraction (PAF) of dementia due to each comorbidity among Veterans with versus without TBI.
Prevalence of all comorbidities were significantly more prevalent (5.7% to 21.5% higher) among Veterans compared to those without TBI. All comorbidities were associated with increased risk of dementia in both groups. There were significant interactions between comorbidities and TBI in which HRs were slightly lower among Veterans with TBI (adjusted HRs 1.08-1.37) compared to those without TBI (adjusted HRs 1.12-2.13). Nevertheless, PAFs for dementia due to depression, hypertension, CAD, CVD, and epilepsy were slightly higher in Veterans with TBI due to their high prevalence in this group.
Targeting depression, hypertension, CAD, CVD, and epilepsy may be especially important for dementia risk reduction among Veterans with TBI.
创伤性脑损伤（TBI）是痴呆症的一个风险因素，且很常见，尤其是在退伍军人中。尚不清楚TBI暴露是否会缓和其他常见的医学/精神共病（这些也是痴呆症的风险因素）的影响。如果可治疗或可预防的风险因素对有TBI暴露的退伍军人有不同影响，那么这可能对痴呆症预防具有重要的公共卫生意义。
确定有和没有TBI的退伍军人中常见医学/精神共病的患病率以及相关的痴呆症风险。
观察性队列研究。
2001 - 2019年全国退伍军人健康管理数据。
在排除基线痴呆症后，年龄≥55岁的TBI退伍军人（N = 95,139）与无TBI的退伍军人按年龄/性别/种族以1:2的比例匹配（N = 190,278）。
我们比较了有和没有TBI的退伍军人中高血压、冠状动脉疾病（CAD）、糖尿病、脑血管疾病（CVD）、癫痫、抑郁症和创伤后应激障碍（PTSD）的患病率。我们使用多变量风险比（HR）计算与每种共病相关的新发痴呆症风险，并根据基线人口统计学对死亡的Fine - Grey竞争风险进行调整。我们估计了有和没有TBI的退伍军人中每种共病导致的痴呆症的人群归因分数（PAF）。
与没有TBI的退伍军人相比，所有共病在退伍军人中的患病率显著更高（高5.7%至21.5%）。两组中所有共病都与痴呆症风险增加相关。共病与TBI之间存在显著交互作用，其中有TBI的退伍军人的HR略低于没有TBI的退伍军人（调整后的HR为1.08 - 1.37）（调整后的HR为1.12 - 2.13）。然而，由于抑郁症、高血压、CAD、CVD和癫痫在有TBI的退伍军人中患病率较高，它们导致的痴呆症的PAF略高。
针对抑郁症、高血压、CAD、CVD和癫痫进行干预对于降低有TBI的退伍军人的痴呆症风险可能尤为重要。
