Author Affiliations: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (Mss Richey and Young, Drs Daneshvari, Bray, and Peters); National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland (Dr Gottesman); University of Mississippi Medical Center, Jackson, Mississippi (Dr Mosley); National Institute on Aging, National Institutes of Health, Baltimore, Maryland (Dr Walker); and Division of Neurocritical Care, Department of Neurology, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Dr Schneider).
J Head Trauma Rehabil. 2024;39(2):E48-E58. doi: 10.1097/HTR.0000000000000880. Epub 2024 Mar 18.
This study investigated associations of prior head injury and number of prior head injuries with mild behavioral impairment (MBI) domains.
The Atherosclerosis Risk in Communities (ARIC) Study.
A total of 2534 community-dwelling older adults who took part in the ARIC Neurocognitive Study stage 2 examination were included.
This was a prospective cohort study. Head injury was defined using self-reported and International Classification of Diseases, Ninth Revision ( ICD -9) code data. MBI domains were defined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) via an established algorithm mapping noncognitive neuropsychiatric symptoms to the 6 domains of decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal perception/thought content.
The primary outcome was the presence of impairment in MBI domains.
Participants were a mean age of 76 years, with a median time from first head injury to NPI-Q administration of 32 years. The age-adjusted prevalence of symptoms in any 1+ MBI domains was significantly higher among individuals with versus without prior head injury (31.3% vs 26.0%, P = .027). In adjusted models, a history of 2+ head injuries, but not 1 prior head injury, was associated with increased odds of impairment in affective dysregulation and impulse dyscontrol domains, compared with no history of head injury (odds ratio [OR] = 1.83, 95% CI = 1.13-2.98, and OR = 1.74, 95% CI = 1.08-2.78, respectively). Prior head injury was not associated with symptoms in MBI domains of decreased motivation, social inappropriateness, and abnormal perception/thought content (all P > .05).
Prior head injury in older adults was associated with greater MBI domain symptoms, specifically affective dysregulation and impulse dyscontrol. Our results suggest that the construct of MBI can be used to systematically examine the noncognitive neuropsychiatric sequelae of head injury; further studies are needed to examine whether the systematic identification and rapid treatment of neuropsychiatric symptoms after head injury is associated with improved outcomes.
本研究旨在探讨既往头部损伤和损伤次数与轻度行为障碍（MBI）各领域的关系。
社区动脉粥样硬化风险研究（ARIC）。
共有 2534 名居住在社区的老年人参加了 ARIC 神经认知研究第二阶段的检查。
这是一项前瞻性队列研究。头部损伤的定义是使用自我报告和国际疾病分类，第九修订版（ICD-9）代码数据。MBI 领域是通过使用神经精神病学问卷（NPI-Q）通过一种将非认知神经精神病症状映射到 6 个领域的既定算法来定义的，这些领域包括动机减退、情感失调、冲动控制障碍、社会不当和异常感知/思维内容。
主要结果是 MBI 领域存在障碍。
参与者的平均年龄为 76 岁，从首次头部损伤到 NPI-Q 管理的中位时间为 32 年。与无既往头部损伤者相比，有既往头部损伤者任何 1+MBI 领域症状的年龄调整患病率明显更高（31.3%对 26.0%，P=0.027）。在调整后的模型中，与无头部损伤史相比，有 2 次或更多次头部损伤史但无 1 次头部损伤史与情感失调和冲动控制障碍领域的损伤几率增加相关（优势比[OR]为 1.83，95%可信区间[CI]为 1.13-2.98，OR 为 1.74，95%CI 为 1.08-2.78）。既往头部损伤与 MBI 领域的动机减退、社会不当和异常感知/思维内容症状无关（均 P＞0.05）。
老年人既往头部损伤与 MBI 各领域的症状更相关，特别是情感失调和冲动控制障碍。我们的结果表明，MBI 可以用来系统地检查头部损伤后的非认知神经精神病后果；需要进一步研究以检查头部损伤后神经精神病症状的系统识别和快速治疗是否与改善结局相关。
