Posis Alexander Ivan B, Alcaraz John E, Parada Humberto, Shadyab Aladdin H, Elman Jeremy A, Panizzon Matthew S, Reynolds Chandra A, Franz Carol E, Kremen William S, McEvoy Linda K
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
School of Public Health, San Diego State University, San Diego, California, USA.
Neurotrauma Rep. 2024 Jun 17;5(1):563-573. doi: 10.1089/neur.2024.0034. eCollection 2024.
Traumatic brain injury (TBI) is associated with increased risk of dementia. However, whether TBI is associated with greater cognitive decline over time in specific cognitive domains among older adults is not well understood. This prospective cohort study used data from 1476 male Vietnam Era Twin Study of Aging participants (average age at study entry = 57.9 years, range = 51-71 years; 97.6% non-Hispanic; 92.5% White) collected from 2003 to 2019, who had complete information on prior TBI. Participants completed a comprehensive neuropsychological assessment at up to three visits over up to a 12-year follow-up period during which they also self-reported their history of TBI. Multivariable, linear mixed-effects models were used to assess associations between TBI and cognitive performance trajectories. Effect measure modification by apolipoprotein E () epsilon 4 () genotype status was assessed in a subset of participants. Thirty-one percent of participants reported a history of TBI; 29.4% were carriers. There were no statistically significant associations of TBI with decline in episodic memory, executive function, or processing speed among participants overall. In models stratified by carrier status, TBI was associated with a larger magnitude of decline in executive function for carriers (β = -0.0181; 95% confidence interval [CI] -0.0335, -0.0027) compared to noncarriers (β = -0.0031; 95% CI -0.0128, 0.0067; = 0.03). In sensitivity analyses, TBI earlier in life (before military induction, average age = 20 years) was associated with faster declines in executive function compared to no TBI, irrespective of status. In this sample of middle-to-older aged men, TBI was associated with faster declines in executive function among carriers and among those who reported TBI in early life. These findings support the importance of a life course perspective when considering factors that may influence cognitive health in aging.
创伤性脑损伤（TBI）与痴呆风险增加相关。然而，TBI是否与老年人特定认知领域随时间推移出现更大程度的认知衰退尚不清楚。这项前瞻性队列研究使用了1476名越南战争时期男性双胞胎衰老研究参与者的数据（研究入组时的平均年龄为57.9岁，范围为51 - 71岁；97.6%为非西班牙裔；92.5%为白人），这些数据收集于2003年至2019年，参与者有关于既往TBI的完整信息。参与者在长达12年的随访期内最多进行三次就诊时完成了全面的神经心理学评估，在此期间他们还自我报告了TBI病史。使用多变量线性混合效应模型来评估TBI与认知表现轨迹之间的关联。在一部分参与者中评估了载脂蛋白E（）ε4（）基因型状态对效应量的修正作用。31%的参与者报告有TBI病史；29.4%为携带者。总体而言，参与者中TBI与情景记忆、执行功能或处理速度的衰退之间无统计学显著关联。在按携带者状态分层的模型中，与非携带者（β = -0.0031；95%置信区间[CI] -0.0128，0.0067； = 0.03）相比，TBI与携带者执行功能衰退幅度更大相关（β = -0.0181；95%置信区间[-0.0335，-0.0027]）。在敏感性分析中，与无TBI相比，早年（入伍前，平均年龄 = 20岁）发生TBI与执行功能衰退更快相关，与状态无关。在这个中老年男性样本中，TBI与携带者以及早年报告有TBI的人群执行功能衰退更快相关。这些发现支持了在考虑可能影响衰老过程中认知健康的因素时采用生命历程视角的重要性。
