Zhu Yiqi, Williams Jonathan, Beyene Kebede, Trani Jean-Francois, Babulal Ganesh M
School of Social Work, Adelphi University, Garden City, New York.
Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
JAMA Netw Open. 2024 Aug 1;7(8):e2426590. doi: 10.1001/jamanetworkopen.2024.26590.
Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups.
To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype.
Health history of TBI, seizures, or both conditions.
Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0.
Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk.
This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.
创伤性脑损伤（TBI）、癫痫发作和痴呆症的发病率都随着年龄增长而上升。在不同种族和族裔群体中，对于TBI、癫痫发作以及抗癫痫药和抗精神病药等药物与认知障碍进展之间的关联，人们的认识存在差距。
研究认知功能正常的老年人中TBI和癫痫发作与认知障碍风险之间的关联，以及药物在调节这种关联中所起的作用。
设计、地点和参与者：这项多中心队列研究是对2005年6月1日至2020年6月30日期间从国家阿尔茨海默病协调中心收集的统一数据集进行的二次分析。统计分析于2024年2月1日至4月3日进行。数据收集自美国36个阿尔茨海默病研究中心的参与者，他们在基线时年龄在65岁及以上，基线时认知功能正常（临床痴呆评定为0，且基于AD的推定病因诊断无损害），并拥有关于种族和族裔、年龄、性别、教育水平和载脂蛋白E基因型的完整信息。
TBI、癫痫发作或两者兼具的健康史。
用临床痴呆评定大于0来衡量认知障碍的进展。
在7180名老年人队列中（年龄中位数为74岁[范围65 - 102岁]；4729名女性[65.9%]），1036人为非裔美国人或黑人（14.4%），21人为美洲印第安人或阿拉斯加原住民（0.3%），143人为亚洲人（2.0%），332人为西班牙裔（4.6%），5648人为非西班牙裔白人（78.7%）；教育水平中位数为16.0年（范围1.0 - 29.0年）。在使用倾向得分加权对选择基础进行调整后，癫痫发作与认知障碍风险高40%相关（风险比[HR]，1.40；95%置信区间[CI]，1.19 - 1.65），TBI与认知障碍风险高25%相关（HR，1.25；95% CI，1.17 - 1.34），癫痫发作和TBI均与风险高57%相关（HR，1.57；95% CI，1.23 - 2.01）。交互模型表明，与其他种族和族裔群体相比，患有TBI和癫痫发作的西班牙裔参与者认知障碍风险更高。使用抗癫痫药物（HR，1.23；95% CI，0.99 - 1.53）、抗抑郁药物（HR，1.32；95% CI，1.17 - 1.50）和抗精神病药物（HR，2.15；95% CI，1.18 - 3.89）与认知障碍风险较高相关，而使用抗焦虑、镇静或催眠药物（HR，0.88；95% CI，0.83 - 0.94）与风险较低相关。
本研究强调了将TBI和癫痫发作作为老年人认知障碍风险因素加以应对的重要性。解决更广泛的健康社会决定因素并弥合不同种族和族裔群体之间的健康差距，对于痴呆症的全面管理和预防至关重要。
