Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
JAMA Netw Open. 2024 Aug 1;7(8):e2426774. doi: 10.1001/jamanetworkopen.2024.26774.
Traumatic brain injuries (TBI) represent an important, potentially modifiable risk factor for dementia. Despite frequently observed vascular imaging changes in individuals with TBI, the relationships between TBI-associated changes in brain imaging and clinical outcomes have largely been overlooked in community cases of TBI.
To assess whether TBI are associated with and interact with midlife changes in neuroimaging and clinical features in otherwise healthy individuals.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used baseline data from the PREVENT Dementia program collected across 5 sites in the UK and Ireland between 2014 and 2020. Eligible participants were cognitively healthy midlife adults aged between 40 and 59 years. Data were analyzed between January 2023 and April 2024.
Lifetime TBI history was assessed using the Brain Injury Screening Questionnaire.
Cerebral microbleeds and other markers of cerebral small vessel disease (white matter hyperintensities [WMH], lacunes, perivascular spaces) were assessed on 3T magnetic resonance imaging. Clinical measures were cognition, sleep, depression, gait, and cardiovascular disease (CVD) risk, assessed using Computerized Assessment of Information Processing (COGNITO), Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies Depression Scale, clinical interviews, and the Framingham Risk Score, respectively.
Of 617 participants (median [IQR] age, 52 [47-56] years; 380 female [61.6%]), 223 (36.1%) had a history of TBI. TBI was associated with higher microbleed count (β = 0.10; 95% CI, 0.01-0.18; P = .03), with a dose-response association observed with increasing number of TBI events (β = 0.05; 95% CI, 0.01-0.09; P = .03). Conversely, TBI was not associated with other measures of small vessel disease, including WMH. Furthermore, TBI moderated microbleed associations with vascular risk factors and clinical outcomes, such that associations were present only in the absence of TBI. Importantly, observations held when analyses were restricted to individuals reporting only mild TBI.
In this cross-sectional study of healthy middle-aged adults, detectable changes in brain imaging and clinical features were associated with remote, even mild, TBI in the general population. The potential contribution of vascular injury to TBI-related neurodegeneration presents promising avenues to identify potential targets, with findings highlighting the need to reduce TBI through early intervention and prevention in both clinical care and policymaking.
创伤性脑损伤 (TBI) 是痴呆的一个重要的、潜在可改变的危险因素。尽管在 TBI 患者中经常观察到血管成像改变，但在社区 TBI 病例中，TBI 相关的脑成像改变与临床结局之间的关系在很大程度上被忽视了。
评估 TBI 是否与中年时的神经影像学和临床特征变化有关，并在其他方面健康的个体中是否存在相互作用。
设计、地点和参与者：这项横断面分析使用了英国和爱尔兰五个地点的 PREVENT Dementia 计划在 2014 年至 2020 年期间收集的基线数据。合格的参与者是年龄在 40 至 59 岁之间的认知健康中年成年人。数据分析于 2023 年 1 月至 2024 年 4 月进行。
使用脑损伤筛查问卷评估终生 TBI 史。
在 3T 磁共振成像上评估脑微出血和其他脑小血管疾病标志物（脑白质高信号[WMH]、腔隙、血管周围间隙）。使用计算机化信息处理评估 (COGNITO)、匹兹堡睡眠质量指数、流行病学研究抑郁量表、临床访谈和弗雷明汉风险评分分别评估认知、睡眠、抑郁、步态和心血管疾病 (CVD) 风险。
在 617 名参与者中（中位数[IQR]年龄，52 [47-56] 岁；380 名女性[61.6%]），223 名（36.1%）有 TBI 史。TBI 与更高的微出血计数相关（β=0.10；95%CI，0.01-0.18；P=0.03），并且随着 TBI 事件数量的增加，观察到剂量反应关系（β=0.05；95%CI，0.01-0.09；P=0.03）。相反，TBI 与其他小血管疾病指标（包括 WMH）无关。此外，TBI 调节了微出血与血管危险因素和临床结局之间的关系，只有在没有 TBI 的情况下才存在这些关系。重要的是，当分析仅限于报告仅有轻度 TBI 的个体时，观察结果仍然成立。
在这项针对健康中年成年人的横断面研究中，在一般人群中，可检测到的脑成像和临床特征变化与远程甚至轻度 TBI 有关。血管损伤对 TBI 相关神经退行性变的潜在贡献为确定潜在靶点提供了有希望的途径，研究结果强调了通过临床护理和决策制定中的早期干预和预防来减少 TBI 的必要性。
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