额颞叶痴呆和原发性进行性失语症患者头部创伤的临床意义。

Clinical implications of head trauma in frontotemporal dementia and primary progressive aphasia.

机构信息

Department of Clinical and Health Psychology, University of Florida, 1Florida Alzheimer's Disease Research Center, Fixel Institute for Neurological Diseases, PO Box 100165, Gainesville, FL, 32610, USA.

Department of Neurology, Biggs Institute for Alzheimer's and Neurodegenerative Diseases South Texas Alzheimer's Disease Research Center, University of Texas Health - San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.

出版信息

Alzheimers Res Ther. 2024 Aug 29;16(1):193. doi: 10.1186/s13195-024-01553-1.

DOI:10.1186/s13195-024-01553-1

PMID:39210451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11363650/

Abstract

BACKGROUND

Traumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications.

METHODS

We studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education).

RESULTS

Years of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p = .008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p = .003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p = .03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p = .009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p = .02, d = 1.1).

CONCLUSIONS

Lifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms.

摘要

背景

创伤性脑损伤（TBI）和重复性头部冲击（RHI）与多种类型的神经退行性疾病、更高的痴呆风险以及更早的痴呆症状发作年龄有关，这表明对以后的生活的大脑健康具有跨诊断意义。额颞叶痴呆（FTD）和原发性进行性失语症（PPA）代表了一组在神经病理学上具有不同表现的临床表型。由于认知和行为症状复杂，FTD/PPA 诊断带来了独特的挑战，这些症状不成比例地表现为早发性痴呆（65 岁之前）。我们对 FTD 和 PPA 患者与健康对照组进行了详细的终生头部创伤暴露评估，以检查一生中 TBI 和 RHI 的频率以及相关的临床意义。

方法

我们研究了 132 名 FTD/PPA（年龄 68.9±8.1，65%为男性）和 132 名性别匹配的健康对照组（HC；年龄 73.4±7.6）。我们比较了 FTD/PPA 和 HC 之间的既往 TBI 和 RHI（接触/碰撞运动）发生率（卡方检验，逻辑回归，方差分析）。在 FTD/PPA 中，我们评估了发病年龄的相关性（方差分析）。在行为变异型 FTD 中，我们评估了认知功能和神经精神症状的相关性（线性回归，控制年龄、性别和受教育年限）。

结果

FTD/PPA 比 HC 参与任何接触/碰撞运动的年数都多（8.5±6.7 年 vs. 5.3±4.5 年，p=0.008），参与美式足球的年数也更多（6.2 年±4.3 年 vs. 3.1 年±2.4 年；p=0.003）。在 FTD/PPA 中，TBI（无 TBI：62.1±8.1，1 TBI：59.9±6.9，2+TBI：57.3±8.4；p=0.03）和美式足球的年数（无：62.2±8.7，1-4 年：59.7±7.0，5+年：55.9±6.3；p=0.009）与发病年龄呈剂量依赖性关系。在 bvFTD 中，那些踢美式足球的人记忆力较差（z 分数：-2.4±1.2 与-1.4±1.6，p=0.02，d=1.1）。