Guan Dylan X, Peters Matthew E, Pike G Bruce, Ballard Clive, Creese Byron, Corbett Anne, Pickering Ellie, Roach Pamela, Smith Eric E, Ismail Zahinoor
Graduate Science Education, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
J Acad Consult Liaison Psychiatry. 2025 Mar-Apr;66(2):118-129. doi: 10.1016/j.jaclp.2024.12.004. Epub 2024 Dec 31.
Traumatic brain injury is associated with greater risk and earlier onset of dementia.
This study investigated whether later-life changes in subjective cognition and behavior - potential markers of Alzheimer disease - could be observed in cognitively unimpaired older persons with a history of suspected mild traumatic brain injury (smTBI) earlier in life and whether changes in cognition and behavior mediated the link between smTBI and daily function.
Data for 1392 participants from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging were analyzed. A validated self-reported brain injury screening questionnaire was used to determine the history of smTBI. Outcomes were measured using the Everyday Cognition scale (for subjective cognitive decline [SCD]), Mild Behavioral Impairment (MBI) Checklist, and Standard Assessment of Global Everyday Activities (for function). Inverse probability of treatment weighted logistic and negative binomial regressions were used to model smTBI (exposure) associations with SCD and MBI statuses, and Everyday Cognition-II and MBI Checklist total scores, respectively. Mediation analyses were conducted using bootstrapping.
History of smTBI was linked to higher odds of SCD (odds ratio = 1.45, 95% confidence interval: [1.14-1.84]) or MBI (odds ratio = 1.75, 95% confidence interval: [1.54-1.98]), as well as 24% (95% confidence interval: [18%-31%]) higher Everyday Cognition-II and 52% (95% confidence interval: [41%-63%]) higher MBI Checklist total scores. Finally, SCD and MBI mediated approximately 45% and 56%, respectively, of the association between smTBI history and poorer function, as indicated by higher Standard Assessment of Global Everyday Activities total scores.
smTBI at any point in the life course is linked to poorer cognition and behavior even in community-dwelling older persons without MCI or dementia. Older persons with smTBI may benefit from early dementia risk assessment using tools that measure changes in cognition and behavior. Interventions for declining cognition and behavior may also be beneficial in this population to address functional impairment.
创伤性脑损伤与痴呆症的更高风险和更早发病相关。
本研究调查了在认知未受损的老年人中，能否观察到早年有疑似轻度创伤性脑损伤（smTBI）病史者晚年主观认知和行为的变化（阿尔茨海默病的潜在标志物），以及认知和行为的变化是否介导了smTBI与日常功能之间的联系。
分析了来自加拿大在线健康、生活质量、认知、行为、功能和老龄化护理研究平台的1392名参与者的数据。使用经过验证的自我报告脑损伤筛查问卷来确定smTBI病史。使用日常认知量表（用于主观认知下降[SCD]）、轻度行为障碍（MBI）检查表和全球日常活动标准评估（用于功能）来测量结果。分别使用治疗加权逻辑回归和负二项回归对smTBI（暴露）与SCD和MBI状态以及日常认知-II和MBI检查表总分之间的关联进行建模。使用自抽样法进行中介分析。
smTBI病史与SCD（优势比=1.45，95%置信区间：[1.14 - 1.84]）或MBI（优势比=1.75，95%置信区间：[1.54 - 1.98]）的更高几率相关，以及日常认知-II高24%（95%置信区间：[18% - 31%]）和MBI检查表总分高52%（95%置信区间：[41% - 63%]）。最后，如全球日常活动标准评估总分更高所示，SCD和MBI分别介导了smTBI病史与较差功能之间约45%和56%的关联。
即使在没有轻度认知障碍或痴呆症的社区居住老年人中，生命历程中任何时候的smTBI都与较差的认知和行为相关。有smTBI的老年人可能会从使用测量认知和行为变化的工具进行早期痴呆风险评估中受益。针对认知和行为下降的干预措施也可能对该人群有益，以解决功能障碍问题。
