Schneider Andrea L C, Hunzinger Katherine J, Brett Benjamin L, Sandsmark Danielle K, Jain Sonia, Sun Xiaoying, Gardner Raquel C, Manley Geoffrey T, Diaz-Arrastia Ramon, Nelson Lindsay D, Belton Patrick, Eagle Shawn, Gopinath Shankar, Grandhi Ramesh, Keene C Dirk, Krishnamoorthy Vijay, Mac Donald Christine, McCrea Michael, Merchant Randall, Mukherjee Pratik, Ngwenya Laura B, Okonkwo David, Robertson Claudia, Schnyer David, Taylor Sabrina R, Yue John K, Zafonte Ross
Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA Netw Open. 2025 Aug 1;8(8):e2525719. doi: 10.1001/jamanetworkopen.2025.25719.
Traumatic brain injury (TBI) and vascular risk factors are associated with cognitive impairment, but it is unknown if individuals with vascular risk factors experience worse cognitive outcomes after TBI.
To evaluate cognitive function among patients with TBI with vs without comorbid preinjury vascular risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study examined individuals with TBI enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Study between February 26, 2014, and August 8, 2018, with a 1-year follow-up. Analyses were conducted February 26, 2024, to May 29, 2025.
Vascular risk factors (ie, hypertension, diabetes, hyperlipidemia, and smoking).
Participants underwent a 5-test cognitive assessment at 2 weeks, 6 months, and 1 year postinjury; tests were combined into a global cognitive factor score in primary analyses and examined individually in secondary analyses. Inverse probability of attrition-weighted generalized estimating equations adjusted for age, sex, race, ethnicity, education, TBI severity, prior TBI, and psychiatric history were used to estimate the associations.
The 1313 participants were a mean (SD) age of 38.7 (16.4) years, 428 were female (32.6%), 885 were male (67.4%), 393 had never smoked (29.9%), 221 had hypertension (16.8%), 98 had diabetes (7.5%), and 116 had hyperlipidemia (8.8%). Both participants with and without vascular risk factors had improvement in cognition over the first year postinjury. Compared with individuals without diabetes, participants with diabetes had lower global cognitive factor scores at 2 weeks postinjury (mean z-score difference, -0.25; 95% CI, -0.45 to -0.04), worse executive functioning at 2 weeks postinjury, and less improvement on processing speed over the first-year postinjury. There were no significant differences in cognitive performance comparing participants with vs without hypertension, hyperlipidemia, and smoking. Individuals with 2 or more vascular risk factors (compared with no vascular risk factors) had lower global factor score at 2 weeks postinjury (mean difference, -0.21; 95% CI, -0.19 to -0.07) and worse verbal episodic memory immediate recall, executive functioning, and processing speed at 2 weeks, but similar improvements in cognitive performance over the first-year postinjury.
In this cohort study of individuals with TBI, those with diabetes displayed poorer global cognitive function and executive functioning 2 weeks after TBI and recovered less in processing speed over the first-year postinjury. Given the modifiable nature of comorbid vascular risk factors, future work interrogating postinjury changes in vascular risk factor burden, over longer follow-up, is warranted.
创伤性脑损伤（TBI）与血管危险因素均与认知障碍相关，但尚不清楚具有血管危险因素的个体在TBI后是否会出现更差的认知结果。
评估有无合并伤前血管危险因素的TBI患者的认知功能。
设计、设置和参与者：这项前瞻性队列研究对2014年2月26日至2018年8月8日期间纳入创伤性脑损伤转化研究与临床知识（TRACK-TBI）研究的TBI个体进行了为期1年的随访。分析于2024年2月26日至2025年5月29日进行。
血管危险因素（即高血压、糖尿病、高脂血症和吸烟）。
参与者在受伤后2周、6个月和1年接受了5项测试的认知评估；在主要分析中，测试被合并为一个整体认知因子评分，并在次要分析中单独进行检查。使用逆概率加权广义估计方程，对年龄、性别、种族、民族、教育程度、TBI严重程度、既往TBI和精神病史进行调整，以估计关联。
1313名参与者的平均（标准差）年龄为38.7（16.4）岁，428名女性（32.6%），885名男性（67.4%），393名从不吸烟（29.9%），221名患有高血压（16.8%），98名患有糖尿病（7.5%），116名患有高脂血症（8.8%）。有和没有血管危险因素的参与者在受伤后的第一年认知功能均有改善。与没有糖尿病的个体相比，患有糖尿病的参与者在受伤后2周时的整体认知因子得分较低（平均z评分差异为-0.25；95%置信区间为-0.45至-0.04），受伤后2周时执行功能较差，并且在受伤后的第一年处理速度改善较少。在比较有和没有高血压、高脂血症和吸烟的参与者的认知表现方面没有显著差异。有2种或更多血管危险因素的个体（与没有血管危险因素的个体相比）在受伤后2周时的整体因子得分较低（平均差异为-0.21；95%置信区间为-0.19至-0.07），在2周时言语情景记忆即时回忆、执行功能和处理速度较差，但在受伤后的第一年认知表现有类似的改善。
在这项对TBI个体的队列研究中，患有糖尿病的个体在TBI后2周时表现出较差的整体认知功能和执行功能，并且在受伤后的第一年处理速度恢复较少。鉴于合并血管危险因素的可改变性质，有必要在更长的随访期内对受伤后血管危险因素负担的变化进行进一步研究。
