Post Traumatic Brain Injury Dementia Risk Trends over 10 years Post Injury

Zabreen Tahir, MD
Department of Neurology
Division of Neuro-Critical Care
Poster Overview

Importance: A growing body of evidence suggests the link between traumatic brain injury (TBI) and increased risk of dementia. Few studies have investigated this risk in TBI patients younger than 55 years old and assessed the effects of TBI severity and pre-existing comorbidities using patients with non-TBI trauma (NTT) as controls.

Objective: To evaluate the age- and severity-stratified risk of dementia following TBI and to identify predictors associated with increased risk of dementia post injury.

Method: 12,423 patients with TBI, aged 45-100 were studied and matched to non-head trauma controls from a hospital-based electronic medical registry from 2000-2018. Demographics, medical comorbidities, injury severity score for both cohorts were recorded. Both groups were followed for up to 10 years to identify incidence of dementia after trauma.

Results: Elderly patients with head injury are at greater risk for long term risk of dementia and cognitive decline, compared to those with minor trauma like limb fracture/sprains. Dementia developed significantly earlier in TBI patients compared to minor trauma patients. The risk of dementia is also significant in patients as young as 45. In addition to those with severe injury, patients with even mild head injury were reported to be at higher risk. Those with history of medical conditions like hyperlipidemia, hypertension, stroke and psychiatric disorders like depression, anxiety had a higher likelihood of having dementia after head injury. These findings should prompt clinicians to screen for dementia regularly in any patient that has suffered a TBI.

Conclusions: Mild TBI patients demonstrated an increased risk of developing dementia compared to severe TBI even in patient as young 45 years old.  TBI patients with underlying history of cardiovascular risk factors, psychiatric diseases were at a higher risk of developing dementia. Prospective studies to better describe the burden of health comorbidities in TBI patients and the role of medical surveillance in modifying disease course

 

Scientific Abstract

Importance: A growing body of evidence suggests the link between traumatic brain injury (TBI) and increased risk of dementia. Few studies have investigated this risk in TBI patients younger than 55 years old and assessed the effects of TBI severity and pre-existing comorbidities using patients with non-TBI trauma (NTT) as controls.

Objective: To evaluate the age- and severity-stratified risk of dementia following TBI and to identify predictors associated with increased risk of dementia post injury.

Method: Retrospective cohort study of 12,423 patients with TBI, aged 45-100 and matched to non-head trauma controls, identified by ICD9/10 Codes, from a hospital-based electronic medical registry from 2000-2018. Demographics, medical comorbidities, injury severity score for both cohorts were recorded. Both groups were followed for up to 10 years to identify incidence of dementia after trauma. Cox proportional hazards models were used to determine the association between TBI and dementia after multivariable adjustment.

Results: TBI patients were 55% male with a mean age of 65 (±13) years at enrollment and a mean follow up time of 6.6 (±3.6) years and were well-matched to the control group. TBI patients had more dementia after injury (7.5% vs <4,6%, p<0.001), with less time to develop dementia after trauma (4.2 in TBI vs 4.7 years in NTT, p<0.001), than control. Mild TBI group had higher incidence of dementia compared to severe (9% vs 5.4%, p<0.001). We found both mild (HR 2.2, 95% CI: 1.9-4.5) and moderate TBI (HR 1.3, 95% CI: 1.2-1.6) were associated with increased risk of dementia, even after adjusting for demographics and comorbidities. Risk of dementia after mild TBI was higher for all age groups, even for 45-54 (HR 4.1, 95% CI: 2.2-7.8) but for moderate, it was not significant for patient > 75 years after adjustments. In a secondary analysis, we found that male sex, history of hypertension, hyperlipidemia, stroke history, depression, anxiety were independent predictors of dementia after TBI.

Conclusions: Mild TBI patients demonstrated an increased risk of developing dementia compared to severe TBI even in patient as young 45 years old.  TBI patients with underlying history of cardiovascular risk factors, psychiatric diseases were at a higher risk of developing dementia. Prospective studies to better describe the burden of health comorbidities in TBI patients and the role of medical surveillance in modifying disease course.

Clinical Implications
Patients with head injury should be followed up regularly to identify and prevent development of dementia and cognitive decline. Even young adults (45-54 years) who sustain injury are at relatively high risk compared to controls. Future prospective studies are needed to understand the biopsychosocial links and assess the role of medical surveillance and preventive protocols.
Research Areas
Authors
Zabreen Tahir, Brittany M Stopa, Farid Radmanesh, Taha Yahya, Saef Izzy
Principal Investigator
Saef Izzy

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