The Impact of Age and Severity on Dementia After Traumatic Brain Injury: A Comparison Study. Issue 5 (14th August 2021)

• Record Type: Journal Article
• Authors: Stopa, Brittany M; Tahir, Zabreen; Mezzalira, Elisabetta; Boaro, Alessandro; Khawaja, Ayaz; Grashow, Rachel; Zafonte, Ross D; Smith, Timothy R; Gormley, William B; Izzy, Saef
• Is Part Of: Neurosurgery. Volume 89:Issue 5(2021)
• Page Start: 810
• Page End: 818
• Publication Date: 2021-08-14
• Subjects: Dementia -- Non-TBI orthopedic trauma -- TBI -- Traumatic brain injury; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab297
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Growing evidence associates traumatic brain injury (TBI) with increased risk of dementia, but few studies have evaluated associations in patients younger than 55 yr using non-TBI orthopedic trauma (NTOT) patients as controls to investigate the influence of age and TBI severity, and to identify predictors of dementia after trauma. OBJECTIVE: To investigate the relationship between TBI and dementia in an institutional group. METHODS: Retrospective cohort study (2000-2018) of TBI patients aged 45 to 100 yr vs NTOT controls. Primary outcome was dementia after TBI (followed ≤10 yr). Cox proportional hazards models were used to assess risk of dementia; logistic regression models assessed predictors of dementia. RESULTS: Among 24 846 patients, TBI patients developed dementia (7.5% vs 4.6%) at a younger age (78.6 vs 82.7 yr) and demonstrated higher 10-yr mortality than controls (27% vs 14%; P < .001). Mild TBI patients had higher incidence of dementia (9%) than moderate/severe TBI (5.4%), with lower 10-yr mortality (20% vs 31%; P < .001). Risk of dementia was significant in all mild TBI age groups, even 45 to 54 yr (hazard ratio 4.1, 95% CI 2.7-7.8). A total of 10-yr cumulative incidence was higher in mild TBI (14.4%) than moderate/severe TBI (11.3%) and controls (6.8%) ( P < .001). Predictors of dementia include TBI, sex, age, hypertension, hyperlipidemia, stroke, depression, anxiety, and Injury Severity Score. CONCLUSION: Mild and moderate/severe TBI patients experienced higher incidence of dementia, even in the youngest group (45-54 yr old), than NTOT controls. All TBI patients, especially middle-aged adults with minor injury who are more likely to be overlooked, should be monitored for dementia.