Research Reports - Clinical phenotype of Dementia after Traumatic Brain Injury
J Neurotrauma. 2013 Feb 4
Sayed N, Culver C, Dams-O'Connor K, Hammond F, Diaz-Arrastia R
Traumatic brain injury (TBI) in early to mid-life is associated with an increased
risk of dementia in late life. It is unclear whether TBI results in acceleration
of Alzheimer's disease (AD) like pathology, or has features of another dementing
condition, such as Chronic Traumatic Encephalopathy (CTE), which is associated
with more prominent mood, behavior, and motor disturbances than AD. Data from the
National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) was
obtained over a 5 year period. Categorical data was analyzed using Fisher's exact
test. Continuous parametric data was analyzed using Student's t-test.
Non-parametric data was analyzed using the Mann-Whitney test. 877 individuals
with dementia who had sustained TBI were identified in the NACC database. Only
TBI with chronic deficit or dysfunction was associated with increased risk of
dementia. Patients with dementia after TBI (n=62) were significantly more likely
to experience depression, anxiety, irritability, and motor disorders than
patients with probable AD. Autopsy data was available for 20 of the 62 TBI
patients. Of the patients with TBI, 62% met National Institute of Aging
(NIA)-Reagan "High Likelihood" criteria for AD. We conclude that TBI with chronic
deficit or dysfunction is associated with an increased odds ratio for dementia.
Clinically, patients with dementia associated with TBI were more likely to have
symptoms of depression, agitation, irritability, and motor dysfunction than
patients with probable AD. These findings suggest that dementia in individuals
with a history of TBI may be distinct from AD.