Research Reports - Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury

J Neurol Neurosurg Psychiatry. 2013 Feb;84(2):177-82

Dams-O'Connor K, Gibbons LE, Bowen JD, McCurry SM, Larson EB, Crane PK

OBJECTIVES: To determine the association of self-reported traumatic brain injury
(TBI) with loss of consciousness (LOC) with late-life re-injury, dementia
diagnosis and mortality.
DESIGN: Ongoing longitudinal population-based prospective cohort study.
SETTING: Seattle-area integrated health system.
PARTICIPANTS: 4225 dementia-free individuals age 65 and older were randomly
selected and enrolled between 1994 and 2010. Participants were seen every 2
years, with mean (range) follow-up of 7.4 (0-16) years. 606 (14%) participants
reported a lifetime history of TBI with LOC at enrolment. 3466 participants
provided information regarding lifetime history of TBI and completed at least one
follow-up visit.
MAIN OUTCOME MEASURES: Self-reported TBI with LOC after study entry, incident
all-cause dementia and Alzheimer's disease (AD), and all-cause mortality.
RESULTS: There were 25 567 person-years of follow-up. History of TBI with LOC
reported at study enrolment was associated with increased risk for TBI with LOC
during follow-up, with adjusted HRs ranging from 2.54 (95% CI 1.42 to 4.52) for
those reporting first injury before age 25 to 3.79 (95% CI 1.89 to 7.61) for
those with first injury after age 55. History of TBI with LOC was not associated
with elevated risk for developing dementia or AD. There was no association
between baseline history of TBI with LOC and mortality, though TBI with LOC since
the previous study visit ('recent TBI') was associated with increased mortality
(HR 2.12, 95% CI 1.62 to 2.78).
CONCLUSIONS: Individuals aged 65 or older who reported a history of TBI with LOC
at any time in their lives were at elevated risk of subsequent re-injury. Recent
TBI with LOC sustained in older adulthood was associated with increased risk for
mortality. Findings support the need for close clinical monitoring of older
adults who sustain a TBI with LOC.

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