Research Reports - Association of traumatic brain injury with subsequent neurological and psychiatric disease

J Neurosurg. 2016 Feb;124(2):511-26. doi: 10.3171/2015.2.JNS14503. Epub 2015 Aug

Perry DC(1), Sturm VE(1), Peterson MJ(2,)(3), Pieper CF(4), Bullock T(5), Boeve
BF(6), Miller BL(1), Guskiewicz KM(7), Berger MS(8), Kramer JH(1), Welsh-Bohmer

OBJECT Mild traumatic brain injury (TBI) has been proposed as a risk factor for
the development of Alzheimer's disease, Parkinson's disease, depression, and
other illnesses. This study's objective was to determine the association of prior
mild TBI with the subsequent diagnosis (that is, at least 1 year postinjury) of
neurological or psychiatric disease. METHODS All studies from January 1995 to
February 2012 reporting TBI as a risk factor for diagnoses of interest were
identified by searching PubMed, study references, and review articles. Reviewers
abstracted the data and assessed study designs and characteristics. RESULTS
Fifty-seven studies met the inclusion criteria. A random effects meta-analysis
revealed a significant association of prior TBI with subsequent neurological and
psychiatric diagnoses. The pooled odds ratio (OR) for the development of any
illness subsequent to prior TBI was 1.67 (95% CI 1.44-1.93, p < 0.0001). Prior
TBI was independently associated with both neurological (OR 1.55, 95% CI
1.31-1.83, p < 0.0001) and psychiatric (OR 2.00, 95% CI 1.50-2.66, p < 0.0001)
outcomes. Analyses of individual diagnoses revealed higher odds of Alzheimer's
disease, Parkinson's disease, mild cognitive impairment, depression, mixed
affective disorders, and bipolar disorder in individuals with previous TBI as
compared to those without TBI. This association was present when examining only
studies of mild TBI and when considering the influence of study design and
characteristics. Analysis of a subset of studies demonstrated no evidence that
multiple TBIs were associated with higher odds of disease than a single TBI.
CONCLUSIONS History of TBI, including mild TBI, is associated with the
development of neurological and psychiatric illness. This finding indicates that
either TBI is a risk factor for heterogeneous pathological processes or that TBI
may contribute to a common pathological mechanism. 

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