Traumatic brain injuries increase the risk of a dementia diagnosis for more than 30 years after a trauma, though the risk of dementia decreases over time, according to a study by Anna Nordström and Peter Nordström of Umeå University in Sweden.
Traumatic brain injury (TBI) has been associated with dementia, but the details of that risk over time and in different TBI types have not been well studied. In the new study, the researchers tracked all diagnoses of dementia and TBI in Swedish nationwide databases from 1964 through 2012. In a retrospective cohort, 164,334 individuals with TBI were matched with control participants who did not have TBI; in a case-control cohort, 136,233 individuals diagnosed with dementia at follow-up were matched with control participants who did not develop dementia; and in a third cohort, the researchers studied 46,970 sibling pairs with one individual having a TBI.
In the first year after TBI, the risk of dementia is increased by 4- to 6-fold, the researchers found. Thereafter, the risk decreased rapidly but was still significant more than 30 years after the TBI. Overall, the risk of dementia diagnosis was increased by about 80% during a mean follow-up period of 15 years. The risk of dementia was higher for those with a severe TBI or multiple TBIs and was similar in men and women. Because the development of dementia can be a risk factor for accidents resulting in TBI, it’s likely that in some cases, the onset of dementia preceded the TBI, so the researchers caution against making causal inferences.
“The findings of this study suggest an existence of a time- and dose-dependent risk of developing dementia more than 30 years after TBI,” the authors say. “To our knowledge, no previous prospective study with similar power and follow-up time has been reported.”
Background: Traumatic brain injury (TBI) has been associated with dementia. The questions of whether the risk of dementia decreases over time after TBI, whether it is similar for different TBI types, and whether it is influenced by familial aggregation are not well studied.
Methods and findings: The cohort considered for inclusion comprised all individuals in Sweden aged ≥50 years on December 31, 2005 (n = 3,329,360). Diagnoses of dementia and TBI were tracked through nationwide databases from 1964 until December 31, 2012. In a first cohort, individuals diagnosed with TBI (n = 164,334) were matched with up to two controls. A second cohort consisted of subjects diagnosed with dementia during follow-up (n = 136,233) matched with up to two controls. A third cohort consisted of 46,970 full sibling pairs with discordant TBI status. During a mean follow-up period of 15.3 (range, 0–49) years, 21,963 individuals in the first cohort (6.3% with TBI, 3.6% without TBI) were diagnosed with dementia (adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.75–1.86). The association was strongest in the first year after TBI (OR, 3.52; 95% CI, 3.23–3.84), but the risk remained significant >30 years (OR, 1.25; 95% CI, 1.11–1.41). Single mild TBI showed a weaker association with dementia (OR, 1.63; 95% CI, 1.57–1.70) than did more severe TBI (OR, 2.06; 95% CI, 1.95–2.19) and multiple TBIs (OR, 2.81; 95% CI, 2.51–3.15). These results were in general confirmed in the nested case-control cohort. TBI was also associated with an increased risk of dementia diagnosis in sibling pairs with discordant TBI status (OR, 1.89; 95% CI, 1.62–2.21). A main limitation of the present study is the observational design. Thus, no causal inferences can be made based on the associations found.
Conclusions: The risk of dementia diagnosis decreased over time after TBI, but it was still evident >30 years after the trauma. The association was stronger for more severe TBI and multiple TBIs, and it persisted after adjustment for familial factors.
Anna Nordström, Peter Nordström
[link url="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002496"]PLOS Medicine abstract[/link]