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July 22, 2014; 83 (4) Article

Traumatic brain injury and risk of dementia in older veterans

Deborah E. Barnes, Allison Kaup, Katharine A. Kirby, Amy L. Byers, Ramon Diaz-Arrastia, Kristine Yaffe
First published June 25, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000616
Deborah E. Barnes
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Allison Kaup
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Katharine A. Kirby
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Amy L. Byers
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Ramon Diaz-Arrastia
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Kristine Yaffe
From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD.
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Citation
Traumatic brain injury and risk of dementia in older veterans
Deborah E. Barnes, Allison Kaup, Katharine A. Kirby, Amy L. Byers, Ramon Diaz-Arrastia, Kristine Yaffe
Neurology Jul 2014, 83 (4) 312-319; DOI: 10.1212/WNL.0000000000000616

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Abstract

Objectives: Traumatic brain injury (TBI) is common in military personnel, and there is growing concern about the long-term effects of TBI on the brain; however, few studies have examined the association between TBI and risk of dementia in veterans.

Methods: We performed a retrospective cohort study of 188,764 US veterans aged 55 years or older who had at least one inpatient or outpatient visit during both the baseline (2000–2003) and follow-up (2003–2012) periods and did not have a dementia diagnosis at baseline. TBI and dementia diagnoses were determined using ICD-9 codes in electronic medical records. Fine-Gray proportional hazards models were used to determine whether TBI was associated with greater risk of incident dementia, accounting for the competing risk of death and adjusting for demographics, medical comorbidities, and psychiatric disorders.

Results: Veterans were a mean age of 68 years at baseline. During the 9-year follow-up period, 16% of those with TBI developed dementia compared with 10% of those without TBI (adjusted hazard ratio, 1.57; 95% confidence interval: 1.35–1.83). There was evidence of an additive association between TBI and other conditions on risk of dementia.

Conclusions: TBI in older veterans was associated with a 60% increase in the risk of developing dementia over 9 years after accounting for competing risks and potential confounders. Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of TBI in younger veterans and civilians.

GLOSSARY

AD=
Alzheimer disease;
FTD=
frontotemporal dementia;
ICD-9-CM=
International Classification of Diseases, ninth revision, Clinical Modification;
PTSD=
posttraumatic stress disorder;
TBI=
traumatic brain injury;
VaD=
vascular dementia;
VHA=
Veterans Health Administration

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 298

  • Received October 22, 2013.
  • Accepted in final form February 28, 2014.
  • © 2014 American Academy of Neurology
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