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Reader response: Blood biomarkers of traumatic brain injury and cognitive impairment in older veterans

  • Thomas Wisniewski, MD, Director of the NYU Alzheimer’s Disease Research Center, New York University School of Medicine
  • Silvia Fossati, MD, Associate Director Alzheimer’s Center at Temple, Temple University (Philadelphia)
Submitted July 23, 2020

The manuscript by Peltz et al.1 provides a nice example that differences in neurodegenerative biomarkers can be found in chronic traumatic brain injury (TBI) patients using blood samples enriched for CNS-derived exosomes. However, these differences seem driven more by the presence of cognitive impairment (CI) rather than the history of TBI itself. Based on the cohort studied (older veterans), there is no proven causality demonstrating that the CI in the TBI-CI group is actually driven by the remote TBI, which occurred decades previously. This could be an independent clinical finding in the veterans. Since the control group and the TBI-no-CI group did not differ in any of the biomarkers, it seems that the main driver of differences is cognitive impairment, which could be independent from the TBI even in the TBI-CI group. This manuscript has some overlap with a recent paper from this group, in which Aβ42 was reported to be elevated for decades after TBI.2 This is not the case in the current manuscript, with no clear explanation. One wonders the utility of these biomarkers in a clinical setting, since they do not clarify the causes of the CI and are not specific to TBI?

Disclosure

The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.

References

1.Peltz CB, Kenney K, Gill J, et al. Blood biomarkers of traumatic brain injury and cognitive impairment in older veterans. Neurology 2020 Epub Jun 22.

2.Goetzl EJ, Peltz CB, Mustapic M, Kapogiannis D, Yaffe K. Neuron-Derived Plasma Exosome Proteins after Remote Traumatic Brain Injury. J Neurotrauma 2020;37:382–388.

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