RT Journal Article
SR Electronic
T1 Mild TBI and risk of Parkinson disease
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1771
OP e1779
DO 10.1212/WNL.0000000000005522
VO 90
IS 20
A1 Raquel C. Gardner
A1 Amy L. Byers
A1 Deborah E. Barnes
A1 Yixia Li
A1 John Boscardin
A1 Kristine Yaffe
YR 2018
UL http://n.neurology.org/content/90/20/e1771.abstract
AB Objective Our aim was to assess risk of Parkinson disease (PD) following traumatic brain injury (TBI), including specifically mild TBI (mTBI), among care recipients in the Veterans Health Administration.Methods In this retrospective cohort study, we identified all patients with a TBI diagnosis in Veterans Health Administration databases from October 2002 to September 2014 and age-matched 1:1 to a random sample of patients without TBI. All patients were aged 18 years and older without PD or dementia at baseline. TBI exposure and severity were determined via detailed clinical assessments or ICD-9 codes using Department of Defense and Defense and Veterans Brain Injury Center criteria. Baseline comorbidities and incident PD more than 1 year post-TBI were identified using ICD-9 codes. Risk of PD after TBI was assessed using Cox proportional hazard models adjusted for demographics and medical/psychiatric comorbidities.Results Among 325,870 patients (half with TBI; average age 47.9 ± 17.4 years; average follow-up 4.6 years), 1,462 were diagnosed with PD during follow-up. Compared to no TBI, those with TBI had higher incidence of PD (no TBI 0.31%, all-severity TBI 0.58%, mTBI 0.47%, moderate-severe TBI 0.75%). In adjusted models, all-severity TBI, mTBI, and moderate-severe TBI were associated with increased risk of PD (hazard ratio [95% confidence interval]: all-severity TBI 1.71 [1.53–1.92]; mTBI 1.56 [1.35–1.80]; moderate-severe TBI 1.83 [1.61–2.07]).Conclusions Among military veterans, mTBI is associated with 56% increased risk of PD, even after adjusting for demographics and medical/psychiatric comorbidities. This study highlights the importance of TBI prevention, long-term follow-up of TBI-exposed veterans, and the need to determine mechanisms and modifiable risk factors for post-TBI PD.AOC=alteration of consciousness; CI=confidence interval; CTBIE=Comprehensive Traumatic Brain Injury Evaluation; DoD=Department of Defense; DVBIC=Defense and Veterans Brain Injury Center; HR=hazard ratio; ICD-9=International Classification of Diseases, Ninth Revision; LOC=loss of consciousness; mTBI=mild traumatic brain injury; NPCD=National Patient Care Database; OEF=Operation Enduring Freedom; OIF=Operation Iraqi Freedom; PD=Parkinson disease; PTA=posttraumatic amnesia; TBI=traumatic brain injury; VHA=Veterans Health Administration