PAPER

Head injury as a risk factor for Alzheimer’s disease: the evidence 10 years on; a partial replication

S Fleminger¹, D L Oliver¹, S Lovestone², S Rabe-Hesketh³, A Giora¹

¹ Lishman Brain Injury Unit, Maudsley Hospital, London, UK
² Section of Old Age Psychiatry, Institute of Psychiatry, London, UK
³ Department of Biostatistics and Computing, Institute of Psychiatry, London, UK

Correspondence to:
Correspondence to:
Dr S Fleminger, Consultant Neuropsychiatrist, Lishman Brain Injury Unit, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK;
s.fleminger{at}iop.kcl.ac.uk

Objective: To determine, using a systematic review of case-control studies, whether head injury is a significant risk factor for Alzheimer’s disease. We sought to replicate the findings of the meta-analysis of Mortimer et al (1991).

Methods: A predefined inclusion criterion specified case-control studies eligible for inclusion. A comprehensive and systematic search of various electronic databases, up to August 2001, was undertaken. Two independent reviewers screened studies for eligibility. Fifteen case-control studies were identified that met the inclusion criteria, of which seven postdated the study of Mortimer et al.

Results: We partially replicated the results of Mortimer et al. The meta-analysis of the seven studies conducted since 1991 did not reach significance. However, analysis of all 15 case-control studies was significant (OR 1.58, 95% CI 1.21 to 2.06), indicating an excess history of head injury in those with Alzheimer’s disease. The finding of Mortimer et al that head injury is a risk factor for Alzheimer’s disease only in males was replicated. The excess risk of head injury in those with Alzheimer’s disease is only found in males (males: OR 2.29, 95% CI 1.47 to 2.06; females: OR 0.91, 95% CI 0.56 to 1.47).

Conclusions: This study provides support for an association between a history of previous head injury and the risk of developing Alzheimer’s disease.

Keywords: brain injury; Alzheimers disease; apolipoprotein E; risk factors

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