Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury: a population-based study
- Kristen Dams-O'Connor1,
- Laura E Gibbons2,
- James D Bowen3,
- Susan M McCurry4,
- Eric B Larson2,5,
- Paul K Crane2
- 1Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, New York, USA
- 2Department of Medicine, University of Washington, Seattle, Washington, USA
- 3Swedish Neuroscience Institute, Seattle, Washington, USA
- 4School of Nursing, Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA
- 5Group Health Research Institute, Seattle, Washington, USA
- Correspondence to Dr Kristen Dams-O'Connor, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1240, New York, NY 10029-6574, USA; kristen.dams-o'
- Received 23 August 2012
- Revised 19 October 2012
- Accepted 24 October 2012
- Published Online First 21 November 2012
Objectives To determine the association of self-reported traumatic brain injury (TBI) with loss of consciousness (LOC) with late-life re-injury, dementia diagnosis and mortality.
Design Ongoing longitudinal population-based prospective cohort study.
Setting Seattle-area integrated health system.
Participants 4225 dementia-free individuals age 65 and older were randomly selected and enrolled between 1994 and 2010. Participants were seen every 2 years, with mean (range) follow-up of 7.4 (0–16) years. 606 (14%) participants reported a lifetime history of TBI with LOC at enrolment. 3466 participants provided information regarding lifetime history of TBI and completed at least one follow-up visit.
Main outcome measures Self-reported TBI with LOC after study entry, incident all-cause dementia and Alzheimer's disease (AD), and all-cause mortality.
Results There were 25 567 person-years of follow-up. History of TBI with LOC reported at study enrolment was associated with increased risk for TBI with LOC during follow-up, with adjusted HRs ranging from 2.54 (95% CI 1.42 to 4.52) for those reporting first injury before age 25 to 3.79 (95% CI 1.89 to 7.61) for those with first injury after age 55. History of TBI with LOC was not associated with elevated risk for developing dementia or AD. There was no association between baseline history of TBI with LOC and mortality, though TBI with LOC since the previous study visit (‘recent TBI’) was associated with increased mortality (HR 2.12, 95% CI 1.62 to 2.78).
Conclusions Individuals aged 65 or older who reported a history of TBI with LOC at any time in their lives were at elevated risk of subsequent re-injury. Recent TBI with LOC sustained in older adulthood was associated with increased risk for mortality. Findings support the need for close clinical monitoring of older adults who sustain a TBI with LOC.