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Flanagan, Steven
1. Steven R. Flanagan, M.D. Professor and Chair Department of Rehabilitation Medicine NYU School of Medicine Rusk Institute of Rehabilitation NYU-Langone Medical Center
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20. Bower 2003 N=196 with PD. Matched to non-PD control Rochester Epidemiology Project Hx of TBI more frequent in men with PD (OR, 6.0) HX TBI more frequent in all cases of PD (OR, 4.3) No increased risk with mTBI without LOC Goldman 2006 93 male twin pairs discordant for PD TBI (LOC or PTA) associated with increase risk of PD (OR, 3.0) Risk greater with multiple TBI (OR, 4.3) Small # of twins concordant for PD indicated earlier onset with TBI Taylor 1999 140 with PD 147 controls Four factors associated with PD - TBI (OR, 6.23) Family history of PD (OR, 6.08 - Family history tremor (OR 3.97) - History of depression (OR, 3.01)
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Editor's Notes
The United States Census Bureau reported that the fastest growing portion of the population is comprised of individuals over the age of 65, with the number expected to increase by 53.2% by 2020. Therefore, an increase in both older adult survivors of TBI and elderly with new onset TBI will increase dramatically.
Degenerative diseases refer to nervous system disorders that result from deterioration of neurons of their myelin sheath that lead to a number of disorders such as those listed here.
Degenerative diseases refer to nervous system disorders that result from deterioration of neurons of their myelin sheath that lead to a number of disorders such as those listed here.
Progressive disorder manifested histologically by the presence of amyloid plaaques and neurofibrillary tangles in the brain.
Compared to injured vets without TBI, matched on age and education. Stratified by injury severity: Mild= LOC or PTA < 30 minutes, Moderate= LOC or PTA of 30 minutes to 24 hours; Severe+ LOC or PTA > 24 hours. Dementia determined by 3 page screening tool and assessment process, that included a telephone interview, dementia questionnaire, and clinical assessment for those who whose scores indicated dementia. Moderate and severe TBI increased risk which was significant. Limitation included reliance on medical records that were 50 years old and the fact that the authors could not rule out other factors in the development of dementia later in life.
Schofield: Northern Manhattan study. 271 participants. Self report of TBI with either PTA or LOC. Therefore based on self report or report of a care provider. French: case controlled study to assess factors related to DAT. N=78 veterans at a VAMC matched to controls on age, race and sex (all males). Information obtained during interviews included variables relevant to viral, genetic, and immunologic hypotheses, environmental and occupation exposures, drug use, psychological stress, smoking and alcohol use as well as hx of TBI. TBI was reported significantly more frequently in subjects than in controls with TBI occurring prior to the dx of DAT. Heyman: Case controlled study to assess risk factors for AD. N=40 with DAT matched to 80 controls on age, sex, and race. Structured interview conducted to ascertain risk factors including prior illnesses, dietary or lifestyle habirs, occupation exposure, exposure to domesticated and wild animals and family hx of DAT. Found the hx of TBI found more frequently in subjects than in controls (15% and 3.8% respectively).
Guo: also a case controlled study that included an investigation b/t TBI and APOE genotype. N-2,233 with AD compared to 14,688 first-degree family members and spouses. Analysis were adjusted for age, sex, and afe oat onsetl of AD. The study suggests that TBI associated with LOC significantly increased risk for AD, but not significantly different with no LOC.
Broe: TBI defined by LOC of at least 15 minutes. Taken as a whole, the studies generally found a strong association between moderate or severe TBI and dementia of the Alzheimer type. Studies suggested an association between mild TBI with LOC and dementia of the Alzheimer type, but mild TBI without LOC was not found to be strongly associated with dementia of the Alzheimer type. The authors found that a history of TBI increased the risk of AD (HR, 2.00; 95% CI, 1.03 – 3.90) and dementia (HR, 2.23; 95% CI, 1.30 – 3.81). Moderate TBI (HR, 2.32; 95% CI, 1.04 – 5.17) and severe TBI (HR, 4.51; 95% CI, 1.77 – 11.47) were both associated with increased risk of AD. Similarly, moderate TBI (HR, 2.39; 95% CI, 1.24 – 4.58) and severe TBI (HR, 4.48; 95% CI, 2.09 – 9.63) were both associated with dementia. There was no significant risk of AD (HR, 0.76; 95% CI, 0.18 – 3.29) or dementia (HR, 1.33; 95% CI, 0.51 – 3.47) in those with mild TBI. Except for the studies of Amaducci et al. (1986) and Broe et al. (1990), the secondary studies found an increased risk of AD after TBI. A meta-analysis of seven case – control studies supported these findings, noting that “ a history of head trauma [was] associated with a statistically significant increase in the risk for AD in the absence of a family history of dementia ” (Van Duijn et al., 1994). Guiskiewicz: No assoc with recurrent mTBI and dementia, but pro football players have earlier onset dementia than general population.
Findings in professional boxers demonstrate an association with the development of DP; pathology study of brains of autopsied boxers also support these findings. The evidence is less clear in amateur boxing and soccer: it is difficult to know the severity, if any, of the head injury experienced. Therefore, the committee cannot draw a conclusion about TBI and DP in general and has limited its conclusions to professional boxers.
The committee identified two primary studies (Bower et al., 2003; Goldman et al., 2006) and one secondary study (Taylor et al., 1999) that evaluated the association between TBI and parkinsonism. The results of all three suggested an association. Bower and colleagues (2003) conducted a case – control study of PD as related to TBI by using the medical-records linkage system of the Rochester Epidemiology Project and found that the frequency of head trauma overall was significantly higher in people with PD than in controls. An increased risk was observed in patients with mild TBI and LOC or with more severe TBI. The authors noted that the “ results suggest an association between head trauma and the later development of PD that varies with severity. ” An association was also found between mild TBI with LOC, but not without LOC. Goldman and colleagues (2006) conducted a case – control study of male twin pairs discordant for PD and found that TBI with LOC or PTA was associated with an increased risk of PD. Subjects and controls were identified from the National Academy of Sciences WWII veteran twins cohort. History of TBI was ascertained by interview. Twins were a mix of monozygotic and dizygotic. Taylor et al. (1999) conducted a case – control study to assess risk factors related to PD and found that TBI was associated with an increased risk of PD. Additional data was collected on environmental exposures, family history of illness, and comprehensvie medical history including age at onset of PD and a diagnosis of TBI, smoking, vitamin intake and depression. TBI was diagnosed if it was sever enough to cause loss of consciousness, blurred or double vision, dizziness, seizures or memory loss.
mTBI: Association less certain except perhaps for QOL or symptom report.
![[object Object],[object Object],[object Object],[object Object],Langlois JA et al. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention, 2004 Selassie A, et al. Incidence of Long term disability following traumatic brain injury hospitalizations, United States, 2003. J Head Trauma Rehabil 2008;23:123-131 Zaloshnja E, et al. Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. J Head Trauma Rehabil 2008;23:394-400](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)