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Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.

Publication ,  Journal Article
Yashkin, AP; Gorbunova, GA; Tupler, L; Yashin, AI; Doraiswamy, M; Akushevich, I
Published in: J Head Trauma Rehabil
November 2023

OBJECTIVE: To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer's disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI. SETTING AND PARTICIPANTS: Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS). DESIGN: Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data. RESULTS: Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80). CONCLUSION: Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.

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Published In

J Head Trauma Rehabil

DOI

EISSN

1550-509X

Publication Date

November 2023

Volume

38

Issue

6

Start / End Page

E384 / E393

Location

United States

Related Subject Headings

  • Veterans
  • United States
  • Rehabilitation
  • Medicare
  • Male
  • Humans
  • Female
  • Chronic Traumatic Encephalopathy
  • Brain Injuries, Traumatic
  • Alzheimer Disease
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Yashkin, A. P., Gorbunova, G. A., Tupler, L., Yashin, A. I., Doraiswamy, M., & Akushevich, I. (2023). Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations. J Head Trauma Rehabil, 38(6), E384–E393. https://doi.org/10.1097/HTR.0000000000000865
Yashkin, Arseniy P., Galina A. Gorbunova, Larry Tupler, Anatoliy I. Yashin, Murali Doraiswamy, and Igor Akushevich. “Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.J Head Trauma Rehabil 38, no. 6 (November 2023): E384–93. https://doi.org/10.1097/HTR.0000000000000865.
Yashkin AP, Gorbunova GA, Tupler L, Yashin AI, Doraiswamy M, Akushevich I. Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations. J Head Trauma Rehabil. 2023 Nov;38(6):E384–93.
Yashkin, Arseniy P., et al. “Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.J Head Trauma Rehabil, vol. 38, no. 6, Nov. 2023, pp. E384–93. Pubmed, doi:10.1097/HTR.0000000000000865.
Yashkin AP, Gorbunova GA, Tupler L, Yashin AI, Doraiswamy M, Akushevich I. Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations. J Head Trauma Rehabil. 2023 Nov;38(6):E384–E393.

Published In

J Head Trauma Rehabil

DOI

EISSN

1550-509X

Publication Date

November 2023

Volume

38

Issue

6

Start / End Page

E384 / E393

Location

United States

Related Subject Headings

  • Veterans
  • United States
  • Rehabilitation
  • Medicare
  • Male
  • Humans
  • Female
  • Chronic Traumatic Encephalopathy
  • Brain Injuries, Traumatic
  • Alzheimer Disease