Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury: a population-based study

Abstract

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.

Figure 1

Cumulative incidence of first and second head injury with loss of consciousness (LOC) reported at baseline or follow-up. TBI, traumatic brain injury.

Figure 2

Nelson–Aalen cumulative hazard estimates for traumatic brain injury (TBI) with loss of consciousness (LOC) reported at follow-up visits, with 95% confidence bands.