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. 2021 Sep;17(9):1432-1441.
doi: 10.1002/alz.12315. Epub 2021 Mar 9.

Head injury and 25-year risk of dementia

Andrea L C Schneider  1 , Elizabeth Selvin  2 , Lawrence Latour  3 , L Christine Turtzo  3 , Josef Coresh  2 , Thomas Mosley  4 , Geoffrey Ling  5   6 , Rebecca F Gottesman  2   6
Affiliations

Head injury and 25-year risk of dementia

Andrea L C Schneider et al. Alzheimers Dement. 2021 Sep.

Abstract

Introduction: Head injury is associated with significant morbidity and mortality. Long-term associations of head injury with dementia in community-based populations are less clear.

Methods: Prospective cohort study of 14,376 participants (mean age 54 years at baseline, 56% female, 27% Black, 24% with head injury) enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. Head injury was defined using self-report and International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. Dementia was defined using cognitive assessments, informant interviews, and ICD-9/10 and death certificate codes.

Results: Head injury was associated with risk of dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.3-1.57), with evidence of dose-response (1 head injury: HR = 1.25, 95% CI = 1.13-1.39, 2+ head injuries: HR = 2.14, 95% CI = 1.86-2.46). There was evidence for stronger associations among female participants (HR = 1.69, 95% CI = 1.51-1.90) versus male participants (HR = 1.15, 95% CI = 1.00-1.32), P-for-interaction < .001, and among White participants (HR = 1.55, 95% CI = 1.40-1.72) versus Black participants (HR = 1.22, 95% CI = 1.02-1.45), P-for-interaction = .008.

Discussion: In this community-based cohort with 25-year follow-up, head injury was associated with increased dementia risk in a dose-dependent manner, with stronger associations among female participants and White participants.

Keywords: cohort study; dementia; head injury.

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Conflict of interest statement

CONFLICT OF INTEREST

Dr. Ling serves as a consultant on the BrainScope Scientific Advisory Board (unpaid position), the National Football League Players Association Mackey-White Health Committee (unpaid position), the National Football League Health Foundation, the National Institutes of Health National Center for Advancing Transitional Sciences, and the Veterans Administration Research Advisory Council. For the other authors, no competing financial interests exist.

Figures

FIGURE 1
FIGURE 1
Study timeline and measures (A: participant flow diagram; B: head injury and dementia measures)
FIGURE 2
FIGURE 2
Kaplan-Meier curve for cumulative dementia incidence by head injury frequency, N = 14,376. Log-rank P-value < .001
FIGURE 3
FIGURE 3
Adjusted* hazard ratios (95% confidence intervals) for incident dementia (A: overall;B: by sex; C: by race) by head injury frequency, N = 14,376. *Model adjusted for age (years; continuous), sex (male; female), race/center (Minneapolis, Minnesota Whites; Washington County, Maryland Whites; Forsyth County, North Carolina Whites; Forsyth County North Carolina Blacks; Jackson, Mississippi Blacks), education (< high school; high school, GED, or vocational school; college, graduate, or professional school), income (< $35,000 per year; ≥ $35,000 per year; not reported), physical activity index (score; continuous) cigarette smoking (current; former; never), alcohol consumption (current; former; never), hypertension (yes; no; defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or use of blood pressure medications), diabetes (yes; no; defined as fasting glucose ≥126 mg/dL or non-fasting glucose ≥200 mg/dL or use of diabetes medications), coronary heart disease (yes; no), stroke (yes; no), military veteran status (yes; no), and APOE ε4 genotype (0 APOE ε4 alleles; 1 or APOE ε4 alleles). P-value for interaction by sex < .001. P-value for interaction by race = .043
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References

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