Traumatic brain injury and age at onset of cognitive impairment in older adults.

Abstract

There is a deficiency of knowledge regarding how traumatic brain injury (TBI) is associated with age at onset (AAO) of cognitive impairment in older adults. Participants with a TBI history were identified from the Alzheimer's disease neuroimaging initiative (ADNI 1/GO/2) medical history database. Using an analysis of covariance (ANCOVA) model, the AAO was compared between those with and without TBI, and potential confounding factors were controlled. The AAO was also compared between those with mild TBI (mTBI) and moderate or severe TBI (sTBI). Lastly, the effects of mTBI were analyzed on the AAO of participants with clinical diagnoses of either mild cognitive impairment (MCI) or Alzheimer's disease (AD). The AAO for a TBI group was 68.2±1.1years [95% confidence interval (CI) 66.2-70.3, n=62], which was significantly earlier than the AAO for the non-TBI group of 70.9±0.2years (95% CI 70.5-71.4, n=1197) (p=0.013). Participants with mTBI history showed an AAO of 68.5±1.1years (n=56), which was significantly earlier than the AAO for the non-TBI group (p=0.032). Participants with both MCI and mTBI showed an AAO of 66.5±1.3years (95% CI 63.9-69.1, n=45), compared to 70.6±0.3years for the non-TBI MCI group (95% CI 70.1-71.1, n=935) (p=0.016). As a conclusion, a history of TBI may accelerate the AAO of cognitive impairment by two or more years. These results were consistent with reports of TBI as a significant risk factor for cognitive decline in older adults, and TBI is associated with an earlier AAO found in patients with MCI or AD.