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Traumatic brain injury in later life increases risk for Parkinson disease.

Abstract

OBJECTIVE

Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson disease (PD), but results are conflicting. Many studies do not account for confounding or reverse causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT; defined as fractures).

METHODS

Using inpatient/emergency department (ED) International Classification of Disease, Ninth Revision code data for California hospitals from 2005-2006, we identified patients aged ≥55 years with TBI (n = 52,393) or NTT (n = 113,406) and without baseline PD or dementia who survived hospitalization. Using Kaplan-Meier estimates and Cox proportional hazards models (adjusted for age, sex, race/ethnicity, income, comorbidities, health care use, and trauma severity), we estimated risk of PD after TBI during follow-up ending in 2011. We also assessed interaction with mechanism of injury (fall vs nonfall) and effect of TBI severity (mild vs moderate/severe) and TBI frequency (1 TBI vs >1 TBI).

RESULTS

TBI patients were significantly more likely to be diagnosed with PD compared to NTT patients (1.7% vs 1.1%, p < 0.001, adjusted hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.31-1.58). Risk of PD was similar for TBI sustained via falls versus nonfalls (interaction p = 0.6). Assessment by TBI severity (mild TBI: HR = 1.24, 95% CI = 1.04-1.48; moderate/severe TBI: HR = 1.50, 95% CI = 1.35-1.66) and TBI frequency (1 TBI: HR = 1.45, 95% CI = 1.30-1.60; >1 TBI: HR = 1.87, 95% CI = 1.58-2.21) revealed a dose response.

INTERPRETATION

Among patients aged ≥55 years presenting to inpatient/ED settings with trauma, TBI is associated with a 44% increased risk of developing PD over 5 to 7 years that is unlikely to be due to confounding or reverse causation.

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  • Authors+Show Affiliations

    ,

    Department of Neurology, University of California, San Francisco, San Francisco, CA. San Francisco Veterans Affairs Medical Center, San Francisco, CA.

    ,

    Department of Neurology, University of Michigan and Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.

    ,

    San Francisco Veterans Affairs Medical Center, San Francisco, CA. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.

    ,

    Department of Neurology, University of California, San Francisco, San Francisco, CA. San Francisco Veterans Affairs Medical Center, San Francisco, CA.

    ,

    Department of Neurology, University of California, San Francisco, San Francisco, CA. San Francisco Veterans Affairs Medical Center, San Francisco, CA.

    Department of Neurology, University of California, San Francisco, San Francisco, CA. San Francisco Veterans Affairs Medical Center, San Francisco, CA. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. Department of Psychiatry, University of California, San Francisco, San Francisco, CA.

    Source

    Annals of neurology 77:6 2015 Jun pg 987-95

    MeSH

    Aged
    Aged, 80 and over
    Brain Injuries
    California
    Female
    Follow-Up Studies
    Fractures, Bone
    Humans
    Kaplan-Meier Estimate
    Male
    Middle Aged
    Parkinson Disease
    Proportional Hazards Models
    Retrospective Studies
    Risk Factors
    Time Factors
    Trauma Severity Indices

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    25726936

    Citation

    Gardner, Raquel C., et al. "Traumatic Brain Injury in Later Life Increases Risk for Parkinson Disease." Annals of Neurology, vol. 77, no. 6, 2015, pp. 987-95.
    Gardner RC, Burke JF, Nettiksimmons J, et al. Traumatic brain injury in later life increases risk for Parkinson disease. Ann Neurol. 2015;77(6):987-95.
    Gardner, R. C., Burke, J. F., Nettiksimmons, J., Goldman, S., Tanner, C. M., & Yaffe, K. (2015). Traumatic brain injury in later life increases risk for Parkinson disease. Annals of Neurology, 77(6), pp. 987-95. doi:10.1002/ana.24396.
    Gardner RC, et al. Traumatic Brain Injury in Later Life Increases Risk for Parkinson Disease. Ann Neurol. 2015;77(6):987-95. PubMed PMID: 25726936.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Traumatic brain injury in later life increases risk for Parkinson disease. AU - Gardner,Raquel C, AU - Burke,James F, AU - Nettiksimmons,Jasmine, AU - Goldman,Sam, AU - Tanner,Caroline M, AU - Yaffe,Kristine, Y1 - 2015/03/28/ PY - 2015/01/08/received PY - 2015/02/16/revised PY - 2015/02/22/accepted PY - 2015/3/3/entrez PY - 2015/3/3/pubmed PY - 2015/8/4/medline SP - 987 EP - 95 JF - Annals of neurology JO - Ann. Neurol. VL - 77 IS - 6 N2 - OBJECTIVE: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson disease (PD), but results are conflicting. Many studies do not account for confounding or reverse causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT; defined as fractures). METHODS: Using inpatient/emergency department (ED) International Classification of Disease, Ninth Revision code data for California hospitals from 2005-2006, we identified patients aged ≥55 years with TBI (n = 52,393) or NTT (n = 113,406) and without baseline PD or dementia who survived hospitalization. Using Kaplan-Meier estimates and Cox proportional hazards models (adjusted for age, sex, race/ethnicity, income, comorbidities, health care use, and trauma severity), we estimated risk of PD after TBI during follow-up ending in 2011. We also assessed interaction with mechanism of injury (fall vs nonfall) and effect of TBI severity (mild vs moderate/severe) and TBI frequency (1 TBI vs >1 TBI). RESULTS: TBI patients were significantly more likely to be diagnosed with PD compared to NTT patients (1.7% vs 1.1%, p < 0.001, adjusted hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.31-1.58). Risk of PD was similar for TBI sustained via falls versus nonfalls (interaction p = 0.6). Assessment by TBI severity (mild TBI: HR = 1.24, 95% CI = 1.04-1.48; moderate/severe TBI: HR = 1.50, 95% CI = 1.35-1.66) and TBI frequency (1 TBI: HR = 1.45, 95% CI = 1.30-1.60; >1 TBI: HR = 1.87, 95% CI = 1.58-2.21) revealed a dose response. INTERPRETATION: Among patients aged ≥55 years presenting to inpatient/ED settings with trauma, TBI is associated with a 44% increased risk of developing PD over 5 to 7 years that is unlikely to be due to confounding or reverse causation. SN - 1531-8249 UR - https://www.unboundmedicine.com/medline/citation/25726936/Traumatic_brain_injury_in_later_life_increases_risk_for_Parkinson_disease_ L2 - https://doi.org/10.1002/ana.24396 DB - PRIME DP - Unbound Medicine ER -