Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working-age population: A retrospective cohort study using the Finnish national health registries

Abstract

BackgroundPrevious epidemiological studies suggest that working-aged persons with a history of moderate-to-severe traumatic brain injury (TBI) may have an increased risk for developing neurodegenerative disease (NDD) while persons with a history of mild TBI do not. In this comprehensive nationwide study in Finland, we assessed the risk of NDD and history of moderate-to-severe TBI in the working-age population.Methods and findingsWe performed a population-based follow-up study using the Finnish Care Register for Health Care to identify all persons between the ages of 18 and 65 years hospitalized during 1987–2014 due to TBI who did not have a baseline NDD diagnosis. We compared the risk of hospitalization with NDD between persons hospitalized due to moderate-to-severe TBI (intracranial lesions) and persons hospitalized due to mild TBI (no intracranial lesions). Follow-up NDD diagnoses were recorded from 1 year following the TBI to the end of 2014. NDD diagnoses included dementia, Parkinson disease, and amyotrophic lateral sclerosis. We used a Cox proportional hazards model, adjusting for age, sex, education, and socioeconomic group, to assess the association between TBI and NDD. In total, 19,936 and 20,703 persons with a history of moderate-to-severe TBI and mild TBI, respectively, were included. The overall time at risk was 453,079 person-years (median 10 years per person). In total, 3.5% (N = 696) persons in the moderate-to-severe TBI group developed NDD compared to 1.6% (N = 326) in the mild TBI group. After adjusting for covariates, moderate-to-severe TBI was associated with an increased risk for NDD, with a hazard ratio (HR) of 1.8 (95% CI 1.6–2.1) compared to mild TBI. Of the NDD subtypes, only moderate-to-severe TBI was associated with an increased risk for dementia (HR 1.9, 95% CI 1.6–2.2). Yet, this large-scale epidemiological study does not prove that there is a causal relationship between moderate-to-severe TBI and NDD. Further, the Care Register for Health Care includes only hospitalized persons; thus, patients diagnosed with NDD in the outpatient setting may have been missed. Additional limitations include the potential for miscoding and unmeasured confounds.ConclusionsIn working-aged persons, a history of moderate-to-severe TBI is associated with an increased risk for future dementia but not for Parkinson disease or amyotrophic lateral sclerosis.

Posttraumatic Psychopathological Manifestations of the Head Injury in Medico-Legal Practice

“…В настоящее время основная концепция черепно-мозговой травмы складывается вокруг представления о ней как о динамическом процессе, которая запускает целый каскад процессов и биохимических реакций, которые обусловливают ее последствия [7,12,25]. Повреждение головного мозга может быть опосредовано токсическим действием клеточного кальция, свободными радикалами и многими другими биохимическими процессами в постравматический период реконвалесценции [26].…”

“…Риск развития деменции обычно связывают с умеренной и тяжелой черепно-мозговой травмой, однако не исключается такая связь и с легкой черепно-мозговой травмой [5,14,23,25]. Психоз, вторичный по отношению к черепно-мозговой травме, считается редким и тяжелым последствием черепно-мозговой травмы, встречаясь у 4,0-8,9 % лиц и появляются в три раза чаще, чем в общей популяции [14,16].…”

“…Во второй фазе выявляются когнитивные и поведенческие расстройства в виде ажитации, спутанности сознания, дезориентации и изменений психомоторной активности. Первые две фазы рассматриваются как форма посттравматического делирия [22,25]. Далее следует третья фаза длительностью 6-12-месяцев с постепенным восстановлением когнитивных функций.…”

Patient’s occupation, electric & head trauma in a cohort of 88 multiple system atrophy patients compared with the general population: a hypothesis stimulating pilot study

“…However, a study using Swedish data on head injuries who reported that 3.4% of all Sweden's A&E admissions were related primarily to a head injury. 63 Using this figure as a denominator, to estimate the possible head injury in the UK general public, we examined A&E data for England to find that there were 5.5 million people with at least one over-night stay. [63][64][65][66] Thus if 3.4% of English A&E admissions were head injuries, as in Sweden, this gives us approximately 187,000 who had a head injury.…”

The GPR17 Receptor—A Promising Goal for Therapy and a Potential Marker of the Neurodegenerative Process in Multiple Sclerosis

“…MS-related disability limits participation in everyday activities and has a considerable impact on quality of life, thereby affecting productivity and employment. Due to the constantly growing number of patients, this disease has major socio-economic consequences and is a significant public health problem [2,3].…”