Screening for Lifetime History of Traumatic Brain Injury Among Older American and Irish Adults at Risk for Dementia: Development and Validation of a Web-Based Survey

Gardner, Raquel C.; Rivera, Ernesto J.; O’Grady, Megan; Doherty, Colin P.; Yaffe, Kristine; Corrigan, John; Bogner, Jennifer; Kramer, Joel H.; Wilson, Fiona

doi:10.3233/jad-191138

Cited by 11 publications

(14 citation statements)

References 37 publications

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“…We evaluated clinically normal older adults without significant health comorbidities and with well-characterized head trauma history, Aβ-PET scans, and cognitive testing. Unique facets of our study included (1) a standardized and validated collection of lifelong head trauma exposure using the OA OSU TBI-ID (Gardner et al 2020), (2) a wider range of reported remote mTBI than similar studies (0, 1, or 2+), (3) investigating head trauma without classical mTBI symptoms like LOC or PTA (more akin to common diagnoses like "concussion"), (4) comprehensive and validated neuropsychological test measures to evaluate cognition, (5) thorough characterization of participants as clinically normal, and (6) having a subgroup with longitudinal Aβ-PET data. We found no associations between remote mTBI and cortical Aβ burden.…”

Section: Discussionmentioning

confidence: 99%

“…Aging studies like ours directly measure long-term outcomes through comprehensive collection of cognitive and neurodegenerative (e.g., Aβ-PET) biomarker data, but often are less representative of the general population than epidemiologic studies due to recruitment and survival biases. Accurate characterization of head trauma history remains tenuous in many study protocols (Gardner et al 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, participants lack cognitive concerns and neurologic and other medical conditions (e.g., history of stroke, sleep apnea, psychiatric disorders), and are physically healthy at the time of study enrollment (see Supplementary Table 1 for frequency of comorbid medical diagnoses and data from common lab tests). Participants in our study completed the older adult modification of the OSU TBI-ID (Gardner et al 2020) plus at least one Aβ-PET scan. All participants were classified as clinically normal during multidisciplinary case conference after undergoing a neurologic examination, neuropsychological testing, and informant interview including the Clinical Dementia Rating scale (CDR; all CDR = 0).…”

Section: Data Source and Ethicsmentioning

confidence: 99%

“…We captured remote head trauma exposure using the older adult version of the OSU TBI-ID (OA OSU TBI-ID) (Corrigan and Bogner 2007;Gardner et al 2020). Participants first were asked about past exposure to common TBI mechanisms (e.g., falls, motor vehicle accidents, assault).…”

Section: Head Trauma Exposure Ascertainmentmentioning

confidence: 99%

“…Characterization of head trauma history in aging studies typically is limited by unknown or binarized TBI frequency (Mielke et al 2014;Sugarman et al 2019a, b;Tripodis et al 2017;Wang et al 2017;Weiner et al 2017), unknown TBI severities (Schneider et al 2019), unknown exposure to repetitive, asymptomatic impacts (e.g., collision sports) (Mielke et al 2014;Schneider et al 2019;Sugarman et al 2019a, b;Tripodis et al 2017;Wang et al 2017;Weiner et al 2017), and exposure ascertainment methods with low sensitivity to mTBI history (Gardner et al 2020). The Ohio State University Traumatic Brain Injury Identification method (OSU TBI-ID) is a National Institute of Neurological Disorders and Stroke (NINDS) Common Data Element (Corrigan and Bogner 2007) for TBI research with presumed higher sensitivity to lifelong head trauma exposure (Gardner et al 2020). Inaccurate ascertainment of brain injury history inherently limits precise quantification of exposure-related risk estimates for poor neurologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults

Asken

Mantyh

Joie

et al. 2021

Brain Imaging and Behavior

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We investigated whether clinically normal older adults with remote, mild traumatic brain injury (mTBI) show evidence of higher cortical Aβ burden. Our study included 134 clinically normal older adults (age 74.1 ± 6.8 years, 59.7% female, 85.8% white) who underwent Aβ positron emission tomography (Aβ-PET) and who completed the Ohio State University Traumatic Brain Injury Identification questionnaire. We limited participants to those reporting injuries classified as mTBI. A subset (N = 30) underwent a second Aβ-PET scan (mean 2.7 years later). We examined the effect of remote mTBI on Aβ-PET burden, interactions between remote mTBI and age, sex, and APOE status, longitudinal Aβ accumulation, and the interaction between remote mTBI and Aβ burden on memory and executive functioning. Of 134 participants, 48 (36%) reported remote mTBI (0, N = 86; 1, N = 31, 2+, N = 17; mean 37 ± 23 years since last mTBI). Effect size estimates were small to negligible for the association of remote mTBI with Aβ burden (p = .94, η 2 < 0.01), and for all interaction analyses. Longitudinally, we found a non-statistically significant association of those with remote mTBI (N = 11) having a faster rate of Aβ accumulation (B = 0.01, p = .08) than those without (N = 19). There was no significant interaction between remote mTBI and Aβ burden on cognition. In clinically normal older adults, history of mTBI is not associated with greater cortical Aβ burden and does not interact with Aβ burden to impact cognition. Longitudinal analyses suggest remote mTBI may be associated with more rapid cortical Aβ accumulation. This finding warrants further study in larger and more diverse samples with well-characterized lifelong head trauma exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Source and Ethicsmentioning

confidence: 99%

Section: Head Trauma Exposure Ascertainmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults

Asken

Mantyh

Joie

et al. 2021

Brain Imaging and Behavior

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Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults

Kornblith,

Diaz-Ramirez,

Yaffe

et al. 2024

JAMA Netw Open

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ImportanceTraumatic brain injury (TBI) occurs at the highest rate in older adulthood and increases risk for cognitive impairment and dementia.ObjectivesTo update existing TBI surveillance data to capture nonhospital settings and to explore how social determinants of health (SDOH) are associated with TBI incidence among older adults.Design, Setting, and ParticipantsThis nationally representative longitudinal cohort study assessed participants for 18 years, from August 2000 through December 2018, using data from the Health and Retirement Study (HRS) and linked Medicare claims dates. Analyses were completed August 9 through December 12, 2022. Participants were 65 years of age or older in the HRS with survey data linked to Medicare without a TBI prior to HRS enrollment. They were community dwelling at enrollment but were retained in HRS if they were later institutionalized.ExposuresBaseline demographic, cognitive, medical, and SDOH information from HRS.Main Outcomes and MeasuresIncident TBI was defined using inpatient and outpatient International Classification of Diseases, Ninth or Tenth Revision, diagnosis codes received the same day or within 1 day as the emergency department (ED) visit code and the computed tomography (CT) or magnetic resonance imaging (MRI) code, after baseline HRS interview. A cohort with TBI codes but no ED visit or CT or MRI scan was derived to capture diagnoses in nonhospital settings. Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sample weights. Fine-Gray regression models estimated associations between covariates and TBI, with death as a competing risk. Imputation considering outcome and complex survey design was performed by race and ethnicity, sex, education level, and Area Deprivation Index percentiles 1, 50, and 100. Other exposure variables were fixed at their weighted means.ResultsAmong 9239 eligible respondents, 5258 (57.7%) were female and 1210 (9.1%) were Black, 574 (4.7%) were Hispanic, and 7297 (84.4%) were White. Mean (SD) baseline age was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received an incident TBI diagnosis with an ED visit and a CT code within 1 day, 964 (10.2%) received an incident TBI diagnosis and an ED code, and 1148 (12.9%) received a TBI code with or without an ED visit and CT scan code. Compared with respondents without incident TBI, respondents with TBI were more likely to be female (absolute difference, 7.0 [95% CI, 3.3-10.8]; P &lt; .001) and White (absolute difference, 5.1 [95% CI, 2.8-7.4]; P &lt; .001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 [95% CI, 2.8-9.3]; P = .001), higher education (absolute difference, 3.8 [95% CI, 0.9-6.7]; P &lt; .001), and wealth (absolute difference, 6.5 [95% CI, 2.3-10.7]; P = .01), and be without baseline lung disease (absolute difference, 5.1 [95% CI, 3.0-7.2]; P &lt; .001) or functional impairment (absolute difference, 3.3 [95% CI, 0.4-6.1]; P = .03). In adjusted multivariate models, lower education (subdistribution hazard ratio [SHR], 0.73 [95% CI, 0.57-0.94]; P = .01), Black race (SHR, 0.61 [95% CI, 0.46-0.80]; P &lt; .001), area deprivation index national rank (SHR 1.00 [95% CI 0.99-1.00]; P = .009), and male sex (SHR, 0.73 [95% CI, 0.56-0.94]; P = .02) were associated with membership in the group without TBI. Sensitivity analyses using a broader definition of TBI yielded similar results.Conclusions and RelevanceIn this longitudinal cohort study of older adults, almost 13% experienced incident TBI during the 18-year study period. For older adults who seek care for TBI, race and ethnicity, sex, and SDOH factors may be associated with incidence of TBI, seeking medical attention for TBI in older adulthood, or both.

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Effect of traumatic brain injury on mild behavioral impairment domains prior to all‐cause dementia diagnosis and throughout disease progression

Bray

Bryant

Esagoff

et al. 2022

A&D Transl Res & Clin Interv

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Introduction Traumatic brain injury (TBI) may alter dementia progression, although co‐occurring neuropsychiatric symptoms (NPS) have received less attention. Originally designed to evaluate behavioral disruption prior to dementia diagnosis, the mild behavioral impairment (MBI) construct relates NPS to underlying neural circuit disruptions, with probable relevance across the progression of neurodegenerative disease. Therefore, the MBI construct may represent a valuable tool to identify and evaluate related NPS both preceding diagnosis of all‐cause dementia throughout the progression of disease, representing an important area of inquiry regarding TBI and dementia. This investigation sought to evaluate the effect of TBI on NPS related by the MBI construct in participants progressing from normal cognitive status to all‐cause dementia. Methods Using National Alzheimer's Coordinating Center data, individuals progressing from normal cognition to all‐cause dementia (clinician diagnosed) over 7.6 ± 3.0 years were studied to estimate prevalence of MBI domains in 124 participants with prior TBI history (57 with loss of consciousness [LOC] <5 minutes, 22 with LOC >5 min, 45 unknown severity) compared to 822 without. MBI domain prevalence was evaluated (1) prior to dementia onset (including only time points preceding time at dementia diagnosis, as per MBI's original definition) and (2) throughout dementia progression (evaluating all available time points, including both before and after dementia diagnosis). Results More severe TBI (LOC >5 minutes) was associated with the social inappropriateness MBI domain (adjusted odds ratio = 4.034; P = 0.024) prior to dementia onset, and the abnormal perception/thought content domain looking across dementia progression (adjusted hazard ratio [HR adj ] = 3.703; P = 0.005). TBI (all severities) was associated with the decreased motivation domain looking throughout dementia progression (HR adj. = 1.546; P = 0.014). Discussion TBI history is associated with particular MBI profiles prior to onset and throughout progression of dementia. Understanding TBI's impact on inter‐related NPS may help elucidate underlying neuropathology with implications for surveillance, detection, and treatment of behavioral concerns in aging TBI survivors. Highlights The mild behavioral impairment (MBI) construct links related neuropsychiatric symptoms (NPS) by probable underlying neural network dysfunction. Traumatic brain injury (TBI) with loss of consciousness (LOC) > 5 minutes was associated with pre‐dementia social inappropriateness. TBI was associated with decreased motivation looking across dementia progression. TBI with LOC > 5 minutes was associated with abn...

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Screening for Lifetime History of Traumatic Brain Injury Among Older American and Irish Adults at Risk for Dementia: Development and Validation of a Web-Based Survey

Cited by 11 publications

References 37 publications

Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults

Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults

Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults

Effect of traumatic brain injury on mild behavioral impairment domains prior to all‐cause dementia diagnosis and throughout disease progression

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