How Does Tbi Differ Among Older Patients? Mdedge Neurology Reviews

• Journal List
• Neurology
• PMC7682824

Neurology. 2020 Sep 29; 95(13): e1768–e1775.

Sex, race, and risk of dementia diagnosis after traumatic brain injury among older veterans

Erica Kornblith, PhD, Carrie B. Peltz, PhD, Feng Xia, MS, MPH, Brenda Plassman, PhD, Tatjana Novakovic-Apopain, PhD, and Kristine Yaffe, Doctor

Received 2019 Sep xi; Accepted 2020 April half-dozen.

Data Availability Statement

The data are derived from VHA electronic health records and contain protected health data; therefore, the data cannot be placed in a public repository. Delight contact the authors for boosted details on the process of accessing these information.

Abstruse

Objective

To investigate whether sex and race differences be in dementia diagnosis risk associated with traumatic brain injury (TBI) amid older veterans.

Methods

Using Fine-Greyness regression models, we investigated incident dementia diagnosis risk with TBI exposure by sex and race.

Results

After the exclusion of baseline prevalent dementia, the final sample (all veterans ≥55 years of age diagnosed with TBI during the 2001–2015 study period and a random sample of all veterans receiving Veterans Health Administration intendance) included nearly 1 million veterans (4.3% female; 81.eight% White, 11.5% Blackness, and 1.25% Hispanic), 96,178 with TBI and 903,462 without TBI. Compared to those without TBI, Hispanic veterans with TBI were nearly two times more probable (17.0% vs 10.3%; hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.51–2.01), Black veterans with TBI were >2 times more likely (11.ii% vs 6.iv%; HR 2.15, 95% CI 2.02–ii.30), and White veterans with TBI were nearly 3 times more than probable to receive a dementia diagnosis (12.0% vs 5.nine%; HR 2.71, 95% CI 2.64–ii.77). A significant interaction between TBI and race for dementia diagnosis was observed (p < 0.001). Both male and female veterans with TBI were more than than twice as likely (men 11.8% vs five.nine%, Hr 2.lx, 95% CI 2.54–two.66; women six.3% vs 3.ane%, HR two.36, 95% CI 2.08–2.69) to receive a diagnosis of dementia compared to those without. There was a significant interaction result between sexual practice and TBI (p = 0.02), just the magnitude of differences was minor.

Conclusions

In this big, nationwide accomplice of older veterans, all race groups with TBI had increased risk of dementia diagnosis, just there was an interaction issue such that White veterans were at greatest risk for dementia after TBI. Further enquiry is needed to sympathise the mechanisms for this discrepancy. Differences in dementia diagnosis risk for men and women after TBI were significant but minor, and male and female person veterans had similarly high risks of dementia diagnosis after TBI.

Traumatic encephalon injury (TBI), including balmy TBI, ¹ is a well-known risk factor for dementia. ^{2 ,– 8} Veterans are particularly at take a chance for TBI and therefore may be more vulnerable to developing dementia. ^ix Most existing enquiry on TBI and risk of dementia diagnosis in veterans has been conducted with predominately male and White participants. Equally the The states armed services becomes more than diverse, understanding the outcomes that female and not-White service members may face afterwards TBI is essential. Women are increasingly involved in combat and at risk for TBI, ¹⁰ and the number of female veterans, particularly those >55 years of age, is expected to ascent sharply in the coming years. ^xi The proportion of Blackness, Hispanic, and other (including American Indian/Alaska Native, Asian, and Pacific Islander) minority veterans is too expected to climb. ¹²

The few studies that straight examine the effect of sexual practice on risk of dementia diagnosis after TBI ^2,13,14 take shown small-scale increases in gamble for men but not women. Most existing studies of run a risk for dementia diagnosis later TBI exercise non directly examine race differences, and many do non report the racial makeup of their samples. ^fifteen Understanding the possible impact of sex- and race-based health differences on dementia diagnosis gamble is fundamental to improving intendance for the growing population of various older veterans with TBI.

The goal of our report was to examine whether differences in TBI-associated risk of dementia diagnosis by sex and race exist among a large cohort of older veterans and to evaluate the impact of other demographic factors, medical comorbid weather condition, and psychiatric weather condition on this relationship.

Methods

Standard protocol approvals, registrations, and patient consents

All report procedures were approved by the institutional review boards of the Academy of California, San Francisco and San Francisco Veterans Affairs (VA) Medical Middle and by the Usa Regular army Medical Enquiry and Material Command, Office of Research Protections, Human Research Protection Office. Informed consent was waived because of the utilise of deidentified archival data. In addition, many participants were deceased or no longer receiving medical care through the VA at the fourth dimension of study completion.

Report population

We identified all Veterans Wellness Administration (VHA) patients ≥55 years of age who received a TBI diagnosis between October i, 2001, and September thirty, 2015, and a 2% random sample of patients who received VHA care within the same time frame (n = i,024,601). Data were sourced from ii nationwide VHA arrangement databases: the inpatient and outpatient visits database (National Patient Care Database) and the Vital Status File. We excluded veterans with prevalent dementia during the 2-year baseline period (defined every bit within two years before the index date, i.e., the date of TBI diagnosis or random choice date) (due north = 24,959). The final sample size was 999,642.

We identified all VHA patients who received an inpatient or outpatient TBI diagnosis using the Defense and Veterans Brain Injury Centre list of ICD-9 codes for TBI surveillance (data bachelor from Damsel, appendix 1, doi.org/ten.7272/Q6V69GSD). Nosotros next identified prevalent dementia at baseline using the VA Dementia Steering Committee'south recommended list of ICD-9 codes (2016 version) ¹⁶ (data available from Dryad, appendix two). For incident dementia diagnoses during the follow-upwardly flow, nosotros used a modified version of the same listing that excluded prion disease and alcohol- or drug-induced dementia.

Biological sex information were also taken from VHA inpatient or outpatient files in which each veteran was coded as male or female. Two participants had missing sex activity information, and the concluding sample size was 999,640 for sex analyses. Race and ethnicity were retrieved from VHA inpatient and outpatient files (supplemented with Medicare information subsequently 2004). Veterans were coded as non-Hispanic Blackness, non-Hispanic White, Hispanic, or other/unknown. The other/unknown race category was removed from the final unadjusted and adjusted race models because of the likelihood of missing information in the unknown grouping misreckoning interpretation of information nigh respondents in the other category. These codes are based on self-report of patient sex and race. The last sample size was 937,380 for race analyses, reflecting 62,262 participants with missing information (other/unknown) for race.

We obtained data on demographics, medical comorbid conditions, health care visits, and psychiatric conditions using VHA inpatient and outpatient files. Zip codes and 2016 American Customs Survey data were used to categorize veterans' residences into educational and income categories (for education, ≤25% of the adult population has a bachelor'southward degree or college vs >25%; income was categorized into median income tertiles). Medical and psychiatric comorbid atmospheric condition equally identified by ICD-9 codes were assessed during the ii-twelvemonth baseline. Comorbid weather included hypertension, diabetes mellitus, myocardial infarction, TIA/stroke, chronic pain, posttraumatic stress disorder, low, drug/booze abuse, and tobacco use or smoking. Health care visits were defined every bit any inpatient or outpatient visit from VA medical records and included information on date of visit and diagnosis.

Baseline characteristics of veterans in each race and sex group were compared by TBI status with t tests for continuous variables and χ ² tests for chiselled variables. Although TBI prevalence by race and sex is reported, these data points stand for estimates only; because of the oversampling of patients with TBI in our sample, these figures lack precision. We used Fine-Gray proportional hazards regression models, accounting for the competing take chances of death, to examine time to dementia diagnosis according to TBI condition for each sex and race group with historic period as the time calibration. Models were unadjusted and adjusted for demographics and medical/psychiatric comorbid weather that significantly differed betwixt sex activity/race groups at p < 0.01 (age, race or sex, education, income, hypertension, diabetes mellitus, myocardial infarction, TIA/stroke, chronic pain, posttraumatic stress disorder, depression, drug/alcohol abuse, and tobacco use/smoking). For cumulative incidence graphs (figures 1 and ​ 2), we used 95 years of age every bit a cutoff indicate, and 1% of data (northward = 9,751) were truncated. Assumptions of the Fine-Gray models were examined and found to be satisfied. We used the cumulative residuals with respect to fourth dimension (SAS ASSESS statement) to test the proportional hazards assumption.

Adjusted* cumulative incidence of dementia

Historic period at dementia diagnosis with and without traumatic brain injury (TBI), accounting for mortality in male and female veterans. *Adjusted for demographic and health characteristics.

Adapted* cumulative incidence of dementia

Age at dementia diagnosis with and without traumatic brain injury (TBI), bookkeeping for mortality in White, Black, and Hispanic veterans. *Adjusted for demographic and health characteristics.

Nosotros also separately examined the interaction upshot of TBI with sex activity and with race on risk of dementia diagnosis in adjusted models and subsequently conducted stratified analyses to examine the interactions. Finally, in sensitivity analyses, we (1) conducted models in which we excluded veterans receiving a dementia diagnosis within one twelvemonth of TBI diagnosis for a washout menstruation to address concerns virtually reverse causation and etiology (TBI vs neurodegenerative) and (2) examined the touch on of number of health care visits during the follow-up period to determine whether increased interest in/access to health intendance accounted for some of the race-based differences in dementia diagnoses we identified. Statistical significance was set at p < 0.05 (ii sided). SAS version 9.four (SAS Institute Inc, Cary, NC) was used for all analyses.

Data availability

The data are derived from VHA electronic health records and contain protected health information; therefore, the data cannot be placed in a public repository. Delight contact the authors for additional details on the process of accessing these information.

Results

The last analytic accomplice (all veterans ≥55 years of age with TBI during the written report period and a 2% random sample of all veterans in the VHA) included 96,178 veterans with TBI and 903,464 veterans without TBI (iv.three% female; 81.8% White, 11.5% Blackness, and one.25% Hispanic). The median follow-up was 4.3 years (interquartile range 1.nine–vii.6 years).

TBI risk for dementia diagnosis by sexual activity

Table 1 shows characteristics of male and female veterans with and without TBI. Male veterans were older (p < 0.001). All veterans with TBI regardless of sex had a college prevalence of medical and psychiatric comorbid atmospheric condition compared to those without TBI history. Amid male veterans, those with TBI were more than twice equally likely to receive a dementia diagnosis (hazard ratio [HR] ii.87, 95% confidence interval [CI] 2.81–2.94) compared to those without a TBI diagnosis. Amidst women, those with TBI vs no TBI were more than than twice as likely to receive a dementia diagnosis (Hr 2.51, 95% CI 2.22–2.84). The difference lessened somewhat after adjustment for demographics and comorbid atmospheric condition (men: HR 2.sixty, 95% CI two.54–ii.66; women: HR 2.36, 95% CI ii.08–two.69). There was a pregnant interaction effect of sexual activity and TBI on dementia diagnosis chance (p = 0.02) such that men with TBI demonstrated slightly increased risk of receiving a dementia diagnosis compared to women. The interaction between sexual practice and TBI on dementia diagnosis take a chance remained pregnant after adjustment (p = 0.03). Adjusted cumulative incidence curves for age at dementia diagnosis accounting for competing risk of mortality are shown in figure 1 for male and female person veterans.

Table 1

Baseline characteristics of male and female veterans with and without TBI

TBI hazard for dementia diagnosis by race

Table 2 shows characteristics of White, Black, and Hispanic veterans with and without TBI. Across all race groups, those with TBI were by and large younger, more likely to exist female, better educated, more likely to fall in the depression-income grouping, and less likely to be diagnosed with hypertension and diabetes mellitus but otherwise had more than wellness and psychological comorbid conditions compared to those without TBI history. The Hispanic grouping was unique, notwithstanding, in that Hispanic veterans with TBI were older (p < 0.001) and did non differ from Hispanic veterans without TBI on sex (p = 0.78). All veterans with TBI were much more likely to fall in the low-income group, but low-income group membership was most likely in the Black and Hispanic groups (31.6% of White veterans with TBI compared to 58.one% of Blackness veterans and lxx.1% of Hispanic veterans with TBI).

Table 2

Characteristics of veterans with and without TBI past race

White veterans with TBI had an almost 3-fold increased hazard of dementia diagnosis (Hour 2.93, 95% CI 2.86–3.00) compared to those without TBI, while Black and Hispanic veterans with TBI had an ≈two-fold increased risk (Blacks: HR two.27, 95% CI 2.thirteen–2.41; Hispanics: HR one.98, 95% CI 1.74–2.24). There was a pregnant interaction between TBI and race on gamble of receiving a dementia diagnosis (p < 0.001) such that White veterans with TBI were at the highest adventure for dementia diagnosis with similar risks for Blacks and Hispanics. After adjustment for demographics and medical and psychiatric conditions, White veterans with TBI remained at college take a chance (HR ii.71, 95% CI 2.64–2.77) compared to Blackness and Hispanic veterans with TBI (Blacks: HR 2.15, 95% CI 2.02–two.30; Hispanics: HR ane.74, 95% CI 1.51–2.01). The interaction betwixt TBI and race on run a risk of dementia diagnosis remained after full adjustment (p < 0.001). Adjusted cumulative incidence curves for age at dementia diagnosis bookkeeping for competing run a risk of mortality are shown in figure two for White, Black, and Hispanic veterans. Results of 1-twelvemonth lag washout sensitivity analyses showed slightly attenuated HRs, but the pattern of sexual practice and race results was identical. Additional adjustment for number of clinic visits slightly adulterate risk estimates just did not change the pattern of results (Whites: HR 2.33, 95% CI two.26–ii.39; Blacks: Hour 1.94, 95% CI 1.82–2.08; and Hispanics: HR 1.63, 95% CI 1.41–one.89).

Give-and-take

In this diverse sample of older veterans, we show an increased take a chance of dementia diagnosis in those with a diagnosis of TBI compared to those without for veterans of both sexes and all major race groups, consequent with previous work on this topic in the veteran population. ⁹ We likewise identified differences in the risk of dementia diagnosis later TBI according to race. Specifically, older White veterans appear to accept an elevated risk of receiving a dementia diagnosis later on TBI compared to Blacks and Hispanics. Sexual activity differences in dementia diagnosis adventure after TBI observed in this large sample, although statistically significant, were small and of unclear clinical significance.

The limited available information on the outcome of sex on dementia take chances subsequently TBI show increased risk for men but not women. For example, an older meta-assay of 11 case-command studies conducted before 1991 suggested that there is an increased adventure of dementia (specifically Alzheimer affliction) after TBI for men just non women ² ; another meta-analysis published in 2003 examining vii boosted studies replicated that finding. ¹³ A recent population-based study in Kingdom of denmark conducted in 2018 similarly found a slightly increased risk of dementia after TBI in men compared to women (30% vs 19% increased risk). ¹⁴ Our results showing a similarly high risk for both men and women are inconsistent with this prior work. Therefore, further exploration of sex activity-based differences in dementia risk later TBI for veterans is indicated. For example, it is possible that although the TBIs of female civilians may exist less severe on average than those of male person civilian, male and female veterans may have TBIs of similar severity. In addition, women in the war machine may experience a unique profile of injuries in which repeated injuries caused by intimate partner violence are superimposed on single or multiple concussive or subconcussive head injuries, conferring elevated dementia take a chance compared to female person civilians.

Most existing studies of the hazard for dementia later on TBI do not directly examine race differences, and many do not report the racial makeup of their samples. ¹⁵ For instance, in a recent review of the evidence for the clan between TBI and dementia, race was not listed as a known demographic factor affecting that relationship. ¹⁷ Therefore, our finding that White veterans may exist at increased chance for dementia after TBI is intriguing. Our findings stand in contrast to previous inquiry that has shown that Black and Hispanic adults accept worse functional outcomes (equally divers by standardized measures such equally the Disability Rating Scale, Functional Independence Measure out, and Customs Integration Questionnaire) compared to White adults 1 year subsequently moderate to astringent TBI. ^xviii However, the different methodologic approach in our work, which uses medical record data including diagnostic codes rather than standardized measures of functional outcome, may account for some of these discrepancies. Our results may also exist explained by race-based differences in the documentation of dementia diagnoses by health care providers; if providers are, for example, more than likely to consider dementia as a diagnosis for White patients, that could account for our findings of increased dementia diagnosis gamble for White veterans.

It is clear that more inquiry is needed to understand the affect of race on dementia diagnosis risk after TBI. Differential chance for dementia by race amongst veterans is unknown and a topic of current ongoing research, and it may be the example that non-White veterans have college baseline take chances such that having a TBI may non lead to increased gamble for these race groups equally it does for Whites. Health disparities research suggests that White individuals may be more likely to collaborate with health care and to receive a diagnosis, ^19,20 which may result in inflated rates of TBI and dementia diagnoses for White veterans compared to other groups. All the same, in our sample, White veterans had fewer follow-up visits compared to Black and Hispanic veterans, and after aligning for number of visits, the increased take chances of dementia after TBI for White veterans persisted. It is also possible that Black and Hispanic individuals, who are significantly more likely to live in multigenerational households with high levels of family support compared to White individuals, ²¹ may part well independently in the community for longer because of this increased support and therefore delay receiving a dementia diagnosis. Nevertheless, all veterans were followed up at VA; therefore, cerebral bug were likely to take been detected, even in the absence of concern from patients or families. In addition, in that location may exist unmeasured and unrecognized social factors affecting differences in medical intendance and driving differences in outcomes betwixt race groups that deserve further study in the time to come.

Furthermore, we did non measure APOE ε4 allele status, which differs by race and increases take a chance for dementia. ²² Although the allele is more common among individuals of African descent, ²³ White individuals have a greater increased run a risk for dementia with APOE ε4 compared to other racial groups. ²⁴ These findings back up our results showing increased risk for White veterans. There is also some testify that APOE ε4 increases risk for negative outcome, including dementia, after TBI, ^{25 ,– 27} which may be related to its decreased ability to finer protect and repair neural tissue after trauma compared to APOE ε3. ²⁸ Other unknown and unmeasured genetic factors may play a role in the race differences and the increased risk of dementia diagnosis for White veterans after TBI seen here, and farther research is required to identify such mechanisms.

Although our report was not designed to precisely measure the prevalence of TBI amidst older veterans, the TBI prevalence estimates nosotros report suggest differential patterns in the prevalence of TBI by both sex and race in our sample that are clinically interesting and behave farther study. Our results suggest a greater prevalence of TBI in female veterans compared to male veterans. These results may reflect a departure from civilian findings, which generally show higher rates of TBI in men. ²⁹ Our results likewise suggest the possibility of increased prevalence of TBI among Hispanic veterans compared to Black and White veterans. This pattern may represent previously unacknowledged health disparity, and in fact there is a dearth of research available on the prevalence or risk of TBI by race amidst veterans and civilians, an area clearly requiring farther study. Existing VA research shows that Hispanic Operation Enduring Liberty/Performance Iraqi Freedom veterans are less probable to receive care for a TBI and that Hispanic veterans of all eras are at higher chance for mortality subsequently a TBI, ^30,31 merely these studies practise non report prevalence of TBI amid Hispanic veterans. In contrast, our results suggest that Hispanic veterans receive more than follow-up care compared to White veterans but less than Black veterans. These patterns demonstrate that further research focused specifically on investigating race and sex differences in TBI prevalence amid veterans is clearly indicated.

In that location are some of import limitations to our report that bear on the interpretation and generalizability of our results. For example, sexual practice and race were based on self-written report, and sex was coded every bit a binary variable merely (i.e., transgender individuals were not captured), likely excluding some of the truthful complexity of this variable. Furthermore, our sample had some limitations: we were unable to examine Asian veterans and veterans identifying their race/ethnicity as other because of small sample size. Further research focused on Asian Veteran samples and those who identify their race as other would be helpful and would provide insights for handling planning and prevention as this growing cohort of veterans ages. Moreover, considering of oversampling of patients with TBI, we are unable to precisely mensurate TBI prevalence in veterans. Although TBI prevalence by race and sex is reported, these information points represent estimates only. In addition, because of our utilize of medical record data, there are likely to be differences between the sex and race groups studied that we were non able to measure out only that are driving differences in risk of dementia after TBI. In addition, we used ICD-9 codes in existing medical records for dementia diagnoses, which may event in less accurate categorization of participants compared to studies in which participants were given a comprehensive dementia examination. Because we included veterans in our sample who may have received a dementia diagnosis shortly later their TBI diagnosis, we are non able to draw conclusions about causality of dementia diagnoses or to brand inferences about neurodegenerative vs traumatic etiology. Finally, results may not generalize to veterans who practise non receive VA wellness care.

This is one of the first studies to examine differential risk for dementia diagnosis after TBI according to sex and race. Key contributions of this study include the large sample size and the direct, explicit consideration of race and sex and their touch on on dementia hazard afterward TBI amongst veterans. Our results show a doubling of dementia diagnosis risk subsequently TBI for both men and women and an interesting difference by sex that is small and of unclear clinical significance. Risk of dementia diagnosis was also approximately doubled for all veterans across race categories afterwards TBI, with White veterans showing an even greater increased risk. These findings suggest that understating the possible differential impact of TBI on dementia diagnosis risk according to race is worth exploring. This is of detail importance given the increasing variety and rapid crumbling of our military and veteran populations and may provide the VA with an important opportunity to identify and correct possible health disparities in TBI and dementia identification and care.

Glossary

CI	confidence interval
Hour	hazard ratio
ICD-9	International Classification of Affliction, 9th Revision
TBI	traumatic brain injury
VA	Veterans Affairs
VHA	Veterans Health Administration

Appendix. Authors

Footnotes

Study funding

This work was supported by Veterans Affairs Rehabilitation Research and Development Career Evolution Award 1 IK2 RX003073-01A2 (E.K.). It was also funded past the National Constitute on Aging (K24 AG031155 to K.Y.) and by the United states Ground forces Medical Enquiry and Fabric Command and the United states of america Department of Veterans Diplomacy (Long-Term Impact of Military-Relevant Brain Injury Consortium) nether awards W81XWH-18-ane-0692, W81XWH-19-ii-0067, and 1I01CX002069. The Us Army Medical Research Acquisition Activity, Fort Detrick, Md, is the application and administering conquering office. Whatsoever opinions, findings, conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reverberate the views of the US government or the US Section of Veterans Affairs, and no official endorsement should be inferred.

Disclosure

E. Kornblith, C.B. Peltz, F. Xia, B. Plassman, and T. Novakovic-Apopain report no disclosures relevant to the manuscript. K. Yaffe serves on Information Safety Monitoring boards for Eli Lilly and several National Institute on Aging–sponsored studies, serves on the board of directors for Alector, Inc, and is member of the Beeson Scientific Informational Board. Go to Neurology.org/Due north for total disclosures.

References

1. Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe One thousand. Association of balmy traumatic brain injury with and without loss of consciousness with dementia in U.s. military veterans. JAMA Neurol 2018;75:1055–1061. [PMC free article] [PubMed] [Google Scholar]

two. Mortimer J, van Duijn CM, Chandra V, et al. . Head trauma every bit a run a risk factor for Alzheimer's illness: a collaborative re-analysis of example-control studies. Int J Epidemiol 1991;20(suppl 2):S28–S35. [PubMed] [Google Scholar]

3. Plassman BL, Havlik RJ, Steffens DC, et al. . Documented caput injury in early adulthood and risk of Alzheimer's disease and other dementias. Neurology 2000;55:1158–1166. [PubMed] [Google Scholar]

4. Guo Z, Cupples LA, Kurz A, et al. . Head injury and the risk of AD in the MIRAGE written report. Neurology 2000;54:1316–1323. [PubMed] [Google Scholar]

five. Wang HK, Lin SH, Sung PS, et al. . Population based study on patients with traumatic encephalon injury suggests increased take a chance of dementia. J Neurol Neurosurg Psychiatry 2012;83:1080–1085. [PubMed] [Google Scholar]

half dozen. Gardner RC, Shush JF, Nettiksimmons J, Kaup A, Barnes DE, Yaffe G. Dementia take a chance afterward traumatic brain injury vs nonbrain trauma: the role of age and severity. JAMA Neurol 2014;71:1490–1497. [PMC free article] [PubMed] [Google Scholar]

7. Lee YK, Hou SW, Lee CC, Hsu CY, Huang YS, Su YC. Increased risk of dementia in patients with mild traumatic brain injury: a nationwide cohort study. PLoS One 2013;8:e62422. [PMC free article] [PubMed] [Google Scholar]

8. Nordström P, Michaëlsson One thousand, Gustafson Y, Nordström A. Traumatic encephalon injury and young onset dementia: a nationwide cohort written report. Ann Neurol 2014;75:374–381. [PubMed] [Google Scholar]

9. Barnes DE, Kaup A, Kirby KA, Byers AL, Diaz-Arrastia R, Yaffe Chiliad. Traumatic brain injury and gamble of dementia in older veterans. Neurology 2014;83:312–319. [PMC gratuitous article] [PubMed] [Google Scholar]

10. Amoroso T, Iverson KM. Acknowledging the run a risk for traumatic encephalon injury in women veterans. J Nerv Ment Dis 2017;205:318–323. [PubMed] [Google Scholar]

13. Fleminger South, Oliver DL, Lovestone South, Rabe-Hesketh Due south, Giora A. Head injury every bit a take chances cistron for Alzheimer's disease: the evidence 10 years on; a partial replication. J Neurol Neurosurg Psychiatry 2003;74:857–862. [PMC costless article] [PubMed] [Google Scholar]

xiv. Fann JR, Ribe AR, Pedersen HS, et al. . Long-term risk of dementia among people with traumatic brain injury in Kingdom of denmark: a population-based observational cohort study. Lancet Psychiatry 2018;five:424–431. [PubMed] [Google Scholar]

15. Bazarian JJ, Zhong J, Blyth B, Zhu T, Kavcic V, Peterson D. Diffusion tensor imaging detects clinically important axonal damage later on mild traumatic brain injury: a airplane pilot study. J Neurotrauma 2007;24:1447–1459. [PubMed] [Google Scholar]

xvi. The states Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Dementia Steering Commission (DSC). VHA Dementia Steering Committee recommendations for dementia care in the VHA healthcare system 2016 . 2016. Bachelor at: va.gov/GERIATRICS/docs/VHA_DSC_RECOMMENDATIONS_SEPT_2016_9-12-sixteen.pdf. Accessed September 3, 2019. [Google Scholar]

17. Peterson Thousand, Veazie Due south, Bourne D, Anderson J. Show Brief: Traumatic Brain Injury and Dementia. Washington, DC: U.s.a. Department of Veterans Affairs; 2019. [Google Scholar]

18. Arango-Lasprilla JC, Rosenthal Thou, Deluca J, et al. . Traumatic brain injury and functional outcomes: does minority status thing? Brain Inj 2007;21:701–708. [PubMed] [Google Scholar]

19. Hall WJ, Chapman MV, Lee KM, et al. . Implicit racial/indigenous bias among wellness care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 2015;105:e60–e76. [PMC gratuitous article] [PubMed] [Google Scholar]

20. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep 2016;118:358–365. [PMC gratuitous commodity] [PubMed] [Google Scholar]

22. Bookheimer South, Burggren A. APOE-4 genotype and neurophysiological vulnerability to Alzheimer'southward and cognitive aging. Annu Rev Clin Psychol 2009;5:343–362. [PMC free article] [PubMed] [Google Scholar]

23. Kuller LH, Shemanski Fifty, Manolio T, et al. . Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study. Stroke 1998;29:388–398. [PubMed] [Google Scholar]

24. Bretsky P, Guralnik JM, Launer L, Albert M, Seeman TE; MacArthur Studies of Successful Aging. The function of APOE-ε4 in longitudinal cognitive reject: MacArthur Studies of Successful Aging. Neurology 2003;60:1077–1081. [PubMed] [Google Scholar]

25. Verghese PB, Castellano JM, Holtzman DM. Apolipoprotein Due east in Alzheimer's disease and other neurological disorders. Lancet Neurol 2011;ten:241–252. [PMC gratis article] [PubMed] [Google Scholar]

26. Zhou W, Xu D, Peng X, Zhang Q, Jia J, Crutcher Thousand. Meta-analysis of APOE iv allele and outcome later on traumatic encephalon injury. J neurotrauma 2008;25:279–290. [PubMed] [Google Scholar]

27. Magnoni S, Brody DL. New perspectives on amyloid-β dynamics later on acute brain injury: moving between experimental approaches and studies in the homo brain. Arch Neurol 2010;67:1068–1073. [PubMed] [Google Scholar]

28. Bu M. Apolipoprotein Eastward and its receptors in Alzheimer's disease: pathways, pathogenesis and therapy. Nat Rev Neurosci 2009;x:333. [PMC free article] [PubMed] [Google Scholar]

29. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic encephalon injury–related emergency department visits, hospitalizations, and deaths: Usa, 2007 and 2013. MMWR Surveill Summ 2017;66:1. [PMC complimentary article] [PubMed] [Google Scholar]

30. Arriola Five, Rozelle J. Traumatic encephalon injury in Usa Operation Enduring Freedom/Functioning Iraqi Freedom (OEF/OIF) Hispanic veterans: a review using the PRISMA method. Behav Sci 2016;half dozen:iii. [PMC free commodity] [PubMed] [Google Scholar]

31. Egede LE, Dismuke C, Echols C. Racial/ethnic disparities in mortality risk amidst U.s.a. veterans with traumatic brain injury. Am J Public Health 2012;102:S266–S271. [PMC free article] [PubMed] [Google Scholar]

---

Articles from Neurology are provided hither courtesy of American Academy of Neurology

---

loaizaexthavird.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682824/

Share this post