Cited by 398Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesDementia and Cognitive Impairment Research

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Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans

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Barnes, Deborah E., Byers, Amy L., Gardner, Raquel C., Seal, Karen H., Boscardin, W. John, Yaffe, Kristine·2018·JAMA Neurology

DOI 10.1001/jamaneurol.2018.0815PMC PMC6143113

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Abstract

Importance: Traumatic brain injury (TBI) is common in both veteran and civilian populations. Prior studies have linked moderate and severe TBI with increased dementia risk, but the association between dementia and mild TBI, particularly mild TBI without loss of consciousness (LOC), remains unclear. Objective: To examine the association between TBI severity, LOC, and dementia diagnosis in veterans. Design, Setting, and Participants: This cohort study of all patients diagnosed with a TBI in the Veterans Health Administration health care system from October 1, 2001, to September 30, 2014, and a propensity-matched comparison group. Patients with dementia at baseline were excluded. Researchers identified TBIs through the Comprehensive TBI Evaluation database, which is restricted to Iraq and Afghanistan veterans, and the National Patient Care Database, which includes veterans of all eras. The severity of each TBI was based on the most severe injury recorded and classified as mild without LOC, mild with LOC, mild with LOC status unknown, or moderate or severe using Department of Defense or Defense and Veterans Brain Injury Center criteria. International Classification of Diseases, Ninth Revision codes were used to identify dementia diagnoses during follow-up and medical and psychiatric comorbidities in the 2 years prior to the index date. Main Outcomes and Measures: Dementia diagnosis in veterans who had experienced TBI with or without LOC and control participants without TBI exposure. Results: The study included 178 779 patients diagnosed with a TBI in the Veterans Health Administration health care system and 178 779 patients in a propensity-matched comparison group. Veterans had a mean (SD) age of nearly 49.5 (18.2) years at baseline; 33 250 (9.3%) were women, and 259 136 (72.5%) were non-Hispanic white individuals. Differences between veterans with and without TBI were small. A total of 4698 veterans (2.6%) without TBI developed dementia compared with 10 835 (6.1%) of those with TBI. After adjustment for demographics and medical and psychiatric comobidities, adjusted hazard ratios for dementia were 2.36 (95% CI, 2.10-2.66) for mild TBI without LOC, 2.51 (95% CI, 2.29-2.76) for mild TBI with LOC, 3.19 (95% CI, 3.05-3.33) for mild TBI with LOC status unknown, and 3.77 (95% CI, 3.63-3.91) for moderate to severe TBI. Conclusions and Relevance: In this cohort study of more than 350 000 veterans, even mild TBI without LOC was associated with more than a 2-fold increase in the risk of dementia diagnosis. Studies of strategies to determine mechanisms, prevention, and treatment of TBI-related dementia in veterans are urgently needed.

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Authors: Barnes, D. E., Byers, A. L., Gardner, R. C., Seal, K. H., Boscardin, W. J., & Yaffe, K.
Affiliations: San Francisco VA Medical Center (US)
ORCID: Barnes, Deborah E.
Byers, Amy L.
Gardner, Raquel C.
Seal, Karen H.
Boscardin, W. John
Yaffe, Kristine
Venue: JAMA Neurology
Publisher: American Medical Association (AMA)
Published: 2018-09-01
Volume: 75
Issue: 9
Pages: 1055
ISSN: 2168-6149 (ISSN-L)
DOI: 10.1001/jamaneurol.2018.0815
PMC: PMC6143113
OpenAlex: W2802173280
Cited by: 398
References: 49
Citations by year: 2026: 37 · 2025: 38 · 2024: 58 · 2023: 50 · 2022: 61 · 2021: 65 · 2020: 38 · 2019: 28 · 2018: 23
FWCI: 30.23
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Neurology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: U.S. Department of Veterans Affairs
Topics: Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords: mild traumatic brain injury, dementia, loss of consciousness, military veterans, TBI severity, Iraq and Afghanistan veterans, dementia risk, psychiatric comorbidity, cognitive impairment, war injuries, neurodegeneration, depression, alcoholism, substance use disorders
MeSH terms: Adult, Brain Concussion, Dementia, Female, Humans, Male, Middle Aged, Risk Factors, Severity of Illness Index, Unconsciousness, United States, Veterans, Cohort Studies

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Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans

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