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Head Trauma as a Risk Factor for Alzheimer's Disease: A Collaborative Re-Analysis of Case-Control Studies
Open accessAbstract
A re-analysis of the data from 11 case-control studies was performed to investigate the association between head trauma and Alzheimer's disease (AD). To increase comparability of studies, exposures were limited to head trauma with loss of consciousness (hereafter referred to as 'head trauma') and comparisons were restricted to community (versus hospital) controls. Test for heterogeneity across studies was negative; consequently, data were pooled in subsequent analyses. The pooled relative risk for head trauma was 1.82 (95% confidence interval: 1.26-2.67). Stratified analyses showed stronger associations in cases without a positive family history of dementia and in males (versus females). Adjustment of the pooled relative risk for family history of dementia, education and alcohol consumption did not alter significantly the association between head trauma and AD. There was no interaction effect between head trauma and family history of dementia, suggesting that these risk factors operate independently. Mean age of onset was not significantly different in cases with a history of head trauma compared to cases without such a history. The findings of the pooled analysis support an association between reported head trauma and AD.
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“In particular, repeated mTBI (rmTBI) has been identified as a major risk factor for neurodegenerative diseases including Alzheimer’s disease (AD) [100], Parkinson’s disease (PD) [68] amyotrophic lateral sclerosis (ALS) [21, 2], fronto-temporal dementia (FTD) [126, 124], and chronic traumatic encephalopathy (CTE) [95].”
From Early onset senescence and cognitive impairment in a murine model of repeated mTBI (2021) · cites this paper as [100]
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“Since brain trauma is regarded as a risk factor for Alzheimer’s disease [60], an upregulation of App mRNA and APP protein following brain injury appears to be a plausible link.”
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“Similarly, a meta-analysis of 11 case-control studies investigating the association between TBI and dementia yielded a pooled unadjusted risk ratio of 1.82 (95% CI=1.26, 2.67; Mortimer et al., 1991), which is within the range of our analyses for TBI associated with a hospital contact.”
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Deletion of PTEN in microglia ameliorates chronic neuroinflammation following repetitive mTBI
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“Of the various environmental (nongenetic) risk factors for Alzheimer’s disease, there is increasing awareness of the importance of a history of previous head injury, perhaps implicated in 2–20% of cases of Alzheimer’s disease (Mortimer et al., 1991; Mayeux et al., 1993, 1995).”
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“…media, and public attention with an increasing body of literature linking r-mTBI to a higher risk of developing neurodegenerative conditions such as Alzheimer’s disease (AD), 18,19 Parkinson’s disease (PD), 20 amyotrophic lateral sclerosis (ALS), 21 and chronic traumatic encephalopathy (CTE).”
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“Furthermore, TBI-induced inflammation and pathology have been strongly associated with increased risks of neurodegenerative diseases such as chronic traumatic encephalopathy, Alzheimer’s disease (AD), and Parkinson’s disease (PD) (Goldman et al., 2006; McKee et al., 2009; Mortimer et al., 1991).”
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“In addition, TBI—particularly when severe or repetitive—has been linked to a higher risk of delayed neuropsychiatric complications, including depression [9], epilepsy [10,11], and neurodegenerative diseases such as chronic traumatic encephalopathy [12], Parkinson’s disease [13], and Alzheimer’s disease [14].”
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“3,4 8 Despite the growing awareness of the chronic consequences of TBI for cognition, however, this is still a greatly under-studied area.”
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“87 It is becoming evident that TBI is a chronic and progressive disease process with evolving pathological features.”
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“…brain injury (TBI) has been suggested to be a significant risk factor for the incidence of dementia (Heyman et al., 1984; Graves et al., 1990; Mortimer et al., 1991; Fleminger et al., 2003; Sivanandam and Thakur, 2012) or the earlier onset of dementia (Nemetz et al., 1999).”
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“In fact, several studies report head injury as a risk factor for Alzheimer’s disease (Guo et al., 2000; Johnson, Stewart, & Smith, 2010; Mortimer et al., 1991; O’Meara et al., 1997; Rasmusson, Brandt, Martin, & Folstein, 1995; Roberts et al., 1994).”
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“Epidemiological studies have reported that individuals exposed to a history of TBI are more susceptible to developing sporadic age-related neurodegenerative conditions in later life (Gedye et al., 1989; Mortimer et al., 1991; Fleminger et al., 2003; Li et al., 2017).”
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Arizaga, R. L., Gogorza, R. E., Allegri, R., et al. (2014) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642014dn84000010 · Cited by 12
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Use of surrogate respondents in studies of stroke and dementia
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“…injury, has been shown to precipitate clinicopathological profiles of patients many years after injury, and exacerbate neuropathological lesions observed in autopsy AD brains (Gedye et al., 1989; Mortimer et al., 1991; Fleminger et al., 2003; McKee et al., 2009, 2013; Omalu et al., 2011).”
Background
Metadata
- Authors
- Mortimer, J. A., Van Duijn, C. M., Chandra, V, Fratiglioni, L., Graves, A. B., Heyman, A., Jorm, A. F., Kokmen, E., Kondo, K., Rocca, W. A., Shalat, S. L., Soininen, H., & A Hofman for the Eurodem Risk Factors Research Group
- Affiliations
- Minneapolis VA Medical Center (US)
- Erasmus University Rotterdam (NL)
- Corresponding author
- Mortimer, J A
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1991-01-01
- Volume
- 20
- Issue
- Supplement 2
- Pages
- S28-S35
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2142046013
- Cited by
- 594
- References
- 0
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 10 · 2023: 16 · 2022: 28 · 2021: 23 · 2020: 21 · 2019: 35 · 2018: 16 · 2017: 28 · 2016: 37 · 2015: 31 · 2014: 22 · 2013: 11 · 2012: 21
- FWCI
- 12.29
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- head trauma, Alzheimer's disease, risk factors, loss of consciousness, family history of dementia, sex differences, age of onset, pooled relative risk, case-control study
- MeSH terms
- Alzheimer Disease, Australia, Europe, Female, Craniocerebral Trauma, Humans, Male, Risk, Risk Factors, United States, Meta-Analysis as Topic, Case-Control Studies
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