Alzheimer's disease after remote head injury: an incidence study.

OBJECTIVE: To evaluate a history of remote head injury as a risk factor for subsequent dementia due to Alzheimer's disease. METHODS: 271 participants of a community based longitudinal study of aging in north Manhattan without evidence of significant cognitive impairment were interrogated for a history of head injury on two occasions at entry into the study. The examining physician sought a history of head injury with loss of conciousness. Independently, a risk factor interviewer inquired about a history of head injury with loss of consiousness or amnesia, the duration of any loss of consiousness, and the date of the head injury. Patients were followed up with standardised annual evaluations for up to five years to determine the first occurrence of dementia. RESULTS: Over the course of the study incident dementia due to probable or possible Alzheimer's disease was diagnosed in 39 patients. Cox proportional hazards modelling showed that a history of head injury with loss of consiousness reported to the physician was associated with earlier onset of dementia due to Alzheimer's disease (relative risk (RR) = 4.1, 95% confidence interval (95% CI) 1.3-12.7). head injury with loss of consiousness or amnesia reported to the risk factor interviewer was not significantly associated with earlier onset of Alzheimer's disease overall (RR 2.0, 95% CI 0.7-6.2), but those who reported loss of consiousness exceeding five minutes were at significantly increased risk (RR 11.2, 95% CI 2.3-59.8). Incident Alzheimer's disease was significantly associated with head injury which occurred within the preceding 30 years (RR 5.4, 95% CI 1.5-19.5). CONCLUSION: The results of this cohort study are consistent with the findings of several case-control studies suggesting that head injury may be a risk factor for Alzheimer's disease.

[1]  J. Mortimer,et al.  Remote effects of head trauma , 1985 .

[2]  M. Ambler,et al.  Posttraumatic premature Alzheimer's disease. Neuropathologic findings and pathogenetic considerations. , 1982, Archives of neurology.

[3]  B. Gurland,et al.  The CARE interview revisited: development of an efficient, systematic clinical assessment. , 1984, Journal of gerontology.

[4]  A. Heyman,et al.  Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. , 1991 .

[5]  J. Povlishock,et al.  Traumatically Induced Axonal Injury: Pathogenesis and Pathobiological Implications , 1991, Brain pathology.

[6]  J. Teresi,et al.  Operating Characteristics of Brief Screens for Dementia in a Multicultural Population. , 1995, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[7]  J. Adams,et al.  Diffuse axonal injury in head injury: Definition, diagnosis and grading , 1989, Histopathology.

[8]  J. Duchek,et al.  Reliability of the Washington University Clinical Dementia Rating. , 1988, Archives of neurology.

[9]  H Morgenstern,et al.  Development of dementing illnesses in an 80‐year‐old volunteer cohort , 1989, Annals of neurology.

[10]  I. T. Draper.  THE ASSESSMENT OF APHASIA AND RELATED DISORDERS , 1973 .

[11]  D. Gronwall,et al.  Delayed recovery of intellectual function after minor head injury. , 1974, Lancet.

[12]  J. Povlishock,et al.  Axonal response to traumatic brain injury: reactive axonal change, deafferentation, and neuroplasticity. , 1992, Journal of neurotrauma.

[13]  L. Murray,et al.  Beta amyloid protein deposition in the brain after severe head injury: implications for the pathogenesis of Alzheimer's disease. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[14]  N. Bohnen,et al.  Neuropsychological deficits in patients with persistent symptoms six months after mild head injury. , 1992, Neurosurgery.

[15]  G. Macflynn,et al.  The psychobiology of minor head injury , 1991, Psychological Medicine.

[16]  E. Kaplan,et al.  The 'preclinical phase' of probable Alzheimer's disease. A 13-year prospective study of the Framingham cohort. , 1995, Archives of neurology.

[17]  J. Brierley,et al.  Observations on the pathology of insidious dementia following head injury. , 1959, The Journal of mental science.

[18]  B. L. Beattie,et al.  Severe Head Injury Hastens Age of Onset of Alzheimer's Disease , 1989, Journal of the American Geriatrics Society.

[19]  D. Gronwall,et al.  CUMULATIVE EFFECT OF CONCUSSION , 1975, The Lancet.

[20]  Yaakov Stern,et al.  Genetic susceptibility and head injury as risk factors for Alzheimer's disease among community‐dwelling elderly persons and their first‐degree relatives , 1993, Annals of neurology.

[21]  Dennis J. Selkoe.  Physiological production of the β-amyloid protein and the mechanism of Alzheimer's disease , 1993, Trends in Neurosciences.

[22]  L M Schuman,et al.  Head injury as a risk factor for Alzheimer's disease , 1985, Neurology.

[23]  W E Wilkinson,et al.  Alzheimer's disease: A study of epidemiological aspects , 1984, Annals of neurology.

[24]  D. Selkoe,et al.  Physiological production of the beta-amyloid protein and the mechanism of Alzheimer's disease. , 1993, Trends in neurosciences.

[25]  D. Oppenheimer,et al.  Microscopic lesions in the brain following head injury. , 1968, Journal of neurology, neurosurgery, and psychiatry.

[26]  A. Hofman,et al.  Head trauma and the risk of Alzheimer's disease. , 1992, American journal of epidemiology.

[27]  J. Poirier.  Apolipoprotein E in animal models of CNS injury and in alzheimer's disease , 1994, Trends in Neurosciences.

[28]  HERMAN BUSCHKE,et al.  Evaluating storage, retention, and retrieval in disordered memory and learning , 1974, Neurology.

[29]  J. Povlishock,et al.  Axonal Change in Minor Head Injury , 1983, Journal of neuropathology and experimental neurology.

[30]  W R Murray,et al.  The relationship between alcohol and head injury and its effect on the conscious level , 1976, The British journal of surgery.

[31]  R. S. Williams,et al.  A prospective study of Alzheimer disease in Down syndrome. , 1989, Archives of neurology.

[32]  M. Thase,et al.  Age-related neuropsychological deficits in Down's syndrome. , 1984, Biological psychiatry.

[33]  T D Koepsell,et al.  The association between head trauma and Alzheimer's disease. , 1990, American journal of epidemiology.

[34]  B. Giordani,et al.  Neuropsychological sequelae of minor head injury. , 1983, Neurosurgery.

[35]  L. Whalley,et al.  The Dementia of Down's Syndrome and its Relevance to Aetiological Studies of Alzheimer's Disease , 1982, Annals of the New York Academy of Sciences.

[36]  R. Mayeux,et al.  Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. , 1992, Archives of neurology.

[37]  B. Tycko,et al.  Synergistic Effects of Traumatic Head Injury and Apolipoprotein-epsilon4 in Patients With Alzheimer's Disease , 1995, Neurology.