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O3‐11‐04: ASSOCIATIONS BETWEEN LIFETIME HISTORY OF TRAUMATIC BRAIN INJURY AND DEMENTIA‐RELATED NEUROPATHOLOGICAL FINDINGS AT AUTOPSY: THE ADULT CHANGES IN THOUGHT STUDY
Author(s) -
Keene Christopher Dirk,
Gibbons Laura E.,
Sonnen Joshua,
DamsO'Connor Kristen,
Walker Rod,
Montine Thomas,
Larson Eric Berg,
Crane Paul
Publication year - 2014
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2014.04.332
Subject(s) - traumatic brain injury , autopsy , medicine , dementia , atrophy , cohort , population , psychology , pediatrics , psychiatry , disease , environmental health
out age and sex identified 3 factors with eigenvalues >1: an "Alzheimer" factor (SMC, CC-SIT, APOE), a "vascular" factor (history of hypertension, diabetes and stroke) and a "brain reserve" factor (3RT, NART-R, education). Because NART-R and APOE were not available for the entire cohort, a second factor analysis was conducted without them to increase representativeness. Factor scores were then dichotomized at the median, creating "high Alzheimer", "high vascular" and "low brain reserve" variables in order to calculate the Population Attributable Fractions (PAFs). Cox regressions using age as the time scale were performed to examine the independent contributions of high Alzheimer, high vascular and low brain reserve to incident dementia. PAFs were calculated from the resulting hazard ratios. Results: Hazard ratios were 2.79 (95%CI 1.73-4.49) for low brain reserve, 2.28 (95%CI 1.47-3.55) for "high Alzheimer", and 1.40 (95%CI 0.94-2.11) for "high vascular." Corresponding PAFs were: 47.2% (brain reserve), 39.7% (Alzheimer) and 16.8% (vascular). Conclusions: Low brain reserve explained the highest proportion of incident dementia in this population, followed by indicators of higher Alzheimer’s disease risk. High vascular risk was not a significant predictor. In addition to Alzheimer pathology, brain reserve is an important target for dementia prevention and needs to be taken into account when predicting its future risk. Our findings are consistent with an analysis of neuropathologic data from the Nun Study demonstrating the same three factors with the reserve factor responsible for the largest fraction of prevalent cases at autopsy.