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Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer’s Disease and Related Dementia: Large Longitudinal Study

  • Elham Mahmoudi
    Correspondence
    Corresponding author Elham Mahmoudi, PhD, Department of Family Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109.
    Affiliations
    Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Paul Lin
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Mark D. Peterson
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Michelle A. Meade
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Denise G. Tate
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Neil Kamdar
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Published:January 25, 2021DOI:https://doi.org/10.1016/j.apmr.2020.12.019

      Highlights

      • We examined the risk of traumatic spinal cord injury (TSCI) on incident Alzheimer disease and related dementia (ADRD) among persons 45 years and older.
      • Incident ADRD was higher among 45-64 years old (0.5% vs 0.3%) and among 65+ years old with TSCI (10.6% vs 6.2%) than their matched cohorts of adults without TSCI.
      • Adults with TSCI are at substantially higher risk for ADRD than those without, particularly for early onset ADRD.
      • Early screening for detection of cognitive decline among TSCI population is the crucial first step. Interventions to preserve level of cognitive function is an optimal strategy.

      Abstract

      Objective

      Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed.

      Design

      Cohort study.

      Setting

      Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD.

      Participants

      Adults with and without TSCI (N=6083).

      Intervention

      Not applicable.

      Main Outcomes Measures

      Diagnosis of ADRD.

      Results

      Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]).

      Conclusions

      Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.

      Keywords

      List of abbreviations:

      95% CI (95% confidence interval), ADRD (Alzheimer disease and related dementia), HR (hazard ratio), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), SCI (spinal cord injury), TBI (traumatic brain injury), TSCI (traumatic spinal cord injury)
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