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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment.Arch Phys Med Rehabil. 2011; 92: 352-360
- Health, secondary conditions, and life expectancy after spinal cord injury.Arch Phys Med Rehabil. 2011; 92: 1770-1775
- Spinal cord injury and Alzheimer’s disease risk: a population-based, retrospective cohort study.Spinal Cord. 2018; 56: 151-157
- Risk of dementia in patients with spinal cord injury: a nationwide population-based cohort study.J Neurotrauma. 2017; 34: 615-622
- 2017 Alzheimer’s disease facts and figures.Alzheimers Dement. 2017; 13: 325-373
- Tau pathology: a marker of neurodegenerative disorders.Curr Opin Neurol. 2000; 13: 371-376
- Cerebrospinal fluid inflammatory cytokines and biomarkers of injury severity in acute human spinal cord injury.J Neurotrauma. 2010; 27: 669-682
- Immune dysfunction and chronic inflammation following spinal cord injury.Spinal Cord. 2015; 53: 14-18
- β-Amyloid is transmitted via neuronal connections along axonal membranes.Ann Neurol. 2014; 75: 88-97
- Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms.Br J Psychiatry. 2018; 212: 96-102
- What is the association between depression and Alzheimer’s disease?.Expert Rev Neurother. 2009; 9: 1667-1676
- Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults.J Gen Intern Med. 2018; 33: 1131-1138
- Potential new approaches for diagnosis of alzheimer's disease and related dementias.Front Neurol. 2020; 11: 496
- Optimizing coding and reimbursement to improve management of Alzheimer’s disease and related dementias.J Am Geriatr Soc. 2002; 50: 1871-1878
- Statistical power and effect sizes of clinical neuropsychology research.J Clin Exp Neuropsychol. 2001; 23: 399-406
- Cognitive function after spinal cord injury: a systematic review.Neurology. 2018; 91: 611-621
- Psychological morbidity and chronic disease among adults with traumatic spinal cord injuries: a longitudinal cohort study of privately insured beneficiaries.Mayo Clin Proc. 2020; 95: 920-928
- Mental health disorders and chronic disease among adults with spinal cord injury.Arch Phys Med Rehabil. 2019; 100: e97
- Multiple mechanisms of extracellular tau spreading in a non-transgenic tauopathy model.Am J Neurodegener Dis. 2012; 1: 316
- Dementia, depression, and associated brain inflammatory mechanisms after spinal cord injury.Cells. 2020; 9: 1420
- A controlled study of neuropsychological deficits in acute spinal cord injury patients.Spinal Cord. 1989; 27: 480-489
- Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease.Neurobiol Aging. 2014; 35: S74-S78
- Linking cardiometabolic disorders to sporadic Alzheimer’s disease: a perspective on potential mechanisms and mediators.J Neurochem. 2010; 115: 551-562
- History of depression as a risk factor for Alzheimer’s disease.Epidemiology. 1995; 6: 366-369
- Sedentary behavior in people with spinal cord injury.Arch Phys Med Rehabil. 2016; 97: 173
- Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre.J Rehabil Med. 2008; 40: 461-467
- Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches.Spinal Cord. 2012; 50: 373-378
- The burden of traumatic spinal cord injury in the United States: disability-adjusted life years.Arch Phys Med Rehabil. 2019; 100: 95-100
- Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury.J Cardiopulm Rehabil Prev. 2011; 31: 73-80
- The projected effect of risk factor reduction on Alzheimer’s disease prevalence.Lancet Neurol. 2011; 10: 819-828
- Environmental factors and their role in participation and life satisfaction after spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1793-1803
- Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management.Spine. 2001; 26: S137-S145
- Experience of rehabilitation following spinal cord injury: a meta-synthesis of qualitative findings.Spinal Cord. 2007; 45: 260-274
- Neurologic recovery after traumatic spinal cord injury: data from the model spinal cord injury systems.Arch Phys Med Rehabil. 1999; 80: 1391-1396
- Cognitive leisure activities and their role in preventing dementia: a systematic review.Int J Evid Based Healthc. 2010; 8: 2-17
- Modifiable lifestyle risk factors for Alzheimer’s disease.J Alzheimers Dis. 2010; 20: 803-811
- Identifying sickle cell disease cases using administrative claims.Acad Pediatr. 2014; 14: S61-S67
- Validation of a case definition for osteoporosis disease surveillance.Osteoporos Int. 2011; 22: 37-46
- An examination of Alzheimer’s disease case definitions using Medicare claims and survey data.Alzheimers Dement. 2010; 6: 334-341
- Traumatic brain injury and the risk of dementia diagnosis: a nationwide cohort study.PLoS Med. 2018; 15e1002496
- Accuracy of administrative health data for surveillance of traumatic brain injury: a Bayesian latent class analysis.Epidemiology. 2018; 29: 876-884
- A comparison of observational studies and randomized, controlled trials.N Engl J Med. 2000; 342: 1878-1886
Article Info
Publication History
Published online: January 25, 2021
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90RTHF0001-01-00 ).
Disclosures: Neil Kamdar has a financial relation with Lucent Surgical, outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine
