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.

中文翻译：

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创伤性脊髓损伤与早发型和晚发型阿尔茨海默病及相关痴呆的风险：大型纵向研究

客观的

创伤性脊髓损伤 (TSCI) 是一种改变生活的事件，最常导致永久性身体残疾。对于患有 TSCI 的中老年人患阿尔茨海默病和相关痴呆 (ADRD) 的风险知之甚少。评估了 ADRD 的诊断时间和调整后的风险。

设计

队列研究。

环境

使用来自 Optum Clinformatics 数据集市的 2007-2017 年索赔数据，我们确定了诊断为 TSCI 的成年人 (45 岁以上) (n=7019)。未诊断出 TSCI 的成年人被纳入作为比较者 (n=916,516)。利用年龄、性别、种族/民族、心脏代谢、心理和肌肉骨骼慢性疾病、美国人口普查部门和社会经济变量，我们对患有和不患有 TSCI 的人进行倾向评分匹配 (n=6083)。在入组 4 年时比较 ADRD 发病率估计值。生存模型用于量化 ADRD 事件的未调整、完全调整和倾向匹配的未调整和调整风险比 (HR)。

参加者

患有和不患有 TSCI 的成人 (N=6083)。

干涉

不适用。

主要成果措施

ADRD 的诊断。

结果

与未发生 TSCI 的中年人和老年人相比，患有 TSCI 的中老年人的 ADRD 发生率更高（45-64 岁和 65 岁以上未匹配队列中分别为 0.5% vs 0.2% 和 11.7% vs 3.3%）（0.5% vs 0.3%） 45-64 岁和 65 岁以上匹配人群中的这一比例分别为 10.6% 和 6.2%）。完全调整的生存模型表明，患有 TSCI 的成年人患 ADRD 的风险更大（45-64 岁之间：不匹配的 HR：3.19 [95% 置信区间，95% CI，2.30-4.44]，匹配的 HR：1.93 [95% CI， 1.06-3.51]；65岁以上人群：不匹配HR：1.90 [95% CI，1.77-2.04]，匹配HR：1.77 [1.55-2.02]）。

结论

患有 TSCI 的成年人患 ADRD 的风险较高。改善临床筛查和旨在保持认知功能的早期干预对于该患者群体至关重要。