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Article ; Online: Author Response: Cognitive Outcome 1 Year After Mild Traumatic Brain Injury: Results From the TRACK-TBI Study.

Gardner, Raquel C / Schneider, Andrea L C

2022 Volume 99, Issue 17, Page(s) 774

MeSH term(s)	Humans ; Brain Concussion/complications ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/psychology ; Neuropsychological Tests ; Cognition
Language	English
Publishing date	2022-10-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000201416
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Article ; Online: Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans.

Schneider, Andrea L C / Peltz, Carrie B / Li, Yixia / Bahorik, Amber / Gardner, Raquel C / Yaffe, Kristine

Stroke

2023 Volume 54, Issue 8, Page(s) 2059–2068

Abstract: Background: Traumatic brain injury (TBI) is associated with significant morbidity, but the association of TBI with long-term stroke risk in diverse populations remains less clear. Our objective was to examine the long-term associations of TBI with ... ...

Abstract	Background: Traumatic brain injury (TBI) is associated with significant morbidity, but the association of TBI with long-term stroke risk in diverse populations remains less clear. Our objective was to examine the long-term associations of TBI with stroke and to investigate potential differences by age, sex, race and ethnicity, and time since TBI diagnosis. Methods: Retrospective cohort study of US military veterans aged 18+ years receiving healthcare in the Veterans Health Administration system between October 1, 2002 and September 30, 2019. Veterans with TBI were matched 1:1 to veterans without TBI on age, sex, race and ethnicity, and index date, yielding 306 796 veterans with TBI and 306 796 veterans without TBI included in the study. In primary analyses, Fine-Gray proportional hazards models adjusted for sociodemographics and medical/psychiatric comorbidities were used to estimate the association between TBI and stroke risk, accounting for the competing risk of mortality. Results: Participants were a mean age of 50 years, 9% were female, and 25% were of non-White race and ethnicity. Overall, 4.7% of veterans developed a stroke over a median follow-up of 5.2 years. Veterans with TBI had 1.69 times (95% CI, 1.64-1.73) increased risk of any stroke (ischemic or hemorrhagic) compared to veterans without TBI. This increased risk was highest in the first-year post-TBI diagnosis (hazard ratio [HR], 2.16 [95% CI, 2.03-2.29]) but remained elevated for 10+ years. Similar patterns were observed for secondary outcomes, with associations of TBI with hemorrhagic stroke (HR, 3.92 [95% CI, 3.59-4.29]) being stronger than with ischemic stroke (HR, 1.56 [95% CI, 1.52-1.61]). Veterans with both mild (HR, 1.47 [95% CI, 1.43-1.52]) and moderate/severe/penetrating injury (HR, 2.02 [95% CI, 1.96-2.09]) had increased risk of stroke compared to veterans without TBI. Associations of TBI with stroke were stronger among older compared to younger individuals ( Conclusions: Veterans with prior TBI are at increased long-term risk for stroke, suggesting they may be an important population to target for primary stroke prevention measures.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Veterans ; Retrospective Studies ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Stroke/epidemiology ; Comorbidity
Language	English
Publishing date	2023-06-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.123.042360
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Article ; Online: Blood Biomarkers in Neurodegenerative Diseases: Implications for the Clinical Neurologist.

Alcolea, Daniel / Beeri, Michal Schnaider / Rojas, Julio C / Gardner, Raquel C / Lleó, Alberto

Neurology

2023 Volume 101, Issue 4, Page(s) 172–180

Abstract: Blood-based biomarkers offer a major advance in the clinical evaluation of neurodegenerative diseases. Currently, research studies have reported robust assays of blood markers for the detection of amyloid and tau pathologies specific to Alzheimer disease ...

Abstract	Blood-based biomarkers offer a major advance in the clinical evaluation of neurodegenerative diseases. Currently, research studies have reported robust assays of blood markers for the detection of amyloid and tau pathologies specific to Alzheimer disease (amyloid-β peptides, and p-tau) and nonspecific blood markers of neuronal (neurofilament light, β-synuclein, and ubiquitin-C-terminal-hydrolase-L1) and glial degeneration (glial fibrillary acidic protein) that can measure key pathophysiologic processes in several neurodegenerative diseases. In the near future, these markers may be used for screening, diagnosis, or disease and treatment response monitoring. Blood-based biomarkers for neurodegenerative diseases have been rapidly implemented in research, and they have the potential to enter clinical use soon in different clinical settings. In this review, we will describe the main developments and their potential implications for the general neurologist.
MeSH term(s)	Humans ; Alzheimer Disease/diagnosis ; Neurodegenerative Diseases/diagnosis ; Neurologists ; Amyloid beta-Peptides ; Biomarkers/blood
Chemical Substances	Amyloid beta-Peptides ; Biomarkers
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article ; Review ; Comment
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000207193
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Article ; Online: Healthy Days at Home Among Older Medicare Beneficiaries With Traumatic Brain Injury Requiring Inpatient Rehabilitation.

Kumar, Raj G / Evans, Emily / Albrecht, Jennifer S / Gardner, Raquel C / Dams-O'Connor, Kristen / Thomas, Kali S

The Journal of head trauma rehabilitation

2024

Abstract: Objective: The objectives of this study were to characterize and identify correlates of healthy days at home (HDaH) before and after TBI requiring inpatient rehabilitation. Setting: Inpatient hospital, nursing home, and home health services.: ... ...

Abstract	Objective: The objectives of this study were to characterize and identify correlates of healthy days at home (HDaH) before and after TBI requiring inpatient rehabilitation. Setting: Inpatient hospital, nursing home, and home health services. Participants: Average of n= 631 community-dwelling fee-for-service age 66+ Medicare beneficiaries across 30 replicate samples who were hospitalized for traumatic brain injury (TBI) between 2012 and 2014 and admitted to an inpatient rehabilitation facility (IRF) within 72 hours of hospital discharge. Design: Retrospective study using data from Medicare claims supplemented with data from the National Trauma Databank. Main measures: The primary outcome, HDaH, was calculated as time alive not using inpatient hospital, nursing home, and home health services in the year before TBI hospitalization and after IRF discharge. Results: We found HDaH declined from 93.2% in the year before TBI hospitalization to 65.3% in the year after IRF discharge (73.6% among survivors only). Most variability in HDaH was: (1) in the first 3 months after discharge and (2) by discharge disposition, with persons discharged from IRF to another acute hospital having the worst prognosis for utilization and death. In negative binomial regression models, the strongest predictors of HDaH in the year after discharge were rehabilitation Functional Independence Measure mobility score (β = 0.03; 95% CI, 0.002-0.06) and inpatient Charlson Comorbidity Index score (β = - 0.06; 95% CI, -0.13 to 0.001). Dual Medicaid eligible was associated with less HDaH among survivors (β = - 0.37; 95% CI, -0.66 to -0.07). Conclusion: In this study, among community-dwelling older adults with TBI, we found a notable decrease in the proportion of time spent alive at home without higher-level care after IRF discharge compared to before TBI. The finding that physical disability and comorbidities were the biggest drivers of healthy days alive in this population suggests that a chronic disease management model is required for older adults with TBI to manage their complex health care needs.
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	639221-0
ISSN	1550-509X ; 0885-9701
ISSN (online)	1550-509X
ISSN	0885-9701
DOI	10.1097/HTR.0000000000000954
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Article ; Online: Traumatic brain injury in older adults: do we need a different approach?

Peters, Matthew E / Gardner, Raquel C

Concussion (London, England)

2018 Volume 3, Issue 3, Page(s) CNC56

Language	English
Publishing date	2018-09-20
Publishing country	England
Document type	Editorial
ISSN	2056-3299
ISSN (online)	2056-3299
DOI	10.2217/cnc-2018-0001
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Article ; Online: Comparison Groups Matter in Traumatic Brain Injury Research: An Example with Dementia.

Albrecht, Jennifer S / Gardner, Raquel C / Wiebe, Douglas / Bahorik, Amber / Xia, Feng / Yaffe, Kristine

Journal of neurotrauma

2022 Volume 39, Issue 21-22, Page(s) 1518–1523

Abstract: The association between traumatic brain injury (TBI) and risk for Alzheimer disease and related dementias (ADRD) has been investigated in multiple studies, yet reported effect sizes have varied widely. Large differences in comorbid and demographic ... ...

Abstract	The association between traumatic brain injury (TBI) and risk for Alzheimer disease and related dementias (ADRD) has been investigated in multiple studies, yet reported effect sizes have varied widely. Large differences in comorbid and demographic characteristics between individuals with and without TBI could result in spurious associations between TBI and poor outcomes, even when control for confounding is attempted. Yet, inadvertent control for post-TBI exposures (e.g., psychological and physical trauma) could result in an underestimate of the effect of TBI. Choice of the unexposed or comparison group is critical to estimating total associated risk. The objective of this study was to highlight how selection of the comparison group impacts estimates of the effect of TBI on risk for ADRD. Using data on Veterans aged ≥55 years obtained from the Veterans Health Administration (VA) for years 1999-2019, we compared risk of ADRD between Veterans with incident TBI (
MeSH term(s)	Humans ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/complications ; Veterans ; Comorbidity ; Dementia/epidemiology ; Dementia/etiology
Language	English
Publishing date	2022-06-15
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2022.0107
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Article ; Online: Systematic Review, Meta-Analysis, and Population Attributable Risk of Dementia Associated with Traumatic Brain Injury in Civilians and Veterans.

Gardner, Raquel C / Bahorik, Amber / Kornblith, Erica S / Allen, Isabel Elaine / Plassman, Brenda L / Yaffe, Kristine

Journal of neurotrauma

2022 Volume 40, Issue 7-8, Page(s) 620–634

Abstract: Traumatic brain injury (TBI) is an established risk factor for dementia. However, the magnitude of risk is highly variable across studies. Identification of sub-populations at highest risk, with careful consideration of potential sources of bias, is ... ...

Abstract	Traumatic brain injury (TBI) is an established risk factor for dementia. However, the magnitude of risk is highly variable across studies. Identification of sub-populations at highest risk, with careful consideration of potential sources of bias, is urgently needed to guide public health policy and research into mechanisms and treatments. We conducted a systematic review and meta-analysis of risk of all-cause dementia after all-severity TBI. We assessed for effect of participant age and sex, veteran status, research methods, and region. The search window covered January 1990 to January 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Thirty-two studies met inclusion criteria. Data were pooled using random effects models. Population attributable risk (PAR) of dementia due to TBI in the U.S. was calculated by sex and veteran status. Pooled risk ratio (RR) for dementia after TBI was 1.66 (95% confidence interval 1.42-1.93). Younger age, male sex, and studies from Asia were associated with significantly higher risk; veteran status was not. Risk of dementia associated with "head injury/trauma" was not significantly different from that associated with "TBI" diagnosis specifically. PAR of dementia due to TBI among U.S. veterans was twice that of the general U.S. population, largely due to the high prevalence of TBI exposure in the majority male veteran population. This meta-analysis found that TBI is associated with nearly 70% increased risk of dementia. Risk may be highest among younger adults, men, and cohorts in Asia. Efforts to prevent TBI and also to prevent post-TBI dementia are of high importance. Additionally, improved methods for diagnosing and tracking TBI on a public health level, such as national registries, may improve the quality and generalizability of future epidemiological studies investigating the association between TBI and dementia.
MeSH term(s)	Adult ; Humans ; Male ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Dementia/epidemiology ; Dementia/etiology ; Risk Factors ; Veterans
Language	English
Publishing date	2022-12-08
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2022.0041
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Article ; Online: Physical and Functional Impairment Among Older Adults With a History of Traumatic Brain Injury.

Kornblith, Erica S / Langa, Kenneth M / Yaffe, Kristine / Gardner, Raquel C

The Journal of head trauma rehabilitation

2020 Volume 35, Issue 4, Page(s) E320–E329

Abstract: Objectives: To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI ... ...

Abstract	Objectives: To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI on these relations. Participants: A total of 1148 respondents to the 2014 Wave of the Health and Retirement Study, a nationally representative survey of older community-dwelling adults, randomly selected to participate in a TBI exposure survey. They reported no prior TBI (n = 737) or prior TBI (n = 411). Design: Cross-sectional survey study. Main measures: Physical impairment (self-reported difficulty with ≥1 of 8 physical activities); FI (self-reported difficulty with ≥1 of 11 activities of daily living); self-reported current neurobehavioral symptoms (pain, sleep problems, depression, subjective memory impairment); The Ohio State University TBI Identification Method (OSU-TBI-ID)-short form. Analyses: Stepwise logistic regression models ([1] unadjusted; [2] adjusted for demographics and medical comorbidities; [3] additionally adjusted for neurobehavioral symptoms) compared PI and FI between TBI groups. Results: Traumatic brain injury-exposed (mean: 33.6 years postinjury) respondents were younger, less likely to be female, and reported more comorbidities and neurobehavioral symptoms. Although TBI was significantly associated with increased odds of PI and FI in unadjusted models and models adjusted for demographics/comorbidities (adjusted odds ratio, 95% confidence interval: PI 1.62, 1.21-2.17; FI 1.60, 1.20-2.14), this association was no longer statistically significant after further adjustment for neurobehavioral symptoms. Conclusion: History of TBI is associated with substantial PI and FI among community-dwelling older adults. Further research is warranted to determine whether aggressive management of neurobehavioral symptoms in this population may mitigate long-term PI and FI in this population.
MeSH term(s)	Activities of Daily Living ; Aged ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Independent Living ; Male ; Middle Aged ; Odds Ratio ; Physical Functional Performance ; Psychomotor Disorders
Language	English
Publishing date	2020-07-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639221-0
ISSN	1550-509X ; 0885-9701
ISSN (online)	1550-509X
ISSN	0885-9701
DOI	10.1097/HTR.0000000000000552
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Article ; Online: Prevalence of Lifetime History of Traumatic Brain Injury among Older Male Veterans Compared with Civilians: A Nationally Representative Study.

Kornblith, Erica S / Yaffe, Kristine / Langa, Kenneth M / Gardner, Raquel C

Journal of neurotrauma

2020 Volume 37, Issue 24, Page(s) 2680–2685

Abstract: Traumatic brain injury (TBI) is common among older adults as well as among veterans in the United States and can increase risk for dementia. We compared prevalence of TBI in older male veterans and civilians using a nationally representative sample. We ... ...

Abstract	Traumatic brain injury (TBI) is common among older adults as well as among veterans in the United States and can increase risk for dementia. We compared prevalence of TBI in older male veterans and civilians using a nationally representative sample. We examined data from 599 male respondents to the 2014 wave of the Health and Retirement Study (HRS), a nationally representative survey of older adults, randomly selected to participate in a comprehensive TBI survey. Respondents self-reported no injury, non-TBI head/neck injury (NTI), or TBI. We used weighted analyses to examine prevalence of injury and relative risk of injury subtypes. Among male veterans, we found a national prevalence of more than 70% for lifetime history of any head/neck injury (TBI plus NTI), 14.3% for multiple NTI, and 36% for lifetime history of at least one TBI. In contrast, prevalence estimates for male civilians were 58% for lifetime history of head/neck injury, 4.8% for multiple NTI, and 45% for lifetime history of at least one TBI (all comparisons,
MeSH term(s)	Aged ; Aged, 80 and over ; Brain Injuries, Traumatic/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; United States/epidemiology ; Veterans/statistics & numerical data
Language	English
Publishing date	2020-08-26
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2020.7062
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Article: The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa.

Bobrow, Kirsten / Hoang, Tina / Barnes, Deborah E / Gardner, Raquel C / Allen, Isabel E / Yaffe, Kristine

Frontiers in neurology

2021 Volume 12, Page(s) 766705

Abstract: Background and Aims: ...

Abstract	Background and Aims:
Language	English
Publishing date	2021-11-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2021.766705
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