• Deborah E Barnes, Allison Kaup, Katharine A Kirby, Amy L Byers, Ramon Diaz-Arrastia, and Kristine Yaffe.
• From the University of California, San Francisco (D.E.B., A.K., K.A.K., A.L.B., K.Y.); San Francisco Veterans Affairs Medical Center (D.E.B., A.K., K.A.K., A.L.B., K.Y.); and Uniformed Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine (R.D.-A.), Bethesda, MD. Deborah.barnes@ucsf.edu.
• Neurology. 2014 Jul 22;83(4):312-9.

ObjectivesTraumatic brain injury (TBI) is common in military personnel, and there is growing concern about the long-term effects of TBI on the brain; however, few studies have examined the association between TBI and risk of dementia in veterans.MethodsWe performed a retrospective cohort study of 188,764 US veterans aged 55 years or older who had at least one inpatient or outpatient visit during both the baseline (2000-2003) and follow-up (2003-2012) periods and did not have a dementia diagnosis at baseline. TBI and dementia diagnoses were determined using ICD-9 codes in electronic medical records. Fine-Gray proportional hazards models were used to determine whether TBI was associated with greater risk of incident dementia, accounting for the competing risk of death and adjusting for demographics, medical comorbidities, and psychiatric disorders.ResultsVeterans were a mean age of 68 years at baseline. During the 9-year follow-up period, 16% of those with TBI developed dementia compared with 10% of those without TBI (adjusted hazard ratio, 1.57; 95% confidence interval: 1.35-1.83). There was evidence of an additive association between TBI and other conditions on risk of dementia.ConclusionsTBI in older veterans was associated with a 60% increase in the risk of developing dementia over 9 years after accounting for competing risks and potential confounders. Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of TBI in younger veterans and civilians.© 2014 American Academy of Neurology.

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