Raquel C Gardner1,2,3, Ernesto Rivera1, Megan O'Grady4, Colin Doherty5, Kristine Yaffe1,2,3,6, John D Corrigan7, Jennifer Bogner7, Joel Kramer1,3, Fiona Wilson4. 1. Memory and Aging Center, Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA. 2. San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA. 3. Global Brain Health Institute, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA. 4. Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 5. Trinity Institute of Neurosciences (TCIN), School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 6. Departments of Psychiatry and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. 7. Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: Traumatic brain injury (TBI) is an established risk factor for dementia but mechanisms are uncertain. Accurate TBI exposure classification is critical for cognitive aging research studies seeking to discover mechanisms and treatments of post-TBI dementia. Brief TBI screens, commonly used in epidemiological studies of cognitive aging, are insensitive, leading to exposure mis-classification. Comprehensive TBI interviews, while more sensitive, may be impractical. OBJECTIVE: We aimed to develop and validate a scalable, self-administered, comprehensive, web-based, TBI exposure survey for use in international cognitive aging research. METHODS: We adapted a gold-standard comprehensive TBI interview (the Ohio State University TBI Identification Method; OSU TBI-ID) into a self-administered web-based survey for older adults (Older Adult modification of the OSU TBI-ID; OA OSU TBI-ID). We assessed reliability of our web-based survey versus the gold-standard interview among 97 older adults with normal cognition and mild cognitive impairment (MCI). In addition, we assessed sensitivity of the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) brief TBI screen versus the interview among 70 older adults with normal cognition. RESULTS: Our OA OSU TBI-ID web-based survey had good to excellent reliability versus the interview (κ 0.66-0.73; ICCs 0.68-0.81) even among the sub-set with MCI (κ 0.74-0.88; ICCs 0.76-0.85), except for several age-at-injury variables. The NACC UDS brief TBI screen missed 50% of TBI exposures identified using the OSU TBI-ID interview. CONCLUSION: The OSU TBI-ID interview and web-based survey may facilitate more accurate TBI exposure classification in cognitive aging research thereby accelerating discovery of targetable mechanisms of post-TBI dementia.
BACKGROUND:Traumatic brain injury (TBI) is an established risk factor for dementia but mechanisms are uncertain. Accurate TBI exposure classification is critical for cognitive aging research studies seeking to discover mechanisms and treatments of post-TBIdementia. Brief TBI screens, commonly used in epidemiological studies of cognitive aging, are insensitive, leading to exposure mis-classification. Comprehensive TBI interviews, while more sensitive, may be impractical. OBJECTIVE: We aimed to develop and validate a scalable, self-administered, comprehensive, web-based, TBI exposure survey for use in international cognitive aging research. METHODS: We adapted a gold-standard comprehensive TBI interview (the Ohio State University TBI Identification Method; OSUTBI-ID) into a self-administered web-based survey for older adults (Older Adult modification of the OSUTBI-ID; OA OSUTBI-ID). We assessed reliability of our web-based survey versus the gold-standard interview among 97 older adults with normal cognition and mild cognitive impairment (MCI). In addition, we assessed sensitivity of the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) brief TBI screen versus the interview among 70 older adults with normal cognition. RESULTS: Our OA OSUTBI-ID web-based survey had good to excellent reliability versus the interview (κ 0.66-0.73; ICCs 0.68-0.81) even among the sub-set with MCI (κ 0.74-0.88; ICCs 0.76-0.85), except for several age-at-injury variables. The NACC UDS brief TBI screen missed 50% of TBI exposures identified using the OSUTBI-ID interview. CONCLUSION: The OSUTBI-ID interview and web-based survey may facilitate more accurate TBI exposure classification in cognitive aging research thereby accelerating discovery of targetable mechanisms of post-TBIdementia.
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