Elham Mahmoudi1, Paul Lin2, Mark D Peterson3, Michelle A Meade3, Denise G Tate4, Neil Kamdar5. 1. Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: Mahmoudi@med.umich.edu. 2. Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI. 3. Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI. 4. Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI. 5. Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
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.
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.
Authors: Ajay Kolli; Kristian Seiler; Neil Kamdar; Lindsey B De Lott; Mark D Peterson; Michelle A Meade; Joshua R Ehrlich Journal: Am J Ophthalmol Date: 2021-09-20 Impact factor: 5.258
Authors: Mark D Peterson; Michelle A Meade; Paul Lin; Neil Kamdar; Gianna Rodriguez; James S Krause; Elham Mahmoudi Journal: Spinal Cord Date: 2022-01-21 Impact factor: 2.473