Citation

White DL, Kunik ME, Yu H, Lin HL, Richardson PA, Moore S, Sarwar AI, Marsh L, Jorge RE. Ann. Neurol. 2020; ePub(ePub): ePub.

Affiliation

Mental Health Care Line, Michael E. DeBakey VA Medical Center and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

Copyright

(Copyright © 2020, John Wiley and Sons)

DOI

10.1002/ana.25726

PMID

32232880

Abstract

OBJECTIVE: Determining if traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are risk factors for Parkinson's disease (PD). This constitutes a research priority for the Veterans Administration (VA) with implications for screening policy and prevention.

METHODS: Population-based, matched case-control study among veterans using VA healthcare facilities from 10/1/1999 to 09/30/2013. We identified 176,871 PD cases and 707,484 randomly selected PD-free matched controls. Parkinson's Disease, TBI and PTSD were ascertained by validated ICD-9 code-based algorithms. We examined the association between both risk factors and PD employing race-adjusted conditional logistic regression.

RESULTS: The overall study cohort prevalence for TBI _mild , TBI _non-mild , and PTSD was 0.65%, 0.69% and 5.5% respectively. Both TBI and PTSD were significantly associated with PD in single-risk factor race-adjusted analyses (conditional odds ratio (cOR) =2.99 (95% CI: 2.69-3.32), 3.82 (95% CI: 3.67-3.97), and 2.71 (95% CI: 2.66-2.77) for TBI _mild , TBI _non-mild and PTSD, respectively). There was suggestive positive interaction observed with comorbid PTSD/TBI in dual-risk factor analyses, with significant 2.69-fold and 3.70-fold excess relative PD risk in veterans with TBI _mild and TBI _non-mild vs. those without TBI when PTSD was present vs. 2.17-fold and 2.80-fold excess risk when PTSD was absent.

INTERPRETATION: Our study was the first to demonstrate that both TBI and PTSD are independently associated with increased relative PD risk in a diverse nationwide cohort of military service veterans, and the first to suggest a potential modest synergistic excess risk in those with comorbid TBI/PTSD. Longitudinal research is needed to confirm these suggestive findings. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Epidemiology; Injury; Mental Health; Movement Disorders; Neurology; Occupational Health