@article{ref1,
title="Post-traumatic stress disorder is associated with further increased Parkinson's disease risk in veterans with traumatic brain injury",
journal="Annals of neurology",
year="2020",
author="White, Donna L. and Kunik, Mark E. and Yu, Hong and Lin, Helen L. and Richardson, Peter A. and Moore, Suzanne and Sarwar, Aliya I. and Marsh, Laura and Jorge, Ricardo E.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>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. <br><br>RESULTS: The overall study cohort prevalence for TBI <sub>mild</sub> , TBI <sub>non-mild</sub> , 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 <sub>mild</sub> , TBI <sub>non-mild</sub> 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 <sub>mild</sub> and TBI <sub>non-mild</sub> vs. those without TBI when PTSD was present vs. 2.17-fold and 2.80-fold excess risk when PTSD was absent. <br><br>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.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0364-5134",
doi="10.1002/ana.25726",
url="http://dx.doi.org/10.1002/ana.25726"
}