Supplementary Material for: Clinical Features of Patients with Alzheimer’s Disease and a History of Traumatic Brain Injury

<b><i>Introduction:</i></b> Traumatic brain injury (TBI) has been associated with a greater risk of developing Alzheimer’s disease (AD). Less is known about the clinical features of AD patients with TBI history. The objective of this study was to examine whether a history of TBI and specific injury characteristics are associated with differences in age of disease onset, cognitive features, and neuropsychiatric symptoms (NPSs) in AD patients. <b><i>Methods:</i></b> Biomarker-proven AD patients (CSF or amyloid PET) were selected from the Amsterdam Dementia Cohort. TBI events were classified by age at injury (TBI &lt;25 or ≥25 years) and TBI severity (loss of consciousness, multiple events). Cognitive composite scores were calculated from results of a neuropsychological test battery. NPSs were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q). Linear regression analyses were utilized to examine associations between TBI, TBI characteristics, and clinical outcome measures. <b><i>Results:</i></b> Among the 1,755 selected AD patients (mean age = 65.2 years), 166 (9.5%) had documented ≥1 TBI in their medical history. Overall, TBI history was not related to differences in age of disease onset, but age at injury &lt;25 years old was associated with 2.3 years earlier age at symptom onset (<i>B</i> = −2.34, <i>p</i> = 0.031). No significant associations were found between TBI history or TBI characteristics and differences in cognition or NPSs. <b><i>Conclusion:</i></b> Our results underscore previous findings on the vulnerability of the brain during critical maturation phases and suggest that an early TBI may contribute to lower resilience to neurodegenerative changes.

<b><i>引言：</i></b> 创伤性脑损伤（traumatic brain injury, TBI）与阿尔茨海默病（Alzheimer’s disease, AD）的发病风险升高密切相关。目前学界对伴有创伤性脑损伤病史的阿尔茨海默病患者的临床特征尚缺乏充分认知。本研究旨在探讨阿尔茨海默病患者的创伤性脑损伤病史及具体损伤特征，是否与其发病年龄、认知特征及神经精神症状（neuropsychiatric symptoms, NPSs）存在关联。<b><i>方法：</i></b> 本研究从阿姆斯特丹痴呆队列（Amsterdam Dementia Cohort）中选取经生物标志物证实的阿尔茨海默病患者（脑脊液（cerebrospinal fluid, CSF）或淀粉样蛋白PET显像确诊）。依据创伤性脑损伤发生时的年龄，将患者分为<25岁组与≥25岁组，并按损伤严重程度分为意识丧失组、多次损伤组。认知综合得分由一套神经心理测试组合的结果计算得到。神经精神症状采用《神经精神问卷》（Neuropsychiatric Inventory Questionnaire, NPI-Q）进行评估。本研究采用线性回归分析方法，探讨创伤性脑损伤、创伤性脑损伤特征与临床结局指标之间的关联。<b><i>结果：</i></b> 本研究共纳入1755名阿尔茨海默病患者（平均年龄65.2岁），其中166名（9.5%）患者的病历资料显示存在至少1次创伤性脑损伤病史。总体而言，创伤性脑损伤病史与患者的发病年龄差异无显著关联，但受伤年龄<25岁的患者，其症状起病年龄较其余患者早2.3年（回归系数B=-2.34，p=0.031）。未发现创伤性脑损伤病史或其损伤特征与患者的认知水平或神经精神症状差异存在显著关联。<b><i>结论：</i></b> 本研究结果印证了此前关于大脑在关键成熟阶段易受损伤的研究结论，并提示早期创伤性脑损伤可能会降低机体对神经退行性病变的耐受能力。