The Association Between Traumatic Brain Injury and the Risk of Cognitive Decline: An Umbrella Systematic Review and Meta-Analysis. [Review]

Mavroudis, I.; Kazis, D.; Petridis, FE.; Balmus, IM.; Papaliagkas, V.; Ciobica, A.

The Association Between Traumatic Brain Injury and the Risk of Cognitive Decline: An Umbrella Systematic Review and Meta-Analysis. [Review]

All Authors

Mavroudis, I.

Kazis, D.

Petridis, FE.

Balmus, IM.

Papaliagkas, V.

Ciobica, A.

LTHT Author

Mavroudis, Ioannis
Mavroudis, Ioannis

LTHT Department

Neurosciences

Publication Date

2024

Item Type

Journal Article
Review

Abstract

BACKGROUND: There is currently increasing interest in the implication of traumatic brain injury (TBI) as a potential risk factor for long-term neurodegenerative conditions, such as dementia and Alzheimer's disease (AD). In this context, we performed a systematic review and meta-analysis to evaluate the association between TBI and the risk of dementia. METHODS: A systematic search was performed across multiple electronic databases, including PubMed, Embase, and Cochrane Library, to identify relevant meta-analyses and cohort studies. Studies were included if they reported effect sizes (odds ratios [ORs] or relative risks [RRs]) for the association between TBI, its severity, and the risk of dementia or AD. Meta-analyses were performed using random-effects models to account for heterogeneity, and sensitivity analyses were conducted. RESULTS: A total of six studies were included in the analysis. The pooled results showed that TBI significantly increases the risk of dementia, with an overall odds ratio of 1.81 (95% CI: 1.53-2.14). Mild TBI was associated with a modest increase in dementia risk (OR = 1.96, 95% CI: 1.70-2.26), while moderate-to-severe TBI showed a stronger association (OR = 1.95, 95% CI: 1.55-2.45). In contrast, the association between TBI and AD was less consistent, with the pooled OR for AD being 1.18 (at 95% CI: 1.11-1.25) for mild TBI; however, in several studies, no significant association was observed (OR = 1.02, 95% CI: 0.91-1.15). The results also indicated substantial heterogeneity across studies, particularly in relation to AD outcomes. CONCLUSIONS: The findings from this umbrella meta-analysis confirm that TBI is a significant risk factor for dementia, with more severe TBIs conferring a higher risk. While mild TBIs also increase the risk of dementia, the effect is more pronounced in moderate-to-severe injuries. The evidence linking TBI to AD is less robust, with inconsistent findings across studies. Clinicians should consider long-term cognitive screening and management for individuals with a history of TBI, particularly those with moderate-to-severe injuries.