Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study

Abstract

ObjectiveTo investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.DesignA retrospective population-based cohort study.SettingAdministrative health data for the Province of Manitoba between 1990–1991 and 2014–2015.ParticipantsA total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions.Results28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson’s disease.ConclusionConcussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

“…Few studies have assessed whether the relationship between TBI and ADRD risk differs by sex, 160 and the evidence has been mixed 161–166 . This may be because adverse health and psychosocial factors throughout the lifespan moderate the risk of ADRD following TBI 167–172 .…”

“…Few studies have assessed whether the relationship between TBI and ADRD risk differs by sex, 160 and the evidence has been mixed. 161 , 162 , 163 , 164 , 165 , 166 This may be because adverse health and psychosocial factors throughout the lifespan moderate the risk of ADRD following TBI. 167 , 168 , 169 , 170 , 171 , 172 For example, greater exposure to adverse childhood experiences earlier in life has been observed as a risk factor for both TBI and other poor health behaviors and outcomes that interact throughout life to increase ADRD risk.…”

Concussion and Psychological Effects: A Review of Recent Literature

“…Their analysis showed that concussion and substance use may have both a direct and indirect association via depression and anxiety with alcohol and cannabis use. This suggests that patients may be self-medicating with alcohol and cannabis to alleviate depression and anxiety symptoms associated with the concussion itself (12).…”

A Critical Analysis of Intestinal Enteric Neuron Loss and Constipation in Parkinson’s Disease

“…Other factors such as pesticide exposures [133][134][135][136], age and sex [137] likely contribute to the individual-level heterogeneity, with PD sex differences themselves seemingly influenced by the population of origin (Western vs. Asian) and the age at disease onset [138]. Concussions have been shown to significantly increase the risk of PD development [139], while cerebral microbleeds have been posited to contribute to heterogeneous PD pathogenesis [140].…”