ImportanceAlthough both head injury and epilepsy are associated with long-term dementia risk, posttraumatic epilepsy (PTE) has only been evaluated in association with short-term cognitive outcomes.ObjectiveTo investigate associations of PTE with dementia risk.Design, Setting, and ParticipantsThe Atherosclerosis Risk in Communities (ARIC) study initially enrolled participants from 1987 to 1989 and this prospective cohort study uses data through December 31, 2019, with a median follow-up of 25 years. Data were analyzed between March 14, 2023, and January 2, 2024. The study took place in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC study participants initially enrolled, 2061 were ineligible and 1173 were excluded for missing data, resulting in 12 558 included participants.ExposuresHead injury was defined by self-report and International Classification of Diseases (ICD) diagnostic codes. Seizure/epilepsy was defined using ICD codes. PTE was defined as a diagnosis of seizure/epilepsy occurring more than 7 days after head injury. Head injury, seizure/epilepsy, and PTE were analyzed as time-varying exposures.Main Outcomes and MeasuresDementia was defined using cognitive assessments, informant interviews, and ICD and death certificate codes. Adjusted Cox and Fine and Gray proportional hazards models were used to estimate dementia risk.ResultsParticipants had a mean (SD) age of 54.3 (5.8) years at baseline, 57.7% were female, 28.2% were of self-reported Black race, 14.4% were ultimately categorized as having head injury, 5.1% as having seizure/epilepsy, and 1.2% as having PTE. Over a median follow-up of 25 (25th to 75th percentile, 17-30) years, 19.9% developed dementia. In fully adjusted models, compared with no head injury and no seizure/epilepsy, PTE was associated with 4.56 (95% CI, 4.49-5.95) times the risk of dementia, while seizure/epilepsy was associated with 2.61 (95% CI, 2.21-3.07) times the risk and head injury with 1.63 (95% CI, 1.47-1.80) times the risk. The risk of dementia associated with PTE was significantly higher than the risk associated with head injury alone and with nontraumatic seizure/epilepsy alone. Results were slightly attenuated in models accounting for the competing risks of mortality and stroke, but patterns of association remained similar. In secondary analyses, the increased dementia risk associated with PTE occurring after first vs second head injury and after mild vs moderate/severe injury was similar.Conclusions and RelevanceIn this community-based cohort, there was an increased risk of dementia associated with PTE that was significantly higher than the risk associated with head injury or seizure/epilepsy alone. These findings provide evidence that PTE is associated with long-term outcomes and supports both the prevention of head injuries via public health measures and further research into the underlying mechanisms and the risk factors for the development of PTE, so that efforts can also be focused on the prevention of PTE after a head injury.

中文翻译：

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创伤后癫痫和痴呆风险

重要性虽然头部受伤和癫痫都与长期痴呆风险相关，但创伤后癫痫 (PTE) 仅与短期认知结果相关。目的调查 PTE 与痴呆风险的关联。设计、设置和参与者动脉粥样硬化风险社区 (ARIC) 研究最初招募了 1987 年至 1989 年的参与者，这项前瞻性队列研究使用截至 2019 年 12 月 31 日的数据，中位随访时间为 25 年。数据分析时间为2023年3月14日至2024年1月2日。该研究在明尼苏达州、马里兰州、北卡罗来纳州和密西西比州的4个美国社区进行。在最初招募的 15,792 名 ARIC 研究参与者中，2061 名不符合资格，1173 名因缺失数据而被排除，最终纳入了 12,558 名参与者。国际疾病分类（ICD) 诊断代码。癫痫发作/癫痫的定义是ICD代码。PTE 被定义为头部受伤后 7 天以上发生的癫痫发作/癫痫的诊断。头部损伤、癫痫发作/癫痫和 PTE 作为随时间变化的暴露进行分析。主要结果和测量痴呆症是通过认知评估、知情者访谈和ICD和死亡证明代码。使用调整后的 Cox 和 Fine and Gray 比例风险模型来估计痴呆风险。结果参与者的基线平均 (SD) 年龄为 54.3 (5.8) 岁，其中 57.7% 为女性，28.2% 为自我报告的黑人种族，14.4% 为女性最终被归类为头部受伤，5.1% 被归类为癫痫发作/癫痫，1.2% 被归类为患有 PTE。在中位随访 25 年（第 25 个百分位至第 75 个百分位数，17-30 年）中，19.9% 的人患上了痴呆症。在完全调整的模型中，与无头部损伤和无癫痫发作/癫痫的情况相比，PTE 与痴呆风险的 4.56 倍（95% CI，4.49-5.95）相关，而癫痫发作/癫痫与 2.61 倍（95% CI，2.21）相关。 -3.07) 倍的风险，头部受伤的风险为 1.63 (95% CI, 1.47-1.80) 倍。与 PTE 相关的痴呆风险显着高于单独头部损伤和单独非创伤性癫痫发作/癫痫相关的风险。在考虑死亡率和中风竞争风险的模型中，结果略有减弱，但关联模式仍然相似。在二次分析中，第一次与第二次头部受伤后以及轻度与中度/重度受伤后发生的与 PTE 相关的痴呆风险增加相似。结论和相关性在这个基于社区的队列中，与 PTE 相关的痴呆风险增加是显着高于仅与头部受伤或癫痫发作/癫痫相关的风险。这些发现提供了PTE与长期结果相关的证据，并支持通过公共卫生措施预防头部损伤，并进一步研究PTE发生的潜在机制和风险因素，以便将努力的重点放在以下方面：头部受伤后预防 PTE。