Background Injuries caused by falling are a major health concern among older population. For older people, falls are the leading cause of head injuries; especially, persons with cognitive disorders have an increased risk of falling.
Objective To compare the incidence of head injury and traumatic brain injury (TBI) among persons with Alzheimer’s disease (AD) with persons without AD.
Methods This register-based study was conducted on a nationwide cohort, which includes all community-dwelling persons diagnosed with AD in Finland in 2005–2011. Persons with previous head injuries were excluded, leaving 67 172 persons with AD. For each person with AD, a matching person without AD and previous head injury were identified with respect to age, sex and university hospital district. The Cox proportional hazard model and competing risk analyses were used to estimate HR for head injury and TBI.
Results Persons with AD had 1.34-fold (95% CI 1.29 to 1.40) risk of head injuries and 1.49-fold (95% CI 1.40 to 1.59) risk of TBIs after accounting for competing risks of death and full adjustment by socioeconomic status, drug use and comorbidities.
Conclusion Persons with AD are more likely to have a head injury or TBI incident than persons without AD.
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Contributors SH and A-MT planned the study. SI performed statistical analyses, drafted the first version of the manuscript and acts as a guarantor. AT and HT preprocessed and modelled the prescription data. All authors contributed to the interpretation of the data, revised the manuscript and approved the final manuscript.
Funding A-MT is funded by the Academy of Finland (grants 307232 and 295334). HT and A-MT acknowledge strategic funding from the University of Eastern Finland. The funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Competing interests SI and A-MT report no competing interests. SH reports lecture fees from MSD and Professional. HT and AT have participated in research projects funded by Janssen and Eli Lilly, with grants paid to the institution where they were employed. AT is a member of the advisory board of Janssen. JT has served as a consultant to the Finnish Medicines Agency Fimea, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, F Hoffmann-La Roche, Janssen-Cilag, Lundbeck and Organon; he has received fees for giving expert testimonies to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Otsuka and Pfizer; lecture fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Novartis, Otsuka and Pfizer; and grants from Stanley Foundation and Sigrid Jusélius Foundation. JT is a member of the advisory boards for AstraZeneca, Eli Lilly, Janssen-Cilag and Otsuka, and has participated in research projects funded by Janssen-Cilag and Eli Lilly, with grants paid to Karolinska Institutet.
Patient consent for publication Not required.
Ethics approval The MEDALZ data are collected from different national registers, and all data were pseudonymised by the register maintenance personnel so that personal identification numbers were replaced by research IDs. Therefore, according to Finnish law and Personal Data Act, informed consent or ethics committee approval is not needed because data used are routinely collected and anonymised, and this research does not have effect on the treatment of study subjects.
Provenance and peer review Not commissioned; externally peer reviewed.