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Ask the Mental Health Expert Archives 2001-2004

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Alzheimer's and TBI

Q. How common is Alzheimer's in people who have traumatic brain injury? I am a 33-year-old female with a level 1 traumatic brain injury (TBI) and have experienced dementia and similar signs of Alzheimer's because of short-term memory issues. Will this be an issue later in life for me? Does this happen to survivors with brain injury? Does it happen worse for people with a TBI than someone who doesn't have brain damage?

A. There are some data showing an association between head injury/TBI and the development of Alzheimer's, but the risk seems to be restricted to males. Fleminger et al (J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):857-62.), in a review of 15 studies, found an excess history of head injury in those with Alzheimer's disease, but only in males. The likelihood of TBI history was about twice as high in males with Alzheimer's, compared with suitable case controls. Of course, "association" does not equal "causality". In other words, it's not clear that TBI actually causes increased rates of Alzheimer's Disease. It could be that some third factor increases the risk of both TBI and Alzheimer's Disease. And, of course, TBI itself is commonly associated with memory problems.

In short, I don't think there are good data to conclude that you are at increased risk for Alzheimer's Disease. Interestingly, there are some theories that do link both TBI and Alzheimer's Disease to deficits in a brain chemical called acetylcholine (DB Arciniegas, Curr Psychiatry Rep. 2003 Oct;5(5):391-9). There is also some very preliminary research suggesting that medications useful in Alzheimer's Disease, such as Aricept, may also be of benefit for those with memory problems due to TBI (see Morey et al, Brain Inj. 2003 Sep;17(9):809-15). You may want to discuss this issue with your doctor, to see if you might benefit from this type of medication. Cognitive "remediation" training may also be very helpful after TBI, and I hope you have had the benefit of this--if not, I'd also discuss that with your doctor.

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January 2004

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