Associations of Race-Ethnicity and History of Traumatic Brain Injury With Age at Onset of Alzheimer's Disease

Objective: This study examined whether a history of traumatic brain injury (TBI) is associated with age at onset of Alzheimer's disease (AD) in three racial-ethnic groups. Methods: Data from 7,577 non-Hispanic Caucasian, 792 African American, and 870 Hispanic participants with clinically diagnosed AD were obtained from the National Alzheimer's Coordinating Center. Participants were categorized by the presence or absence of self-reported remote history of TBI (>1 year before diagnosis of AD) with loss of consciousness (LOC) (TBI+) or no history of TBI with LOC (TBI-). Any group differences in education; sex; APOE epsilon 4 alleles; family history of dementia; or history of depression, stroke, hypertension, hypercholesterolemia, and diabetes were included in analyses of covariance comparing clinicianestimated age at AD symptom onset for the TBI+ and TBI- groups. Results: AD onset occurred 2.3 years earlier for non-Hispanic Caucasians (F=30.49, df=1, 7,572, p,0.001) and 3.4 years earlier for African Americans (F=5.17, df=1, 772, p=0.023) in the TBI+ group. In the Hispanic cohort, females in the TBI+ group had AD onset 5.6 years earlier, compared with females in the TBI- group (F=6.96, df=1, 865, p=0.008); little difference in age at AD onset was observed for Hispanic males with and without a TBI history. Conclusions: A history of TBI with LOC was associated with AD onset 2-3 years earlier in non-Hispanic Caucasians and African Americans and an onset nearly 6 years earlier in Hispanic females; no associationwas observed inHispanicmales. Further work in underserved populations is needed to understand possible underlying mechanisms for these differences.