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Mild head injury: Relation to cognition, dementia, fatigue & genetics
Umeå University, Faculty of Social Sciences, Department of Psychology.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Following a mild head injury (MHI), a person may report a variety of symptoms such as headache, memory disturbance, dizziness, and concentration difficulties. For most persons the symptoms are transient, but some suffer persistent symptoms that can have a major impact on everyday life. It remains poorly understood why some but not others have full recovery after MHI. The aim of this thesis was to investigate outcomes after MHI, with particular focus on neuropsychological functioning, fatigue, and risk of dementia. A related objective was to examine the potential association of a genetic factor, Apolipoprotein (APOE), with MHI outcome. The APOE є4 allele has been associated with unfavorable outcomes after moderate or severe head injury, but little is known about its influence on outcome after MHI. In Study I and II, data from a population-based longitudinal study were used to compare neuropsychological functioning and fatigue before and after MHI. The results from Study I showed a post-injury decline in neuropsychological performance for є4-carriers, whereas the performance remained unchanged for non-carriers. Study II showed an increase in self-reported fatigue after MHI for both є4-carriers and non-carriers, with a more pronounced increase for є4-carriers. In Study III, a case-control study was conducted to examine whether a history of MHI increased the risk of developing dementia later in life. It was found that MHI alone did not increase the risk, but the combination of MHI and APOE є4 was associated with increased risk of dementia. Taken together, the studies generally indicate a positive outcome after MHI, but in combination with APOE є4 even mild head injury may lead to long-lasting negative outcomes. Consideration of pre-injury level of functioning and genetic factors seems critical for a complete understanding of the impact of MHI.

Place, publisher, year, edition, pages
Umeå: Psykologi , 2006.
Keyword [en]
Neuropsychology, mild head injury, mild brain injury, apolipoprotein E
National Category
Psychology
Identifiers
URN: urn:nbn:se:umu:diva-852ISBN: 91-7264-158-4 (print)OAI: oai:DiVA.org:umu-852DiVA: diva2:144738
Public defence
2006-09-15, Beteendevetarhuset, Bt 102, Umeå universitet, Umeå, 10:15 (English)
Opponent
Supervisors
Available from: 2006-09-04 Created: 2006-09-04 Last updated: 2011-04-15Bibliographically approved
List of papers
1. APOE influences on neurosychological function after mild head injury: within-person comparisons
Open this publication in new window or tab >>APOE influences on neurosychological function after mild head injury: within-person comparisons
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2004 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 62, no 11, 1963-1966 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To examine the relationship between neuropsychological outcome following mild head injury (MHI) and APOE genotype.

Methods: Data from a population-based longitudinal study (n = 3,500) were used to identify 34 adults who experienced MHI during the course of the study. Their pre- and postinjury performances on a battery of nine neuropsychological tests were compared within person, and the postinjury performance was compared with that of age- and gender-matched control subjects.

Results: The within-person comparisons showed that participants with at least oneAPOE ε4 allele (n = 11) had a significantly decreased postinjury performance on three of the tests, whereas the postinjury performance for APOE ε4-negative participants (n = 23) was unchanged. There was no significant difference in postinjury performance between participants with/without the ε4 allele, and neither group was impaired relative to controls.

Conclusions: APOE genotype may influence the outcome following an MHI. Pre/postinjury within-person comparisons seem more sensitive than control group comparisons for detecting injury-related effects.

Place, publisher, year, edition, pages
Minneapolis, Minn: Lancet Publications Inc., 2004
Identifiers
urn:nbn:se:umu:diva-5270 (URN)10.1212/01.WNL.0000129268.83927.A8 (DOI)
Available from: 2006-09-04 Created: 2006-09-04 Last updated: 2011-04-13Bibliographically approved
2. Fatigue before and after mild head injury: pre-post injury comparisons in relation to Apolipoprotein E
Open this publication in new window or tab >>Fatigue before and after mild head injury: pre-post injury comparisons in relation to Apolipoprotein E
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(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-5271 (URN)
Available from: 2006-09-04 Created: 2006-09-04 Last updated: 2010-10-05Bibliographically approved
3. Increased risk of dementia following mild head injury for carriers but not for non-carriers of the APOE ε4 allele
Open this publication in new window or tab >>Increased risk of dementia following mild head injury for carriers but not for non-carriers of the APOE ε4 allele
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2007 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 19, no 1, 159-165 p.Article in journal (Refereed) Published
Abstract [en]

Background: The ε4 allele of apolipoprotein E (APOE) and head injury are risk factors for dementia diseases, and may act synergistically to further increase the risk. The aim of this study was to examine the association between mild head injury, APOE and dementia.

Methods: Data were obtained from the Betula prospective population-based study of aging, memory, and health. The study included 543 participants in the age range 40–85 years, free of dementia at baseline, who were followed up within a 5-year interval. Dementia was classified using DSM-IV criteria. Information on previous head injury was obtained through screening of the participants' answers to health questionnaires at baseline and at follow-up.

Results: Subjects with head injury but without APOE ε4 had no increased risk of dementia. Subjects with APOE ε4 had an increased risk and those with both APOE ε4 and head injury had the highest risk of dementia (odds ratio = 5.2).

Conclusions: APOE ε4 constitutes a risk factor for dementia, mild injury in isolation does not increase the risk, but head injury in combination with the APOE ε4 leads to increased risk of dementia.

Place, publisher, year, edition, pages
New York: Springer, 2007
Keyword
brain injury, apolipoprotein, Alzheimer´s disease
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-7470 (URN)10.1017/S1041610206003498 (DOI)
Available from: 2008-01-14 Created: 2008-01-14 Last updated: 2015-12-14

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Sundström, Anna

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