The association of traumatic brain injury with rate of progression of cognitive and functional impairment in a population-based cohort of Alzheimer's disease: the Cache County Dementia Progression Study.

BACKGROUND: There is limited research on factors that influence the rate of progression in Alzheimer's disease (AD). A history of traumatic brain injury (TBI) is associated with an increased risk for AD, but its role on the rate of dementia progression after the onset of AD has not been examined. METHODS: A population-based cohort of 325 persons with incident AD was followed for up to 11 years. The sample was 65% female with a mean (SD) age of dementia onset = 84.4 (6.4) years. History of TBI was categorized as number, severity (with or without loss of consciousness), and timing in relation to dementia onset (within ten years or more than ten years). Cognition was assessed by the Consortium to Establish a Registry of AD battery, and functional ability was assessed by the Clinical Dementia Rating Sum of Boxes. RESULTS: In linear mixed models, a history of TBI within ten years of onset showed faster progression of functional impairment (LR x2 = 10.27, p = 0.006), while those with TBI more than ten years before dementia onset had higher scores on a measure of list learning (ß = 1.61, p = 0.003) and semantic memory (ß = 0.75, p = 0.0035). CONCLUSIONS: History of TBI and its recency may be a useful factor to predict functional progression in the course of AD.

Positive psychological variables in the prediction of life satisfaction after spinal cord injury.

OBJECTIVE: To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge. DESIGN: Prospective observational design; correlational and regression analyses. Eighty-seven adults who were participating in in-patient, acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures: Benefit finding Scale, Hope Scale, Brief Symptom Inventory, COPE, Positive and Negative Affect Schedule, and Satisfaction with Life Scale. RESULTS: Hypothesized relationships of hope and positive affect (facilitator variables) with greater life satisfaction during the initial acute rehabilitation period were supported. Facilitators, as measured at baseline, accounted for a significant amount of variance in life satisfaction above and beyond barrier variables (depression, negative affect, and avoidant coping) both during the acute rehabilitation phase (R(2) change = .20, p < .0001) and at 3 months after discharge (R(2) change = .09, p < .029). CONCLUSIONS: Findings suggest that positive psychological variables play a significant role in postrehabilitation subjective well-being for persons with spinal cord injury and may provide potential avenues for interventions to facilitate positive outcomes.