Traumatic Brain Injury Linked to Higher Long-Term Dementia-Related Mortality

Traumatic brain injury (TBI) was associated with higher long-term all-cause mortality in participants in the Framingham Heart Study (FHS), and the association appeared to be largely attributable to dementia-related mortality, according to a cohort study published in JAMA Network Open. In adjusted analyses, all-cause mortality risk increased with greater TBI severity, with a stronger association observed for moderate-to-severe injuries than for mild injuries.

In the study, investigators analyzed longitudinal data from the multigenerational, community-based FHS original and offspring cohorts, which spanned from 1948 to 2022. Participants with TBI were matched 1:3 to unexposed participants by birth year, sex, and generational cohort. TBI exposure was determined through medical record review and study examination visit documentation, and time-to-event models were adjusted for covariates including education, smoking, diabetes, hypertension, cardiovascular disease, and stroke history.

Key findings included the following:

• In the overall analysis, TBI was associated with higher all-cause mortality (hazard ratio [HR], 1.15; 95% CI, 1.06 to 1.26), with HRs of 1.06 (95% CI, 0.96 to 1.16) for mild TBI and 1.82 (95% CI, 1.48 to 2.25) for moderate-to-severe TBI.
• TBI was associated with higher dementia-related mortality (all TBI: HR, 1.83; 95% CI, 1.52 to 2.21), including mild TBI (HR, 1.60; 95% CI, 1.31 to 1.97) and moderate-to-severe TBI (HR, 3.67; 95% CI, 2.31 to 5.80).
• In analyses of participants with TBI, multiple TBIs (vs a single TBI) were associated with higher all-cause mortality (HR, 2.00; 95% CI, 1.66-2.41) and higher dementia-related mortality (HR, 3.61; 95% CI, 2.42 to 5.39).
• Dementia-related deaths accounted for 24.1% of deaths among participants with any TBI vs 8.7% among those without TBI (91/378 vs 150/1725).

Source: Burton R, Durape S, Price E, et al. Traumatic brain injury and all-cause and dementia-related mortality in the Framingham Heart Study. JAMA Netw Open. 2026;9(1):e2555138. doi:10.1001/jamanetworkopen.2025.55138.