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Cognitive testing was performed at five visits over 30 years and scores were combined into a global cognition factor score. Adjusted linear mixed\u2010effects models estimated the association of TBI with cognitive change.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 11,701 Atherosclerosis Risk in Communities (ARIC) Study participants (mean baseline age 58 years, 58% female, 25% Black) without TBI at baseline were included. Over follow\u2010up, 18% experienced TBI. The adjusted average decline in cognition per decade (standard deviation units) was more than twice as fast among individuals with \u2265 2 incident TBIs (\ud835\udefd\u00a0=\u00a0\u20130.158, 95% confidence interval [CI]\u00a0=\u00a0\u20130.253,\u20130.063), but not among individuals with 1 TBI (\ud835\udefd\u00a0=\u00a0\u20130.052, 95% CI\u00a0=\u00a0\u20130.107, 0.002), compared to without TBI (\ud835\udefd\u00a0=\u00a0\u20130.057, 95% CI\u00a0=\u00a0\u20130.095, \u20130.020).<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>This study provides robust evidence that TBIs fundamentally alter the trajectories of cognitive decline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The adjusted average decline in cognition per decade (standard deviation units) was more than twice as fast among individuals with \u2265 2 incident traumatic brain injuries (TBIs; \ud835\udefd\u00a0=\u00a0\u20130.158, 95% confidence interval [CI]\u00a0=\u00a0\u20130.253, \u20130.063), but not with 1 TBI (\ud835\udefd\u00a0=\u00a0\u20130.052, 95% CI\u00a0=\u00a0\u20130.107, 0.002), compared to without TBI (\ud835\udefd\u00a0=\u00a0\u20130.057, 95% CI\u00a0=\u00a0\u20130.095, \u20130.020).<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Over a period of 30 years, this difference in cognitive decline is equivalent to individuals with \u2265 2 TBIs being 9.7 years older at baseline.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Associations of TBI were stronger among individuals with one or two apolipoprotein E (<jats:italic>APOE<\/jats:italic>) \u03b54 alleles than among individuals with zero <jats:italic>APOE<\/jats:italic> \u03b54 alleles (<jats:italic>P<\/jats:italic> interaction\u00a0=\u00a00.007).<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.14104","type":"journal-article","created":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T00:59:20Z","timestamp":1720227560000},"page":"6232-6242","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Traumatic brain injury and cognitive change over 30 years among community\u2010dwelling older adults"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0026-5052","authenticated-orcid":false,"given":"Andrea L. 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