Increased Risk of Dementia in Patients with Craniofacial Trauma: A Nationwide Population-Based Cohort Study

OBJECTIVE: The role of maxillofacial trauma in dementia risk is not well established. The aim of this study was to evaluate the association between craniofacial trauma, including facial bone fracture and traumatic brain injury (TBI), and dementia. METHODS: Using Taiwan's National Health Insurance Research Database, we identified 501,889 adults who had had >= 1 medical record of craniofacial trauma between 2000 and 2010 and did not have a dementia diagnosis at baseline. Diagnoses of craniofacial trauma, including facial bone fracture and TBI, and dementia were made using International Classification of Diseases, Ninth Revision codes. The standardized incidence ratio was used to determine whether craniofacial trauma was associated with a greater risk of incident dementia compared with the general population. The Cox proportional hazards model was used to predict the risk of dementia among the trauma cohort by comparing the patients with and without comorbidities. RESULTS: A total of 501,889 patients with craniofacial trauma were included, of which 1.5% (n = 7804) developed dementia. Facial bone fracture (standardized incidence ratio, 1.58; 95% confidence interval, 1.25-2.00) was shown to be associated with an increased dementia risk compared with the general population. In addition, craniofacial trauma accompanied with postinjury comorbidities was associated with an increased risk of dementia during follow-up periods compared with the group without comorbidities. CONCLUSIONS: Craniofacial traumas, especially facial bone fracture, were associated with an increased risk of subsequent dementia. Maintaining a high index of suspicion for associated TBIs in all patients with facial trauma is crucial, even if no obvious initial signs and symptoms of brain injury are observed.