Traumatic brain injury and firearm use and risk of progressive supranuclear palsy among veterans
Background: Progressive supranuclear palsy (PSP) is a tauopathy that has a multifactorial etiology. Numerous studies that have investigated lead exposure and traumatic brain injury (TBI) as risk factors for other tauopathies, such as Alzheimer's disease, but not for PSP. Objective: We sought to investigate the role of firearm usage, as a possible indicator of lead exposure, and TBI as risk factors for PSP in a population of military veterans. Methods: We included participants from a larger case-control study who reported previous military service. Our sample included 67 PSP cases and 68 controls. Participants were administered a questionnaire to characterize firearm use in the military and occurrence of TBI. Results: Cases were significantly less educated than controls. In unadjusted analyses, the proportion of PSP cases (80.6%) and controls (64.7%) who reported use of firearms as part of their military job was positively associated with PSP, odds ratio (OR) 2.2 (95% CI: 1-5.0). There were no significant case-control differences in mean service duration. There was only a weak association with history of TBI, OR 1.6 (95% CI: 0.8-3.4). In multivariate models, firearm usage (OR 3.7, 95% CI: 1.5, 9.8) remained significantly associated with PSP. Conclusions: Our findings show a positive association between firearm usage and PSP and an inverse association between education and PSP. The former suggests a possible etiologic role of lead. Further studies are needed to confirm the potential etiologic effects of metals on PSP. Copyright 2018 Kelley, Checkoway, Hall, Reich, Cunningham and Litvan. ; This study was funded by National Institute of Aging 5R01AG024040. Additionally, the project described was partially supported by the National Institutes of Health, Grant TL1TR001443 of CTSA, NIH, National Institute of Environmental Health Sciences, the National Multiple Sclerosis Society, the Parkinson Foundation, the Shapiro Foundation, Pfizer, Neurocrine and NIH-NINDS/ORDR-NCATS. ; https://dx.doi.org/10.3389/fneur.2018.00474