Virginia Via Research Day Book 2026

Medical Student Research Clinical

02 POST-CONCUSSION NEUROENDOCRINE DYSFUNCTION IS ASSOCIATED WITH MILD COGNITIVE IMPAIRMENT AND INCREASED RISK OF DEMENTIA

Marie-Claire Evans, MS-III; Luke Ignell, MS-III; Justin Weppner, DO Corresponding author: jlweppner@carilionclinic.org VCOM-Virginia, Blacksburg, Virginia Virginia Tech-Carilion School of Medicine, Roanoke, Virginia Carilion Clinic Brain Injury Center, Roanoke, Virginia Context: Traumatic brain injury (TBI) affects over 50 million people each year. Even mild TBI (mTBI) can lead to significant physical, cognitive, emotional, and psychosocial consequences. Previous studies have reported growth hormone deficiency, adrenocortical insufficiency, hypothyroidism, and hypogonadism after mTBI. While some studies suggest that neuroendocrine dysfunction (NED) following mTBI may increase the risk of cognitive impairment, the relationship between post-traumatic NED, mild cognitive impairment (MCI), and subsequent dementia remains unclear. Objective : This study aimed to evaluate the risk of developing MCI and dementia after mTBI in patients who develop NED. Methods: Using de-identified electronic health records from the TriNetX Research Network, we initially created two cohorts: the mTBI with NED (mTBI+/NED+) group contained patients between the ages 18-65 who developed NED after TBI; the TBI control group (mTBI+NED-) consisted of patients between the ages 18-65 with a diagnosis of TBI without post-injury NED. Several analyses were conducted centered around these 2 cohorts (mTBI+NED+ and

mTBI+NED-). Patients were 1:1 propensity matched by age, sex, race, and common comorbidities. Outcomes assessed included MCI at 3 months, 6 months, 12 months, 3 years, 5 years, and all-time after the index event. Analysis techniques including measures of association and survival were conducted across these different time points after the injury. The same analyses were then repeated for mTBI+/NED+ and mTBI+/ NED- cohorts stratified by age (18-29, 30-50, 50-65, 65+). We then created 2 more cohorts including patients between the ages of 18-65: mTBI with post-injury NED and MCI (mTBI+/NED+/MCI+) and mTBI with post-injury NED without MCI (mTBI+/NED+/MCI-) assessing dementia as the primary outcome using the same cohort-balancing parameters. Results: A total of 579,802 patients were identified in this study. After 1:1 propensity score-matching, there were 23,277 patients (mean [SD] age, 46.4 [13.6], 16,081 females [69.1%]) in the mTBI+/NED+ cohort and 23,277 patients (mean [SD] age, 46.7 [13.5], 16,669 females [71.6%]) in the mTBI+/NED- cohort. A diagnosis of neuroendocrine dysfunction any time after mTBI in patients 18-65 years old is associated with a higher risk of having MCI (p < 0.001). After

age stratification (18-29, 30-50, 50-65, 65+), risk is highest in patients 30-50 years old (p < 0.003) but was also significant in the 65+ age group (p < 0.001). Furthermore, there is a significantly increased risk of conversion to dementia in mTBI+/NED+/MCI+ patients all-time (p < 0.001) that increases over time (p < 0.001 at 3 years, p < 0.000 at 5 years). Conclusions: Adults who experience mTBI and subsequently develop NED are at increased risk for MCI and later progression to dementia. These findings emphasize the need for screening for NED and MCI, as well as early intervention, to help slow the progression to dementia in this patient population. IRB Statement: This study was determined to be exempt by the Carilion Clinic IRB.

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173 2026 Research Recognition Day