About

Andrea Lauren Christman Schneider, MD, PhD, is an Assistant Professor of Neurology at the Hospital of the University of Pennsylvania and a Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. She is also a Senior Scholar at the Penn Injury Science Center and a Senior Fellow at the Leonard Davis Institute of Health Economics, all within the University of Pennsylvania Perelman School of Medicine. Her department is Neurology, and she is affiliated with the Graduate Group in Neuroscience and the Graduate Group in Epidemiology and Biostatistics. Dr. Schneider's educational background includes a BA in Neuroscience from Johns Hopkins University (2006), a PhD in Epidemiology from Johns Hopkins University Bloomberg School of Public Health (2012), and an MD from Johns Hopkins School of Medicine (2014). Her research focuses on traumatic brain injury, cerebrovascular risk factors, and neurodegenerative biomarkers, with numerous publications in these areas. She is involved in advancing understanding of the outcomes and epidemiology of neurological injuries and diseases, contributing significantly to her field through her research and academic roles.

Research topics

• Medicine
• Physical therapy
• Gerontology
• Internal medicine
• Surgery
• Medical emergency
• Physical medicine and rehabilitation
• Emergency medicine
• Psychiatry

Selected publications

• Occupation, Retirement Age, and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities Neurocognitive Study

  UNC Libraries · 2026-04-21

  articleOpen access

  INTRODUCTION: We examined the association of both midlife occupation and age at retirement with cognitive decline in the Atherosclerosis Risk in Communities (ARIC) biracial community-based cohort. METHODS: Current or most recent occupation at ARIC baseline (1987-1989; aged 45-64 years) was categorized based on 1980 US Census major occupation groups and tertiles of the Nam-Powers-Boyd occupational status score (n = 14,090). Retirement status via annual follow-up questionnaires administered ascertained in 1999-2007 was classified as occurring before or after age 70 (n = 7,503). Generalized estimating equation models were used to examine associations of occupation and age at retirement with trajectories of global cognitive factor scores, assessed from visit 2 (1990-1992) to visit 5 (2011-2013). Models were a priori stratified by race and sex and adjusted for demographics and comorbidities. RESULTS: Low occupational status and blue-collar occupations were associated with low baseline cognitive scores in all race-sex strata. Low occupational status and homemaker status were associated with faster decline in white women but slower decline in black women compared to high occupational status. Retirement before age 70 was associated with slower cognitive decline in white men and women and in black men. Results did not change substantially after accounting for attrition. CONCLUSION: Low occupational status was associated with cognitive decline in women but not in men. Earlier retirement was associated with a slower cognitive decline in white participants and in black men. Further research should explore reasons for the observed associations and race-sex differences.

  PublisherDOI

• Neuroimaging Correlates of Traumatic Brain Injury in an Older Community-Dwelling Population

  Neurology · 2025-04-04 · 1 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Neuroimaging correlates of remote traumatic brain injury (TBI) are not well understood. Our objective was to examine associations of TBI with brain MRI markers of degeneration and vascular disease. METHODS: -score cut-point of -1.5 for volumetrics, cortical thickness, and fractional anisotropy (FA) and above +1.5 for mean diffusivity (MD). RESULTS: -score cut-point only for FA and MD. DISCUSSION: In this community-dwelling cohort of older adults, TBI was associated with smaller brain volumes, lower cortical thickness, lower FA, and higher MD. Further work is needed in the chronic postinjury period to elucidate the mechanisms underlying the observed structural changes after TBI.

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• Traumatic brain injury, changes in plasma amyloid, tau, and neurodegenerative biomarkers, and dementia risk

  Alzheimer s & Dementia · 2025-09-01 · 3 citations

  articleOpen accessSenior authorCorresponding

  Abstract INTRODUCTION Long‐term trajectories of plasma biomarkers in relation to incident traumatic brain injury (TBI) and whether TBI modifies associations of biomarkers with dementia risk are unknown. METHODS One thousand fifty Atherosclerosis Risk in Communities (ARIC) study participants without prior TBI had amyloid beta (Aβ 42 /Aβ 40 ), phosphorylated‐tau181 (pTau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) measured from plasma collected in 1993 to 1995, 2011 to 2013, and 2016 to 2019. Linear mixed‐effects models estimated biomarker trajectories associated with TBI and Cox proportional hazards models determined if TBI modified associations of biomarkers with incident dementia through December 31, 2020. RESULTS After the median time of incident TBI, Aβ 42 /Aβ 40 levels remained lower for 9.3 years, and pTau181, NfL, and GFAP remained elevated for 8.5, >13.8, and 12.7 years, respectively. There was evidence of additive interaction by TBI in associations of log 2 NfL with incident dementia ( p = 0.024). DISCUSSION TBI alters trajectories of plasma biomarkers of neurodegeneration for approximately a decade after the injury and modifies associations of NfL with dementia risk. Highlights Our findings provide evidence that TBI fundamentally alters trajectories of plasma biomarkers of AD‐related pathology, neuronal degeneration, and astrogliosis for approximately a decade after the injury. Further, our findings also suggest that an incident TBI event adds to and interacts with ongoing neurodegenerative processes to increase the risk of later life dementia. These results suggest that the pathologic processes underlying post‐TBI dementia are heterogeneous, that individuals with preclinical changes in neurodegenerative biomarkers may be more susceptible to TBI (i.e., that associations are bidirectional), or a combination thereof.

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• Swallowing and choking difficulties as potential markers of FXTAS progression in FMR1 premutation carriers

  Scientific Reports · 2025-11-26

  articleOpen access

  Fragile X-associated tremor/ataxia syndrome (FXTAS) affects motor and coordination pathways and is linked to swallowing and choking difficulties, which can lead to aspiration pneumonia, a leading cause of death in late-stage FXTAS. Despite their severity, these issues are under-investigated. This study examined their association with FXTAS stages and potential as markers of disease progression in FMR1 premutation (PM) carriers. A secondary analysis of Genotype-Phenotype cohort data (2017-2025, MIND Institute, UC Davis) examined swallowing/choking problems, FXTAS stage, neuroimaging, and psychological distress (Symptom Checklist-90-Revised; SCL-90-R). Associations between independent and dependent variables were tested using Generalized Estimating Equation (GEE) regression due to their correlated data. The study included 169 PM carriers (mean age 65 ± 10.9 years; 54% male), with approximately 35% reporting swallowing/choking difficulties. After adjusting for age and sex, individuals in the severe stage of FXTAS (stage 4-5) had a significantly higher risk of swallowing/choking problems compared to those without FXTAS (adjusted odds ratio [aOR] = 4.17; 95%CI = 1.28-13.58). PM carriers with swallowing/choking problems showed a significantly increased association with magnetic resonance imaging (MRI) findings of moderate to severe abnormalities in several brain regions, including cerebral atrophy (aOR = 2.69, p = 0.027), cerebellar atrophy (aOR = 3.34, p = 0.013), cerebellar white matter hyperintensity (aOR = 3.33, p = 0.012), and pons white matter hyperintensity (aOR = 3.93, p = 0.035). Swallowing/choking problems are common in FXTAS, particularly in later stages, and may represent an important clinical marker of disease progression. These patients should be referred to speech-language pathologists for evaluation and treatment. Such interventions could reduce morbidity-mortality associated with these problems.

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• Income, Race-Ethnicity, and Dementia Risk Factors in the United States

  Neurology · 2025-11-12

  articleOpen accessSenior author

  OBJECTIVES: To determine population attributable fractions (PAFs) of modifiable dementia risk factors by income, and independent and interactive associations of race-ethnicity and income with each risk factor and cumulative number of midlife risk factors. METHODS: This nationally representative cross-sectional study of the 1999-2008, 2011-2014, and primarily the 2015-2018 National Health and Nutrition Examination Surveys comprised of individuals aged 18-44, 45-64, and 65+ years for early-life, midlife, and late-life analyses, respectively. Income was operationalized using the poverty-income ratio. The primary outcomes were PAFs and prevalence ratios (PR) of the 13 individual-level dementia risk factors and cumulative number of midlife risk factors. RESULTS: There were 13,145 individuals with risk factor data between 2015 and 2018 (51.1% aged 18-44, 31.0% aged 45-64, and 17.9% aged ≥65 years; 51.5% female after survey-weighting). Higher income was associated with lower prevalence of each dementia risk factor except obesity, high LDL, and TBI. The highest PAF for those with incomes <100% of the federal poverty level was late-life vision loss (20.9%, 95% CI 16.8%-25.2%). Higher income was associated with lower number of midlife risk factors (PR: 0.91, 95% CI 0.89-0.94). Race-ethnicity categories historically-underrepresented in dementia studies were associated with midlife diabetes, obesity, physical inactivity, and late-life vision loss. DISCUSSION: Lower income and historically underrepresented race-ethnicity categories are associated with many dementia risk factors. Dementia prevention efforts may be more successful by targeting modifiable risk factors in these higher-risk populations.

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• Traumatic Brain Injury and Depressive Symptoms in Community-Dwelling Older Adults

  Neurology · 2025-11-20 · 1 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Mood symptoms are recognized short-term sequelae of traumatic brain injury (TBI). Research regarding depressive symptoms among older, community-based individuals with TBI is limited. Previous studies have largely focused on short-term and intermediate-term follow-up. METHODS: The Atherosclerosis Risk in Communities study is an ongoing prospective cohort study of community-dwelling adults in the United States, initially recruited from 1987 to 1989. TBI was defined using self-reported and International Classification of Diseases diagnostic codes. Participants were sampled from centers in Maryland, Minnesota, Mississippi, and North Carolina. Depressive symptoms and antidepressant prescription(s) were assessed beginning at visit 5 (2011-2013) and were analyzed as time-varying repeated outcome measures until visit 7 (2018-2019), representing a maximum follow-up interval of 9 years. We used generalized estimating equations (GEEs) with an autoregressive working correlation structure and binomial distribution with a log link to estimate risk ratios (RRs) for the association of TBI with time-varying depressive symptoms and antidepressant prescription(s), adjusting for sociodemographic characteristics including age, race and study center, income, educational attainment, and history of military service. RESULTS: Our analysis included 6,607 individuals who attended at least 1 study visit between visits 5 and 7. The median age was 75 years (25th-75th percentiles = 72-80). More than half were female (59.0%), and 23.7% self-identified as Black. There were 2,113 participants (32.0%) with a lifetime history of TBI, most of which were classified as mild. There were 665 individuals (10.1%) who experienced depressive symptoms and 1,225 (18.5%) with antidepressant prescriptions recorded during follow-up. In fully adjusted GEE models, TBI was associated with an increased risk of depressive symptoms (RR 1.59, 95% CI 1.37-1.85) and antidepressant use (RR 1.32, 95% CI 1.20-1.45). These results persisted in analysis of subgroups defined by age, sex, race, and participant health characteristics, regardless of TBI frequency or severity. DISCUSSION: We observed a robust and persistent association of TBI with depressive symptoms and antidepressant prescriptions in this cohort of older, community-dwelling adults regardless of participant characteristics. These results suggest that universal screening for and prompt treatment of depressive symptoms in among older adults with a history of TBI is warranted.

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• Hospital Readmission After Traumatic Brain Injury Hospitalization in Community‐Dwelling Older Adults

  Annals of Clinical and Translational Neurology · 2025-11-30

  articleOpen accessSenior authorCorresponding

  OBJECTIVE: To examine the risk of hospital readmission after an index hospitalization for TBI in older adults. METHODS: Using data from the Atherosclerosis Risk in Communities (ARIC) study, we used propensity score matching of individuals with an index TBI-related hospitalization to individuals with (1) non-TBI hospitalizations (primary analysis) and (2) orthopedic injury hospitalizations (secondary analysis). The rate of all-cause hospital readmission was estimated using adjusted Fine-Gray proportional hazards regression models within strata defined by time since hospitalization. Follow-up extended from the date of index hospitalization after study enrollment (1987-1989) through December 31, 2019. RESULTS: Six hundred sixty-seven participants with an index TBI-related hospitalization were matched using propensity scores with replacement with a ratio of 1:4-2668 participants with non-TBI-related hospitalizations and 1:3 with 2001 participants with orthopedic injury-related hospitalizations. Median age was 68 years (IQR = 46-95) at index hospitalization. Compared to participants with an index non-TBI-related hospitalization, readmission rates were lower among participants with an index TBI-related hospitalization (HR = 0.80, 95% CI = 0.74, 0.87) over a median follow-up of 2.7 years, although similar readmission rates were observed within the first year of follow-up (HR = 1.03, 95% CI = 0.88, 1.21). Rates of hospital readmission among persons with an index TBI-related hospitalization were similarly decreased compared with persons with an orthopedic injury-related hospitalization (HR = 0.78, 95% CI = 0.72, 0.85) over a median follow-up of 3.1 years. INTERPRETATION: Among community-dwelling older adults with a TBI-related hospitalization, rates of hospital readmission were similar to individuals hospitalized for a non-TBI cause in the first year, but lower subsequently. Targeted interventions in the first year post-hospitalization may be most beneficial for reducing readmissions among individuals with TBI.

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• Risk of Mortality Among Adult Females Diagnosed with Traumatic Brain Injury in an Academic Medical System

  Neurotrauma Reports · 2025-10-08

  articleOpen accessCorresponding

  The objective of this retrospective cohort study was to evaluate mortality risk over five years among 6,432 female patients with a health care encounter diagnosis of TBI from hospitals and outpatient clinics within a university health system. We used TBI severity, defined by the Centers for Disease Control and Department of Defense/Veterans Affairs: mild, moderate/severe/penetrating, indeterminate severity. To determine patient death, we used death in a Penn Medicine facility and linkage to the Social Security Death Index. We used Cox proportional hazards models adjusted for age at the time of TBI diagnosis, race, and encounter type to estimate associations of TBI severity with mortality risk. We evaluated interactions with encounter type and age, and stratified results by inpatient/outpatient and age group (≥65 years). Median age was 47 years (25th–75th percentiles: 29–63). Patients were most commonly self-reported White race ( n = 4,126, 64.0%), and diagnosed at an outpatient encounter ( n = 5,099, 79.3%; among them, 1–2% urgent/emergent). Median follow-up time was 4.22 years (IQR, 2.3–4.9 years). Overall, 2.9% ( n = 185) of patients died within five years of injury. Compared with mild TBI, mortality risk over five years was 2.06 times higher (95% CI = 1.27–3.33) for moderate/severe/penetrating TBI, and 1.54 times higher (95% CI = 0.98–2.42) for indeterminate TBI. Associations were attenuated among females with inpatient encounter type and those aged 65 years or older. Our results demonstrate that TBI severity affects survival among females, and this differs by encounter type and age. Findings motivate future, more focused research into the dynamics of TBI among females.

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• Message From the Editors to Our Reviewers

  Neurology · 2025-06-12

  article
  PublisherDOI

• An Introduction to Regression Discontinuity Design and Potential for Application in Neurology

  Neurology · 2025-12-05

  articleOpen accessSenior author

  Regression discontinuity design (RDD) offers a rigorous approach for estimating causal effects using observational data where randomized clinical trials are not feasible by leveraging cutoff-based treatment rules, effectively accounting for confounding when certain assumptions hold true. RDD remains underused in neurologic research, with most existing applications in neurology emerging only in the past 5 years. We introduce RDD and explain how effects can be estimated within this framework, including a discussion of the key assumptions required for valid causal inference. In addition, we highlight the relevance and potential applications of RDD in neurologic research, particularly in contexts where treatment decisions are based on clinical or policy thresholds. We also outline best practices and limitations associated with this method, with the aim of encouraging thoughtful applications of RDD in neurologic research.

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Recent grants

• Establishing Mechanisms Between Traumatic Brain Injury and Dementia Using Epidemiology, Clinical Studies, Blood-Based Biomarkers, and Neuroimaging Biomarkers

  NIH · $884k · 2022–2027

Frequent coauthors

• Rebecca F. Gottesman

  812 shared

• B. Gwen Windham

  University of Mississippi Medical Center

  307 shared

• David S. Knopman

  Mayo Clinic

  278 shared

• Thomas H. Mosley

  Jackson Memorial Hospital

  266 shared

• Clifford R. Jack

  WinnMed

  212 shared

• Josef Coresh

  Bloomberg (United States)

  211 shared

• Priya Palta

  University of North Carolina at Chapel Hill

  189 shared

• Álvaro Alonso

  Emory University

  172 shared

Education

• MD, Medicine

  Johns Hopkins School of Medicine

  2014

• PhD, Epidemiology

  Johns Hopkins University Bloomberg School of Public Health

  2012

• BA, Neuroscience

  Johns Hopkins University

  2006

Awards & honors

• Senior Scholar, Center for Clinical Epidemiology and Biostat…
• Senior Scholar, Penn Injury Science Center, University of Pe…
• Senior Fellow, Leonard Davis Institute of Health Economics,…