Traumatic brain injury poses complex diagnostic, management and treatment challenges in older people

May 6, 2013

Each year more than 1.7 million people in the United States sustain a traumatic brain injury (TBI). The incidence of TBI in older adults poses special diagnostic, management and treatment challenges, say experts in a special collection of papers on TBI in the elderly in NeuroRehabilitation: An Interdisciplinary Journal.

"As our understanding of TBI increases, it is becoming clear that its impact is not uniform across the lifespan and that the response of a young brain to a TBI is different from that of an old brain," writes Guest Editor Wayne A. Gordon, PhD, ABPP, Vice Chair of the Department of at Mount Sinai School of Medicine, New York, NY. "Indeed, the literature is beginning to suggest that TBI in the elderly brings to light a complex set of challenges, some of which are highlighted in this issue."

Although evidence is mixed, several previous studies have found an association between lifetime TBI and dementia risk in later life. Kristen Dams-O'Connor, PhD, Mount Sinai School of Medicine, and colleagues compare the medical history and cognitive function of those with dementia and a history of TBI and those with dementia without a TBI history and report subtle differences between the groups. Their findings suggest that dementia in patients who have sustained a TBI is a unique phenotype that is distinct from that seen among individuals who develop dementia without a history of TBI.

A study by Jeff Victoroff, MD, University of Southern California Keck School of Medicine, presents the first published provisional for traumatic encephalopathy (TE) based on a of its clinical characteristics in 436 published cases of TE. "Provisional research diagnostic criteria for TE should allow clinicians to focus on this significant subset of TBI victims, and hopefully accelerate the understanding of this important condition," says Victoroff. "Currently diagnosis of this disorder is based solely on post-mortem examination, making the differential diagnosis of TBI, dementia, and CTE all but impossible in living Individuals," adds Gordon. "While these criteria require validation, research and the subsequent endorsement by professional organizations, they represent an important first step in this process."

The factors related to death following TBI in the elderly are in need of more research and our understanding of the long-term consequences of TBI is quite limited, according to an article by Chari I. Hirshson, PhD, Mount Sinai School of Medicine, and colleagues. They report on the findings of a medical chart review of individuals 55 years and older who died one to four years after moderate or severe TBI, and compared these to matched living patients. Deceased patients were discharged with significantly more medications including diabetic medication (35%) and there was a significantly higher proportion of deceased patients with a diagnosis of Abnormality of Gait (53%), respiratory medications at admission (32%) and discharge (17%). These results suggest the need for medical and lifestyle interventions for selected elderly TBI patients, say the authors.

The characteristics of the inpatient rehabilitation treatments received by individuals with a TBI who were above the age of 65 when they received their injury are examined in a paper by Marcel Dijkers, PhD, Mount Sinai School of Medicine, and colleagues. They found that in contrast with the situation just a few decades ago, elderly people with TBI are admitted to rehabilitation in fairly large numbers. Elderly patients may have relatively limited brain injury severity, and make significant but nevertheless more restricted progress (compared with young and middle-aged patients) during and after inpatient rehabilitation. The majority of elderly people with TBI can be rehabilitated successfully and discharged home, where they may even resume employment and driving, say the authors.

As Gordon points out, "Cognitive assessments are costly, time-consuming and are often a burden on the patients and their families." The Brief Test of Adult Cognition by Telephone (BTACT) has been recommended for inclusion in the National Institutes of Health Common Data Elements for assessing TBI and is currently being piloted by the National Institute on Disability and Rehabilitation Research,-funded TBI Model Systems, for potential inclusion in a prospective longitudinal study of TBI outcomes. Brandon E. Gavett, PhD, University of Colorado at Colorado Springs, and co-investigators applied modern psychometric approaches to examine the validity of using the BTACT in TBI patients. They conclude that modern psychometric approaches have the benefit of linear scaling and a modest criterion validity advantage, and that the tool has the potential of increasing understanding of the long-term impact of TBI on cognitive function.

To round off this collection of papers, Angela Yi, PhD, Sports Concussion Institute, Atlanta, and Kristen Dams-O'Connor, PhD, Mount Sinai School of Medicine, review the literature on age-specific factors that are related to successful outcomes in the elderly who sustain a TBI. They conclude there is a clear need for more cross-sectional and prospective studies that examine psychosocial issues in this unique population. "The trajectory of recovery and social reintegration after a TBI sustained in older adulthood is unique," say the authors. "It should not be assumed that predictors of psychosocial outcomes in younger adults apply to with TBI. Level of severity, cause of injury, age at injury, co-morbid conditions, cohort characteristics, and pre-morbid functioning are all factors to take into account when exploring how a TBI affects psychosocial functioning in the older adult cohort."

Explore further: Prior brain injury linked to re-injury later in life

More information: NeuroRehabilitation: An Interdisciplinary Journal, 32(2) April, 2013

Related Stories

Prior brain injury linked to re-injury later in life

January 3, 2013
(HealthDay)—Older adults with a history of traumatic brain injury (TBI) with loss of consciousness (LOC) have a 2.5- to almost four-fold higher risk of subsequent re-injury later in life, according to research published ...

New research on the effects of traumatic brain injury

March 28, 2013
Considerable opportunity exists to improve interventions and outcomes of traumatic brain injury (TBI) in older adults, according to three studies published in the recent online issue of NeuroRehabilitation by researchers ...

Risk factors predictive of psychiatric symptoms after traumatic brain injury

July 12, 2011
A history of psychiatric illness such as depression or anxiety before a traumatic brain injury (TBI), together with other risk factors, are strongly predictive of post-TBI psychiatric disorders, according to an article published ...

Traumatic brain injury worsens outcomes for those with nonepileptic seizures

April 8, 2013
A new study by a Rhode Island Hospital researcher has found that traumatic brain injury (TBI) can significantly increase the odds of having major depression, personality impulsivity and post-traumatic stress disorder (PTSD) ...

Cultural differences may impact neurologic and psychiatric rehabilitation of Spanish speakers

March 9, 2012
The number of people with neurological and psychiatric disorders in Spanish-speaking countries has increased over the past two decades. The February issue of NeuroRehabilitation assesses important factors that should be considered ...

In combat vets and others, high rate of vision problems after traumatic brain injury

February 4, 2013
Visual symptoms and abnormalities occur at high rates in people with traumatic brain injury (TBI)—including Iraq and Afghanistan War veterans with blast-related TBI, reports a study, "Abnormal Fixation in Individuals with ...

Recommended for you

Now you like it, now you don't: Brain stimulation can change how much we enjoy and value music

November 20, 2017
Enjoyment of music is considered a subjective experience; what one person finds gratifying, another may find irritating. Music theorists have long emphasized that although musical taste is relative, our enjoyment of music, ...

MRI uncovers brain abnormalities in people with depression and anxiety

November 20, 2017
Researchers using MRI have discovered a common pattern of structural abnormalities in the brains of people with depression and social anxiety, according to a study presented being next week at the annual meeting of the Radiological ...

Deletion of a stem cell factor promotes TBI recovery in mice

November 20, 2017
UT Southwestern molecular biologists today report the unexpected finding that selectively deleting a stem cell transcription factor in adult mice promotes recovery after traumatic brain injury (TBI).

Brain cell advance brings hope for Creutzfeldt-Jakob disease

November 20, 2017
Scientists have developed a new system to study Creutzfeldt-Jakob disease in the laboratory, paving the way for research to find treatments for the fatal brain disorder.

Neuroscience research provides evidence the brain is strobing, not constant

November 17, 2017
It's not just our eyes that play tricks on us, but our ears. That's the finding of a landmark Australian-Italian collaboration that provides new evidence that oscillations, or 'strobes', are a general feature of human perception.

Brain activity buffers against worsening anxiety

November 17, 2017
Boosting activity in brain areas related to thinking and problem-solving may also buffer against worsening anxiety, suggests a new study by Duke University researchers.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.