Head-injured subjects aged over 50 years: correlations between variables of trauma and neuropsychological follow-up

Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury

OBJECTIVE

To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation.

DESIGN

Retrospective cohort.

SETTING

Six TBI Model Systems (TBIMS) centers.

PARTICIPANTS

In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity.

RESULTS

At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders.

CONCLUSIONS

People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.

Traumatic Brain Injury as a Risk Factor for Dementia and Alzheimer Disease: Critical Review of Study Methodologies

Despite much previous research stating that traumatic brain injury (TBI) has been confirmed as a risk factor for dementia and Alzheimer disease (AD), findings from observational studies are mixed and are of low methodological quality. This review aimed to critically evaluate the methodologies used in previous studies. Relevant literature was identified by examining reference lists for previous reviews and primary studies, and searches in MEDLINE, PubMed, Google Scholar, and Research Gate. Sixty-eight identified reports, published between 1982 and August 2018, met inclusion criteria. Common methodological weaknesses included self-reported TBI (62%); poor TBI case definition (55%); low prevalence of TBI in samples (range 0.07-28.7%); reverse causality (86% moderate to high risk of reverse causality); not controlling for important confounding factors. There were also key areas of methodological rigor including use of individual matching for cases and controls (57%); gold standard dementia and AD criteria (53%); symmetrical data collection (65%); large sample sizes (max, 2,794,752); long follow-up periods and controlling of analyses for age (82%). The quality assessment revealed methodological problems with most studies. Overall, only one study was identified as having strong methodological rigor. This critical review identified several key areas of methodological weakness and rigor and should be used as a guideline for improving future research. This can be achieved by using longitudinal prospective cohort designs, with medically confirmed and well characterized TBI sustained sufficient time before the onset of dementia, including appropriate controls and informants, and considering the impacts of known protective and risk factors.

Cognitive recovery instead of decline after acute encephalitis: a prospective follow up study

OBJECTIVE

Follow up of cognitive sequelae of acute encephalitis and estimation of the frequency of persisting dementia.

METHODS

Out of a series of 45 consecutive patients with acute encephalitis prospectively studied in 1990-95, 40 were screened for difficulty in everyday life using the Blessed dementia scale (BDS) 3.7 (1.4), mean (SD), years after onset. Eight patients had had herpes simplex encephalitis (HSVE), 16 some other identified aetiology, and in 21 the aetiology was unknown. All, except two patients with a nonherpetic encephalitis, were treated with acyclovir. All patients with disability in BDS (12/40), were invited to a neuropsychological reassessment, and the results of this assessment were compared with those of a similar assessment done after the acute stage. At follow up one patient could not complete the tests due to intractable epilepsy.

RESULTS

In six of 11 cases the symptoms causing disability were mainly psychiatric. Five patients (two with HSVE) had a pronounced memory impairment together with other cognitive deficits, indicating dementia (frequency of 12.8%). In eight of the 11 testable cases cognitive performance had improved over the years, in two cases a decline was found and one patient with severe deficits showed no change. Intractable epilepsy was found in four of 12 cases.

CONCLUSION

Cognitive decline had taken place already at the acute stage, and further deterioration was uncommon. Considerable improvement occurred in most patients during follow up. Also in patients with HSVE treated with acyclovir the cognitive recovery was substantial and of a magnitude not expected based on previous literature. Intractable epilepsy contributed to the cognitive deterioration in some cases. Affective disorders also had a surprisingly important role for the long term outcome.

Neurobehavioural consequences of closed head injury in older adults

This study examined the neurobehavioural effects of closed head injury (CHI) in adults aged 50 years and older. Twenty two mild to moderate CHI patients who were within seven months of the injury were administered measures of language, memory, attention, and executive functioning. Compared with demographically similar normal controls, the patients exhibited significantly poorer functioning on the cognitive domains. Naming and word fluency under timed conditions, verbal and visual memory, and the ability to infer similarities were especially vulnerable. These initial findings indicate that CHI in older adults produces considerable cognitive deficits in the early stages of recovery. Future research should characterise long term outcome and the potential links between head injury and the development of progressive dementia.