Objective: Beyond the peak incidence of traumatic brain injury (TBI) in young adults, TBI incidence increases with advancing age. Severe TBI in the elderly is associated with high mortality, but the majority of TBI in this age group is of the milder spectrum. Despite this, studies of outcome in older persons are lacking, and research to date has been limited by small sample size, selection bias, and failure to control for premorbid impairment. The purpose of the present study is to explore the effects in older adults of mild-to-moderate TBI on neurobehavioral outcome.
Design: Cross-sectional.
Materials and Methods: Seventy-one participants ages fifty and over with mild-to-moderate TBI were assessed within three months of injury and compared with seventy-eight controls on aspects of neurobehavioral functioning. We excluded those with a previous history of dementia. Major depression was assessed using the Structured Clinical Interview for the DSM-IV (SCID); Cognition was assessed using the Mini-Mental Status Examination (MMSE); Self-report measures of psychosocial functioning, psychological distress, and physical symptoms were also used.
Results: Sixty participants with mild TBI and eleven subjects with moderate TBI were included. The mean age of the TBI group was 67.08 (SD 8.6, range 50 to 89) years. Mechanism of TBI was falls in 49.3%, motor vehicle accidents in 19.7%. Of the 51 patients who had CT scans, 49.0% had focal abnormalities related to TBI. There were no significant differences between cases and controls in their age, gender, education, marital status, family psychiatric history, and past history of depression or TBI. Patients with TBI were more likely to be employed (49.3% vs 14.1%, c2 [1]=21.07, p<0.0001) and to have a prior history of alcohol misuse (8.5% vs 1.3%, Fisher’s Exact Test, p<0.05) than controls. Following injury, patients with TBI were more likely to have Major Depression (17.0% vs 0 %, Fisher’s Exact Test, p<0.0001), and to have lower scores on the MMSE (Mean 27.78, SD 2.2 vs Mean 28.94, SD 1.3, F[1,146]= 14.88, p<0.0001) than those without. Psychosocial dysfunction, psychological distress and physical symptoms were significantly higher in the TBI group (all p<0.0001). These results remained significant once we controlled for the effects of employment and alcohol.
Conclusion: In older persons, mild-to-moderate TBI is associated with depression, physical complaints, psychosocial dysfunction, and psychological distress in the acute period following injury. This substantial morbidity adversely affects the quality of life of people recovering from TBI, and interventions may be helpful in improving outcome. Cognitive differences between groups were subtle because of the insensitivity of the MMSE to cognitive dysfunction in the TBI population. A longitudinal study investigating the effects of mild-to-moderate TBI on cognitive outcome in the elderly, incorporating detailed neurocognitive data, is underway.
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