Impact of aging on the immune response to traumatic brain injury (AIm:TBI) study protocol

BackgroundTraumatic brain injury (TBI) in older adults leads to considerable morbidity and mortality. Outcomes among older adults with TBI are disparately worse than in younger adults. Differences in immunological response to injury may account for at least some of this disparity. Understanding how ageing differentially affects the immune response to TBI and how older age and these immunological changes affect the natural history of recovery following TBI are the goals of this study.Design/methodsA prospective multiple cohort design is being used to assess the effects of ageing and TBI on immune makers and to test predictors of impairment and disability in older adults following mild TBI. Older adults (>55 years) with mild TBI are enrolled with three comparison groups: younger adults (21–54 years) with mild TBI, non-injured older adults (>55 years) and non-injured young adults (21–54 years). For the primary analysis, we will assess the association between immune markers and Glasgow Outcome Scale-Extended at 6 months, using logistic regression. Predictors of interest will be inflammatory biomarkers. Multivariate linear regression will be used to evaluate associations between biomarkers and other outcomes (symptoms, function and quality of life) at 3 and 6 months. Exploratory analyses will investigate the utility of biomarkers to predict outcome using receiver-operating characteristic curves.DiscussionA better understanding of the recovery trajectory and biological rationale for disparate outcomes following TBI in older adults could allow for development of specific interventions aimed at reducing or eliminating symptoms. Such interventions could reduce impairment and healthcare costs.

Download Full-text

Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults

Journal of the International Neuropsychological Society ◽

10.1017/s1355617701733115 ◽

2001 ◽

Vol 7 (3) ◽

pp. 373-383 ◽

Cited By ~ 60

Author(s):

FELICIA C. GOLDSTEIN ◽

HARVEY S. LEVIN ◽

WILLIAM P. GOLDMAN ◽

ALLISON N. CLARK ◽

TRACY KENEHAN ALTONEN

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Outcome ◽

Cognitive Measures ◽

Post Injury ◽

Mild Tbi ◽

Moderate Traumatic Brain Injury ◽

Comparable Control ◽

Neurobehavioral Outcomes

This study evaluated the early cognitive and neurobehavioral outcomes of older adults with mild versus moderate traumatic brain injury (TBI). Thirty-five patients who were age 50 years and older and sustained mild or moderate TBI were prospectively recruited from acute care hospitals. Patients were administered cognitive and neurobehavioral measures up to 2 months post-injury. Demographically comparable control participants received the same measures. Patients and controls did not have previous histories of substance abuse, neuropsychiatric disturbance, dementia, or neurologic illness. Moderate TBI patients performed significantly poorer than mild TBI patients and controls on most cognitive measures, whereas the mild patients performed comparably to controls. In contrast, both mild and moderate patients exhibited significantly greater depression and anxiety/somatic concern than controls. The results indicate that the classification of TBI as mild versus moderate is prognostically meaningful as applied to older adults. The findings extend previous investigations in young adults by demonstrating a relatively good cognitive outcome on objective measures, but subjective complaints after a single, uncomplicated mild TBI in older persons. (JINS, 2001, 7, 373–383.)

Download Full-text

What Are the Characteristics of Traumatic Brain Injury in Older Adults?

Brain Impairment ◽

10.1375/brim.12.1.71 ◽

2011 ◽

Vol 12 (1) ◽

pp. 71-75 ◽

Cited By ~ 2

Author(s):

Glynda J. Kinsella

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Traffic Accidents ◽

Considerable Increase ◽

Road Traffic ◽

Older Age ◽

Road Traffic Accidents ◽

Younger Adults ◽

Australian Community

AbstractThe Australian community is ageing; over the next 40 years, our population over the age of 65 years will double to around 23%, and this considerable increase in older adults means an increasing number of people will be at risk of sustaining trauma through falls or road traffic accidents. In contrast to the increasingly well-documented outcome literature on younger adults, very few studies have focused on older adults. Instead of assuming that outcomes posttraumatic brain injury (post-TBI) will follow similar patterns as in younger samples, there are several reasons to investigate older age recovery separately, and these issues will be discussed by reviewing some of the primary characteristics of older adults who experience traumatic brain injury.

Download Full-text

Systematic Review and Meta-analysis of Outcome after Mild Traumatic Brain Injury in Older People

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000795 ◽

2021 ◽

pp. 1-20

Author(s):

Camilla H. Hume ◽

Bradley J. Wright ◽

Glynda J. Kinsella

Keyword(s):

Systematic Review ◽

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Psychological Health ◽

Meta Analysis ◽

Older Age ◽

Younger Adults ◽

Health Service Provision ◽

Time Points

Abstract Objective: Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate–severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains – cognition, psychological health, and life participation. Methods: Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. Results: By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. Conclusions: Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.

Download Full-text

Cognitive control constrains memory attributions

Behavioral and Brain Sciences ◽

10.1017/s0140525x19001869 ◽

2019 ◽

Vol 42 ◽

Author(s):

Colleen M. Kelley ◽

Larry L. Jacoby

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Control

Abstract Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.

Download Full-text