Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities

Abstract

While chronic neurological effects from concussion have been studied widely, little is known about possible links between concussion and long-term medical and behavioral comorbidities. We performed a retrospective cohort study of 9205 adult patients with concussion, matched to non-concussion controls from a hospital-based electronic medical registry. Patients with comorbidities before the index visit were excluded. Behavioral and medical comorbidities were defined by International Classification of Diseases, Ninth and Tenth Revision codes. Groups were followed for up to 10 years to identify comorbidity incidence after a concussion. Cox proportional hazards models were used to calculate associations between concussion and comorbidities after multi-variable adjustment. Patients with concussion were 57% male (median age: 31; interquartile range [IQR] = 23-48 years) at enrollment with a median follow-up time of 6.1 years (IQR = 4.2-9.1) and wellmatched to healthy controls. Most (83%) concussions were evaluated in outpatient settings (5% inpatient). During followup, we found significantly higher risks of cardiovascular risks developing including hypertension (hazard ratio [HR] = 1.7, 95% confidence interval [CI]: 1.5-1.9), obesity (HR = 1.7, 95% CI: 1.3-2.0), and diabetes mellitus (HR = 1.8, 95% CI: 1.4-2.3) in the concussion group compared with controls. Similarly, psychiatric and neurological disorders such as depression (HR = 3.0, 95% CI: 2.6-3.5), psychosis (HR = 6.0, 95% CI: 4.2-8.6), stroke (HR = 2.1 95% CI: 1.5-2.9), and epilepsy (HR = 4.4, 95% CI: 3.2-5.9) were higher in the concussion group. Most comorbidities developed less than five years post-concussion. The risks for post-concussion comorbidities were also higher in patients under 40 years old compared with controls. Patients with concussion demonstrated an increased risk of development of medical and behavioral health comorbidities. Prospective studies are warranted to better describe the burden of long-term comorbidities in patients with concussion.

Association of Traumatic Brain Injury With the Risk of Developing Chronic Cardiovascular, Endocrine, Neurological, and Psychiatric Disorders

“…Notably, the risk of postconcussion comorbidities was higher in patients younger than 40 years old compared with age-matched unexposed patients. 3 However, it is unclear whether our findings apply to more severe subtypes of TBI and whether post-TBI comorbidities are associated with mortality risk. 12 , 13 A better understanding of the interplay between TBI and the development of medical and neurologic comorbidities can have important implications for preventive care, prognosis, and targeted screening in a high-risk population.…”

“…In addition, large-scale studies of American-style football players and military veterans have demonstrated that prior TBI is associated with multisystem chronic conditions, suggesting that recurrent severe head injuries may be associated with long-term health and functional status. 3 , 4 The development of chronic medical comorbidities after TBI can complicate the course of recovery and increase health care costs and mortality. 5 A number of registry-based studies have demonstrated increased risk of cardiovascular 5 , 6 and metabolic disorders, 7 as well as epilepsy, 8 stroke, 6 and depression, 9 , 10 , 11 in the chronic phase of TBI recovery.…”

Hypertension and Ventricular–Arterial Uncoupling in Collegiate American Football Athletes

“… 7 Second, modifiable behaviors and potential risks common within the competitive AF culture, including intentional and rapid weight gain, poor dietary choices, overused nonsteroidal anti‐inflammatory drug use, and concussions may contribute to increases in resting SBP. 12 , 40 , 41 A critical emphasis on cardiac preventive education and counseling for competitive AF athletes is therefore essential, while also ensuring appropriate guideline‐based pharmacologic interventions are offered to those athletes who are confirmed hypertensive.…”

Post-Concussion Syndrome Latent Onset Related to Intracranial Lesion on Head Injury Patient in Dr. M. Djamil General Hospital Padang

“…Studies report that more than half of people with PCS still have symptoms more than 1 year after the injury. 10,11 PCS usually disappears within 2-4 weeks but some studies have found PCS last more than 6 months (latent onset). Another study states that PCS may be permanent if recovery has not occurred within 3 years.…”