Neurobehavioural consequences of closed head injury in older adults.

Abstract

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 significandy 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. Apart from these studies of global outcome, little is known about cognitive functioning in older CHI patients. An exception is a recent study'0 which examined cognitive performance in patients who were 50-75 years old at the time of their injuries. Seventy patients were administered tests of general intellectual functioning, memory, language, and visuomotor abilities. Mazzucchi and colleagues'0 found that 50% of their patients exhibited generalised deterioration and dementia, whereas only 25% had minimal or no deterioration. Moreover, patients with mild head injuries, ie, no loss of consciousness, Glasgow coma scale" scores of 13-15, post-traumatic amnesia of <1 day, and normal CT head scans were no more likely to have a better outcome than those with severe injuries. Generalised deterioration and dementia were common in both groups with mild and moderate to severe injury. The study of Mazzucchi et al'0 represents an important first step in describing neurobehavioural functioning in the older head injured population. Their research indicates that CHI produces cognitive deficits across the injury severity spectrum. However, one limitation is that Mazzucchi et al did not examine specific cognitive features, such as memory and language. Instead, they made a gross classification of groups according to impairment on any of these measures. Moreover, their patients were tested from six months to three years after injury. Therefore, early neurobehavioural performance was not characterised.The present study provided an initial examination of the early neurobehavioural features of individuals who were > 50 years and sustained mild to moderate head injuries. We evaluated abilities which are frequently compromised after CHI in young adults, including expressive language,'2 memory,'3 14 attention,'5 and executive processing.'6 We also compared pre-and postinjury living and employment status in a subset of patients. Methods SUBJECTSProspective data were collected on 18 men and four women aged ) 50 years who sustained mild to moderate CHI. Patients were recruited from acute care hospitals affiliated with the Emory University School of Medicine in Atlanta and the University of Texas Medical Schools in Ga...

Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment

“…Therefore, PO patients significantly differed from GO patients for cognitive tests that investigated working memory and mental flexibility, both at the subacute phase and remote stage. These results are in agreement with previous studies, which reported a significant impairment in cognitive functions in patients with PCS [Bohnen and Jolles, 1992;Carroll et al, 2004;Dikmen et al, 1986;Goldstein et al, 1994;Hugenholtz et al, 1988;Levin et al, 1987;van der Naalt et al, 1999]. They also suggest that frontal lobe functions are predominantly impaired in PO patients and that this may help distinguishing PO from GO patients at the subacute stage.…”

Self-assessment of Impairment, Impaired Self-awareness, and Depression After Traumatic Brain Injury

“…Several investigators 19,24,25 have reported that depressed patients with TBI had poorer social functioning at 3-, 6-, and 12-month follow-up examinations compared to nondepressed patients with TBI. Similarly, Goldstein and colleagues 26,27 reported a decline in social functioning and activities of daily living in older depressed patients with TBI compared with nondepressed patients with TBI, a trend also seen in younger patients who had major depression for greater than 6 months post-TBI. 28 Depression is more common among individuals who fail to return to work after TBI and those with financial stressors.…”

Cognitive Outcome After Mild and Moderate Traumatic Brain Injury in Older Adults

“…As part of a two-center study funded by the National Institute on Disability and Rehabilitation Research, we have examined the cognitive and neurobehavioral functioning of middle-aged and older adults following mild and moderate TBI (Goldstein et al, 1994(Goldstein et al, , 1996(Goldstein et al, , 1999(Goldstein et al, , 2001Levin, Goldstein, & MacKenzie, 1997). Our research has focused on patients 50 years and older as a separate group, rather than rely on the ®ndings in young adults, since the literature suggests that the ®fth decade may represent an important transition.…”