Through the diligent work of many clinicians, researchers, patients, and advocates, traumatic brain injury (TBI) is increasingly recognized as a public health priority. Due to improved diagnostic and treatment modalities, more individuals with TBI are surviving to die of other causes later in life. Media attention has focused on military- and sports-related TBI and progress has been made in decreasing motor vehicle accident-related TBI.
Despite these advances, a silent epidemic of older adults who sustain a TBI remains. These individuals, as well as those aging with a TBI from earlier in life, warrant a focused approach to scientific study and treatment that is informed by, yet distinct from, that of TBI in disparate populations.
Overview of geriatric TBI
Across all age groups, an estimated 5.3 million Americans are living with a TBI-related disability.1 Many of these individuals will live to be older adults (here defined as ≥65 years of age). From 2009 through 2010, approximately 39 million older adults were evaluated for a new TBI in US emergency departments (EDs). This represents a 61% increase from prior year estimates.2 In addition to rising numbers of ED visits, older adults have rising levels of hospitalizations and death following TBI. In fact, as of 2013, adults 75 years and older sustained the highest number of TBIs—exceeding that of infants.3
Aging with a TBI
Most research that examines the effect of TBI on the aging process takes a cross-sectional approach; individuals of different ages are compared rather than following the same individual across time. This lack of longitudinal investigation may be precluding valuable insights into clinical trajectory post-TBI.
In a subset of individuals, it has been found that cognitive and other neuropsychiatric symptoms manifesting acutely after TBI may persist throughout life.4 Conceptually, and making the assumptions that the brain has a finite capacity for recovery and adaptation and that both TBI recovery and aging utilize the same plasticity mechanisms, a brain after TBI may have fewer resources to devote to the aging process. It is important to think of this as an alteration in how the brain handles “normal” aging rather than the onset of a new neurodegenerative process.
When conceptualizing TBI in an aging individual, one should consider how this prior insult may affect the development and progression of neurodegenerative processes. In a recent study of 350,000 military veterans, even mild TBI without loss of consciousness was associated with more than a 2-fold increase in the risk of dementia diagnosis.5
Dr Narapareddy is a Neuropsychiatry Fellow, Ms Richey is Research Coordinator, and Dr Peters is Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
The authors report no conflicts of interest concerning the subject matter of this article.
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