Skip to main content

Advertisement

Log in

Traumatic brain injury in older adults

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Traumatic brain injury (TBI) is a serious health risk for older adults, and the consequences of TBI range from full recovery to death. For many who survive, there is a legacy of cognitive, physical, and emotional disability. Falls are the major cause of head injury in older adults. There are many risk factors including pre-existing brain disease, other diseases, and, sometimes, iatrogenic factors. Efforts directed at prevention are of great importance. Outcome studies indicate that outcome is generally worse for older people than for younger people with similar injuries, but older individuals also deserve aggressive rehabilitation directed at the best possible recovery. This review will discuss the symptoms and syndromes that commonly result from TBI with comments about treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Schootman M, Harlan M, Fuortes L: Use of the capturerecapture method to estimate severe traumatic brain injury rates. J Trauma 2000, 48:70.

    PubMed  CAS  Google Scholar 

  2. Rehabilitation of persons with traumatic brain injury. JAMA 1999, 282:974–983. This consensus report gives good background information about the magnitude of TBI as a public health and rehabilitation problem.

  3. Kraus JF, Fife D, Ramstein K, et al.: The relationship of family income to the incidence, external causes and outcome of serious brain injury, San Diego County, California. Am J Public Health 1986, 76:1345–1347.

    PubMed  CAS  Google Scholar 

  4. Klauber MR, Barrett-Connor E, Marshall L, et al.: The epidemiology of head injury: a prospective study of an entire community: San Diego County, California. Am J Public Health 1981, 113:500–509.

    CAS  Google Scholar 

  5. Jagger J, Levine J, Jane JA, et al.: Epidemiologic features of head injury in a predominantly rural population. J Trauma 1984, 2:40–44.

    Article  Google Scholar 

  6. Cooper J, Tabaddor K, Hause W: The epidemiology of head injury in the Bronx. Euroepidemiology 1983, 2:70–88.

    Google Scholar 

  7. MacKenzie E, Edelstein S, Flynn J: Hospitalized head-injured patients in Maryland: incidence and severity of injuries. Maryland Med J 1989, 387:725–732.

    Google Scholar 

  8. Fife D, Faich G, Hollenshead W, et al.: Incidence and outcome of hospital treated head injury in Rhode Island. Am J Public Health 1986, 76:773–778.

    Article  PubMed  CAS  Google Scholar 

  9. Kraus JF, Nourjah P: The epidemiology of mild head injury. In Mild Head Injury. Edited by Levin HS, Eisenberg HM, Benton AL. New York: Oxford University Press; 1989:8–22.

    Google Scholar 

  10. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: a practical scale. Lancet 1974, 2:81–84.

    Article  PubMed  CAS  Google Scholar 

  11. Murray G, Teasdale G: The European brain injury consortium of head injuries. Acta Neurochirurgica 1999, 141:223–236.

    Article  PubMed  CAS  Google Scholar 

  12. Rapoport MJ, Feinstein A: Outcome following traumatic brain injury in the elderly: a critical review. Brain Inj 2000, 14:749–61. This is a critical review of outcome studies of TBI in older patients with a cogent discussion about prognosis. This report and the report by Goleburn and Golden are good reviews of the topic.

    Article  PubMed  CAS  Google Scholar 

  13. Goleburn G, Golden C: Traumatic brain injury outcome in older adults: a critical review of the literature. J Clin Geropsychol 2001, 7:161. This is another comprehensive review article that reviews eighteen previously reported outcome studies. In aggregate, these studies support the contention that older people with TBI have a worse outcome than do younger people.

    Article  Google Scholar 

  14. Klein M, Houx PJ, Jolles J: Long-term persisting cognitive sequelae of traumatic brain injury and the effect of age. J Nerv Ment Dis 1996, 184:459–467.

    Article  PubMed  CAS  Google Scholar 

  15. Amacher AL, Bybee DE: Toleration of head injury by the elderly. Neurosurgery 1987, 20:954–958.

    Article  PubMed  CAS  Google Scholar 

  16. Tinetti ME, Speechley M: Prevention of falls among the elderly. N Engl J Med 1989, 320:1055–1059.

    Article  PubMed  CAS  Google Scholar 

  17. Ferrell R: Pharmacotherapy of disruptive behaviors associated with brain disease. Semin Clin Neuropsychiatry 2000, 5:283–289.

    Article  PubMed  CAS  Google Scholar 

  18. Koski K, Luukinen H, Laippala P, Kivela SL: Risk factors for major injurious falls among the home-dwelling elderly by functional abilities: a prospective population-based study. Gerontology 1998, 44:232–238.

    Article  PubMed  CAS  Google Scholar 

  19. Gennarelli TA, Graham DI: Neuropathology of the head injuries. Semin Clin Neuropsychiatry 1998, 3:160–175.

    PubMed  Google Scholar 

  20. Teasdale G, Teasdale E, Hadley D: Computed tomographic and magnetic resonance imaging classification of head injury. J Neurotraum 1992, 9:S249-S257.

    Google Scholar 

  21. Bruce DA: Imaging after head trauma: why, when and which. Childs Nerv Sys 2000, 16:755–759.

    Article  CAS  Google Scholar 

  22. Gean A, Kates R, Lee ST: Neuroimaging in head injury. New Horizons 1995, 3:549–561.

    PubMed  CAS  Google Scholar 

  23. Azouvi P: Neuroimaging correlates of cognitive and functional outcome after traumatic brain injury. Curr Opin Neurol 2000, 13:665–669.

    Article  PubMed  CAS  Google Scholar 

  24. McAllister TW, Sparling MB, Flashman LA, Saykin AJ: Neuroimaging findings in mild traumatic brain injury. J Clin Exp Neuropsychol 2001, 23:775–791.

    Article  PubMed  CAS  Google Scholar 

  25. Simon RI: Ethical and legal issues.In Neuropsychiatry of Brain Injury. Edited by Silver J, Yudofsky SC, Hales RE. Washington, DC: American Psychiatric Press, Inc; 1994:569–630.

    Google Scholar 

  26. Arciniegas DB: Traumatic brain injury. In Neuropsychiatry: An Introductory Approach. Cambridge: Cambridge University Press; 2002:353–321. This chapter in Dr. Arciniegas’s book gives an up-to-date and concise, yet comprehensive review of TBI. It is organized well and is very readable. The authors highly recommend it.

    Google Scholar 

  27. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  28. Mayeux R, Ottman R, Maestre G, et al.: Synergistic effects of traumatic head injury and apolipoprotein-epsilon 4 in patients with Alzheimer’s disease. Neurology 1995, 45:555–557.

    PubMed  CAS  Google Scholar 

  29. Mayeux R, Ottman R, Tang MX, et al.: Genetic susceptibility and head injury as risk factors for Alzheimer’s disease among community-dwelling elderly persons and their first-degree relatives. Ann Neurol 1993, 33:494–501.

    Article  PubMed  CAS  Google Scholar 

  30. Nicoll J, Roberts G, Graham D: Apolipoprotein E e4-allele is associated with deposition of amyloid b-protein following head injury. Nature Med 1995, 1:135.

    Article  PubMed  CAS  Google Scholar 

  31. Friedman SD, Brooks WM, Jung RE, et al.: Quantitative proton MRS predicts outcome after traumatic brain injury. Neurology 1999, 52:1384–1391.

    PubMed  CAS  Google Scholar 

  32. Gedye A, Beattie B, Tuokko H, et al.: Severe head injury hastens age of onset of Alzheimer’s disease. J Am Geriatr Soc 1989, 37:970–973.

    PubMed  CAS  Google Scholar 

  33. Teasdale G, Nicoll J, Murray G, Fiddes M: Association of apolipoprotein E polymorphism with outcome after head injury. Lancet 1997, 350:1069.

    Article  PubMed  CAS  Google Scholar 

  34. Mehta KM, Ott A, Kalmijn S, et al.: Head trauma and risk of dementia and Alzheimer’s disease: the Rotterdam Study. Neurology 1999, 53:1959–1962.

    PubMed  CAS  Google Scholar 

  35. Levin HS, Peters BH, Kalisky Z, et al.: Effects of oral physostigmine and lecithin on memory and attention in closed head-injured patients. Cent Nerv Sys Traum 1986, 3:333–342.

    CAS  Google Scholar 

  36. Cardenas DD, McLean A, Farrell-Roberts L, et al.: Oral physostigmine and impaired memory in adults with brain injury. Brain Inj 1994, 12:77–80.

    Google Scholar 

  37. Cummings JL: Cholinesterase inhibitors: a new class of psychotropic compounds. Am J Psychiatry 2000, 157:4–15.

    PubMed  CAS  Google Scholar 

  38. Masanic CA, Bayley MT, VanReekum R, Simard M: Open-label study of donepezil in traumatic brain injury. Arch Physical Med Rehabil 2001, 82:896–901.

    Article  CAS  Google Scholar 

  39. Whelan FJ, Walker MS, Schultz SK: Donepezil in the treatment of cognitive dysfunction associated with traumatic brain injury. Ann Clin Psychiatry 2000, 12:131–135.

    Article  PubMed  CAS  Google Scholar 

  40. Tayerni JP, Seliger G, Lichtman SW: Donepezil mediated memory improvement in traumatic brain injury during post acute rehabilitation. Brain Inj 1998, 12:77–80.

    Article  Google Scholar 

  41. Weinberg RM, Auerbach AH, Moore S: Pharmacologic treatment of cognitive deficits: a case study. Brain Inj 1987, 1:57–59.

    PubMed  CAS  Google Scholar 

  42. McDowell S, Whyte J, D’Esposito M: Differential effect of a dopaminergic agonist on prefrontal function in traumatic brain injury patients. Brain 1998, 121:115–164.

    Article  Google Scholar 

  43. Whyte J, Hart T, Schuster K, et al.: Effects of methylphenidate on attentional function after traumatic brain injury: a randomized, placebo-controlled trial. Am J Physical Rehabil 1997, 76:440–450.

    Article  CAS  Google Scholar 

  44. Busch CR, Alpern HP: Depression after mild traumatic brain injury: a review of current research. Neuropsychol Rev 1998, 8:95–108.

    Article  PubMed  CAS  Google Scholar 

  45. Robinson RG, Jorge RE: Mood disorders. In Neuropsychiatry of Traumatic Brain Injury. Edited by Silver J, Yudofsky SC, Hales RE. Washington, DC: American Psychiatric Press; 1994:219–250.

    Google Scholar 

  46. Cassidy J: Fluoxetine: a new serotonergically active antidepressant. J Head Trauma Rehab 1989, 4:67–69.

    Google Scholar 

  47. Wroblewski B, Joseph A, Cornblatt R: Antidepressant pharmacotherapy and the treatment of depression in patients with severe traumatic brain injury: a controlled prospective study. J Clin Psychiatry 1996, 57:582–587.

    PubMed  CAS  Google Scholar 

  48. Taylor C, Jung H: Disorders of mood after traumatic brain injury. Semin Clin Neuropsychiatry 1998, 3:224–231.

    PubMed  Google Scholar 

  49. Robinson RG, Boston JD, Starkstein SE, et al.: Comparison of mania and depression after brain injury: causal factors. Am J Psychiatry 1988, 145:172–178.

    PubMed  CAS  Google Scholar 

  50. Starkstein SE, Boston JD, Robinson RG: Mechanisms of mania after brain injury: 12 case reports and review of the literature. J Nerv Ment Dis 1988, 176:87–100.

    Article  PubMed  CAS  Google Scholar 

  51. Bouvy P, vandeWetering M, Meerwaldt J, et al.: A case of organic brain syndrome following head injury successfully treated with carbamazepine. Acta Psychiatr Scand 1988, 77:361–363.

    PubMed  CAS  Google Scholar 

  52. Pope HG, McElroy SL, Satlin A, et al.: Head injury, bipolar disorder, and response to valproate. Compr Psychiatry 1988, 29:34–38.

    Article  PubMed  Google Scholar 

  53. Andersson S, Krogstad JM, Finset A: Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity. Psychol Med 1999, 29:447–456.

    Article  PubMed  CAS  Google Scholar 

  54. Fann JR, Katon WJ, Uomoto JM, Esselman PC: Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. Am J Psychiatry 1995, 152:1493–1499.

    PubMed  CAS  Google Scholar 

  55. van Reekum R, Bolago I, Finlayson M, et al.: Psychiatric disorders after traumatic brain injury. Brain Inj 1996, 10:319–327.

    Article  PubMed  Google Scholar 

  56. Hibbard MR, Uysal S, Kepler K, et al.: Axis I psychopathology in individuals with traumatic brain injury. J Head Trauma Rehab 1998, 13:24–39.

    CAS  Google Scholar 

  57. Sbordone RJ, Liter JC: Mild traumatic brain injury does not produce post-traumatic stress disorder. Brain Inj 1995, 9:405–412.

    PubMed  CAS  Google Scholar 

  58. Harvey AG, Bryant RA: Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. Am J Psychiatry 2000, 157:626–628.

    Article  PubMed  CAS  Google Scholar 

  59. Hickling E, Blanchard E, Silverman D, Schwarz S: Motor vehicle accidents, headaches, and post-traumatic stress disorder: assessment findings in a consecutive series. Headache 1992, 32:147–151.

    Article  PubMed  CAS  Google Scholar 

  60. Bryant RA, Marosszeky JE, Crooks J, Gurka JA: Posttraumatic stress disorder after severe traumatic brain injury. Am J Psychiatry 2000, 157:629–631.

    Article  PubMed  CAS  Google Scholar 

  61. Silver JM, Yudofsky SC, Slater JA, et al.: Propranolol treatment of chronically hospitalized aggressive patients. J Neuropsychiatry Clin Neurosci 1999, 11:328–335.

    PubMed  CAS  Google Scholar 

  62. Grafman J, Salazar A: Traumatic brain injury. In Synopsis of Neuropsychiatry. Edited by Fogel BS, Schiffer RB, Rao SM. Philadelphia: Lippincott Williams and Wilkins; 2000:491–501.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrell, R.B., Tanev, K.S. Traumatic brain injury in older adults. Curr Psychiatry Rep 4, 354–362 (2002). https://doi.org/10.1007/s11920-002-0083-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-002-0083-9

Keywords

Navigation