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LEARNING OBJECTIVES

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Learning Objectives

  • Understand the epidemiology, pathophysiology, clinical manifestations, and adverse outcomes of traumatic brain injury (TBI) in older adults.

  • Learn the specific neuropsychological deficits and psychiatric diseases associated with TBI.

  • Acquire cutting-edge knowledge about chronic traumatic encephalopathy (CTE) and the risk of developing dementia following traumatic insults to the brain.

  • Learn about various strategies and treatments used to address cognitive deficits associated with TBI.

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Key Clinical Points

  1. Older adults have several age-related risk factors or diseases that increase their vulnerability to TBI and its consequences.

  2. Falls are a major risk factor and the underlying cause in more than half of older patients with TBI.

  3. The adverse outcomes of TBI in the older population include cognitive, psychiatric, and functional deficits with long-term dependence.

  4. The selective vulnerability of the frontal and temporal lobes to injury underlies the preponderance of neuropsychological deficits involving frontal systems, including executive function, attention, and working memory.

  5. History of TBI increases risk for CTE—a chronic neurodegenerative disease characterized by tau pathology in the brain and a constellation of clinical symptoms, including cognitive, mood, and motor impairments.

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DEFINITION

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Traumatic Brain Injury (TBI) is craniocerebral trauma associated with decreased consciousness, cognitive or neurologic abnormalities, skull fracture, or intracranial injuries. TBI is common among older adults mainly through the association with falls. TBI in older adults presents special issues for the clinician to consider in the management of these patients, including a higher risk of poor recovery and physiatric and neuropsychiatric comorbidity. This chapter will review the epidemiology of TBI, mechanisms of injury, features on brain imaging, cognitive and psychosocial outcomes, and postacute management, with particular attention to research and practice with geriatric patients.

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EPIDEMIOLOGY

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More than 5.3 million Americans have disabilities related to TBI. With approximately 1.7 million incident cases per year, resulting in 1.3 million emergency department visits, 275,000 hospitalizations, and 52,000 deaths, TBI is a common cause of morbidity and mortality. Approximately 468/100,000 population are evaluated in the emergency department for TBI. In adults aged 65 and older, there are an estimated 141,997 TBI-related emergency department visits each year, with the highest rates of TBI-related hospitalization and death occurring in adults aged 75 and older as shown in Figures 69-1 and 69-2. The incidence of mild TBI across all ages (not resulting in hospitalization or death) is 392 TBI-related emergency department visits per 100,000 population.

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FIGURE 69-1.

When TBI occurs in the older adult, it results in a greater rate of hospitalization compared with other age groups.

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FIGURE 69-2.

When TBI occurs in the older adult, it results in a greater rate of death compared with other age groups.

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The economic consequences of TBI are alarming. The annual ...

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