Cognitive profiles of older adults with a prior traumatic brain injury versus healthy controls: A meta-analysis

Detecting and Predicting Cognitive Decline in Individuals with Traumatic Brain Injury: A Longitudinal Telephone-Based Study

Traumatic brain injuries (TBIs) can lead to long-lasting cognitive impairments, and some survivors experience cognitive decline post-recovery. Early detection of decline is important for care planning, and understanding risk factors for decline can elucidate targets for prevention. While neuropsychological testing is the gold standard approach to characterizing cognitive function, there is a need for brief, scalable tools that are capable of detecting clinically significant changes in post-TBI cognition. This study examines whether a clinically significant change can be detected using the Brief Test of Adult Cognition by Telephone (BTACT) in a sample of individuals with chronic TBI and investigates whether potentially modifiable factors are associated with cognitive decline. Ninety participants aged 40 or older with complicated mild-to-severe TBI participated in two telephone-based study visits ∼1 year apart. Demographic, head trauma exposure, comorbid medical conditions, physical, and psychosocial functioning data were collected via self-report. The BTACT, a brief measure of global cognitive function, was used to assess cognitive performance across six domains. A reliable change index for quantifying clinically significant changes in BTACT performance was calculated. Results revealed cognitive decline in 10-27% of participants across various cognitive domains. More specifically, only depressive symptoms, including depressed affect and anhedonia, were significantly associated with cognitive decline after correcting for multiple comparisons using false discovery rate (FDR). Other factors such as the number of blows to the head, male gender, dyspnea, increased anxiety symptoms, seizures, illicit drug use, and fewer cardiovascular comorbidities should be considered hypothesis generating. Importantly, age was not a significant predictor of cognitive decline, which challenges the assumption that cognitive decline is solely related to the natural aging process. It suggests that there are unique factors associated with TBI that impact cognitive function, and these factors can affect individuals across the lifespan. The BTACT is a brief and sensitive tool for identifying clinically meaningful changes in cognitive function over a relatively brief period (i.e., 1 year) in a sample of individuals in the chronic stages of TBI (i.e., x̄ = 6.7 years post-TBI). Thus, the BTACT may be useful in surveillance efforts aimed at understanding and detecting decline, particularly in situations where in-person cognitive screening is impractical or unfeasible. We also identified potentially modifiable targets for the prevention of post-TBI cognitive decline. These findings can offer insights into treatment goals and preventive strategies for individuals at risk for cognitive decline, as well as help to facilitate early identification efforts.

Cognitive-communication difficulties due to traumatic brain injury sustained in adults 55 years and older: A survey of speech-language pathology professional practice in Australia

PURPOSE

Limited research informs management of cognitive-communication difficulties following traumatic brain injury (TBI) in older adulthood. The purpose of this study was to understand the characteristics and practice of speech-language pathologists (SLPs) working with people who sustained TBI at ≥55 years and more specifically their management of cognitive-communication difficulties with this population. This included assessment and treatment practices, resource needs, barriers to practice, and impact to service delivery from COVID-19 restrictions.

METHOD

A cross-sectional survey-based design with non-probability sampling of SLPs working in Australia with adults with TBI was utilised. Descriptive statistics and content analysis were used for analysis of survey data.

RESULT

Fifty responses were eligible for inclusion. Participants predominantly worked in inpatient rehabilitation (48%), acute (40%), and community settings (36%). Service delivery to adults who sustained TBI at ≥55 years commonly included cognitive-communication management. Assessment and treatment trends are described. Most SLPs (74%) perceived barriers to cognitive-communication management, often relating to time and funding, that existed prior to the COVID-19 pandemic. Pandemic restrictions presented additional challenges.

CONCLUSION

Research relating to cognitive-communication difficulties following TBI in older adulthood is required to support evidence-based practice and inform services for older adults who sustain TBI.

In-hospital mortality and risk factors among elderly patients with traumatic brain injury: protocol for a systematic review and meta-analysis

INTRODUCTION

The elderly population is more vulnerable to traumatic brain injury (TBI) compared with younger adults, and there is an increasing trend in TBI-related hospitalisations and deaths in the elderly due to the ageing global population. This is a thorough update to a previous meta-analysis on the mortality of elderly TBI patients. Our review will include more recent studies and provide a comprehensive analysis of risk factors.

METHODS AND ANALYSIS

The protocol of our systematic review and meta-analysis is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will search the following databases: PubMed, Cochrane Library and Embase from inception to 1 February 2023 reporting in-hospital mortality and/or risk factors predicting in-hospital mortality among elderly patients with TBI. We will perform a quantitative synthesis for in-hospital mortality data combined with meta-regression and subgroup analysis to determine whether there is a trend or source of heterogeneity. Pooled estimates for risk factors will be presented in the form of ORs and 95% CIs. Examples of risk factors include age, gender, cause of injury, severity of injury, neurosurgical intervention and preinjury antithrombotic therapy. Dose-response meta-analysis for age and risk of in-hospital mortality will be performed if sufficient studies are included. We will perform a narrative analysis if quantitative synthesis is not appropriate.

ETHICS AND DISSEMINATION

Ethics approval is not required; we will publish findings from this study in a peer-reviewed journal and present results at national and international conferences. This study will promote a better understanding and management of elderly/geriatric TBI.

PROSPERO REGISTRATION NUMBER

CRD42022323231.

Age-Based Trends in Cognitive-Communication Management for Adults in Subacute Rehabilitation Following New Onset Traumatic Brain Injury

PURPOSE

Although traumatic brain injury (TBI) has a disproportionate impact on older adults, there has been limited inclusion of these individuals in post-TBI cognitive-communication research. This study was undertaken to compare demographic and injury characteristics, speech-language pathology input, and broad outcomes for younger and older adults admitted to inpatient rehabilitation following TBI.

METHOD

A retrospective audit of first occasion adult TBI admissions in 2019 to inpatient rehabilitation in an Australian metropolitan subacute hospital was conducted via medical record data. Admissions were located using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) coding that aligned with TBI. Comparisons were made for younger (18-54 years) and older (≥ 55 years) adults.

RESULTS

A total of 114 admissions (51.75% older adults) were included. Patient age ranged between 18 and 90 years. Falls caused TBI in the majority of older adults, whereas transport-related accidents were the most common cause for younger adults. Age-based trends for intracranial injury were observed. Cognitive-communication difficulties were the most common speech-language pathology diagnosis with no significant difference in prevalence between younger and older adults. Age group was not significantly associated with length of stay or discharge home.

CONCLUSIONS

The implications of injury-related trends for older adults on post-TBI cognitive-communication are poorly understood. This lack of information is problematic given the frequency of cognitive-communication difficulties in this population. Research into cognitive-communication following new onset TBI in older adults is crucial to support rehabilitation service provision and improve outcomes for older adults.

Cognitive-communication difficulties following traumatic brain injury sustained in older adulthood: a scoping review

BACKGROUND

Older adults are a peak incidence group for traumatic brain injury (TBI). However, empirical evidence on TBI in older adults is often limited to extrapolated findings from studies involving younger adults. While cognitive-communication deficits are an established consequence of TBI with substantial impact on social outcome for younger adults, little is known about the nature of cognitive-communication changes experienced by older adults following a new-onset TBI. In order to inform evidence-based service delivery and support older adults who sustain TBI, it is important to understand how these difficulties manifest in older adults.

AIMS

To review the empirical literature to determine the nature and breadth of research that has addressed the influence of older age on cognitive-communication outcomes following TBI sustained in older adulthood.

METHODS & PROCEDURES

A scoping review framework was used. Five electronic databases (Medline, PsycINFO, Embase, CINAHL and Scopus) were searched to locate peer-reviewed studies addressing cognitive-communication following TBI sustained at ≥ 55 years. Given the absence of dedicated investigations within the search yield, studies were included where at least 30% of participants were aged ≥ 55 years at injury, and age was a stated focus of the investigation.

OUTCOMES & RESULTS

A total of 2468 unique records were identified and reduced to 225 after title and abstract screening. Full-text review revealed only three studies that met the criteria. Collectively these studies included adults aged 55-93 years at injury. Two studies focused on age as a predictor for acute cognitive-communication difficulty, and one on the impact of age on facial emotion recognition in the chronic stages of injury. None of the studies had a dedicated focus on cognitive-communication outcomes for older adults who sustained a TBI within the defined period of older adulthood.

CONCLUSIONS & IMPLICATIONS

This scoping review produced limited results and insufficient evidence to inform rehabilitation for older adults. Indeed, very little is known about cognitive-communication outcomes for older adults who sustain a TBI. This review highlights the need, in the context of an ageing population, for research within this area to be prioritized. What this paper adds What is already known on the subject Empirical evidence to support the management of post-TBI cognitive-communication difficulties in adults predominantly stems from studies with young adults. However, the broader TBI literature suggests that outcome for older adults requires specific consideration due to its distinct nature and occurrence during a stage of life when there is the potential for subtle change to the processes of cognition and communication as part of typical ageing. What this paper adds to existing knowledge This scoping review identifies that research related to cognitive-communication outcomes for older adults who have sustained a TBI is very much in its infancy. Overarching statements about post-TBI cognitive-communication outcomes for older adults cannot be drawn, nor can it be determined if outcomes for older adults differ from younger adults. What are the potential or actual clinical implications of this work? The lack of research in this area means that tangible guidance cannot be provided to clinicians working with older adults following TBI to support evidence-based practice for cognitive-communication. This scoping review strongly supports the need for further research in this area.