Age, symptoms, and functional outcome after mild traumatic brain injury

Justin E. Karr; Teemu M. Luoto; Isabelle G. Gilman; Ksenia Berghem; Anna Kerttu Kotilainen; Grant L. Iverson

doi:10.1111/ane.13190

Age, symptoms, and functional outcome after mild traumatic brain injury

Justin E. Karr, Teemu M. Luoto, Isabelle G. Gilman, Ksenia Berghem, Anna Kerttu Kotilainen, Grant L. Iverson

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objectives: Previous older adult studies have examined outcome from moderate-to-severe traumatic brain injury (TBI), but fewer have focused on the effects of milder brain injuries. This study examined age-related differences in symptom reporting and whether symptoms are differentially related to functional outcome based on age. Materials & Methods: Patients presenting with a head injury at the Tampere University Hospital emergency department (N = 325, aged 18-100) were evaluated at 1 week post injury on the Modified Rankin Scale and Rivermead Post Concussion Symptoms Questionnaire (RPQ). Results: A quarter of participants had missing RPQ data, with missingness associated with greater age and strongly associated with pre-existing functional impairment, dementia, and/or neurological conditions. Among participants with complete data, participants <65 years old endorsed headaches, noise/light sensitivity, irritability, and frustration/impatience at a greater frequency than participants ≥65 years old. However, no differences were found in the number of symptoms endorsed or the total symptom severity score. The correlations between the severity of symptoms and change in function were similar between the two age groups. Conclusions: Older adults tended to report fewer symptoms, but symptoms had a roughly equivalent relationship with declines in functioning across age groups. A large percentage of older adults in this study had pre-injury dementia or neurological disease that contributed to missing data on the 1-week outcome measures. The results provide insight into the impact of mild spectrum TBI on older adults compared to younger patients.

Original language	English
Pages (from-to)	183-190
Number of pages	8
Journal	Acta Neurologica Scandinavica
Volume	141
Issue number	2
DOIs	https://doi.org/10.1111/ane.13190
State	Published - Feb 1 2020

Bibliographical note

Funding Information:
Teemu Luoto, MD, PhD, has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences (Finland). Grant Iverson, PhD, has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc, CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc). He has received salary support from the National Football League and the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc, and BioDirection, Inc. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc, the Heinz Family Foundation, and the Mooney‐Reed Charitable Foundation.

Funding Information:
Funding information The study was financially supported by the Finnish State Research Funding and the Finnish Medical Society Duodecim. The authors acknowledge research assistant Anne Simi for her assistance with the patient enrollment and data collection at Tampere University Hospital.

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Keywords

aged
brain concussion
head injuries: closed
outcome assessment (health care)
post-concussion syndrome

ASJC Scopus subject areas

Neurology
Clinical Neurology

Access to Document

10.1111/ane.13190

Cite this

@article{8cbb122d301a43018fe49468cbef3ff3,

title = "Age, symptoms, and functional outcome after mild traumatic brain injury",

abstract = "Objectives: Previous older adult studies have examined outcome from moderate-to-severe traumatic brain injury (TBI), but fewer have focused on the effects of milder brain injuries. This study examined age-related differences in symptom reporting and whether symptoms are differentially related to functional outcome based on age. Materials & Methods: Patients presenting with a head injury at the Tampere University Hospital emergency department (N = 325, aged 18-100) were evaluated at 1 week post injury on the Modified Rankin Scale and Rivermead Post Concussion Symptoms Questionnaire (RPQ). Results: A quarter of participants had missing RPQ data, with missingness associated with greater age and strongly associated with pre-existing functional impairment, dementia, and/or neurological conditions. Among participants with complete data, participants <65 years old endorsed headaches, noise/light sensitivity, irritability, and frustration/impatience at a greater frequency than participants ≥65 years old. However, no differences were found in the number of symptoms endorsed or the total symptom severity score. The correlations between the severity of symptoms and change in function were similar between the two age groups. Conclusions: Older adults tended to report fewer symptoms, but symptoms had a roughly equivalent relationship with declines in functioning across age groups. A large percentage of older adults in this study had pre-injury dementia or neurological disease that contributed to missing data on the 1-week outcome measures. The results provide insight into the impact of mild spectrum TBI on older adults compared to younger patients.",

keywords = "aged, brain concussion, head injuries: closed, outcome assessment (health care), post-concussion syndrome",

author = "Karr, {Justin E.} and Luoto, {Teemu M.} and Gilman, {Isabelle G.} and Ksenia Berghem and Kotilainen, {Anna Kerttu} and Iverson, {Grant L.}",

note = "Funding Information: Teemu Luoto, MD, PhD, has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences (Finland). Grant Iverson, PhD, has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc, CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc). He has received salary support from the National Football League and the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc, and BioDirection, Inc. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc, the Heinz Family Foundation, and the Mooney‐Reed Charitable Foundation. Funding Information: Funding information The study was financially supported by the Finnish State Research Funding and the Finnish Medical Society Duodecim. The authors acknowledge research assistant Anne Simi for her assistance with the patient enrollment and data collection at Tampere University Hospital. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

year = "2020",

month = feb,

day = "1",

doi = "10.1111/ane.13190",

language = "English",

volume = "141",

pages = "183--190",

number = "2",

}

TY - JOUR

T1 - Age, symptoms, and functional outcome after mild traumatic brain injury

AU - Karr, Justin E.

AU - Luoto, Teemu M.

AU - Gilman, Isabelle G.

AU - Berghem, Ksenia

AU - Kotilainen, Anna Kerttu

AU - Iverson, Grant L.

N1 - Funding Information: Teemu Luoto, MD, PhD, has received funding from the Government's Special Financial Transfer tied to academic research in Health Sciences (Finland). Grant Iverson, PhD, has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc, CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc). He has received salary support from the National Football League and the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He serves as a scientific advisor for Sway Operations, LLC, Highmark, Inc, and BioDirection, Inc. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc, the Heinz Family Foundation, and the Mooney‐Reed Charitable Foundation. Funding Information: Funding information The study was financially supported by the Finnish State Research Funding and the Finnish Medical Society Duodecim. The authors acknowledge research assistant Anne Simi for her assistance with the patient enrollment and data collection at Tampere University Hospital. Publisher Copyright: © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objectives: Previous older adult studies have examined outcome from moderate-to-severe traumatic brain injury (TBI), but fewer have focused on the effects of milder brain injuries. This study examined age-related differences in symptom reporting and whether symptoms are differentially related to functional outcome based on age. Materials & Methods: Patients presenting with a head injury at the Tampere University Hospital emergency department (N = 325, aged 18-100) were evaluated at 1 week post injury on the Modified Rankin Scale and Rivermead Post Concussion Symptoms Questionnaire (RPQ). Results: A quarter of participants had missing RPQ data, with missingness associated with greater age and strongly associated with pre-existing functional impairment, dementia, and/or neurological conditions. Among participants with complete data, participants <65 years old endorsed headaches, noise/light sensitivity, irritability, and frustration/impatience at a greater frequency than participants ≥65 years old. However, no differences were found in the number of symptoms endorsed or the total symptom severity score. The correlations between the severity of symptoms and change in function were similar between the two age groups. Conclusions: Older adults tended to report fewer symptoms, but symptoms had a roughly equivalent relationship with declines in functioning across age groups. A large percentage of older adults in this study had pre-injury dementia or neurological disease that contributed to missing data on the 1-week outcome measures. The results provide insight into the impact of mild spectrum TBI on older adults compared to younger patients.

AB - Objectives: Previous older adult studies have examined outcome from moderate-to-severe traumatic brain injury (TBI), but fewer have focused on the effects of milder brain injuries. This study examined age-related differences in symptom reporting and whether symptoms are differentially related to functional outcome based on age. Materials & Methods: Patients presenting with a head injury at the Tampere University Hospital emergency department (N = 325, aged 18-100) were evaluated at 1 week post injury on the Modified Rankin Scale and Rivermead Post Concussion Symptoms Questionnaire (RPQ). Results: A quarter of participants had missing RPQ data, with missingness associated with greater age and strongly associated with pre-existing functional impairment, dementia, and/or neurological conditions. Among participants with complete data, participants <65 years old endorsed headaches, noise/light sensitivity, irritability, and frustration/impatience at a greater frequency than participants ≥65 years old. However, no differences were found in the number of symptoms endorsed or the total symptom severity score. The correlations between the severity of symptoms and change in function were similar between the two age groups. Conclusions: Older adults tended to report fewer symptoms, but symptoms had a roughly equivalent relationship with declines in functioning across age groups. A large percentage of older adults in this study had pre-injury dementia or neurological disease that contributed to missing data on the 1-week outcome measures. The results provide insight into the impact of mild spectrum TBI on older adults compared to younger patients.

KW - aged

KW - brain concussion

KW - head injuries: closed

KW - outcome assessment (health care)

KW - post-concussion syndrome

UR - http://www.scopus.com/inward/record.url?scp=85075235524&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075235524&partnerID=8YFLogxK

U2 - 10.1111/ane.13190

DO - 10.1111/ane.13190

M3 - Article

C2 - 31693184

AN - SCOPUS:85075235524

VL - 141

SP - 183

EP - 190

IS - 2

ER -

Age, symptoms, and functional outcome after mild traumatic brain injury

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this