Healthy Aging with Traumatic Brain Injury

Life Expectancy Following Traumatic Brain Injury

A very large study[1] looked at the life expectancy of people with traumatic brain injury in comparison to the general population in the USA found that the life expectancy of people with traumatic brain injury is lower than that of the general population and depends on age, sex, and severity of disability Walking and feeding are is a strong predictive factors, from <40% of normal life expectancy for individuals with a traumatic brain injury who were non-ambulant and dependent on others for feeding, to >85% for those who were independently mobile. The brief video below shows some research going on the field of ageing and traumatic brain injury.
[2]

Effects of Increasing Age with Traumatic Brain Injury

Effects on Cognition

People who have had moderate or severe traumatic brain injury are known to have an increased risk of decline of cognitive abilities, and increased risk of dementia, later in life. One 2015 study [3] compared MRI brain scans of people with traumatic brain injury to a control group; they developed a computer program with an algorithm to estimate the persons "brain age", and the people with traumatic brain injury were found to have a brain age on average 5 years older than the control group. The authors note: "There was also a correlation between time since injury and predicted age difference, suggesting that these changes in brain structure do not occur during the injury itself, but result from ongoing biological processes, potentially similar to those seen in normal ageing, that progress more quickly after an injury."

This suggests that after traumatic brain injury there may be secondary process, which leads to increased brain damage for years afterwards.[3]


Dementia

There is evidence that a traumatic brain injury earlier in life increases the risk of developing dementia of the Alzheimer's type in old age.[4][5][6] It is commonly thought to be a result of a combination of the following:

Effects on Physical Condition

People with a moderate or severe traumatic brain injury can experience increased musculoskeletal deterioration with aging, more than occurs in the general non-traumatic brain injury population. Frequently this occurs due to the nature of the accident/incident which caused the traumatic brain injury, such as road traffic accidents, also causing bony and soft tissue damage to trunk and/or limbs.

Frailty in Elderly People

Definition: “Frailty" is a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor.”[7]

Sarcopenia

This is defined as loss of muscle function, strength and mass; it is a normal consequence of growing older, and in some people with traumatic brain injury an increase in sarcopenia when compared to the general population may be seen as a result of reduced physical activity and exercise levels.

Osteopenia / Osteoporosis

Osteoporosis is a characterised by a decrease in bone density which results in bones become increasingly porous and brittle leading to increased risk of fracture. Osteoporosis is a major health threat across the globe.[8]

Osteopenia is a milder reduction in bone density, which can be described as being a midpoint between having healthy bones and osteoporosis. In osteopenia the bones are weaker than normal, but not sufficiently weak that they fracture easily (as they do in osteoporosis).

The incidence of osteopenia increases with age, with most people losing approximately .5% of bone mass every year after the age of 50. People who are taking anti-epileptic medication are known to have an increased risk of osteopenia and osteoporosis, and so people with seizures following traumatic brain injury who take such medication have a markedly increased risk.

Physical Activity

The amount of physical activity, which any person with traumatic brain injury engages in, has a great impact on healthy ageing, just as it does in the general population. The Health Benefits of Physical Activity are shown below:

Physical and mental health benefits.png

Other benefits include a decrease in the risks of secondary conditions, such as hypertension, osteoporosis, and cardiovascular disease. [9]

Physical Activity in the Traumatic Brain Injury Population

People with traumatic brain injury have been found to have fitness levels well below the lowest fitness levels of adults, matched for age and sex.[10] Studies have demonstrated that the traumatic brain injury population benefit from aerobic conditioning and strength training [9], specifically:

  • An increase in aerobic capacity [11]
  • Increase in muscle strength and endurance [12]
  • Reduced risk of secondary conditions - cardiovascular disease, osteoporosis, hypertension [13]

Healthy Aging Advice

People with a traumatic brain injury encounter the same challenges as the general population in regard to aging, and the advice which is given to the general population applies just as much to individuals following traumatic brain injury.

This advice includes:

  • Stay active - do exercise targeting aerobic, strengthening and balance
  • Eat a balanced diet of healthy, natural food
  • Manage body weight, avoiding obesity
  • Stay connected to your community
  • Maintain your brain - keep learning and challenging your mind
  • Look after your vision, which deteriorates with age, and use glasses as appropriate

Resources

References

  1. Brooks JC, Shavelle RM, Strauss DJ, Hammond FM, Harrison-Felix CL. 2015 Long-Term Survival After Traumatic Brain Injury Part II: Life Expectancy. Arch Phys Med Rehabil. 2015 Jun;96(6):1000-5. doi: 10.1016/j.apmr.2015.02.002.
  2. University of Denver Knoebel Institute for Healthy Aging - Traumatic Brain Injury Research Available from: https://www.youtube.com/watch?v=5PTYsqvriDs (last accessed 18.10.2019)
  3. 3.0 3.1 Cole JH, Leech R, Sharp DJ, Alzheimer's Disease Neuroimaging Initiative. Prediction of brain age suggests accelerated atrophy after traumatic brain injury. Annals of Neurology.2015;77(4):571-81
  4. Guo Z, Cupples LA, Kurz A, Auerbach SH, Volicer L, Chui H, et al. Head injury and the risk of AD in the MIRAGE study. Neurology. 2000; 54(6):1316-23.
  5. Mortimer JA, Vanduijn CM, Chandra V, Fratiglioni L, Graves AB, Heyman A, et al. Head trauma as a risk factor for Alzheimers-disease—a collaborative reanalysis of case-control studies. Int J Epidemiol. 1992;20: S28-S35
  6. Plassman BL, Havlik RJ, Steffens DC, Helms MJ, Newman TN, Drosdick D, et al. Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias. Neurology. 2000;55(8):1158-66.
  7. Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer JM, Bernabel R et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013. 14(6): 392-7
  8. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-33
  9. 9.0 9.1 Irwin K, Ed A, Buddhadev H, Driver S, Ronai P. Physical Activity and Traumatic Brain Injury. Strength and Conditioning Journal.  2011; 33 (4): 43-47 doi: 10.1519/SSC.0b013e318210e899
  10. Hassett L, Moseley AM, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database of Systematic Reviews. 2017(12): CD006123. DOI: 10.1002/14651858.CD006123.pub3
  11. Jankowski LW, Sullivan SJ. Aerobic and neuromuscular training: Effect on the capacity, efficiency, and fatigability of patients with traumatic brain injuries.  Arch Phys Med Rehabil. 1990;71: 500-504.
  12. Bhambhani Y, Rowland G, Farag M. Effects of circuit training on body composition and peak cardiorespiratory responses in patients with moderate to severe traumatic brain injury.  Arch Phys Med Rehabil. 2005; 86: 268-276.
  13. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. 2009. Available from:http://www.health.gov/PAGuidelines/pdf/paguide.pdf. [Accessed 1 September 2019.]