Healthy Aging with Traumatic Brain Injury

Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Naomi O'Reilly, Rachael Lowe and Kim Jackson  

Life Expectancy following TBI

A very large study[1] looked at the life expectancy of people with TBI in comparison to the general population in the USA found that the life expectancy of the TBI people varied enormously, from <40% of normal life expectancy for TBI patients who were non-ambulant and dependent on others for feeding, to >85% for those who were independently mobile.

Effects of Increasing Age with TBI

Effects on Cognition

People who have had moderate or severe TBI are known to have an increased risk of decline of cognitive abilities, and increased risk of dementia, later in life. One 2015 study[2] compared MRI brain scans of people with TBI to a control group; they developed a computer program with an algorithm to estimate the person't "brain age", and the people with TBI 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 TBI there may be secondary process which lead to increasing brain damage for years afterwards[2].

Dementia
There is evidence that a TBI earlier in life increases the risk of developing dementia of the Alzheimer's type in old age[3][4][5].

Effects on Physical Condition

People with moderate or severe TBI can experience increased musculoskeletal deterioration with aging, more than occurs in the general non-TBI population. Frequently this occurs due to the nature of the accident/incident which caused the TBI, such as road traffic accident, 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.”[6] It is commonly thought to be a result of a combination of the following:

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 TBI 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 characterized 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[7].

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).

People who are taking anti-epileptic medication are known to have an increased risk of osteopenia and osteoporosis, and so people with seizures following TBI who take such medication have a markedly increased risk.

The incidence of osteopenia increases with age, with most people losing approximately .5% of bone mass every year after the age of 50.

Physical Activity

The amount of physical activity [PA] which any person with TBI engages in, has a great impact on healthy ageing (just as it does in the general population).

The health benefits of PA 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[8].

Physical Activity in the TBI population

People with TBI have been found to have fitness levels well below the lowest fitness levels of adults (matched for age and sex)[9].

Studies have demonstrated that the TBI population benefit from aerobic conditioning and strength training[8], specifically:

  • An increase in aerobic capacity [10]
  • Increase in muscle strength and endurance[11]
  • Reduced risk of secondary conditions - cardiovascular disease, osteoporosis, hypertension[12]

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. 2.0 2.1 Cole JH, Leech R, Sharp DJ. Prediction of brain age suggests accelerated atrophy after traumatic brain injury. Annals of Neurology, Vol 77, Issue 4.
  3. Z. Guo, L.A. Cupples, A. Kurz, S.H. Auerbach, L. Volicer, H. Chui, et al. Head injury and the risk of AD in the MIRAGE study Neurology, 54 (2000), pp. 1316-
  4. J.A. Mortimer, C.M. Vanduijn, V. Chandra, L. Fratiglioni, A.B. Graves, A. Heyman, et al. Head trauma as a risk factor for Alzheimers-disease—a collaborative reanalysis of case-control studies Int J Epidemiol, 20 (1991), pp. S28-S35
  5. B.L. Plassman, R.J. Havlik, D.C. Steffens, M.J. Helms, T.N. Newman, D.Drosdick, et al. Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias Neurology, 55 (2000), pp. 1158-
  6. 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.
  7. Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726
  8. 8.0 8.1 Irwin, Kelley BS; Ede, Alison MS; Buddhadev, Harsh BPT et al. Physical Activity and Traumatic Brain Injury Strength and Conditioning Journal: August 2011 - Volume 33 - Issue 4 - p 43-47 doi: 10.1519/SSC.0b013e318210e899
  9. Hassett L, Moseley AM, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD006123. DOI: 10.1002/14651858.CD006123.pub3
  10. Jankowski LW and Sullivan SJ. Aerobic and neuromuscular training: Effect on the capacity, efficiency, and fatigability of patients with traumatic brain injuries.  Arch Phys Med Rehabil 71: 500-504, 1990.
  11. Bhambhani Y, Rowland G, and 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 86: 268-276, 2005.
  12. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. 2009. Available at: http://www.health.gov/PAGuidelines/pdf/paguide.pdf. Accessed 1 September 2019.