Severe traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory (d=0.82 to 1.18), attention set-shifting (d=−0.61 to −0.69), and physical quality of life measures (d=0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory (d=0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma. (JINS, 2014, 20, 1–9)

Several factors have been linked to severity of postconcussive-type (neurobehavioral) symptoms. In this study, predictors of neurobehavioral symptoms were examined using multivariate methods to determine the relative importance of each. Data regarding demographics, symptoms, current alcohol use, history of traumatic brain injury (TBI), orthopedic injuries, and psychiatric/developmental diagnoses were collected via questionnaire from 3027 university students. The most prominent predictors of symptoms were gender, history of depression or anxiety, history of attention-deficit/hyperactivity disorder or learning disability diagnosis, and frequency of alcohol use. Prior mild TBI was significantly related to overall symptoms, but this effect was small in comparison to other predictors. These results provide further evidence that neurobehavioral symptoms are multi-determined phenomena, and highlight the importance of psychiatric comorbidity, demographic factors, and health behaviors to neurobehavioral symptom presentation after mild TBI. (JINS, 2013, 19, 1–9)

Mild traumatic brain injury (mild TBI) is often associated with postconcussive symptoms such as headache, memory problems, and irritability. However, high rates of similar symptoms in groups without a history of TBI raise questions about the clinical validity of the postconcussive syndrome. This study was conducted to address these issues through systematic examination of symptoms reported by those with and without a history of mild TBI or orthopedic injury. Responses to the Postconcussion Syndrome Checklist (PCSC), demographic information, and medical history were collected via online questionnaire from 3027 non-referred university students (2280 without a history of mild TBI or orthopedic injury, 491 with a history of orthopedic injury, and 256 with post-acute mild TBI). Although the mild TBI group reported higher mean levels of symptoms, confirmatory factor analyses demonstrated that symptoms clustered into parallel cognitive, somatic, affective, and sensory factors in all three groups. Despite modestly higher mean symptoms among those with a history of mild TBI, symptom clusters did not differ from non-TBI groups. These findings cast doubts about the clinical validity of the “postconcussive syndrome” and raise questions about pathways by which mild TBI and other factors may influence the expression of chronic symptoms. (JINS, 2012, 18, 451–460)

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries. (JINS, 1999, 5, 58–68.)