• Posted June 22, 2023

Head Injury Outcomes Could Take Years to Unfold

A traumatic brain injury (TBI) can have long-term effects, much like a chronic condition, a new study says.

Looking at hundreds of patients, researchers found that problems related to traumatic brain injuries can last for years, with people improving and declining at different time points. These problems encompassed memory, thinking and everyday functioning.

"TBI is essentially a chronic condition like many other chronic conditions," said lead researcher Benjamin Brett, an assistant professor in the Departments of Neurosurgery and Neurology at the Medical College of Wisconsin. "Things can change, both up and down, improve and decline throughout multiple years."

Because of this, there's a need to monitor patients "well beyond that post-injury period," Brett said. "We need to establish systems of care that involve continued monitoring and treatment."

The idea may be controversial, however.

A chronic condition implies an underlying disease that is expected to change and/or get worse in predictable ways, said Dr. Daniel Torres, a neurologist at Northwell Lenox Hill Hospital in New York City.

"I would not consider TBI a chronic condition because it is an unpredictable condition with which different individuals can have greatly different consequences," Torres said.

For the study, Brett and his colleagues collected data on more than 900 people who had mild TBIs, mostly concussions, and nearly 200 people who had moderate to severe TBI. These were conditions like fractured skulls or penetrating injuries.

The researchers compared the TBI patients with more than 150 people who had orthopedic injuries but no head injuries. All were followed for up to seven years.

During follow-up, patients were tested on thinking, memory, mental health and ability to perform daily activities. They were also asked about their abilities and symptoms, including headache, fatigue and sleep disturbances.

Brett's team found that 21% of people with mild TBI experienced a decline reflected in overall test scores, as did 26% of people with moderate to severe TBI and 15% of people with no head injury.

Most of the decline was in the ability to function with daily activities, such as caring for oneself, living unassisted, driving and engaging in social activities. Over an average of two to seven years after injury, 29% of those with mild TBI declined in their everyday abilities as did 23% of those with moderate to severe TBI.

Some patients, however, showed improvement in those same areas, with 22% of those with mild TBI improving over time and 36% of those with moderate to severe TBI, Brett noted.

Older patients tended to show a decline, while more educated patients tended to show improvement, he said.

Brett also said that patients' overall health may play a part in how they recover from a TBI and whether they improve or decline over time.

But Torres, who was not part of the research, said the study does not prove that TBI is causing those other problems like functional decline.

"Lifestyle choices also greatly impact whether a given problem caused by TBI becomes chronic," he said.

Recent studies in dementia and degenerative conditions have shown the dramatic effect that healthy lifestyle changes can have on the development and progression of these diseases, Torres noted.

"This study cannot separate out brain injury factors that might cause worsening over time from the many other factors that can impact brain health throughout the life of a person," he said.

If you have had a TBI and worry about the long-term impacts or ongoing symptoms, Torres recommended seeing a doctor "who has specific experience managing patients who have sustained brain injury."

"The field is changing fairly rapidly, which means that doctors who don't treat these problems regularly might not be practicing with the most up-to-date information," he added.

The report was published online June 21 in the journal Neurology.

More information

For more on traumatic brain injury, see the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Benjamin Brett, PhD, assistant professor, departments of neurosurgery and neurology, Medical College of Wisconsin, Milwaukee; Daniel Torres, MD, neurologist, Northwell Lenox Hill Hospital, New York City; Neurology, online, June 21, 2023

EMBARGOED Long-term Multi-domain Patterns of Change Following Traumatic Brain Injury - A TRACK-TBI LONG Study - Brett Titled.pdf

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