BrainLine sat down with Dr. Steven Flanagan to talk about the issues of aging after a traumatic brain injury. Dr. Flanagan is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center.
BrainLine: Are there any increased risks as people age after a traumatic brain injury?
Dr. Flanagan: We think the answer is yes. Although aging after a brain injury has not been terribly well studied to date, some research, including a study conducted in 2008 by the Institute of Medicine, has suggested that people with TBI are at an increased risk of seizures. We have also found that people with poorly controlled seizures are at a higher risk of dying at an earlier age than people without brain injury-related seizures.
Studies also suggest that the more physically disabled a person is post-injury, the more likely he is to have a shorter life span. This is common sense. For example, if a person has trouble swallowing or can’t exercise at all post-injury, he will more likely have medical complications earlier on in life than someone who can move around, stay physically healthy, and swallow without problems.
Medical evidence also suggests that after a moderate or severe TBI, a person is more likely to develop Parkinson’s disease or Parkinson-like symptoms. The same is true for the development of dementia. That being said, the medical evidence to date shows an association between TBI and these problems, not a direct cause and effect.
For people with a mild TBI, there is little evidence of any association between TBI and developing Parkinson’s or early-onset dementia.
BrainLine: Are there symptoms to watch for? If so, which ones in particular?
Dr. Flanagan: That is a tough question because everyone is different. Symptoms can differ across the board but can include anything from depression to problems with balance. But if a person has more significant physical or cognitive problems that resulted from a moderate or severe brain injury, he should get checked by his doctor on a regular basis, meaning once or twice a year; and his doctor should be someone who specializes in or has experience with traumatic brain injury.
People with what’s called “complicated mild TBI” — a mild TBI with symptoms that don’t resolve quickly or that remain chronic — should also check in with their doctor periodically.
BrainLine: What can people do to protect their health after a TBI? Are there long-term health problems that may crop up?
Dr. Flanagan: This is an important question because people who live with long-term effects from TBI often forget that they have other parts of their bodies to look after. Everyone — with or without a TBI — should do “upkeep” tests like pap smears and mammograms for women, prostate exams for men, colonoscopies at 50 years old, cholesterol checks, and so forth. They should also maintain a good diet and fitness regimen.
It’s easy for people with TBI to focus solely on their brain and the long-term issues that persist from their injury; however, it’s crucial not to forget about the rest of the body.
A person with TBI should also make sure his doctor keeps signs and symptoms of Parkinson’s disease and early-onset dementia on the radar screen. Again, TBI is not a cause of these other diseases, rather an association.
BrainLine: How does a brain injury affect cognitive issues as a person ages?
Dr. Flanagan: This has not been well studied at all and is difficult to answer. Some studies suggest that people with moderate to severe TBI have accelerated cognitive decline as they age. But, again, this has not been proven.
Ideally, we need to have a long-term study that looks at how brain injury affects cognition as a person gets older. For example, if we could study the cognitive skills of people with TBI versus those without TBI at 30 years of age and then at 60 years of age, we would probably learn a great deal. However, that kind of study is almost impossible because it is hard to follow people for so many years.
That said, people with TBI, especially those with long-term cognitive issues, should stay in touch with their doctor, preferably a physician knowledgeable about TBI.
BrainLine: How does a brain injury affect physical issues as a person ages?
Dr. Flanagan: Folks with TBI who have chronic problems with balance, for example, may need to schedule periodic sessions with a physical therapist or an occupational therapist. Sometimes these “tune ups” bring people back to a safer level of function. As we get older, our sensory system changes, more so for people who may have had their sensory system disrupted or damaged from a brain injury. Therefore, we need to pay more attention to how we move and do things. Balance can get worse and our bones and muscles weaker, making it harder to move safely through the world. So, getting a therapy here and there can be incredibly helpful not just physically but also emotionally, for one’s self-confidence.
BrainLine: How does a brain injury affect emotional or behavioral issues as a person ages?
Dr. Flanagan: Behavioral problems are part of what separates people with TBI from others in rehabilitation medicine. Many behavioral and emotional problems that are a result of a brain injury can be chronic, and the severity of these problems can fluctuate over time. Depression is a significant risk. Anxiety and other mood disorders can also persist. People who have a hard time multitasking or concentrating tend to be vulnerable to frustration, anger, and depression.
We are not sure if the risk of these types of emotional or behavioral issues ever goes away entirely after a brain injury. Data show, for example, that there is an increased risk of depression for people with TBI even years after an injury.
BrainLine: What do you tell people who are concerned about developing Alzheimer’s disease or early-onset dementia after a brain injury?
Steven Flanagan, MD is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center.
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