The impact of major depression on outcome following mild-to-moderate traumatic brain injury in older adults

2006 ◽  
Vol 92 (2-3) ◽  
pp. 273-276 ◽  
Author(s):  
Mark J. Rapoport ◽  
Alexander Kiss ◽  
Anthony Feinstein
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Major Depression ◽  
Moderate Traumatic Brain Injury ◽  
The Impact

scholarly journals In-Hospital Mortality Following Traumatic Brain Injury Among Older Medicare Beneficiaries, Comparing Statin Users With Nonusers

2017 ◽  
Vol 33 (6) ◽  
pp. 225-236 ◽  
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Health Concern ◽  
Future Research ◽  
Small Scale ◽  
Medicare Beneficiaries ◽  
The Impact ◽  
Statin Use

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI. Methods: A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse. Results: Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI. Conclusions: In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.

scholarly journals Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

2017 ◽  
Vol 33 (4) ◽  
pp. 156-166
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
National Sample ◽  
Pharmacological Therapy ◽  
Medicare Beneficiaries ◽  
Future Studies ◽  
Factors Associated ◽  
The Impact ◽  
Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults

2001 ◽  
Vol 7 (3) ◽  
pp. 373-383 ◽  
Author(s):  
FELICIA C. GOLDSTEIN ◽  
HARVEY S. LEVIN ◽  
WILLIAM P. GOLDMAN ◽  
ALLISON N. CLARK ◽  
TRACY KENEHAN ALTONEN
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Outcome ◽  
Cognitive Measures ◽  
Post Injury ◽  
Mild Tbi ◽  
Moderate Traumatic Brain Injury ◽  
Comparable Control ◽  
Neurobehavioral Outcomes

This study evaluated the early cognitive and neurobehavioral outcomes of older adults with mild versus moderate traumatic brain injury (TBI). Thirty-five patients who were age 50 years and older and sustained mild or moderate TBI were prospectively recruited from acute care hospitals. Patients were administered cognitive and neurobehavioral measures up to 2 months post-injury. Demographically comparable control participants received the same measures. Patients and controls did not have previous histories of substance abuse, neuropsychiatric disturbance, dementia, or neurologic illness. Moderate TBI patients performed significantly poorer than mild TBI patients and controls on most cognitive measures, whereas the mild patients performed comparably to controls. In contrast, both mild and moderate patients exhibited significantly greater depression and anxiety/somatic concern than controls. The results indicate that the classification of TBI as mild versus moderate is prognostically meaningful as applied to older adults. The findings extend previous investigations in young adults by demonstrating a relatively good cognitive outcome on objective measures, but subjective complaints after a single, uncomplicated mild TBI in older persons. (JINS, 2001, 7, 373–383.)

Cognitive Impairment Associated With Major Depression Following Mild and Moderate Traumatic Brain Injury

2005 ◽  
Vol 17 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Mark J. Rapoport ◽  
Scott McCullagh ◽  
Prathiba Shammi ◽  
Anthony Feinstein
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Major Depression ◽  
Moderate Traumatic Brain Injury

scholarly journals Apoptotic and Antiapoptotic Mechanisms after Traumatic Brain Injury

2001 ◽  
Vol 21 (10) ◽  
pp. 1189-1198 ◽  
Author(s):  
Robert W. Keane ◽  
Susan Kraydieh ◽  
George Lotocki ◽  
Ofelia F. Alonso ◽  
Phillip Aldana ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Protective Role ◽  
Current Data ◽  
Caspase 8 ◽  
Effector Caspase ◽  
Moderate Traumatic Brain Injury ◽  
Apoptotic Pathways ◽  
The Impact ◽  
The Brain

Caspase and inhibitor of apoptosis (IAP) expression was examined in rats subjected to moderate traumatic brain injury (TBI) using a parasagittal fluid-percussion brain insult (1.7 to 2.2 atm). Within 1 hour after injury, caspase-8 and −9, two initiators of apoptosis, were predominantly expressed in superficial cortical areas adjacent to the impact site and in the thalamus. Caspase-3, an effector caspase, was evident at 6 hours throughout the traumatized cerebral cortex and hippocampus. Moreover, the authors observed that XIAP, cIAP-1, and cIAP-2, members of the IAP family, were constitutively expressed in the brain. Colocalization of XIAP-immunolabled cells with cell-specific markers indicated that XIAP is expressed within neurons and a subpopulation of oligodendrocytes. Immunoblots of brain extracts revealed that the processed forms of caspase-8, −9, and −3 are present as early as 1 hour after trauma. The appearance of activated caspases corresponded with the detection of cleavage of XIAP into fragments after injury and a concomitant increase in the levels of cIAP-1 and cIAP-2 in the traumatized hemispheres. The current data are consistent with the hypotheses that caspases in both the extrinsic and intrinsic apoptotic pathways are activated after moderate TBI and that IAPs may have a protective role within the brain with alterations in levels and cleavage of IAPs that contribute to cell death in this setting.

The impact of multimodal cognitive rehabilitation on executive functions in older adults with traumatic brain injury

2021 ◽  
Vol 64 (5) ◽  
pp. 101559
Author(s):  
Eduardo Cisneros ◽  
Véronique Beauséjour ◽  
Elaine de Guise ◽  
Sylvie Belleville ◽  
Michelle McKerral
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functions ◽  
Cognitive Rehabilitation ◽  
The Impact

scholarly journals The impact of multimodal cognitive rehabilitation on executive functions in older adults with traumatic brain injury (TBI)

2020 ◽  
Author(s):  
Eduardo Cisneros ◽  
Véronique Beauséjour ◽  
Elaine de Guise ◽  
Sylvie Belleville ◽  
Michelle McKerral
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Active Control ◽  
Cognitive Rehabilitation ◽  
Daily Life ◽  
Control Group ◽  
Active Control Group ◽  
Daily Life Activities ◽  
The Impact

AbstractObjectivesThis study evaluated the impact of a multimodal cognitive rehabilitation intervention, the Cognitive Enrichment Program (CEP), on executive functioning (EF) and resumption of daily activities following traumatic brain injury (TBI) in older individuals, in comparison to an active control group having received holistic rehabilitation as usual care.MethodsThe CEP’sexecutive function module included planning, problem solving, and goal management training, as well as strategies focusing on self-awareness. Effectiveness was evaluated by psychometric tests (Modified Six Elements Task-adapted – MSET-A, D-KEFS Sorting test and Stroop four-color version), while generalization was measured through self-reported questionnaires about daily functioning (Dysexecutive Functioning Questionnaire – DEX, Forsaken daily life activities). Measures were obtained before and after intervention, and six months later.ResultsANCOVA results showed significant group-by-time interactions on Tackling the 6 subtasks and Avoiding rule-breaking measures of the MSET-A, with moderate effect sizes. Despite improvements in Sorting and Stroop scores, there were no group-by-time interaction on these measures. DEX generalization measure showed a significant reduction in patient/significant other difference on the Executive Cognition subscale. There was a reduction in the number of Forsaken daily life activities in the experimental group compared to controls which was not significant immediately after CEP, but that was significant six months later.ConclusionsOur study shows that older adults with TBI can improve their executive functioning with a positive impact on everyday activities after receiving multimodal cognitive training compared to an active control group.

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