Factors associated with self-reported arthritis 7 to 24 years after a traumatic brain injury.

The purpose of this study was to profile characteristics of people with traumatic brain injury (TBI) who self-reported arthritis 7 to 24 yr. post-injury. Pre- and post-injury socio-demographic factors, injury-related factors, and postinjury standardized assessments measuring health, activity, and participation outcomes were assessed in a retrospective cohort study of 274 participants. The group self-reporting arthritis had significantly more sleep disturbances, poorer overall health, lower mental health and physical function, and decreased productivity. Also, they were older and reported a shorter length of loss of consciousness from TBI. These resulted suggest that musculoskeletal complaints from long-term survivors of TBI sholud be addressed in post-acute care and could guide future research on arthritis in the TBI population.

Preventive health practices and behavioral risk factors in women surviving traumatic brain injury.

Traumatic brain injury (TBI) affects millions globally and is considered a universal public health concern. Our study addresses a considerable knowledge gap about the health of female survivors of TBI. Using a retrospective cohort study design, we examined behavioral risk factors, access to health screenings, and primary care services among women with a history of moderate to severe TBI. We compared findings with a general female population. Female survivors (n = 75) appeared to have comparable use of primary care services with the general population. Significantly more women reported poor mental health postinjury; reported alcohol consumption was also greater.

Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury.

BACKGROUND: The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. METHODS: This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. RESULTS: Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. CONCLUSION: This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.

Prescription medication use in persons many years following traumatic brain injury.

BACKGROUND: This research study examined the prevalence of prescription medication use in persons many years following moderate-to-severe traumatic brain injury (TBI). DESIGN: Retrospective cohort study. SETTING AND SUBJECTS: Consecutive records were examined of persons with moderate-to-severe TBI who were discharged from a large rehabilitation hospital in Pennsylvania from 1973-1989. Consenting participants (n = 306) were interviewed, who were traced up to 24 years post-injury. Data on current use of prescription medications, in addition to demographic characteristics and health conditions were collected from the participants. RESULTS: The prevalence of prescription medication was 58.9% in the sample, greater in females (65.6%) than in males (56.1%). The most prescribed medication types were anti-convulsants (25.8%) followed by anti-depressants (8.2%), painkillers (8.2%) and anti-anxiety medications (5.9%). On average, persons with TBI were prescribed 2.64 (SD = 2.14) medications with a range of 1-12. CONCLUSION: The research findings indicate a high prevalence of prescription medications in persons with past history of TBI. There is also a high prevalence of anti-convulsants medication use.

Predictors of postacute mortality following traumatic brain injury in a seriously injured population.

BACKGROUND: Traumatic brain injury (TBI) is a primary cause of injury mortality in developed countries but less is known about the impact of TBI on postacute mortality in large study populations. This study investigates the rate and predictors of postacute mortality (1-9 years after the initial injury) of severely injured persons with TBI in the Province of Ontario from April 1, 1993 to March 31, 1995. METHOD: Cases were identified (n = 2,721) from the Ontario Trauma Registry Comprehensive Data Set based on lead trauma hospitals in the province which also provided data on predictors. Severely injured patients (n = 557) who had lower extremity injuries during the sample time period formed a control population. RESULTS: Poisson regression modeling showed that having a TBI was a significant predictor of premature death controlling for age and injury severity. Age, the number of comorbidities, injury severity, mechanism of injury, and discharge destination were significant predictors in the multivariate analyses for the TBI population. CONCLUSIONS: This research quantifies the elevated risk of premature death in the postacute period for seriously injured adults with TBI and identifies factors most associated with highest mortality rates in this population.

Depressive symptoms and cognitive decline in late life: a prospective epidemiological study.

CONTEXT: Depression is associated with cognitive impairment and dementia. It is less clear whether depression contributes to further cognitive decline over time, independently of incipient dementia. OBJECTIVE: To examine the relationship between depressive symptoms and subsequent cognitive decline in a cohort of nondemented older adults, some of whom remained dementia free during follow-up and others in whom incident dementia eventually developed. DESIGN: Twelve-year prospective epidemiological study, including biennial measurement of cognition and depressive symptoms, biennial assessment of dementia, and comparison of cognitive function at baseline and over time in persons with and without baseline depressive symptoms in the dementia-free and eventual-dementia groups, using random-effects models. SETTING: A largely blue-collar rural community. PARTICIPANTS: Population-based sample of 1265 adults 67 years and older without dementia at baseline. MAIN OUTCOME MEASURES: Scores over time on each of several cognitive test composites. RESULTS: Among 1094 participants who remained dementia free, those with baseline depressive symptoms had significantly lower baseline scores on all cognitive composites than the nondepressed participants. Among the 171 individuals in whom dementia later developed, depression was associated with worse performance in some but not all baseline cognitive composites. Cognitive decline over time was minimal in the dementia-free group, whereas marked decline was seen in the eventual-dementia group. Depressive symptoms were not associated with rate of cognitive decline over time in either group. CONCLUSIONS: Depressive symptoms are cross-sectionally associated with cognitive impairment but not subsequent cognitive decline. Substantial cognitive decline over time cannot be explained by depression and most likely reflects incipient dementia.

Long-term survival following traumatic brain injury.

PURPOSE: The study used a retrospective cohort design to establish long-term mortality rates and predictors of mortality for persons after moderate to severe traumatic brain injury (TBI). METHOD: Consecutive records of persons with moderate to severe TBI who were discharged from a large rehabilitation hospital in Pittsburgh, Pennsylvania in the years 1974-1984, 1988 and 1989 were reviewed. RESULTS: Six hundred and forty-two eligible individuals were identified and mortality was ascertained up to 24 years post injury. One hundred and twenty-eight of these individuals were found to be deceased. Poisson regression analyses revealed at least a 2-fold increased risk for mortality compared to the general population. Pre-injury characteristics and levels of disability at discharge from in-patient rehabilitation were among the strongest predictors of mortality. CONCLUSIONS: These data constitute evidence for premature death in the post-acute TBI population following a moderate to severe head injury and are discussed in relation to other research in the area.

Tracking cognitive functioning over time: ten-year longitudinal data from a community-based study.

Over 10 years, a community-based sample age 65> or = years, with a starting cohort size of 1,206, was assessed biennially with the Mini-Mental State Exam; the Consortium to Establish a Registry for Alzheimer's Disease battery; Immediate and Delayed Recall of a Story; Verbal Fluency for P and S, Fruits and Animals; Clock Drawing; Temporal Orientation; and Trail Making tests. We report distributions of scores over time, at each wave, in (a) all individuals who were assessed at that wave, whether or not they participated in all waves, and (b) the Survivor subgroup of 425 participants who completed all tests at all 5 waves. Scores and factor structures remained remarkably stable over the study period. The most marked decline over time was seen on the Trail Making tests. As the survivors are de facto a largely healthy and motivated group, their data can be considered population-based healthy norms and may serve as a reference for other studies conducting repeated evaluations using the same tests.

Sensitivity and specificity of cognitive and functional screening instruments for dementia: the Indo-U.S. Dementia Epidemiology Study.

There is a shortage of adequate screening instruments for dementia in poorly educated populations and non-English-speaking groups. An epidemiological survey was conducted in a population-based, largely illiterate, sample of 5,126 individuals aged 55 and older in 28 villages in the rural community of Ballabgarh in northern India. All participants were administered a general mental status test, the Hindi Mental State Examination (HMSE), and a brief battery of neuropsychological tests. Their informants answered a questionnaire assessing functional ability, the Everyday Abilities Scale for India (EASI). Six hundred thirty-two participants underwent clinical diagnostic evaluation for dementia. We investigated whether the sensitivity, specificity, and predictive value for dementia of the mental status test could be improved by the addition of the brief neuropsychological test battery or the functional questionnaire, comparing the instruments alone and in combination. In participants who could be tested cognitively, the HMSE, the neuropsychological battery, and EASI had sensitivities of 81.3%, 81.3%, and 62.5%, respectively, with specificities of 60.2%, 74.5%, and 89.7%, respectively. The combination of all three was 93.8% sensitive and 41.8% specific. The sensitivity of the HMSE alone was nonsignificantly improved by the addition of either the EASI or the neuropsychological battery, whereas its specificity was significantly decreased by either addition. An advantage of the EASI was that it could also be administered to informants of subjects who were cognitively untestable. In this largely illiterate community, with a low prevalence of dementia, the combination of cognitive tests and a functional ability questionnaire had substantial value for population screening.