Section, KU Leuven, Louvain, Belgium.
Bicometrixicometrix, Louvain, Belgium.
Acta Neurochir (Wien). 2023 Apr;165(4):849-864. doi: 10.1007/s00701-023-05546-1. Epub 2023 Mar 16.
Recovery after traumatic brain injury (TBI) in older adults is usually affected by the presence of comorbidities, leading to more severe sequelae in this age group than in younger patients. However, there are only few reports that prospectively perform in-depth assessment of outcome following TBI in elderly.
This study aims at documenting structural brain characteristics and functional outcome and quality of life in elderly patients 6 months after TBI and comparing these data with healthy volunteers undergoing the same assessments.
Thirteen TBI patients ≥ 65 years old, admitted to the University Hospitals Leuven (Belgium), between 2019 and 2022 due to TBI, including all injury severities, and a group of 13 healthy volunteers with similar demographic characteristics were prospectively included in the study. At admission, demographic, injury, and CT scan data were collected in our database. Six months after the accident, a brain MRI scan and standardized assessments of frailty, sleep quality, cognitive function, motor function, and quality of life were conducted.
A total of 13 patients and 13 volunteers were included in the study, with a median age of 74 and 73 years, respectively. Nine out of the 13 patients presented with a mild TBI. The patient group had a significantly higher level of frailty than the control group, presenting a mean Reported Edmonton Frailty Scale score of 5.8 (SD 2.7) vs 0.7 (SD 1.1) (p < 0.01). No statistically significant differences were found between patient and control brain volumes, fluid attenuated inversion recovery white matter hyperintensity volumes, number of lesions and blackholes, and fractional anisotropy values. Patients demonstrated a significantly higher median reaction time in the One Touch Stockings of Cambridge (22.3 s vs 17.6, p = 0.03) and Reaction Time (0.5 s vs 0.4 s, p < 0.01) subtests in the Cambridge Neuropsychological Test Automated Battery. Furthermore, patients had a lower mean score on the first Box and Blocks test with the right hand (46.6 vs 61.7, p < 0.01) and a significantly higher mean score in the Timed-Up & Go test (13.1 s vs 6.2 s, p = 0.02) and Timed Up & Go with cognitive dual task (16.0 s vs 10.2 s, p < 0.01). Substantially lower QOLIBRI total score (60.4 vs 85.4, p < 0.01) and QOLIBRI-OS total score (53.8 vs 88.5, p < 0.01) were also observed in the patients' group.
In this prospective study, TBI patients ≥ 65 years old when compared with elder controls showed slightly worse cognitive performance and poorer motor function, higher fall risk, but a substantially reduced QoL at 6 months FU, as well as significantly higher frailty, even when the TBI is classified as mild. No statistically significant differences were found in structural brain characteristics on MRI. Future studies with larger sample sizes are needed to refine the impact of TBI versus frailty on function and QoL in elderly.
老年人创伤性脑损伤 (TBI) 后的恢复通常受到合并症的影响，导致该年龄段的后遗症比年轻患者更严重。然而，只有少数研究前瞻性地评估了老年 TBI 后的结果。
本研究旨在记录老年 TBI 患者 6 个月后的结构脑特征和功能结局以及生活质量，并将这些数据与接受相同评估的健康志愿者进行比较。
2019 年至 2022 年期间，由于 TBI 而入住鲁汶大学医院（比利时）的 13 名年龄≥65 岁的 TBI 患者，包括所有损伤严重程度，以及 13 名具有相似人口统计学特征的健康志愿者被纳入前瞻性研究。入院时，在我们的数据库中收集了人口统计学、损伤和 CT 扫描数据。事故发生后 6 个月，进行了脑 MRI 扫描和衰弱、睡眠质量、认知功能、运动功能和生活质量的标准化评估。
共有 13 名患者和 13 名志愿者纳入研究，患者的中位年龄为 74 岁，对照组的中位年龄为 73 岁。13 名患者中有 9 名患有轻度 TBI。患者组的衰弱程度明显高于对照组，报告的埃德蒙顿衰弱量表评分中位数为 5.8（SD 2.7）比 0.7（SD 1.1）（p<0.01）。患者和对照组的脑体积、液体衰减反转恢复白质高信号体积、病变和黑洞数量以及各向异性分数值之间无统计学显著差异。患者在剑桥认知测试自动化电池中的 One Touch Stockings of Cambridge（22.3s 比 17.6，p=0.03）和反应时间（0.5s 比 0.4s，p<0.01）亚测试中的中位反应时间明显更长。此外，患者右手第一 Box and Blocks 测试的平均得分较低（46.6 比 61.7，p<0.01），Timed-Up & Go 测试（13.1s 比 6.2s，p=0.02）和 Timed Up & Go with cognitive dual task（16.0s 比 10.2s，p<0.01）的平均得分明显更高。患者组的 QOLIBRI 总分（60.4 比 85.4，p<0.01）和 QOLIBRI-OS 总分（53.8 比 88.5，p<0.01）也明显较低。
在这项前瞻性研究中，与老年对照组相比，年龄≥65 岁的 TBI 患者表现出稍差的认知表现和较差的运动功能、更高的跌倒风险，但在 6 个月随访时的生活质量明显降低，以及明显更高的衰弱程度，即使 TBI 被归类为轻度。在 MRI 上未发现结构脑特征的统计学显著差异。需要更大样本量的未来研究来细化 TBI 与衰弱对老年人功能和生活质量的影响。
