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Older patients recover from mild traumatic brain injury more slowly than younger patients

Functional MRI demonstrated that postconcussion symptoms manifest differently in older and younger patients, according to data recently published in Radiology.

The imaging confirmed that age plays an important role in working memory processing after mild traumatic brain injury (MTBI), according David Yen-Ting Chen, MD, department of radiology and the brain and consciousness research center, Taipei Medical University, Shuang-Ho Hospital, Taiwan, and colleagues.

The researchers collected the postconcussion syndrome symptoms of 26 patients for the study. Of these patients, 13 were aged 30 years and younger and 13 were aged 51 years and older. The patients, who all had a Glasgow coma scale score of 15, also underwent continuous performance testing and n-back working memory task functional MRI. These participants were compared with control participants who were matched for age and sex.

Chen and colleagues stated that functional MRI was done with a 3.0 T MRI system (Discover MR750, GE Healthcare).

Results showed hypoactivation in the right precuneus (P = .013) and right inferior frontal gyrus (P = .019) in older patients when compared with matched controls. They also demonstrated initial hyperactivation in the right precuneus (P = .047) and right inferior parietal gyrus (P = .025) in younger patients when compared with matched controls.

In younger patients, increased working memory activity was associated with poor working memory performance in the right precuneus (r = 0.55; P = .027). Increased working memory activity was also associated with increased postconcussion symptoms in the right inferior frontal gyrus (r = 0.6; P = .019) and the right precuneus (r = 0.57; P = .026).

At follow-up, data showed reduced postconcussion scores in younger patients (P = .04) after 6 weeks when compared with initial imaging. No changes were found in older adults.

"Taken together, these findings provide evidence for differential neural plasticity across different ages, with potential prognostic and therapeutic implications," Chen and colleagues wrote.

Researchers stated that the findings have several implications in patient care.

"The age effect in MTBI outcomes may lead to future development of separate management strategies for different age groups following MTBI," they wrote. "Functional [MRI] has the potential to provide objective diagnostic and prognostic information in [working memory] sequelae after MTBI, as hyperactivation during [working memory] tasks in younger patients within 1 month of injury may indicate greater severity of brain injury and neuronal dysfunction." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.