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Concussions Have More Profound Effect on Older Patients


Brain imaging with fMRI shows older patients may experience more difficulties.

Functional MRI shows that older people have a more difficult time recovering from concussions, according to a study published in Radiology.

Researchers from Taiwan performed a current longitudinal study to evaluate if a person’s age had an effect on working memory (WM) performance and functional activation following a mild traumatic brain injury (MTBI). “Old age has been recognized as an independent predictor of worse outcome from concussion, but most previous studies were performed on younger adults,” lead author, David Yen-Ting Chen, MD, Department of Radiology at Shuang-Ho Hospital, Taipei Medical University, New Taipei City, said in a release.

Twenty-six people with MTBI participated in the trial, 13 who ranged from 21 to 30 years (mean age: 26.2) and 13 who ranged from 51 to 68 years (mean age: 57.8), along with 26 matched controls. Glasgow coma scale was 15 for all patients.

Mechanism of injury:

Younger group
Older group
Motor vehicle collision

Functional MR images were obtained from the study participants within one month after injury and again at six weeks after the initial study. Group comparison and regression analysis were performed among postconcussion symptoms, neuropsychologic tests, and WM activity in both groups.

The researchers found that the younger patients had significantly reduced postconcussion syndrome (PCS) scores at follow-up imaging compared with the initial imaging study, but this was not seen among the older patients. However, there was no stage difference in the n-back WM accuracy and digit span score among patients in both age groups.[[{"type":"media","view_mode":"media_crop","fid":"42911","attributes":{"alt":"David Yen-Ting Chen, MD","class":"media-image media-image-right","id":"media_crop_9475160821744","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4668","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"David Yen-Ting Chen, MD","typeof":"foaf:Image"}}]]

The younger patients also showed initial hyperactivation in the right precuneus and right inferior parietal gyrus in two-back greater than one-back conditions compared with younger control subjects. Older patients showed hypoactivation in the right precuneus and right inferior frontal gyrus compared with older control subjects. Increased WM activity was associated with increased postconcussion symptoms in the right precuneus and right inferior frontal gyrus and poor WM performance in the right precuneus in younger patients at initial studies but not in older patients.

 “Taken together, these findings provide evidence for differential neural plasticity across different ages, with potential prognostic and therapeutic implications,” co-author, Ying-Chi Tseng, MD, Shaung-Ho Hospital, said in the release. “The results suggest that MTBI might cause a more profound and lasting effect in older patients.”

The researchers hope that these findings might eventually lead to the development of separate management strategies for different age groups following concussion.

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