The protective effect of youth in MTBI

In the unfortunate event that you experience a trauma to your brain, it is to your benefit for it to happen when you are young. Age is an independent variable in predicting morbidity and mortality following head injury, regardless of how that injury was acquired. That means that even if you remove variables such as a greater amount of systemic illness in older people, or how the head injury was acquired, older people have a poorer outcome following brain injury than do younger people. Research published as early as 1979 (Rutherford, et al.) and as recently as 1999 (Sweeney) have found evidence that with mild traumatic brain injury, with or without actual impact to the head, there is a higher percentage and severity of neuropsychological deficits in older adults when compared to younger adults.

There are several possibilities as to why this may be the case. First, it is suggested that there is less neuronal plasticity in the older brain and therefore recovery is slower and more likely less optimal than in the younger brain. A second hypothesis is that along with neuronal loss in normal aging there may be neuronal adaptation and compensation which takes place in the remaining neurons, making them more sensitive to the stimulation of excitatory neurotransmitters. With trauma, however, there is a large and rapid release of the excitatory neurotransmitters. In such high concentrations, these neurotransmitters have been found to produce damaging effects to the brain.

Thus, it is especially relevant to carefully assess the effects of mild head injury, even without head impact, in the elderly as they appear to be an identified “high-risk” group likely to exhibit disproportionate difficulty in recovering neuropsychologically from mild TBI. A neuropsychological consultation is recommended to differentiate cognitive complaints due to the effects of normal aging versus an acquired traumatic brain injury.

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