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Falls Can Result in Traumatic Brain Injury

Falls are the leading cause of traumatic brain injury (TBI). People aged 75 and older have the highest rates of TBI-related hospitalization and death due to falls.

Physicians classify TBI as mild, moderate, or severe depending on whether the injury causes unconsciousness, how long unconsciousness lasts, and the severity of symptoms. Although most TBIs are classified as mild because they're not life threatening, even a mild TBI can have serious and long-lasting effects.

TBI threatens cognitive health in the following two ways:

• A TBI’s direct effects, which may be long-lasting or even permanent, can include unconsciousness, inability to recall the traumatic event, confusion, difficulty learning and remembering new information, trouble speaking coherently, unsteadiness, lack of coordination, and vision or hearing problems.
• Certain types of TBI may increase the risk of developing Alzheimer’s disease or another form of dementia years after the injury occurs.

Brain Injury Symptoms
Symptoms of a brain injury include: unconsciousness, inability to remember the cause of the injury or events that occurred immediately before or up to 24 hours after the injury, confusion and disorientation, difficulty remembering new information, headache, dizziness, blurred vision, nausea and vomiting, ringing in the ears, difficulty speaking coherently, and changes in emotions or sleep patterns. Symptom severity depends on whether the injury is mild, moderate, or severe.

Mild TBI, known as a concussion, may not result in unconsciousness or results in unconsciousness that lasts for 30 minutes or fewer. Symptoms often appear at the time of the injury or soon after but sometimes may not develop for days or weeks. Mild TBI symptoms usually are temporary and clear up within hours, days, or weeks, but they can last months or longer.

Moderate TBI causes unconsciousness lasting more than 30 minutes. Symptoms of moderate TBI are similar to those of mild TBI but more serious and longer lasting. Severe TBI results in unconsciousness that lasts for more than 24 hours. Symptoms of severe TBI are similar to those of mild TBI but more serious and longer lasting.

Diagnosing TBI
Evaluations by health care professionals typically include questions about the circumstances of the injury, assessment of the person’s level of consciousness and confusion, and a neurological examination to assess memory and thinking, vision, hearing, touch, balance, reflexes, and other indicators of brain function.

Depending on the nature of the TBI and the severity of symptoms, brain imaging with computed tomography (CT) may be needed to determine whether there’s bleeding or swelling in the brain.

Causes and Risks
Falls are the most common cause of TBI, and falling poses an especially serious risk for older adults. When an older adult sustains a TBI in a fall, direct effects of the injury may result in long-term cognitive changes, reduced ability to function, and changes in emotional health.

Over the past 30 years, research has linked moderate and severe TBI to a greater risk of developing Alzheimer’s disease or another type of dementia years after the original head injury.

Other studies, but not all, have found a link between moderate and severe TBI and elevated risk of cognitive impairment. Current research on how TBI changes brain chemistry indicates a relationship between TBI and hallmark protein abnormalities (beta-amyloid and tau) linked to Alzheimer’s disease.

Some research suggests that TBI may be more likely to cause dementia in individuals who have a variation of the gene for apolipoprotein E (APOE) called APOE-e4. More research is needed to understand the link between APOE-e4 and dementia risk in those who have experienced a brain injury.

Treatment and Outcomes
The most serious traumatic brain injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic brain injuries are mild and can be managed with either a short hospital stay for observation or at-home monitoring followed by outpatient rehab, if needed.

Treating dementia in a person with a history of TBIs varies, depending on the type of dementia diagnosed. Strategies for treating Alzheimer’s disease or another specific type of dementia are the same for individuals with and without a history of TBI.

Alzheimer’s disease and other dementias that may occur as a long-term result of TBI are progressive disorders that worsen over time. As with all dementias, they affect quality of life, shorten life span, and complicate efforts to manage other health conditions effectively.

— Source: Alzheimer’s Association