Outcome following traumatic brain injury in the elderly: a critical review

BACKGROUND: The elderly are at risk for traumatic brain injury (TBI), but their outcome following these injuries remains unclear. OBJECTIVE: This paper critically reviews research done to date on cognitive and functional outcome following TBI in the elderly. METHODS: MEDLINE and PSYCHLIT databases going back to 1965 were searched. RESULTS: Studies suggest that TBI results in adverse cognitive and functional outcomes in the elderly. There is uncertainty as to whether TBI is a significant risk factor for Alzheimer's disease (AD). Methodological problems in these studies include selection bias, small samples, retrospective analyses, and, particularly, the failure to address the role of pre-morbid functioning. These problems limit the strength of the outcome studies, and may account for the equivocal findings on AD risk. CONCLUSIONS: It is premature to conclude from the published research to date that the elderly have a uniformly poor outcome following TBI. Directions for further research are suggested.