The chronic and evolving neurological consequences of traumatic brain injury

Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.

[1]  Douglas H. Smith,et al.  Widespread Tau and Amyloid‐Beta Pathology Many Years After a Single Traumatic Brain Injury in Humans , 2012, Brain pathology.

[2]  Anne Vik,et al.  White matter microstructure in chronic moderate‐to‐severe traumatic brain injury: Impact of acute‐phase injury‐related variables and associations with outcome measures , 2015, Journal of neuroscience research.

[3]  M. Dijkers,et al.  The Traumatic Brain Injury Model Systems: History and Contributions to Clinical Service and Research , 2010, The journal of head trauma rehabilitation.

[4]  K. Tsai,et al.  Population based study on patients with traumatic brain injury suggests increased risk of dementia , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[5]  S. Kolakowsky-Hayner,et al.  Mortality After Surviving Traumatic Brain Injury: Risks Based on Age Groups , 2012, The Journal of head trauma rehabilitation.

[6]  S. Kolakowsky-Hayner,et al.  Ageing and traumatic brain injury: Age, decline in function and level of assistance over the first 10 years post-injury , 2012, Brain injury.

[7]  P. Hume,et al.  A Comparison of Cognitive Function in Former Rugby Union Players Compared with Former Non-Contact-Sport Players and the Impact of Concussion History , 2017, Sports Medicine.

[8]  Jeffrey P. Cuthbert,et al.  US Population Estimates of Health and Social Outcomes 5 Years After Rehabilitation for Traumatic Brain Injury , 2014, The Journal of head trauma rehabilitation.

[9]  T. Novack,et al.  Differences in employment outcomes 10 years after traumatic brain injury among racial and ethnic minority groups , 2010 .

[10]  B. Lawlor,et al.  Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union? , 2016, QJM : monthly journal of the Association of Physicians.

[11]  D. Hovda,et al.  It’s Not All Fun and Games: Sports, Concussions, and Neuroscience , 2017, Neuron.

[12]  A. Chiò,et al.  ALS in Italian professional soccer players: The risk is still present and could be soccer-specific , 2009, Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases.

[13]  J. Phillips,et al.  Neuroendocrine disorders after traumatic brain injury , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[14]  A. McKee,et al.  The spectrum of disease in chronic traumatic encephalopathy. , 2013, Brain : a journal of neurology.

[15]  J. Hardy,et al.  Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players , 2017, Acta Neuropathologica.

[16]  D. Donaldson,et al.  Evidence for Acute Electrophysiological and Cognitive Changes Following Routine Soccer Heading , 2016, EBioMedicine.

[17]  Paul Edison,et al.  Amyloid pathology and axonal injury after brain trauma , 2016, Neurology.

[18]  Douglas H. Smith,et al.  Blood-Brain Barrier Disruption Is an Early Event That May Persist for Many Years After Traumatic Brain Injury in Humans , 2015, Journal of Neuropathology and Experimental Neurology.

[19]  T. McMillan,et al.  Mortality and morbidity 15 years after hospital admission with mild head injury: a prospective case-controlled population study , 2014, Journal of Neurology, Neurosurgery & Psychiatry.

[20]  A. McConnachie,et al.  Long-term health outcomes after exposure to repeated concussion in elite level: rugby union players , 2016, Journal of Neurology, Neurosurgery & Psychiatry.

[21]  R. Diaz-Arrastia,et al.  Clinical phenotype of dementia after traumatic brain injury. , 2013, Journal of neurotrauma.

[22]  B. Masel,et al.  Traumatic brain injury: a disease process, not an event. , 2010, Journal of neurotrauma.

[23]  Erika D. Sears,et al.  Traumatic brain injury may be an independent risk factor for stroke , 2013, Neurology.

[24]  Laura Moretti,et al.  Cognitive decline in older adults with a history of traumatic brain injury , 2012, The Lancet Neurology.

[25]  D. Fergusson,et al.  Long term psychosocial outcomes after mild head injury in early childhood , 2002, Journal of neurology, neurosurgery, and psychiatry.

[26]  N. Pearce,et al.  Head trauma in sport and neurodegenerative disease: an issue whose time has come? , 2015, Neurobiology of Aging.

[27]  J. Meaney,et al.  Blood–Brain Barrier Dysfunction as a Hallmark Pathology in Chronic Traumatic Encephalopathy , 2016, Journal of neuropathology and experimental neurology.

[28]  Cyril H Wecht,et al.  Chronic Traumatic Encephalopathy in a National Football League Player. , 2006, Neurosurgery.

[29]  Allen W. Brown,et al.  Relative risk of mortality after traumatic brain injury: a population-based study of the role of age and injury severity. , 2007, Journal of neurotrauma.

[30]  D. Mathews,et al.  Evidence of increased brain amyloid in severe TBI survivors at 1, 12, and 24 months after injury: report of 2 cases. , 2016, Journal of neurosurgery.

[31]  Robin O Cleveland,et al.  Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model , 2012, Science Translational Medicine.

[32]  N. Temkin,et al.  5-Year imaging sequelae of concussive blast injury and relation to early clinical outcome , 2017, NeuroImage: Clinical.

[33]  D. Sharp,et al.  Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes , 2016, PLoS medicine.

[34]  Etienne E. Pracht,et al.  The burden of neurological disease in the United States: A summary report and call to action , 2017, Annals of neurology.

[35]  S. Stein,et al.  150 years of treating severe traumatic brain injury: a systematic review of progress in mortality. , 2010, Journal of neurotrauma.

[36]  Herng‐Ching Lin,et al.  Patients With Traumatic Brain Injury: Population-Based Study Suggests Increased Risk of Stroke , 2011, Stroke.

[37]  G. Murray,et al.  Disability in young people and adults one year after head injury: prospective cohort study , 2000, BMJ : British Medical Journal.

[38]  T. Miller,et al.  Prevalence of Long‐Term Disability From Traumatic Brain Injury in the Civilian Population of the United States, 2005 , 2008, The Journal of head trauma rehabilitation.

[39]  D. Bennett,et al.  Association of Traumatic Brain Injury With Late-Life Neurodegenerative Conditions and Neuropathologic Findings. , 2016, JAMA neurology.

[40]  H. Kamel,et al.  Subarachnoid Hemorrhage and Long-Term Stroke Risk After Traumatic Brain Injury , 2017, The Neurohospitalist.

[41]  P. Decq,et al.  Long-term consequences of recurrent sports concussion , 2016, Acta Neurochirurgica.

[42]  N. Stocchetti,et al.  Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review , 2016, Critical Care.

[43]  S. Rauch,et al.  Long‐term Psychiatric Outcomes Following Traumatic Brain Injury: A Review of the Literature , 2009, The Journal of head trauma rehabilitation.

[44]  J. Schneider,et al.  Overview and findings from the rush Memory and Aging Project. , 2012, Current Alzheimer research.

[45]  T. Yen,et al.  Accumulation of amyloid in cognitive impairment after mild traumatic brain injury , 2015, Journal of the Neurological Sciences.

[46]  D. Salat,et al.  Mild traumatic brain injury is associated with reduced cortical thickness in those at risk for Alzheimer’s disease , 2017, Brain : a journal of neurology.

[47]  M. Berger,et al.  Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. , 2016, Journal of neurosurgery.

[48]  K. Dams-O’Connor,et al.  Global Outcome Trajectories After TBI Among Survivors and Nonsurvivors: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study , 2015, The Journal of head trauma rehabilitation.

[49]  P. Crane,et al.  Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury: a population-based study , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[50]  P. Hof,et al.  Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury , 2014, Translational Psychiatry.

[51]  T. Révész,et al.  Histological evidence of chronic traumatic encephalopathy in a large series of neurodegenerative diseases , 2015, Acta Neuropathologica.

[52]  Nicola Vanacore,et al.  Neurodegenerative causes of death among retired National Football League players , 2013, Neurology.

[53]  T. Jernigan,et al.  Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. , 2008, Brain : a journal of neurology.

[54]  J. Rosenfeld,et al.  Functional Plasticity or Vulnerability After Early Brain Injury? , 2005, Pediatrics.

[55]  D. Sharp,et al.  Inflammation after trauma: Microglial activation and traumatic brain injury , 2011, Annals of neurology.

[56]  Odette A. Harris,et al.  Service needs and barriers to care five or more years after moderate to severe TBI among Veterans , 2017, Brain injury.

[57]  Kristine Yaffe,et al.  Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity. , 2014, JAMA neurology.

[58]  J. Grafman,et al.  Traumatic brain injury and late-life dementia. , 2015, Handbook of clinical neurology.

[59]  S. Juvela,et al.  Predictors of new-onset seizures: a 10-year follow-up of head trauma subjects with and without traumatic brain injury , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[60]  Jeffrey P. Cuthbert,et al.  Prevalence of Self-Reported Lifetime History of Traumatic Brain Injury and Associated Disability: A Statewide Population-Based Survey , 2016, The Journal of head trauma rehabilitation.

[61]  Fiona Lecky,et al.  Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. , 2015, Neurosurgery.

[62]  C. DeCarli,et al.  Head injury and the risk of AD in the MIRAGE study , 2000, Neurology.

[63]  C. Hawley,et al.  Outcomes following childhood head injury: a population study , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[64]  J. Whyte,et al.  mpact of Age on Long-Term Recovery From Traumatic rain Injury , 2008 .

[65]  Daniel Rueckert,et al.  Dynamic Changes in White Matter Abnormalities Correlate With Late Improvement and Deterioration Following TBI , 2015, Neurorehabilitation and neural repair.

[66]  Allen W. Brown,et al.  Life Expectancy Following Rehabilitation: A NIDRR Traumatic Brain Injury Model Systems Study , 2012, The Journal of head trauma rehabilitation.

[67]  Shaojie Chen,et al.  Neuroinflammation and brain atrophy in former NFL players: An in vivo multimodal imaging pilot study , 2015, Neurobiology of Disease.

[68]  R. Green Editorial: Brain Injury as a Neurodegenerative Disorder , 2016, Front. Hum. Neurosci..

[69]  Young T. Hong,et al.  Amyloid imaging with carbon 11-labeled Pittsburgh compound B for traumatic brain injury. , 2014, JAMA neurology.

[70]  P. McCrory,et al.  What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? , 2013, British Journal of Sports Medicine.

[71]  C. Bruton,et al.  The aftermath of boxing , 1973, Psychological Medicine.

[72]  A. Chiò,et al.  Severely increased risk of amyotrophic lateral sclerosis among Italian professional football players. , 2005, Brain : a journal of neurology.

[73]  S Rabe-Hesketh,et al.  Head injury as a risk factor for Alzheimer’s disease: the evidence 10 years on; a partial replication , 2003, Journal of neurology, neurosurgery, and psychiatry.

[74]  I. Baguley,et al.  Late mortality after severe traumatic brain injury in New South Wales: a multicentre study , 2011, The Medical journal of Australia.

[75]  K. Dams-O’Connor,et al.  Longitudinal description of the glasgow outcome scale-extended for individuals in the traumatic brain injury model systems national database: a National Institute on Disability and Rehabilitation Research traumatic brain injury model systems study. , 2013, Archives of physical medicine and rehabilitation.

[76]  S. Marshall,et al.  Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players , 2005, Neurosurgery.

[77]  Mohammad Reza Najafi,et al.  Early and late posttraumatic seizures following traumatic brain injury: A five-year follow-up survival study , 2015, Advanced biomedical research.

[78]  Y. Gustafson,et al.  Traumatic brain injury and young onset dementia: A nationwide cohort study , 2014, Annals of neurology.

[79]  J. Powell,et al.  Outcome 3 to 5 years after moderate to severe traumatic brain injury. , 2003, Archives of physical medicine and rehabilitation.

[80]  R. Jorge,et al.  Dementia after traumatic brain injury , 2005, International Psychogeriatrics.

[81]  J. Trojanowski,et al.  Inflammation and white matter degeneration persist for years after a single traumatic brain injury. , 2013, Brain : a journal of neurology.

[82]  J. Trojanowski,et al.  Biomarkers of neurodegeneration for diagnosis and monitoring therapeutics , 2007, Nature Reviews Drug Discovery.

[83]  Allen W. Brown,et al.  Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study. , 2010, Archives of physical medicine and rehabilitation.

[84]  J. Powell,et al.  Return to driving within 5 years of moderate–severe traumatic brain injury , 2010, Brain injury.

[85]  J. Hallervorden,et al.  Dementia pugilistica mit anatomischem Befund , 2004, Virchows Archiv für pathologische Anatomie und Physiologie und für klinische Medizin.

[86]  H. Levin,et al.  Diagnosis, prognosis, and clinical management of mild traumatic brain injury , 2015, The Lancet Neurology.

[87]  M. Etminan,et al.  Head injury and risk of Parkinson disease: A systematic review and meta‐analysis , 2013, Movement disorders : official journal of the Movement Disorder Society.

[88]  I. Baguley,et al.  Age‐related trends in late mortality following traumatic brain injury: A multicentre inception cohort study , 2015, Australasian journal on ageing.

[89]  Allen W. Brown,et al.  A survey of very-long-term outcomes after traumatic brain injury among members of a population-based incident cohort. , 2011, Journal of neurotrauma.

[90]  G. Murray,et al.  Disability in young people and adults after head injury: 5–7 year follow up of a prospective cohort study , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[91]  Wayne A. Gordon,et al.  The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy , 2015, Acta Neuropathologica.

[92]  S. Dikmen,et al.  Social Functioning After Traumatic Brain Injury , 2009, The Journal of head trauma rehabilitation.

[93]  E. Bigler Traumatic brain injury, neuroimaging, and neurodegeneration , 2012, Front. Hum. Neurosci..

[94]  J. Schneider,et al.  Overview and findings from the religious orders study. , 2012, Current Alzheimer research.

[95]  N. Temkin,et al.  Long‐term Neurologic Outcomes After Traumatic Brain Injury , 2009, The Journal of head trauma rehabilitation.

[96]  Douglas H. Smith,et al.  Chronic Traumatic Encephalopathy: The Neuropathological Legacy of Traumatic Brain Injury. , 2016, Annual review of pathology.

[97]  R. Portin,et al.  Longitudinal cognitive changes in traumatic brain injury , 2006, Neurology.

[98]  Victoria E. Johnson,et al.  Chronic neuropathologies of single and repetitive TBI: substrates of dementia? , 2013, Nature Reviews Neurology.

[99]  F. Hammond,et al.  Traumatic brain injury as a chronic health condition. , 2013, Archives of physical medicine and rehabilitation.

[100]  Kristine Yaffe,et al.  Epidemiology of mild traumatic brain injury and neurodegenerative disease , 2015, Molecular and Cellular Neuroscience.

[101]  S. Villapol,et al.  Polypathology and dementia after brain trauma: Does brain injury trigger distinct neurodegenerative diseases, or should they be classified together as traumatic encephalopathy? , 2016, Experimental Neurology.

[102]  C. Tanner,et al.  Traumatic brain injury in later life increases risk for Parkinson disease , 2015, Annals of neurology.

[103]  Douglas H. Smith,et al.  Axonal pathology in traumatic brain injury , 2013, Experimental Neurology.

[104]  G. Teasdale,et al.  Disability in young people and adults after head injury: 12–14 year follow-up of a prospective cohort , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[105]  J. Sweeney,et al.  White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study. , 2007, Brain : a journal of neurology.

[106]  R. Diaz-Arrastia,et al.  An exploration of clinical dementia phenotypes among individuals with and without traumatic brain injury. , 2013, NeuroRehabilitation.

[107]  D. Perl,et al.  Dementia resulting from traumatic brain injury: what is the pathology? , 2012, Archives of neurology.

[108]  Sung-Cheng Huang,et al.  In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging , 2015, Proceedings of the National Academy of Sciences.

[109]  C. Jack,et al.  Tracking pathophysiological processes in Alzheimer's disease: an updated hypothetical model of dynamic biomarkers , 2013, The Lancet Neurology.

[110]  Kristen Dams-O'Connor,et al.  Traumatic brain injury as a risk factor for Alzheimer's disease: current knowledge and future directions. , 2016, Neurodegenerative disease management.

[111]  I. Baguley,et al.  Aggressive Behavior Following Traumatic Brain Injury: How Common Is Common? , 2006, The Journal of head trauma rehabilitation.

[112]  Ronald Boellaard,et al.  Widespread and Prolonged Increase in (R)-11C-PK11195 Binding After Traumatic Brain Injury , 2011, The Journal of Nuclear Medicine.