The cognitive profile of elderly patients with mild traumatic brain injury: a role for cognitive reserve?

Objective: To assess cognitive status in elderly patients with mild traumatic brain injury (mTBI) in the subacute phase, examine the role of cognitive reserve, and investigate associations with cognitive complaints, mental distress, and functional outcomes. Setting: A level 1 trauma center in the Netherlands. Participants: A total of 52 individuals with mTBI and 42 healthy controls. Design: A prospective observational cohort study. Main Measures: Neuropsychological assessment in the subacute phase (2 weeks to 6 months post-injury) to objectively measure the cognitive functioning, the Head Injury Symptom Checklist for subjective cognitive complaints, the Hospital Anxiety and Depression Scale for anxiety and depression, the Cognitive Reserve Index questionnaire for cognitive reserve, the Community Integration Questionnaire for community integration, and the Glasgow Outcome Scale Extended for functional outcome. Results: Cognitive impairments were observed in memory (P < .001) and attention, processing speed and executive control (P < .001). Cognitive reserve was not associated with neuropsychological test performance, except for one test measuring working memory. The relationship between injury severity and cognitive outcome was not moderated by cognitive reserve. Elderly patients reported significantly more complains than healthy controls regarding forgetfulness, concentration problems, and slowness. Complaints of concentration were associated with cognitive impairment. All cognitive complaints were significantly correlated with mental distress. Conclusions: Cognitive impairments may be present in elderly patients in the subacute phase after mTBI, and these impairments were not significantly associated with cognitive reserve. This suggests that cognitive reserve might not serve as a protective factor against the effects of mTBI in the elderly. Concentration complaints may serve as a specific indicator for cognitive impairment, while complaints of memory and mental slowness may represent more generic indicators of mental distress. These findings highlight the importance of careful screening in older adults with mTBI, guiding clinicians toward specific treatment targets encompassing cognitive impairment, diminished mental well-being, or both.