Evidence for a multidomain clinical assessment of mild traumatic brain injury in older adults

BackgroundThere are few guidelines on the appropriate clinical tools to evaluate mTBI in older adults.ObjectiveWe aimed to investigate the utility of a multidomain assessment to differentiate older adults with mTBI from controls.MethodsParticipants included 68 older adults (37% male) aged 60-76 (M = 66.24, SD = 4.50) years. Thirty-four patients were diagnosed with a mTBI at a specialty mTBI clinic within 90 days of injury, and age- and sex-matched to 34 community controls. Participants completed the following assessments: Post-Concussion Symptom Scale (PCSS), Short Fall Efficacy Scale-International (Short FES-I), Generalized Anxiety Disorder-7 Item Scale (GAD-7), Geriatric Depression Scale-5 Item (GDS-5), Wide Range Achievement Test-Fourth Edition (WRAT-4) reading subtest, subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), clock drawing, and Vestibular/Ocular Motor Screening for Concussion (VOMS). Independent-samples t-tests or chi-squared analyses were used to compare assessment results between groups. A logistic regression (LR) was conducted to determine which combination of assessments best identified the mTBI group from controls.ResultsThe mTBI group endorsed significantly more symptoms of concussion (p < .001), balance concerns (p < .001), anxiety (p < .001), and depression (p = 0.04), and performed worse on cognitive (p < .001), vestibular (p < .001), and oculomotor (p = .004) screening relative to controls. The LR (p < .001; r(2) = 0.90) correctly identified 98.5% of older adults and retained concussion (p = .01) and depression (p = .02) symptoms, and cognitive (p = .03) and vestibular (p = .04) screening in the final model.DiscussionThe current findings support a multidomain assessment model of care for evaluating mTBI in older adults.