Ageing with Traumatic Brain Injury: Long-Term Cognition and Wellbeing

Whether and how traumatic brain injury (TBI) impacts ageing in the decades post-injury remains a matter of debate, partly due to a lack of controlled studies. This study examined the long-term impact of TBI on cognition and wellbeing in middle-aged and older adults and explored the relationship between age, cognition, and wellbeing, compared with a non-TBI control group. Cross-sectional data from 143 participants aged ≥40 with moderate-severe TBI (6-33 years post-injury; mean age 59.64) were compared with 71 non-TBI controls (mean age 62.10) group matched on age, gender, and premorbid IQ. Individuals with significant confounding comorbidities were excluded. A battery of neuropsychological tests and wellbeing measures (emotional distress, sleep, health-related quality of life [HRQoL]) was administered. Older age and TBI were each independently associated with poorer cognition across multiple domains (<i>p</i> < 0.05). The relationship between verbal learning and memory impairment post-TBI differed between age groups: individuals with TBI in their 40s-60s performed significantly worse than same-aged controls on verbal story acquisition (<i>B</i> = 0.09, <i>p =</i> 0.040, 95% confidence interval [CI] [0.004, 0.17]) and recall (<i>B</i> = 0.12, <i>p =</i> 0.009, 95% CI [0.03, 0.21]), and verbal wordlist recall (<i>B</i> = 0.11, <i>p</i> = 0.007, 95% CI [0.03, 0.19]). In comparison, no significant group differences in verbal memory emerged for ages 70-90. The TBI group reported greater emotional distress (<i>B</i> = 3.55, <i>p</i> < 0.001, 95% CI [1.73, 5.37]), poorer sleep quality (<i>B</i> = 1.07, <i>p =</i> 0.016, 95% CI [0.20, 1.94]), and poorer physical HRQoL (<i>B</i> = -4.26, <i>p =</i> 0.003, 95% CI [-7.08, -1.43]) than controls at all ages. Poorer physical HRQoL was related to poorer cognition post-TBI (<i>p</i> < 0.05). Our results challenge the notion that TBI exacerbates ageing. Moderate-severe TBI resulted in significant long-term impairments in cognition and wellbeing, with verbal learning and memory more impaired during middle-adulthood but not older adulthood compared to controls. TBI was not associated with changes to wellbeing with ageing. Intervention for verbal memory deficits in middle-aged adults with TBI is important, along with wider long-term supports for cognition, wellbeing, and activity participation in all individuals with TBI.