Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were seen within three months of injury and evaluated for aggression. The prevalence of aggression was found to be 28.4% and to be predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency on activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.

Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.

The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7% versus 5.4%, OR=2.8, p=0.02), but not other neuropsychiatric symptoms. Traumatic brain injury may increase the risk of disinhibition in patients with dementia.

Mild traumatic brain injury (mTBI) is the most common form of TBI. Most people recover after mTBI but a small percentage continues to have persistent problems, predominantly depression. There is however minimal literature on the risk factors associated with mTBI depression. In a sample of 43 mTBI patients, followed longitudinally for one year the prevalence of new-onset depression was found to be 18%. Older age and presence of frontal subdural hemorrhage were the only two significant findings noted in the depressed group compared to the non-depressed group. Identifying risk factors for mTBI depression can aid in early diagnosis and treatment.

The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7%Address correspondence to Vani Rao, M.D., Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins University, 5300 Alpha Commons Dr., 4th Floor, #444, Baltimore, MD 21224; vrao@jhmi.edu. These results were presented as a poster by DP at Northeastern Ohio Universities College of Medicine's Summer Research Fellowship Program on 9/3/08 in Rootstown, Ohio, and as an oral presentation at Summa Health System on 1/8/09 in Akron, Ohio. DP is a Medical Student Training in Aging Research (MSTAR) scholar and presented these results at the 2009 American Geriatric Society Annual Scientific Meeting. While patients affected by dementia and TBI independently are at increased risk for neuropsychiatric symptoms, no published data have examined the question of whether people with dementia who have sustained a TBI in the past are at increased risk for developing neuropsychiatric symptoms. Given that dementia and TBI are both associated with damage to the frontal cortex and associated frontal-subcortical circuits, and damage to these circuits from a variety of insults predisposes patients to psychopathology, 9 we hypothesized that, in persons with dementia, TBI prior to the onset of dementia would be a risk factor for increased neuropsychiatric symptoms associated with frontal lobe damage such as disinhibition, irritability, depression, apathy, and aggression. We examined this question in a population-based study of persons with dementia whose history of TBI was assessed prior to the onset of dementia and in whom dementia-onset was assessed prospectively (incident cohort). NIH Public Access METHODSThis is a prospective study involving persons with incident dementia who took part in the Cache County Study on Memory, Health, and Aging (CCSMHA). The CCSMHA is an ongoing population-based study of the epidemiology and progression of dementia. The study has been approved by Institutional Review Boards at Duke University Medical Center, Johns Hopkins University, and Utah State University. Informed consent was obtained from either the study participants or appropriate next of kin. This study has been described previously. 10,11 Briefly, a total of 5,092 respondents (5,677 were invited) ages 65 years and older participated in the study. All participants underwent a multistage screening and assessment for prevalent dementia (Wave 1). Those with dementia in Wave 1 and those that did not develop dementia or dropped out between Waves 1 and 3 were excluded from these analyses (n=4,265). TBI AssessmentHead injury was assessed prior to the onse...