Biomarkers of Traumatic Brain Injury in the Geriatric Population

Abstract

Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality, and advanced age is an independent predictor of worse outcome. Mortality is nearly double that of younger TBI patients, regardless of injury severity. In addition, geriatric patients are more prone to complications, have longer hospital stays, and require long-term rehabilitative services, the cost of which can be a significant burden. These observations are often attributed to anatomic and physiologic changes that occur with age, as well as patient comorbidities and the medications required to treat those conditions. Although current diagnostic and treatment guidelines have led to improved outcomes in the general population, data regarding the specific management of geriatric patients remain sparse. The identification and management of TBI has been the focus of both basic science and clinical investigations. Recent advances in molecular biology have identified specific markers of brain cell damage that may offer insight to the nature and progression of injury, lead to improved monitoring and diagnostic capability, and potentially guide therapy. This review highlights some of the latest technology that may pave the way for advanced diagnostic and treatment modalities.

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

“…Recent advances in biochemical assays of serum and cerebrospinal fluid (CSF) have identified a number of promising candidate blood-based and proteomic biomarkers of apoptosis and neuronal injury (neuron-specific enolase, tau, and amyloid-beta 1-42), glial injury (glial fibrillary acidic protein [GFAP], S100B, and excitatory amino acids), demyelination (myelin basic protein), proinflammatory cytokines (interleukins-1, -6, and -8), and gene expression of microRNAs (miR-16, miR-26a). 111 Very few studies have evaluated the impact of aging on the kinetics or clinical performance of serum or CSF-based biomarkers of TBI. [112][113][114][115][116][117] For example, although serum S100b showed initial promise in identifying low-risk patients who do not require head CT, 118 this biomarker may have reduced specificity among adults ages ‡65 years.…”