Older adults with traumatic brain injury (TBI) or seizures face up to a 40% higher risk of developing cognitive impairment, with Hispanic individuals showing the greatest vulnerability, according to a recent study.
A cohort study examined the associations between TBI, seizure, and cognitive impairment in older adults, identifying differences across racial and ethnic groups. The study, published in JAMA Network Open, involved 7,180 individuals with a median age of 74 years (range = 65–102 years). The cohort included 65.9% women (n = 4,729), with 14.4% identifying as African American or Black, 4.6% as Hispanic, and 78.7% as non-Hispanic White. The median education level was 16 years (range = 1–29 years).
Among the participants, TBI was linked to a 25% higher risk of cognitive impairment, and seizures were associated with a 40% increased risk. Hispanic participants with both conditions faced an even greater risk of cognitive decline—specifically, they had a 24% higher likelihood of developing cognitive impairment compared to non-Hispanic White participants (hazard ratio [HR] = 1.24; 95% confidence interval [CI] = 1.11-1.39), while African American participants had a 16% lower risk compared to White participants (HR, = 0.84; 95% CI = 0.73-0.97).
The study further quantified these risks, showing that TBI increased likelihood of cognitive impairment by 25% (HR = 1.25; 95% CI = 1.17-1.34), and seizures by 40% (HR = 1.40; 95% CI = 1.19-1.65). When both TBI and seizures were present, the risk rose by 57% (HR = 1.57; 95% CI = 1.23-2.01).
Additionally, the study assessed the impact of medications on cognitive outcomes. Antiseizure medications were associated with a 33% increased risk of cognitive impairment, and antipsychotic use was linked to a 115% higher risk; in contrast, the use of anxiolytics, sedatives, or hypnotic agents was associated with a reduced risk of cognitive decline.
The median follow-up period for the study was 4.0 years (range = 0.1–14.7 years). During this time, 28.1% of the participants (n=2,020) developed cognitive impairment. Those who progressed to cognitive decline had a median follow-up of 3.2 years compared to 4.2 years for those who did not.
The study authors concluded, "This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia."
Full disclosures can be found in the published study.
