Mild traumatic brain injury in older adults, provocation evaluation: A pilot study

Standard evaluation protocols for mild traumatic brain injury (mTBI), the same as concussion, support cost-effective care and successful outcomes. While clinical guidelines endorse these in young populations (ages <65), evidence is limited for older adults (ages ≥65), particularly regarding self-reported measures and provocation testing. This study aims to assess mTBI-specific protocols, including provocation tests, in older adults with and without mTBI.

This pilot study was conducted in an academic research laboratory, in which 13 community members aged ≥65 with or without a history of mTBI were enrolled. Participants completed: 1) a participant-reported Health History Form, a Patient-Specific Functional Scale (PSFS), and a Post Concussion Symptom Scale (PCSS); and 2) physical provocation testing using the Motion Sensitivity Quotient (MSQ) and a modified submaximal protocol of the Buffalo Concussion Bike Test (BCBT-M). Descriptive and Mann-Whitney U tests were used for statistical analysis.

This study was safely completed by all participants (n = 13) in one session. Findings (95%CI, P < 0.05) included no differences between the group (non-mTBI = 9, mTBI = 4) median (Mdn) in age (Mdn = 73; U = 17; P = 0.940), and BCBT-M level of completion (Mdn = 7; 5.3-8.5; U = 13.5; P = 0.472). The PSFS (Mdn = 6.3; 5.8-7.1; U = 4.0; P = 0.034), the PCSS (Mdn = 42.5; U = 0.00; P = 0.003), and the MSQ (Mdn = 16.0; U = 3.0; P = 0.020) had significant differences between mTBI and non-mTBI groups.

This pilot study demonstrated that older adults with and without mTBI fully engaged in standard guidelines of self-reported and physical provocation measures, with differences between the mTBI and non-mTBI groups. These early findings may inform baseline status among older adults with mTBI.