Head Injury

Head Injury

The risk of head injuries associated with antipsychotic use among persons with Alzheimer’s disease
Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. J. Am. Geriatr. Soc. 2020; ePub(ePub): ePub.
Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jgs.16275 PMID 31912482
Abstract
BACKGROUND/OBJECTIVES: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer’s disease (AD).

DESIGN: Nationwide register-based cohort study. SETTING: Medication Use and Alzheimer’s Disease (MEDALZ) cohort, Finland. PARTICIPANTS: The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded. MEASUREMENTS: Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD-10] codes S00-S09) and traumatic brain injuries (TBIs; ICD-10 codes S06.0-S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS: Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person-years = 1.65 [95% confidence interval {CI} = 1.50-1.81] for users and 1.26 [95% CI = 1.16-1.37] for nonusers; IPT-weighted hazard ratio [HR] = 1.29 [95% CI = 1.14-1.47]) and TBIs (event rate per 100 person-years = 0.90 [95% CI = 0.79-1.02] for users and 0.72 [95% CI = 0.65-0.81] for nonusers; IPT-weighted HR = 1.22 [95% CI = 1.03-1.45]). Quetiapine users had higher risk of TBIs (IPT-weighted HR = 1.60 [95% CI = 1.15-2.22]) in comparison to risperidone users.

CONCLUSIONS: These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.
Language: en

Keywords
Alzheimer’s disease; antipsychotics; dementia; risk factors; traumatic brain injury

 

Incidence of intracranial bleeding in seniors presenting to the emergency department after a fall: a systematic review
de Wit K, Merali Z, Kagoma Y, Mercier E. Injury 2019; ePub(ePub): ePub.
Affiliation
Centre de recherche sur les soins et services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Quebec, Canada.
(Copyright © 2019, Elsevier Publishing)
DOI 10.1016/j.injury.2019.12.036 PMID 31901331
Abstract
INTRODUCTION: Seniors who fall are an increasing proportion of the patients who are treated in emergency departments (ED). Falling on level-ground is the most common cause of traumatic intracranial bleeding. We aimed to determine the incidence of intracranial bleeding among all senior patients who present to ED after a fall.

METHOD: We performed a systematic review. Medline, EMBASE, Cochrane, and Database of Abstracts of Reviews of Effects databases, Google Scholar, bibliographies and conference abstracts were searched for articles relevant to senior ED patients who presented after a ground-level fall. Studies were included if they reported on patients aged 65 or older who had fallen. At least 80% of the population had to have suffered a ground-level fall. There were no language restrictions. We performed a meta-analysis (using the random effects model) to report the pooled incidence of intracranial bleeding within 6 weeks of the fall.

RESULTS: We identified eleven studies (including 11,102 patients) addressing this clinical question. Only three studies were prospective in design. The studies varied in their inclusion criteria, with two requiring evidence of head injury and four requiring the emergency physician to have ordered a head computed tomography (CT). One study excluded patients on therapeutic anticoagulation. Overall, there was a high risk of bias for eight out of eleven studies. The pooled incidence of intracranial bleeding was 5.2% (95% CI 3.2-8.2%). A sensitivity analysis excluding studies with a high risk of bias gave a pooled estimate of 5.1% (95% CI 3.6-7.2%).

CONCLUSION: We found a lack of high-quality evidence on senior ED patients who have fallen. The available literature suggests there is around a 5% incidence of intracranial bleeding in seniors who present to the ED after a fall.
Language: en

Keywords
Falls; Seniors; Traumatic brain injury

 

Anticipatory and compensatory postural responses during perturbed standing in individuals with traumatic brain injury
Pilkar R, Ibironke O, Ehrenberg N, Nolan KJ. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2019; 2019: 5080-5083.
(Copyright © 2019, IEEE (Institute of Electrical and Electronics Engineers))
DOI 10.1109/EMBC.2019.8857851 PMID 31947001
Abstract
Anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) are neuromuscular responses generated to stabilize the body and achieve balance during perturbations. The impaired sensory integration after a traumatic brain injury (TBI) can limit the ability to perceive perturbations and potentially affect the ability to generate APA and CPA responses. The main objective of this investigation is to explore the existence of APA and CPA generation in tibialis anterior (TA) and gastrocnemius (GAST) muscles during base of support perturbations in healthy controls (HC) as well as individuals with TBI. The secondary objective is to explore the effectiveness of a novel computerized biofeedback based intervention (CBBI) at improving APA and CPA responses in individuals with TBI. We observed that all three groups – HC (n=5), TBI-control (n=5), and TBI-Intervention (n=4) showed the presence of only CPA responses for the TA muscle, however, these responses were longer and variable for both TBI groups, compared to the short and consistent responses of the HC group. The GAST was involved in both APA and CPA for all groups. After the 4-week CBBI period, the TBI-I group showed increased APA responses for both TA and GAST. Further, the TBI-I group showed reduced CPA responses for both TA and GAST after the intervention. The elevated and longer CPA responses of TA and GAST and lower APA responses of GAST could suggest impaired postural control. Due to their significance and potential link to the balance dysfunction, these mechanisms need to be studied comprehensively in larger samples in order to effectively optimize the rehabilitation approaches for improving balance and avoiding falls in individuals with TBI.
Language: en