Predictors of Changes in Multidomain Clinical Outcomes in Older Adults following Concussion

Anthony Kontos, University of Pittsburgh, Pittsburgh, United States
Aaron Zynda, University of Pittsburgh, Pittsburgh, United States
Alicia Trbovich, University of Pittsburgh, Pittsburgh, United States
Cyndi Holland, University of Pittsburgh, Pittsburgh, United States
Courtney Perry, University of Pittsburgh, Pittsburgh, United States
Brooke Collins, Middlebury College, Middlebury, United States
Michael Collins, University of Pittsburgh, Pittsburgh, United States


Researchers have focused little attention on concussion in older adults (i.e., 50+ years) in spite of increasing rates of injury in this vulnerable population. Researchers have recently demonstrated that a multidomain assessment including symptoms, neuropsychological, ocular, psychological health, and vestibular components is effective for identifying concussion in older adults (Sherry et al., 2023). However, older adults are more likely to have confounding medical history and other factors that might influence the trajectory of clinical outcomes following concussion. Researchers have yet to examine the role of pre-injury factors on clinical outcomes following concussion in this at-risk population. The objective of this study was to evaluate the role of pre-injury risk factors on changes in multidomain clinical outcomes in older adults following concussion.

Participants and Methods:

This prospective cohort study included older adults aged 50+ years presenting to a concussion specialty clinic. Participants completed demographics, medical history; and a multidomain assessment comprising symptoms (Concussion Clinical Profile Screening [CP Screen], Dizziness Handicap Inventory [DHI]), cognitive (Repeatable Battery for Assessment of Neuropsychological Status [RBANS], Immediate Post-concussion Assessment and Cognitive Testing [ImPACT], psychological health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disoder-7 [GAD-7]),  vestibular/ocular (Vestibular/Ocular-Motor Screening [VOMS], Functional Gait Assessment [FGA]), quality of life (Neurologic Quality of Life [NQOL]) at their initial and follow-up visits. Paired samples t-tests were used to evaluated change in outcomes at the initial and follow-up clinic visit. Multiple regressions (MR) were conducted to determine the association between demographic and medical history predictors at the initial visit and change on multidomain clinical assessments across visits.


Sixty-nine participants (age=59.35 6.32 years, 59.4% female) were included in the study, with 51 (73.9%) completing assessments at both time points. Mean time between injury and initial clinic visit was 35.0 ± 34.7 days and mean time between initial clinic visit and follow-up was 26.8 ± 14.0 days. Results supported significant improvement (p<0.05) across visits on the following assessment outcomes: CP Screen; RBANS Recall, Fluency; ImPACT Visual Memory, Visual Motor Speed, Reaction Time; PHQ-9; VOMS Vestibular, Ocular, Total; and FGA. Results of the MRs supported history of motion sickness as predictor of less improvement in VOMS Total (B=50.3, p=0.007; Adj R2=0.2), RBANS Digits (B=-2.6, p=0.032; Adj R2=0.1), and Coding Scores (B=-7.5, p=0.005; Adj R2=0.22). History of depression was associated with less improvement in CP Cognitive (B=1.8, p=0.017; Adj R2=0.1) and Vestibular (B=2.3, p=0.021; Adj R2=0.1), and RBANS Fluency (B=-3.9, p=0.002; Adj R2=0.2). Gender was associated with less improvement in RBANS Fluency (B=-4.8, p=0.002; Adj R2=0.2), and concussion history was associated with less improvement in RBANS Recall (B=-3.6, p=0.015; Adj R2=0.13).


Motion sickness, depression, gender, and concussion history were associated with less improvement in clinical outcomes in older adults across clinic visits following concussion. The results highlight the importance of assessing medical history and other pre-injury risk factors when interpreting multidomain clinical assessments in at-risk older adults following this injury.

Category: Concussion/Mild TBI (Adult)

Keyword 1: concussion/ mild traumatic brain injury
Keyword 2: neuropsychological assessment
Keyword 3: aging (normal)