Definition

What is dementia in head injury?

Dementia after a head injury is a significant public health problem.

The nature of dementia in head-injured persons varies greatly by type and location of head injury and the person’s characteristics before the head injury.

The dementia that follows a head injury differs from other types of dementia. Many types of dementia, such as Alzheimer’s disease, get steadily worse over time. Dementia from head injury usually does not get worse over time. It may even improve somewhat over time. The improvement usually is slow and gradual and takes months or years.

How common is dementia in head injury?

Dementia in head injury is extremely common. It can affect patients at any age. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of dementia in head injury?

Dementia-related symptoms in head injury include those that affect thinking and concentration, memory, communication, personality, interactions with others, mood, and behavior.

Individuals experience different combinations of these symptoms depending on the part of the head injured, the force of the blow, the damage caused, and the person’s personality before the injury. Some symptoms appear rapidly, while others develop more slowly. In most cases, symptoms have at least started to appear in the first month after the injury.

Symptoms of dementia in people with head injuries include:

  • Problems thinking clearly
  • Memory loss
  • Poor concentration
  • Slowed thought processes
  • Irritability, easily frustrated
  • Impulsive behavior
  • Mood swings
  • Inappropriate behavior in social situations
  • Grooming and dressing eccentric or neglected
  • Restlessness or agitation
  • Insomnia
  • Aggression, combativeness, or hostility
  • Headache
  • Fatigue
  • Vague, nonspecific physical symptoms
  • Apathy

Some people develop seizures after a head injury. These are not part of the dementia, but they can complicate the diagnosis and treatment of dementia.

Major mental disorders may develop after head injury. Two or more of these may appear together in the same person:

  • Depression — Sadness, tearfulness, lethargy, withdrawal, loss of interest in activities once enjoyed, insomnia or sleeping too much, weight gain or loss
  • Anxiety — Excessive worry or fear that disrupts everyday activities or relationships; physical signs such as restlessness or extreme fatigue, muscle tension, sleeping problems
  • Mania — State of extreme excitement, restlessness, hyperactivity, insomnia, rapid speech, impulsiveness, poor judgment
  • Psychosis — Inability to think realistically; symptoms such as hallucinations, delusions (fixed false beliefs not shared by others), paranoia (suspicious and feeling of being under outside control), and problems thinking clearly; if severe, behavior seriously disrupted; if milder, behavior bizarre, strange, or suspicious
  • Obsessive-compulsive symptoms — Development of obsessions (uncontrolled, irrational thoughts and beliefs) and compulsions (odd behaviors that must be carried out to control the thoughts and beliefs); preoccupation with details, rules, or orderliness to such a degree that the larger goal is lost; lack of flexibility or ability to change
  • Suicide risk — Feelings of worthlessness or that life is not worth living or that world would be better off without him or her, talks about suicide, states intention to commit suicide, develops plan to commit suicide

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

Any of the symptoms and signs described in the symptoms section warrants a visit to the person’s health care provider. This is true regardless of whether the person has a known head injury. Be sure the health care provider knows about any falls or accidents that could have involved even a mild head injury.

Causes

What causes dementia in head injury?

The following are the most common causes of head injury in civilians:

  • Falls (40%)
  • Unintentional blunt trauma (15%)
  • Motor vehicle accidents (14%)
  • Assaults (11%)
  • Unknown causes (19%)

Use of alcohol or other substances is a factor in about half of these injuries.

Certain groups are more likely than others to sustain head injury:

  • In children, bicycle accidents are a significant cause of head injury.
  • Most head injuries in infants reflect child abuse. A common name for this is shaken baby syndrome.
  • Older adults are especially likely to injure themselves by falling.

Risk factors

What increases my risk for dementia in head injury?

Please consult your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is dementia in head injury diagnosed?

In most cases, the appearance of dementia symptoms is clearly linked to a known head injury. The health care provider will ask for a detailed account of the onset of symptoms. This account should include the following:

  • The exact nature of any injury and how it happened, if known
  • Medical attention received in the period immediately after the injury (such as a visit to the emergency room; medical records should be available.)
  • The person’s state since the injury
  • Any prescription or over-the-counter medications, or illicit drugs, the person may be taking
  • A description of all symptoms and their timing and severity
  • An account of all treatment undergone since the injury
  • Whether any legal action is pending or under consideration

The medical interview will ask for details of all medical problems now and in the past, all medications and other therapies, family medical history, work history, and habits and lifestyle. In most cases, a parent, spouse, adult child, or other close relative or friend should be available to provide information that the injured person cannot provide.

At any time in this evaluation process, the primary health care provider may refer the injured person to a neurologist (specialist in disorders of the nervous system, including the brain).

A thorough physical exam will be done to identify neurological and cognitive problems, problems in mental or social function, and unusual appearance, behavior, or mood.

Many health care providers refer head-injured persons for neuropsychological testing. This is the most reliable way to document cognitive impairments following a head injury.

Neuropsychological testing for dementia

Neuropsychological testing is the most sensitive means of identifying dementia in persons with head injury. It is carried out by a specialist trained in this specific area of clinical psychology. The neuropsychologist uses clinical rating scales to identify subtle cognitive problems. This testing also establishes clear baselines for measuring changes over time.

Imaging studies for head injury, dementia

Head injury warrants a brain scan to detect which parts of the brain are injured.

A CT scan is a type of X-ray that shows details of the brain. It is the standard test in a person who has had a head injury. A scan performed one to three months after injury may detect damage not visible immediately after the injury.

MRI is more sensitive than CT scan in demonstrating certain types of injury.

Single-photon emission computed tomography (SPECT) scan is a relatively new imaging method that is still being studied in people with head injuries. It may be better than CT scan or MRI in detecting functional problems in the brain for some types of dementia or other brain disorders. SPECT is available only at some large medical centers.

Other tests for head injury

Electroencephalogram (EEG) measures the electrical activity of the brain. It may be used to diagnose seizures or abnormally slow rates of brain activity.

How is dementia in head injury treated?

Head injuries often bring an abrupt “coping crisis.” The sudden adverse changes that go with a head injury inevitability cause many emotions. Anxiety is a common response, and the person may become demoralized or depressed. Damage to the brain may impair the person’s ability to cope at a time when the need to adapt is greatest. Persons with head injury typically are more distressed and have more difficulty coping with their injury than persons who have other types of injuries.

Usually, a particular family member assumes most of the responsibility for the injured person’s care. Ideally, more than one family member should be closely involved in caregiving. This helps family members share the burdens of providing care and helps the primary caregiver keep from becoming isolated or overwhelmed. Caregivers should be included in all significant interactions with health care professionals.

Caregivers must encourage and expect the injured person to be as independent and productive as possible. At the same time, caregivers need to be patient and tolerant. They should accept that the person may have real limitations and that these will likely worsen if the person is tired, ill, or stressed. Emphasizing what the person can still do, rather than what seems to be lost, is helpful.

With head injuries, the greatest improvement is expected in the first six months, but delayed improvement is possible as long as five years after the injury.

The head-injured person who has become demented will benefit from any of the following:

  • Behavior modification
  • Cognitive rehabilitation
  • Medication for specific symptoms
  • Family or network intervention
  • Social services

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage dementia in head injury?

The extent to which a person with a head injury can care for himself at home depends on his disabilities. If self-care is possible, a plan should be developed with input from the professional care team and family members. The team should assess the person’s ability to function on his or her own and comply with medical treatment. In many cases, the person must be supervised by a caregiver to ensure compliance and safety.

The injured person’s surroundings must be neither too calm nor too hectic. He or she should have regular routines of light and dark, eating, sleeping, relaxing, using the bathroom, and taking part in rehabilitation and leisure activities. This helps the injured person remain emotionally balanced and minimizes the caregiver’s burden.

The environment should be made safe by taking away area rugs to reduce falls, removing hazards, providing grab bars in bathtubs and showers and around toilets, and putting child locks on cabinets or stove knobs if necessary.

If the patient is capable of going out alone, he or she should know the route well, carry identification, wear a medic alert bracelet, and be able to use phones (especially cell phones) and public transportation.

Caregivers must decide whether the person should have access to checking accounts or credit cards. In general, the person should continue to handle his or her own money if he or she seems willing and able. The caretaker can get power of attorney to monitor the person’s financial responsibility. If the person has markedly poor judgment or seems unable to handle financial matters, the caregiver should seek formal conservatorship, which gives legal authority to manage the person’s resources.

Many over-the-counter (nonprescription) drugs can interfere with medications that might be prescribed by the health care team. These interactions can decrease how well the prescription drugs work and might worsen side effects. The person’s care team must know what sorts of nonprescription medications the head-injured person uses.

Caregivers should seek help if the person has very disrupted sleep, does not eat enough, or eats too much, loses control of his or her bladder or bowels (incontinence), or becomes aggressive, or sexually inappropriate. Any marked change in behavior should prompt a call to the professional who is coordinating the person’s care.

If you have any questions, please consult with your doctor to better understand the best solution for you.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: October 31, 2017 | Last Modified: October 31, 2017

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