Interventions to Improve Cognitive Outcomes in Older Adults with Traumatic Brain Injury and Association Between Social Determinants of Health and Intervention Effectiveness: A Scoping Review

Abstract

Background

At least one million Canadians are at risk of experiencing a traumatic brain injury (TBI) in later life, which can lead to cognitive decline. We identified interventions studied to improve cognitive outcomes in older adults with TBI, and examined how social determinants of health (SDoH) may influence their effectiveness.

Methods

We followed JBI guidance and searched five electronic databases from inception until March 2023 for studies evaluating the clinical and cost effectiveness, and safety of interventions being studied to improve cognitive outcomes in older adults with TBI. We abstracted SDoH following the PROGRESS-Plus framework.

Results

We included 20 studies and 44,462 predominantly men/male (65%) participants with a mean age of 65.9 years; studies reported 51 cognitive outcomes. Three studies reported on race or ethnicity, eight studies reported on education, and no studies differentiated gender from sex. No studies reported on the association between SDoH and intervention effectiveness. We did not identify any economic evaluations. We classified 10 interventions into four categories: non-pharmacologic cognitive strategies (number of studies [n]=16), medications (n=1), non-invasive procedures (n=2), and invasive procedures (n=1). Invasive procedures and non-pharmacologic cognitive strategies had a statistically significant positive effect on cognitive measures in one and seven studies, respectively. Non-invasive procedures (n=2) did not have significant cognitive effects. Use of hypnotics (benzodiazepines and non-benzodiazepines) was significantly associated with a shorter time to incident dementia in one study.

Conclusion

Non-pharmacologic cognitive strategies were the most-studied interventions for improving cognitive outcomes in older adults with TBI. Future research should better integrate a health equity lens and standardize outcome measurement.