Mood and cognition changes after traumatic brain injury

Mental health issues are common in people with traumatic brain injury (TBI) and can continue for years. They may be related to the brain injury itself or may result from patients’ challenges with everyday functions.

In a recent study, Jefferson Health researchers investigated levels of depression and apathy in older adults with TBI. Amanda Rabinowitz, MD, PhD, a brain injury researcher at Thomas Jefferson University, says the conditions are distinct in this way: Depression is a loss of pleasure and interest in things, whereas apathy is a state of low motivation or a failure to engage in life activities.

Both  conditions have been reported in older adults with dementia and with Parkinson’s disease, but there’s little data on apathy in people with TBI. Dr. Rabinowitz and her colleague, Umesh Venkatesan, PhD, both of whom work at the Jefferson Moss Rehabilitation Research Institute, sought to understand whether depression and/or apathy lead to changes in cognition or engaging in daily tasks, especially social engagement.

In their study, people with apathy were more likely to have cognitive problems — particularly with executive functions like working memory and attention control. People with depression were less likely to engage in societal activities. Those who showed signs of both apathy and depression had poorer overall functioning.

Awareness of these relationships has important clinical implications. For instance, some outcomes may signal a progression of brain injury in older adults, Dr. Rabinowitz says. Further, if apathy is a consequence of an injured brain, then it may also be “a harbinger of other neurological changes that need tracking, such as dementia and cognitive decline."

In addition, the conditions may require different therapeutic approaches. Treatment for depression is well-established — talk therapy and medication, for instance — although the particulars of depression in the context of TBI is less clear. Little clinical guidance exists for apathy.

“We need to know more,” Dr. Rabinowitz says. “How closely can we tailor our treatments to the individual?”

By Jill Adams