blog, Brain Injury, Elderly Care

Understanding Concussions: Risks, Symptoms, and Recovery

July 3, 2024

by Dr Steve Allder

Consultant Neurologist Dr Steve Allder was interviewed by the Telegraph for a feature about concussion and the long-term risks for people over 60. Below he shares an insight into concussion, symptoms, risks and when to seek medical help:


What is a Concussion?

A concussion is a type of traumatic brain injury (TBI) resulting from a blow to the head, a fall, or any other incident that causes the brain to jar or shake within the skull. This sudden movement can lead to chemical changes and sometimes stretching and damaging brain cells.

Recognising Concussion Symptoms

Concussions can present a variety of symptoms, not limited to unconsciousness, headaches or nausea, and may not appear immediately. Key symptoms to watch for include:

  • Changes in Mood or Behaviour: Irritability, depression, anxiety, or other mood changes
  • Visual Disturbances: Blurred vision, double vision or difficulty focusing
  • Balance Problems: Dizziness, unsteadiness or difficulty maintaining balance
  • Cognitive Difficulties: Memory issues, difficulty concentrating, feeling mentally foggy, slurred speech or delayed responses
  • Sleep Disturbances: Insomnia, excessive sleepiness, or other changes in sleep patterns

Other common symptoms include headaches, temporary loss of consciousness, amnesia surrounding the traumatic event, ringing in the ears, nausea, vomiting, fatigue and sensitivity to light and noise.

Why Concussions are Riskier for Older Adults

Older adults face increased risks from concussions due to several factors:

  • Brain Atrophy: More space within the skull allows the brain to move more upon impact
  • Fragile Blood Vessels: Increased risk of brain bleeds or haemorrhages
  • Slower Recovery: Longer healing times for injuries
  • Pre-existing Conditions: Blood thinning medications and other health issues complicate recovery

Concussion and Dementia Risks

Even a single traumatic brain injury can elevate the risk of developing dementia, particularly in older adults. Concussions can cause brain cell damage, initiate inflammatory responses, and lead to secondary injuries from swelling and bleeding. These impacts can disrupt neural connections critical for cognitive function, increasing dementia risk over time.

Immediate Actions After a Head Injury:

  • Seek Medical Advice: Always consult a healthcare professional if a head injury occurs, even if symptoms seem mild
  • Rest: Avoid physical and cognitive activities that might worsen symptoms
  • Monitor Symptoms: Keep track of any changes and seek immediate medical attention if symptoms worsen
  • Avoid Alcohol and Drugs: These substances can interfere with the healing process
  • Gradual Return to Activities: Gradually resume normal activities once cleared by a doctor
  • Limit Screen Time: Bright screens can exacerbate symptoms; limit use of computers, phones, and TVs
  • Stay Hydrated: Dehydration may worsen concussion symptoms
  • The Dangers of Untreated Concussions

Failing to seek medical attention for concussion symptoms can lead to severe consequences, including:

  • Second Impact Syndrome: A second concussion before the first heals can cause rapid and severe brain swelling, often leading to fatality or severe disability
  • Intracranial Haemorrhage: Bleeding in or around the brain can increase intracranial pressure, causing brain damage or death if untreated
  • Chronic Traumatic Encephalopathy (CTE): Linked to repeated head injuries, leading to memory loss, confusion and dementia
  • Post-Concussion Syndrome: Persistent symptoms lasting for months, with cognitive and emotional difficulties

When to Get a CT Scan

Not everyone with concussion symptoms needs a CT scan. CT scans are typically used for severe cases with symptoms like loss of consciousness, repeated vomiting, severe headaches, worsening symptoms, or high-risk factors such as older age or blood thinners. For milder cases, clinical evaluation and observation may suffice.

Comprehensive Recovery: Beyond CT Scans

While CT scans identify structural damage, they do not detect cellular or functional impairments caused by concussions. Therefore, therapies such as vestibular therapy for balance and dizziness, cognitive rehabilitation for memory and attention issues, physical therapy for physical symptoms, and psychological support for emotional difficulties are essential for holistic recovery.

Taking head injuries seriously, especially in older adults, is crucial due to the increased risk of complications and longer recovery times. Proper management and monitoring can help mitigate long-term risks. Everyone’s recovery process is different, so it’s important to attend all appointments and work with your medical team to develop a personalised treatment plan.


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