Looking after brain health as you age after an injury
Everyday habits that help protect your brain in the years after a head injury
If you had a concussion or a more serious brain injury years ago, you may wonder what it means as you get older. Maybe a parent had dementia, or a news story about head injuries caught your eye. Maybe names simply slip away more often than they used to.
Those worries make sense. A brain injury is one of several things linked to a higher chance of dementia later in life [1]. Many of the others are things you and your care team can work on, such as blood pressure, hearing and how active you are [1].
This article sorts the research into two piles: what has been studied in aging adults in general, and what has been studied in people with a brain injury. It then turns that research into steps you can talk over with your care team.
What we know about brain injury and aging
Recovery after a brain injury does not follow one path. The CDC reports on people 16 and older who had inpatient rehabilitation for TBI. Five years later, 26% had improved, 22% stayed the same, 30% had become worse, and 22% had died [4]. Those numbers come from people with moderate to severe injuries. They do not describe a typical concussion. Most people with a concussion feel better within a couple of weeks [5].
The CDC also says some later health problems after a moderate or severe TBI can be headed off or eased [6]. The steps below build on that point.
Evidence from people with TBI
A 2019 study tracked 404 people with moderate to severe TBI from the national TBI Model Systems over 10 years [2]. People with high blood pressure, diabetes, cancer, rheumatoid arthritis or anxiety tended to lose more physical function over time [2]. Diabetes, cancer, chronic bronchitis, anxiety and depression were tied to weaker thinking skills [2]. The authors called for active health care that treats these other conditions as part of long term TBI care [2].
This was an observational study, so it shows links. It cannot prove that these conditions caused the decline. It also included only people who lived at least 10 years after the injury [2].
Evidence on TBI and dementia
The 2024 Lancet Commission on dementia pooled studies of people with and without a past TBI. Across those studies, people with a TBI had about 1.66 times the risk of dementia [1]. The commission concluded that TBI likely raises dementia risk and may bring on dementia earlier [1].
A relative risk describes large groups. It cannot predict what will happen to any one person. It says nothing about how fast or whether your own memory will change.
The 14 risk factors and what they mean for you
In 2024 the Lancet Commission updated its list of dementia risk factors that people and health systems can change [1]. In plain terms, the list covers high blood pressure, diabetes, obesity, high LDL (“bad”) cholesterol, hearing loss, untreated vision loss and TBI [7]. It also covers lack of exercise, smoking, heavy drinking, depression, social isolation, less schooling and air pollution [7]. High cholesterol and vision loss were the two new additions [1].
Taken together, the commission says, these 14 explain close to half of dementia risk [1]. Some carry more weight than others across the whole population. The commission estimates that hearing loss and high LDL cholesterol each account for about 7% of dementia cases [7]. Social isolation in later life accounts for about 5%, and untreated vision loss for about 2% [7].
Keeping the numbers in perspective
These percentages describe populations. They do not tell you your own risk. The commission also notes that some of these links may be only partly causal [1]. That is why it says changing these factors may prevent or delay dementia, and stops short of saying it will [1].
The table below sorts each step by the kind of evidence behind it. General evidence comes from aging adults without a known brain injury. TBI evidence comes from studies of people who had one.
Comparison compiled by Safety Behind the Wheel Foundation
Brain health steps and the evidence behind them
| Step | Evidence in aging adults | Evidence in people with TBI |
|---|---|---|
| Blood pressure control | Commission advises a top number of 130 or lower from age 40 | High blood pressure tied to more loss of physical function |
| Blood sugar and weight | Healthy weight helps prevent diabetes | Diabetes tied to worse physical and thinking function |
| Treating hearing loss | Trial found slower decline only in a higher risk subgroup | General evidence only |
| Staying active | Exercise linked to lower dementia risk | General evidence only |
| Sleep | Heart Association sets 7 to 9 hours as ideal | General evidence only; concussion can affect sleep |
| Fall prevention | Falls can be prevented, even in older age | General evidence only; falls cause nearly half of TBI hospital stays |
General evidence only means the sources reviewed for this article did not include TBI specific studies of that step. Sources: Lancet Commission [1]; Malec et al. [2]; ACHIEVE trial [8]; American Heart Association [9]; CDC [5, 10, 3].
Blood pressure, blood sugar and cholesterol
The numbers your provider checks for heart disease matter for the brain too. The American Heart Association’s Life’s Essential 8 checklist covers diet, physical activity, nicotine, sleep, body weight, blood fats such as cholesterol, blood sugar and blood pressure [9, 11]. The association counts sleep as essential for both heart and brain health [9].
A study in Brazil followed about 11,390 adults for about 8 years [11]. People with the highest Life’s Essential 8 scores had 42% slower decline in overall thinking skills than people with the lowest scores [11]. Blood sugar and blood pressure drove most of that link [11]. These were adults from the general population. The authors note that other factors they could not fully measure may play a part [11].
Blood pressure
Based on research in the general population, the commission advises preventing high blood pressure and keeping the top number (systolic pressure) at 130 or lower from about age 40 [1]. After a moderate to severe TBI, high blood pressure was one of the conditions tied to more loss of physical function over 10 years [2]. Ask your provider what your own target should be. Never stop or change a blood pressure medicine on your own.
Blood sugar and weight
Diabetes stood out in the TBI Model Systems study, where it was tied to worse physical function and worse thinking skills over time [2]. The commission advises keeping a healthy weight and notes that treating obesity early also helps prevent diabetes [1]. If you already have diabetes, your care team can help you set goals that fit your life after the injury.
Cholesterol
The commission recommends finding and treating high LDL cholesterol from midlife onward [1]. A routine blood test checks it, and your provider can tell you how often you need one.
Hearing and vision
The commission estimates that hearing loss accounts for about 7% of dementia cases [7]. Many people with hearing loss still go without hearing aids. In the studies the commission reviewed, between 18% and 64.5% of people with hearing loss wore them [1]. Hearing aid users in those studies had a lower risk of dementia. The commission calls for hearing aids to be within reach of everyone who needs them [1].
What the ACHIEVE trial found
A large randomized trial called ACHIEVE put this idea to the test [8]. It enrolled 977 adults aged 70 to 84 with untreated hearing loss at four U.S. sites and followed them for three years [8]. About half received hearing aids, a self management kit and regular sessions with an audiologist, a hearing care professional. The others attended health education sessions [8].
In the full group, hearing care did not slow the decline in thinking skills compared with health education [8]. In a smaller group of 238 people who started out at higher risk of decline, hearing care was tied to 48% less decline over three years [8]. That subgroup result is encouraging. The researchers reported it as a planned extra analysis, apart from the main result, so it still needs confirming [8].
Nobody joined ACHIEVE because of a brain injury, so its results may or may not apply to TBI survivors. If you drive, ask whether your hearing or vision results affect your driving, since state rules on medical fitness to drive vary.
Vision
Untreated vision loss in later life accounts for about 2% of dementia cases, by the commission’s estimate [7]. The commission wants eye screening and treatment to be available to all [1]. The CDC’s fall prevention materials also tell older adults to get their eyes checked [12].
Sleep, activity and staying connected
Most of the research in this section comes from aging adults in general, not from people with a brain injury. The TBI Model Systems study on mood is the exception.
Sleep
The CDC lists sleep as one of the four areas a concussion can affect, along with how a person feels, thinks and acts [5]. In 2022 the American Heart Association added sleep to its heart health checklist and named 7 to 9 hours a day as the ideal for adults [9]. If you snore loudly, wake up gasping, or feel worn out after a full night in bed, tell your care team. A sleep problem is worth checking whether or not it began with the injury.
Physical activity
The commission notes that people who play sports or work out have a lower chance of developing dementia [1]. It adds that this link probably runs in both directions [1]. In other words, exercise may protect the brain. People in the early stages of memory decline may also move less.
After a brain injury, activity has to fit your symptoms, balance and any other injuries. Walking, swimming, a stationary bike, and strength and balance work are common choices. Ask your care team or a physical therapist which ones suit you. The CDC notes that keeping active and keeping your balance helps prevent falls [12].
Social connection
Social isolation in later life accounts for an estimated 5% of dementia cases [7]. The commission urges communities to build places to live that support older people and help them take part in activities [1].
After a brain injury, social plans can be tiring. Memory slips can make you shy away from conversation. Small, steady contact still counts. A weekly phone call, a class, a faith group, a walking partner or a volunteer shift can all keep you connected without wearing you out.
Mood, alcohol and smoking
Depression is on the commission’s list. It urges effective treatment [1]. In the TBI Model Systems study, depression and anxiety were among the conditions tied to weaker thinking skills over the years [2]. If your mood has been low, raise it with your care team as its own topic, and decide on treatment together.
Heavy drinking and smoking are on the list too [7]. The commission backs efforts to cut high alcohol use and smoking across whole communities [1]. If you want to cut back on either one, ask your provider what help is available to you.
Preventing another head injury
Another blow to the head is one risk you can lower directly. Older adults are more likely than people of any other age to be hospitalized for a TBI or die from one [3]. Falls are the most common cause of TBI in older adults [13]. They lead to nearly half of TBI hospital stays at all ages [3].
More than one in four older people fall each year. Less than half of them tell their doctor [13]. One fall doubles your odds of another [13]. The CDC says there are proven ways to reduce falls, even for older adults [10].
Fall prevention checklist
Checklist from Safety Behind the Wheel Foundation
- Tell your provider about any fall, even one that did not hurt you, and ask about your fall risk [12].
- Ask your provider or pharmacist to review your medicines for any that raise fall risk [12].
- Do strength and balance exercises your care team approves [12].
- Get your eyes checked [12].
- Wear safe, supportive shoes and look after your feet [12].
- Clear clutter and make your home safer, starting with stairs and bathrooms [12].
- Tell your provider if you feel dizzy when you stand up. The CDC has a patient guide on this kind of blood pressure drop [12].
On the road and on wheels
Buckle up on every trip, in every seat. Wear a helmet on a bike, as the commission advises [1], and on a motorcycle or e-scooter. If your memory, vision or reaction time seems to be slipping, ask whether a driving evaluation makes sense for you.
If you take a blood thinner, the CDC warns that these medicines may raise the risk of bleeding in the brain after a TBI [3]. Anyone who might have a TBI needs to be checked by a health care provider [3].
Get emergency care right away
Get emergency help by calling 911 if any of these CDC danger signs appear after a fall or a knock to the head [5].
- A headache that keeps building and will not let up
- Weakness, numbness, poor coordination, convulsions or seizures
- Throwing up more than once
- Slurred speech or behavior that seems off
- One pupil larger than the other (pupils are the round black openings in your eyes)
- Not knowing people or places, or becoming confused, restless or agitated
- Losing consciousness, being extremely sleepy, or not waking when someone tries to wake you
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Given my brain injury, which health numbers should I watch most closely?
- What should my blood pressure target be?
- Should my blood sugar and cholesterol be checked, and how often?
- Can I get a hearing test, and would hearing aids help me?
- When was my last eye exam, and is it time for another?
- Could any of my medicines raise my risk of falling or affect my memory?
- What kind of exercise is safe for me right now?
- Could I have a sleep problem that needs testing?
- Should I have a driving evaluation as I get older?
Frequently asked questions
Does having a TBI mean I will get dementia?
No. Pooled studies found about 1.66 times the dementia risk after TBI, but that is a group average. TBI sits alongside 13 other risk factors that shape risk [1]. In CDC figures on people who had inpatient rehabilitation for TBI, outcomes five years later varied widely. About a quarter had improved [4].
Can hearing aids lower my risk of dementia?
They may help some people. ACHIEVE tested hearing care in adults aged 70 to 84. It did not slow thinking decline in the full group. But it was tied to slower decline in a smaller group at higher risk [8]. The trial did not enroll people because of a brain injury.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Your brain injury is part of your health history. It is one of many things that shape how your brain ages. Most of the others, such as blood pressure, blood sugar, hearing, activity, friendships and fall risk, are things you can work on with your care team. None of these steps is a guarantee. But each one is a reasonable way to look after your brain and the rest of your body.
Start small. Pick one item from this article, such as booking a hearing test or asking for a fall risk check, and bring the list of questions to your next visit.
Sources and further reading
- 1Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024;404:572-628. doi.org/10.1016/S0140-6736(2401296-0)
- 2Malec JF, Ketchum JM, Hammond FM, et al. Longitudinal effects of medical comorbidities on functional outcome and life satisfaction after traumatic brain injury: an individual growth curve analysis of NIDILRR Traumatic Brain Injury Model System data. Journal of Head Trauma Rehabilitation. 2019;34(5):E24-E35. doi.org/10.1097/HTR.0000000000000459
- 3Centers for Disease Control and Prevention. Facts about TBI. Updated August 2025. cdc.gov/…/index.html
- 4Centers for Disease Control and Prevention. About moderate and severe TBI. Updated May 2024. cdc.gov/…/moderate-severe-tbi.html
- 5Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 2025. cdc.gov/…/index.html
- 6Centers for Disease Control and Prevention. About potential effects of a moderate or severe TBI. Updated May 2024. cdc.gov/…/potential-effects.html
- 7The Lancet. Nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors starting in childhood (news release, EurekAlert). July 31, 2024. eurekalert.org/news-releases/1052982
- 8Lin FR, et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet. 2023. doi.org/10.1016/S0140-6736(2301406-X)
- 9American Heart Association. American Heart Association adds sleep to cardiovascular health checklist. October 25, 2022. easternstates.heart.org/…/american-heart-association-…
- 10Centers for Disease Control and Prevention. About older adult fall prevention. Updated September 2026. cdc.gov/falls/about/index.html
- 11Ferreira NV, Goncalves NG, Szlejf C, et al. Optimal cardiovascular health is associated with slower cognitive decline. European Journal of Neurology. 2024;31(2):e16139. doi.org/10.1111/ene.16139
- 12Centers for Disease Control and Prevention. STEADI: patient and caregiver resources. Updated September 2026. cdc.gov/steadi/patient-resources/index.html
- 13Centers for Disease Control and Prevention. Facts about older adult falls. Updated September 2026. cdc.gov/falls/data-research/facts-stats
This article reflects the safety priorities of brain injury recovery, healthy aging and road safety education. It offers general education, not medical advice. Research on dementia risk keeps changing, so check official sources such as the CDC and talk with your own care team before you change your health routine. Reviewed October 2026.
Special thanks to our contributors
We appreciate the professionals, experts, and community members who share their knowledge and perspectives to help make this resource better. Your insights are always welcome and appreciated.
Have professional expertise, firsthand experience, or a perspective that could make this resource better?
We welcome your input. Your knowledge and experience can help us make this resource more useful, accurate, and meaningful to the people who rely on it.
Thank you. Your contribution is on its way.
We’re grateful you took the time to share your knowledge with us. Our team reviews every contribution with care. If it helps improve this resource, we’ll update the page and recognize you the way you chose.
Keep learning
Safe Driving Resource Center
Guides, self-checks and articles for drivers, parents of new drivers, and families recovering after a crash.
