Adults who experience a head injury face a substantially higher risk of attempting suicide compared to those without such injuries, according to the findings from a new UK-based study.

Published in Neurology® the medical journal of the American Academy of Neurology, the study was led by University of Birmingham researchers. The paper is the first of its kind to examine suicide risk across all types of head injuries in a general population, moving beyond the traditional focus on traumatic brain injuries (TBIs) in military, athletic or hospital settings.

The population-based matched cohort study used nationally represented electronic primary healthcare records from more than 1.8 million adults, linked with Hospital Episode Statistics and Office for National Statistics data.

Researchers found that people with head injuries were 21% more likely to attempt suicide than those without, after analysing data across a 20-year period.

Key findings:

• Researchers found that people with head injuries were 21% more likely to attempt suicide than those without, even after adjusting for age, sex, deprivation, and mental health history.
• The incidence rate was 2.4 per 1,000 person-years in individuals with head injuries, compared to 1.6 per 1,000 person-years in the control group. This translates to an absolute increase in risk of 0.7% (1.3% vs 0.6%), yet the adjusted hazard ratio reported was 21%, and
• Elevated risk was observed across all subgroups, including individuals with no prior mental health conditions, highlighting that head injuries alone are linked to increased psychological vulnerability.

Professor Nicola Adderley, Professor of Epidemiology and Real-World Evidence at the University of Birmingham and a lead author of the study, said: “Our findings show that the impact of head injuries are not limited to just physical symptoms or repercussions. They can have profound psychological consequences. Suicide risk assessments should be considered for anyone with a recent head injury, regardless of their mental health history, to improve and safeguard patient outcomes.”

In the UK alone, nearly 6,000 deaths each year are attributed to suicide whilst the number of attempts is significantly higher. The study’s findings showed that the risk of suicide attempt was highest in the first 12 months following a head injury, suggesting a critical window for intervention.

While the risk declined over time, it remained elevated compared to those without head injuries. Researchers also found that social deprivation and a history of mental health conditions further amplified the risk.

While suicide attempts were more common among those with head injuries, the study did not find a significant increase in deaths by suicide after accounting for competing risks such as other causes of death; suggesting that head injuries may lead to more frequent non-fatal attempts.

Researchers are calling for the following changes in healthcare settings:

• Routine suicide risk screening in primary and secondary care settings for patients with head injuries.
   
• Enhanced mental health support, particularly during the first 12 months post-injury; with public awareness campaigns to help families and caregivers recognise warning signs.
   
• The development and testing of suicide risk assessment and prevention strategies for people with head injuries should be investigated, especially within the first 12 months post-head injury and irrespective of mental health history.

Professor G. Neil Thomas, Professor of Epidemiology and Research Methods and a lead author of the study, said: “These findings have implications for both clinical practice and health policy; highlighting the urgent need for targeted mental health and wellbeing support.

“The development and testing of robust suicide risk assessment and prevention strategies for people with head injuries should be further investigated; especially within the first 12 months post-head injury and irrespective of mental health history.”

The research utilised data from the Clinical Practice Research Datalink (CPRD), linked with hospital and mortality records, covering a 20-year period (2000–2020). Ethical approval was granted by the Health Research Authority and CPRD Independent Scientific Advisory Committee.

There is increasing evidence that gum disease is associated with increased risk of cardiovascular events, including heart attack, stroke, atrial fibrillation, heart failure and cardiometabolic health conditions. Effective prevention and treatment of gum disease, also called periodontal disease, could potentially decrease the burden of cardiovascular disease, according to a new scientific statement published today in the American Heart Association’s flagship journal Circulation.

The new American Heart Association scientific statement, “Periodontal Disease and Atherosclerotic Cardiovascular Disease,” features new data supporting an association between periodontal disease and atherosclerotic cardiovascular disease (ASCVD) and updates the Association’s 2012 scientific statement. ACSVD, the leading cause of death globally, is caused by buildup of arterial plaque (fatty deposits in the arteries) and refers to conditions that include coronary heart disease, stroke, peripheral artery disease and aortic aneurysms.

“Your mouth and your heart are connected,” said Chair of the scientific statement writing group Andrew H. Tran, M.D., M.P.H., M.S., FAHA, a pediatric cardiologist and the director of the preventive cardiology program at Nationwide Children’s Hospital in Columbus, Ohio. “Gum disease and poor oral hygiene can allow bacteria to enter the bloodstream, causing inflammation that may damage blood vessels and increase the risk of heart disease. Brushing, flossing and regular dental checkups aren’t just about a healthy smile—they’re an important part of protecting your heart.”

Highlights of the statement include:

• Periodontal disease is a chronic inflammatory condition affecting over 40% of U.S. adults over age 30. The earliest stage is gingivitis (inflammation of the gums due to buildup of oral plaque). If left untreated, gingivitis may progress to periodontitis, where the gums begin to pull away from the teeth, forming small pockets that can trap bacteria and lead to infection. The most advanced stage, severe periodontitis, involves extensive damage to the bones supporting the teeth; teeth may become loose and fall out. This stage often requires surgical intervention. 
• Periodontal disease is more common in individuals with poor oral hygiene and other cardiovascular disease risk factors, such as high blood pressure, overweight or obesity, diabetes and smoking. The prevalence of periodontal disease is also higher among men, older adults, individuals with low physical activity and people affected by adverse social determinants of health, such as lower socioeconomic status, food insecurity and/or lack of access to health care including dental care.
• Although periodontal disease and ASCVD share common risk factors, emerging data indicates there is an independent association between the two conditions. Potential biological mechanisms linking periodontal disease with poor cardiovascular outcomes include direct pathways such as bacteria in the blood and vascular infections, as well as indirect pathways such as chronic systemic inflammation.
• Numerous studies have found that periodontal disease is associated with an increased risk of heart attack, stroke, atrial fibrillation, heart failure, peripheral artery disease, chronic kidney disease and cardiac death. Although periodontal disease clearly contributes to chronic inflammation that is associated with ASCVD, a cause-and-effect relationship has not been confirmed.
• There is also no direct evidence that periodontal treatment will help prevent cardiovascular disease. However, treatments that reduce the lifetime exposure to inflammation appear to be beneficial to reducing the risk of developing ASCVD. The treatment and control of periodontal disease and associated inflammation may contribute to the prevention and improved management of ASCVD.
• People with one or more cardiovascular disease risk factors are considered to be at higher risk and may benefit from regular dental screenings and targeted periodontal care to address chronic inflammation. Previous studies have found that more frequent tooth brushing is associated with lower 10-year ASCVD risk (13.7% for once-daily or less brushing vs. 7.35% for brushing three or more times per day) and reduced inflammatory markers.
• More research, including long-term studies and randomized controlled trials, is needed to determine whether periodontal treatment can impact ASCVD progression and outcomes.
• In addition, the role of socioeconomic status, access to dental care and other social factors that adversely affect health should be explored to develop targeted prevention and treatment strategies that can help reduce the prevalence and adverse outcomes of periodontal disease and ASCVD.

This scientific statement was prepared by the volunteer writing group on behalf of the Cardiovascular Disease Prevention Committee of the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Clinical Cardiology; the Stroke Council; the Council on Basic Cardiovascular Sciences; and the Council on Cardiovascular and Stroke Nursing. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Abbas H. Zaidi, M.D., M.S.; Ann F. Bolger, M.D., FAHA; Oscar H. Del Brutto, M.D.; Rashmi Hegde, B.D.S., M.S.; Lauren L. Patton, D.D.S.; Jamie Rausch, Ph.D., R.N.; and Justin P. Zachariah, M.D., Ph.D., FAHA. Authors’ disclosures are listed in the manuscript.

When it comes to sleep, traditional advice has focused on the number of hours a person sleeps. But for older adults, the quality of sleep may affect cognitive performance the following day regardless of their quantity of sleep, according to a new study by researchers from the Penn State College of Health and Human Development and Albert Einstein College of Medicine, Bronx, New York.

In a study published in Sleep Health, the researchers found that the quality of a night of sleep — rather than the length of the night of sleep — predicted how quickly older adults processed information the next day. The researchers evaluated sleep quality based on how much time someone was awake between when they first went to sleep and when they rose in the morning.

“Anyone who has stayed up too late knows that sleep can affect your cognition the next day,” said Orfeu Buxton, professor of biobehavioral health at Penn State and lead author of the study. “In this study, we wanted to identify which aspects of sleep health impact daily cognitive functioning so that people know how to improve their sleep. When it comes to ‘getting a good night’s sleep,’ it would appear that quality matters in the short term for older adults.”

Few studies have examined how poor sleep impacts cognitive functioning the following day, according to Carol Derby, professor of neurology and epidemiology & population health, Louis and Gertrude Feil Faculty Scholar in Neurology at Albert Einstein College of Medicine and senior author of the study.

“Understanding the nuances of how sleep impacts older adults’ cognition and their ability to perform daily activities may indicate which individuals are at risk for later cognitive impairment, such as Alzheimer’s disease,” Derby said.

Measuring sleep and cognitive performance

The study analyzed data from 261 participants who were part of the Einstein Aging Study, a multiyear study of aging and cognitive health. Participants — all over the age of 70 — lived in the community in Bronx County, New York.

For 16 days, participants wore devices similar to Fitbits or smart watches that tracked their sleep. They also completed cognitive assessment “games” six times a day on a smartphone — when they woke up, before they went to bed and four randomly selected times throughout the day. The games, which took roughly four minutes to complete each time, measured different aspects of cognitive performance including visual working memory, visuospatial memory and processing speed. At the study’s conclusion, the researchers had collected a total of 20,532 cognitive assessments from the participants.

On average, participants slept 7.2 hours each night and spent just over one hour awake during a given night of sleep. Additionally, participants took an average of 0.4 naps each day, which is two naps every five days.

When the researchers analyzed each participant’s day-to-day cognitive performance, they found that when an individual was awake for 30 minutes longer during the night than their average amount, their processing speed was slower than usual the next day. Napping the previous day, bedtime and quantity of sleep showed no effect on processing speed or any other aspects of cognitive performance.

When the researchers compared performance on cognitive tests not just to participants’ own performance but across participants in the entire study sample, they found that older adults who, on average, spent more time awake during their night’s sleep performed worse on three of the four cognitive tests. In addition to slower processing speed, participants with more wake time after falling asleep performed worse on two tests of visual working memory.

“Repeatedly waking after you’ve fallen asleep for the night diminishes the overall quality of your sleep,” said Buxton, associate director of both the Penn State Clinical and Translational Science Institute and the Penn State Social Science Research Institute and an investigator in the Penn State Center for Healthy Aging. “We examined multiple aspects of sleep, and quality is the only one that made a day-to-day difference in cognitive performance.”

What should older people do if they have sleep problems?

Nearly half of older adults report some type of sleep disruption. Over time, sleep problems are associated with higher rates of cognitive decline and Alzheimer’s disease, according to the researchers.

“My number one piece of advice is not to worry about sleep problems,” Buxton said. “Worrying only creates stress that can disrupt sleep further. This does not mean that people should ignore sleep, though. There are research-validated interventions that can help you sleep better.”

To promote healthy sleep, people should go to bed at a consistent time each night, aiming for a similar length of sleep in restful circumstances, Buxton continued.

“When it comes to sleep, no single night matters, just like no single day is critical to your exercise or diet,” Buxton said. “What matters is good habits and establishing restful sleep over time.”

For older adults who have sleep problems, the researchers recommended evaluating their sleep environment — including avoiding screens before bed and sleeping in dark, quiet conditions at a consistent time.

If problems persist, the researchers encouraged people to talk to their medical providers about cognitive behavioral therapy, which has been proven to be a safe and effective way to address sleep-related issues. In contrast, the researchers said that medication is not a good solution for many older adults because sleep medication can increase the risk of falling.

Sleep health and Alzheimer’s disease

Ultimately, the goal of this research is to support healthy cognitive aging, the researchers said, particularly factors that could prevent or delay the onset of Alzheimer’s disease and related dementias. While there is extensive research evidence linking sleep and dementia, it is not yet clear whether poor sleep is a risk factor or a consequence of Alzheimer’s disease.

“The work demonstrating the day-to-day impact of sleep quality on cognition among individuals who do not have dementia suggests that disrupted sleep may have an early impact on cognitive health as we age,” Derby said. “This finding suggests that improving sleep quality may help delay later onset of dementia.”

Other contributors to this research included Jonathan Hakun of the Penn State Department of Neurology; Martin J. Sliwinski of the Penn State Department of Human Development and Family Studies and Center for Healthy Aging; Qi Gao of Albert Einstein College of Medicine’s Department of Epidemiology & Population Health; Cuiling Wang of Albert Einstein College of Medicine’s Department of Neurology; Linying Ji of the Montana State University Department of Psychology; Alyssa Gamaldo of the Clemson University Department of Psychology; and Suzanne Bertisch of the Department of Medicine at Brigham and Women’s Hospital and Harvard Medical School.