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This study aimed to assess the long-term clinical profile and participation level course in a large cohort of aging ABI patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multi-center observational study (BRAIN-ReADAPT study), recruiting 550 patients aged 50\u201368\u00a0years, at least five years post-ABI. Current participation levels were compared to levels post-ABI to assess the participation level course. Cognitive complaints and psychological factors were measured by validated questionnaires. With group comparisons and regression analyses the influence of demographic and injury-related factors were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A decline in participation level was reported by 43% independent of age, sex, type and severity of ABI or injury chronicity. Patients experiencing this decline reported more cognitive complaints (especially mental slowness, memory, concentration difficulties) and experienced higher levels of fatigue and emotional distress, with lower resilience. No difference in current participation level was present between groups, although more restrictions and less satisfaction with participation were reported when a decline in participation was present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      A substantial proportion of aging ABI patients experience a secondary decline in participation. This phenomenon is referred to as the\n                      <jats:italic>post-ABI effect<\/jats:italic>\n                      . This effect is not associated with demographic or injury-related characteristics, but resilience might be a mitigating factor. Greater awareness in clinical practice of this post-ABI effect is needed to identify potential targets for treatment to cope with this effect.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13423-3","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T09:37:04Z","timestamp":1759743424000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The post-ABI effect\u2014long-term impact of aging on participation after acquired brain injury"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8157-5708","authenticated-orcid":false,"given":"Nikki S.","family":"Th\u00fcss","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7659-267X","authenticated-orcid":false,"given":"Heleen M.","family":"den Hertog","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9754-261X","authenticated-orcid":false,"given":"Coen A. 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