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The fastest rising incidence of TBI in the United States is in older adults, who have higher mortality, lower rates of functional recovery, and higher risk for post-TBI dementia. Pre-existing TBI, medical\/psychiatric conditions, and substance use\u2014common in older veterans\u2014are emerging risk factors for TBI and worse outcomes thereafter. There is an urgent need to characterize acute TBI in older veterans to inform effective interventions to optimize outcomes. We aim to characterize military, clinical, and biological features using a combination of TBI common data elements (CDEs) and validated dementia and geriatrics research assessments. This single-site, longitudinal, observational research study aims to enroll 70 older veterans with acute TBI who receive computed tomography in the emergency department and 30 matched non-neurotrauma controls who present to the San Francisco VA Medical Center within 14 days of their event. Participants and study partners complete pre-injury health\/military relevant exposure assessments and multi-domain geriatric and TBI CDE follow-up assessments at 2 weeks, 3, 6, and 12 months. Blood for proteomic biomarkers is collected at baseline, 6 months, and 12 months. Willing participants also undergo magnetic resonance imaging at 2 weeks, 6 months, and 12 months. This study aims for comprehensive characterization of baseline and longitudinal endophenotypes of an intentionally heterogeneous, \u201creal-world,\u201d population of older veterans presenting with acute TBI. Findings will inform the development of future studies focused on optimizing outcomes and evaluating interventions in TBI. This study will provide critical insights into the unique characteristics and the natural history of incident TBI in older veterans, paving the way for larger, Veteran Affairs-based, multicenter prospective studies of acute TBI to inform prevention, support correct diagnosis, and optimize short- and long-term recovery.<\/jats:p>","DOI":"10.1177\/2689288x261442468","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:21:11Z","timestamp":1776928871000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transforming Research and Clinical Knowledge in Older Veterans with Acute Traumatic Brain Injury: A Longitudinal Observational Study"],"prefix":"10.1177","volume":"7","author":[{"given":"Phiroz E.","family":"Tarapore","sequence":"first","affiliation":[{"name":"San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaila J.","family":"Cutone-Dion","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico H.","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine H.","family":"Kuang","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael Rosen","family":"Lang","sequence":"additional","affiliation":[{"name":"Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Yaffe","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Epidemiology\/Biostatistics, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratik","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, USA."},{"name":"Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA."},{"name":"Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel C.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Epidemiology\/Biostatistics, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the TRACK-TBI Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_3_3_2_1","volume-title":"Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths United States, 2014","author":"Peterson AB","year":"2019","unstructured":"1.Peterson AB, , Xu L, , Daughterty J, et al. 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