Spinal Cord Injury, Aging, and the Brain: Key Takeaways from Dr. Freddi Segal-Gidan

At the 2025 Sara Mulroy Symposium, Dr. Freddi Segal-Gidan delivered a thoughtful and compelling presentation on a topic often overlooked in rehabilitation medicine: the intersection of spinal cord injury (SCI), cognition, and aging. While much of the focus in SCI research has traditionally been on physical function, Dr. Segal-Gidan reminded us that the brain—and particularly cognitive health—must remain central to the conversation.

One of the first themes Dr. Segal-Gidan underscored was that aging is a normal physiological process, not a pathology. However, when combined with a pre-existing condition like SCI, the natural process of aging can magnify challenges. People with SCI now often live 40+ years post-injury, raising new questions about what long-term health, cognition, and independence look like in this population.

The Brain and SCI: A Tightly Woven Story 🧠

• SCI is not just about mobility. The central nervous system is a single network, so injuries to the spinal cord inevitably affect the brain.

• Research shows people with SCI face a 13x higher risk of cognitive impairment than able-bodied individuals.

• Up to 64% of patients experience cognitive changes—including memory, attention, and executive function difficulties—after injury.

These brain changes may be compounded by factors like traumatic brain injury at the time of SCI, depression, anxiety, chronic pain, cardiovascular disease, and even untreated sleep apnea.

Accelerated Cognitive Aging in SCI

Cognitive decline happens to everyone, but in SCI it often arrives earlier and progresses more quickly.

• Slower processing speed and reaction time

• Memory challenges (both recall and forming new memories)

• Reduced attention and multitasking ability

• Planning and decision-making difficulties

Dr. Segal-Gidan emphasized that what typically surfaces in one’s 70s in the general population may appear by age 50–55 in those with SCI.

What Can Help? Lifestyle, Screening, and Research

The talk stressed the importance of both prevention and proactive care:

• Healthy lifestyle: Mediterranean-style diet, regular adapted exercise, no smoking, limited alcohol and drug use.

• Better sleep: Addressing sleep disorders like apnea can significantly protect brain health.

• Routine cognitive screening: Just as we monitor blood pressure, cognition should be checked regularly—starting as early as midlife in people with SCI.

• Mental health and social support: Therapy, social work, and caregiver involvement can mitigate depression, anxiety, and stress, all of which influence brain function.

• Ongoing research: There is a critical need for adapted cognitive testing tools and deeper study of how SCI alters neuroplasticity and long-term brain function.

A Call to Action

Dr. Segal-Gidan closed with a candid reminder: biomedical research is under attack. Much of what we now know about SCI, aging, and cognition is the result of federally funded research programs, and without continued investment, progress could stall. She urged attendees to advocate with policymakers to ensure future patients continue to benefit from this essential work.

Final Word

Aging with SCI presents unique challenges, but also opportunities. By acknowledging the brain as central to rehabilitation, prioritizing early detection of cognitive changes, and pushing for strong scientific investment, we can help ensure that people with SCI not only live longer but live well.

Watch the full session video here