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Here's a list of additional articles related to Frontline's NFL 2-part series "League of Denial: The NFL's Concussion Crisis.

How CTE Affects the Brain

It’s the disease linked to brain trauma in football players – here’s how it works.

Dig Deeper: Investigating the NFL’s Concussion Crisis

A collection of essential reads on the NFL and its response to the concussion crisis.

Debating the Science of Concussions

In an excerpt from their book, League of Denial, reporters Mark Fainaru-Wada and Steve Fainaru detail how an official NFL conference on concussions descended into a near brawl between neuroscientists.

In Damage Control Mode, NFL Shied From Its Own Brain Research

In 2009, a leaked NFL study seemed to mark a game-changer in the concussion crisis — until the league distanced itself from the research.

The Autopsy That Changed Football

When Dr. Bennet Omalu found CTE in the brain of Steelers legend Mike Webster, he believed NFL doctors would want to know more. They didn’t.

NFL Commissioner Highlights Safety Record In Letter To Fans

The letter, sent to roughly 10 million fans, comes one day after the release of two book excerpts detailing the NFL’s checkered response to football’s concussion crisis.

How One Client’s Concussion Shook the Real “Jerry Maguire”

As an NFL super agent, Leigh Steinberg saw it all, especially when it came to injuries. But of all the hard hits he ever witnessed, there was one that especially frightened him: Troy Aikman’s concussion.

Report: NFL Concussion Settlement Could Shut Out Many

The very first players to be diagnosed with football-related brain damage may not allow any compensation, according to a new report.

NFL Reaches $765 Million Settlement In Concussion Lawsuit

The NFL has reached a settlement with more than 4,500 former players who were suing the league for allegedly concealing a link between traumatic brain injuries and professional football.

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As some of you will know, the PBS show Frontline devoted its October 8th program to the NFL concussion crisis, called appropriately "League of Denial: The NFL's Concussion Crisis." The following link will take you to an entire page of links to stories on the NFL's history of brain injury and what they have and have not done about it. Jack highly recommends that you visit this page and read up on some of the latest information available.

http://www.pbs.org/wgbh/pages/frontline/league-of-denial/

And here are some excerpts from a few of the articles available:

Since 2007, when headlines began to link the NFL and concussions, two questions have come to dominate the story: What did the league know about football’s risks to the brain, and when did it know it? With each high-profile suicide or scientific breakthrough, these questions have only grown more important. Many journalists have examined the crisis, seeking to determine what it may mean for the future of football. Here are some highlights:

GQ, March 2011
[Fred McNeil's] “memory started failing as early as the mid-’90s. He never told Tia; he didn’t understand it himself. Even when he got voted out of Zimmerman Reed, and then the next firing, and the next. Everything was just taking so long. Something that should take an hour was taking him four. Reading a brief. The simplest tasks. He blamed his deteriorating eyesight. He went to an eye doctor—the only medical help he ever sought. He got glasses, then stronger ones, and stronger ones still. He kept forgetting things. He was supposed to pick up Freddie at school. Forgot. So many thoughts just—poof! He learned to compensate. He learned to say ‘Nice to see you’ instead of ‘Nice to meet you.’ The latter was simply too risky. Apparently some of those people he had been saying that to were friends. But he had no memory of them. Blank. So it was ‘Nice to see you,’ always, just in case.”

New York Times, March 2007
“Mr. [John] Mackey is a sturdy 6-foot-3 and 240 pounds underneath his trademark black cowboy hat. He’s convivial with fans who remember him, but soon into any interaction quickly demonstrates his mental decline. During lunch on Friday, he used a spoon to drink his coffee, thinking it was soup, and uttered non sequiturs to almost any question, including several repetitions of ‘I want a cookie’ and ‘I got in the end zone.’”

ESPN, November 2006
“‘There’s going to be some controversy about you going back to play.’ Elliot Pellman looks Wayne Chrebet in the eye in the fourth quarter of a tight game, Jets vs. Giants on Nov. 2, 2003, at the Meadowlands. A knee to the back of the head knocked Chrebet stone-cold unconscious a quarter earlier, and now the Jets’ team doctor is putting the wideout through a series of mental tests. Pellman knows Chrebet has suffered a concussion, but the player is performing adequately on standard memory exercises. ‘This is very important for you,’ the portly physician tells the local hero, as was later reported in the New York Daily News. ‘This is very important for your career.’ Then he asks, ‘Are you okay?’ When Chrebet replies, ‘I’m fine,’ Pellman sends him back in.”

Popular Science, December 2012
“For equipment manufacturers, the demand for protective headgear has never been greater. Leading companies, as well as an army of upstarts, have responded by developing a number of new helmet designs, each claiming to offer unprecedented safety. The trouble is that behind them all lie reams of conflicting research, much of it paid for, either directly or indirectly, by the helmet manufacturers or the league.”

Wired, December 2012 
“There is no doubt the league is concerned. In 2011, the NFL’s Head Neck and Spine Committee rolled out a league-wide concussion assessment protocol, and the league’s $30 million donation to the NIH for the study of mild traumatic brain injury is the largest in NFL history.
Yet for all the league’s efforts, Johnson’s story is hardly unique. During the tenth week of this season, three star quarterbacks – Alex Smith of the San Francisco 49ers, Jay Cutler of the Chicago Bears and Michael Vick of the Philadelphia Eagles – were concussed, and each remained on the field for several plays before being benched. Smith managed to throw a 14-yard touchdown pass despite having blurred vision after a brutal helmet-to-helmet hit.”


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From the New York Times:

THE FACTS

Last week, New York City began its long-awaited bicycle sharing program, the largest in the nation. As in many other cities, helmet use was made optional, in part to encourage greater participation.

But a look at the statistics suggests that riding without a helmet is not a decision to make lightly. While football tends to dominate the discussion of sports-related head injuries, research shows that bike accidents account for far more traumatic brain injuries each year.

According to the American Association of Neurological Surgeons, cycling accidents played a role in about 86,000 of the 447,000 sports-related head injuries treated in emergency rooms in 2009. Football accounted for 47,000 of those head injuries, and baseball played a role in 38,394.

Cycling was also the leading cause of sports-related head injuries in children under 14, causing 40,272 injuries, roughly double the number related to football (21,878).

Part of the reason is that bicycling is so ubiquitous. But people are also more cavalier about taking precautions, said Dr. Gonzalo Vazquez-Casals, a neuropsychologist at Jamaica Hospital Medical Center in New York.

Bicyclists are also at high risk of colliding with motor vehicles, and when riders are not wearing helmets, such collisions frequently result in serious head injuries. For example, about 90 percent of bicyclists killed in the United States in 2009 were not wearing helmets. A majority were middle-aged men.

In New York City, 75 percent of all fatal bike accidents involve a head injury. In addition to wearing a helmet, another helpful precaution is using a marked bike lane: Streets that have them have 40 percent fewer crashes ending in death or serious injury.

THE BOTTOM LINE

Bike accidents contribute to more sports-related head injuries than any other activity.


Link to the New York Times.

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This one's a little off-topic for the TBI Blog, but since Jack is such an avid supporter of Touch Therapy, we felt we should include this article about the latest research.

FromTeatro Naturale:


Massage Envy, the pioneer and national leader of professional, convenient and affordable massage and spa services, in conjunction with the Touch Research Institute at the University of Miami School of Medicine, recently announced the results of a new study that concludes moderate pressure massage therapy can decrease pain for rheumatoid arthritis patients.

Massage Envy, the pioneer and national leader of professional, convenient and affordable massage and spa services, in conjunction with the Touch Research Institute at the University of Miami School of Medicine, recently announced the results of a new study that concludes moderate pressure massage therapy can decrease pain for rheumatoid arthritis patients.

Additionally, the study found that rheumatoid arthritis patients experienced perceived greater grip strength and greater range of motion in their wrists and large upper joints, including elbows and shoulders, after receiving moderate pressure massage therapy for one month. The study’s overview and results were published in the 2013 19 edition of Complementary Therapies in Clinical Practice Journal.


“Rheumatoid arthritis is a chronic disease that causes joints to become swollen, tender and stiff. While there is no cure to date, we do know now that moderate pressure massage therapy can help relieve pain and improve the quality of life for patients,” said C.G. Funk, vice president of industry relations and product development for Massage Envy. “The findings will be utilized to better educate our therapists, members, guests and the public on how to best incorporate massage into an overall wellness plan.”


Led by Tiffany Field, Ph.D., of the Touch Research Institute, the study examined the effects of moderate pressure versus light pressure massage therapy on 42 adults with rheumatoid arthritis in the upper limbs. The adults were randomly assigned to a moderate pressure or a light pressure massage therapy group. A therapist massaged the affected arm and shoulder once a week for a four-week period and also taught the participant self-massage to be done once daily. By the end of the one-month period, results of the study demonstrated the moderate pressure massage group had less pain, increased grip strength, increased wrist flexion, increased elbow flexion and increased shoulder abduction. The study also found that participants in both groups experienced a reduction in depressed mood and anxiety.


“As patients with rheumatoid arthritis work with their doctors to determine the best treatment option, we recommend discussing routine massage therapy given the positive effects found in our study,” said Field. “In addition to physical activity, such as yoga, moderate pressure massage therapy along with self-massage techniques can help manage the pain and stress that occurs from various forms of arthritis.”


Over the last eight years, Massage Envy has donated more than $150,000 to support research related to the benefits of massage therapy. Today, there are more than 870 Massage Envy locations, making it the largest system of franchised massage and spa clinics in the industry. The company has created 21,000 new massage therapists positions since 2002 and plans to add 1,500 new positions annually through 2018.


In 2011, Massage Envy formed a partnership with the Arthritis Foundation to raise awareness and funds to support the organization's mission to prevent, control and cure arthritis. In total, Massage Envy has raised more than $1 million in two, one-day Healing Hands for Arthritis events. The brand is also as a national sponsor of the Arthritis Foundation's 250 Arthritis Walk® events around the country, where local Massage Envy owners share information about the benefits of massage therapy, provide chair massages and support the Arthritis Foundation at their respective local walks. Massage Envy and the Arthritis Foundation share a common understanding about the devastating effects of the disease on the body and the potential for massage therapy to relieve and control certain symptoms. 

Link to Teatro Naturale.

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From Bloomberg Businessweek:

Older people who undergo general anesthesia for major surgery have a 35 percent higher risk of developing dementia later in life, according to a French study.

The findings are based on information from the Three-City Study, which included thousands of people age 65 and older in Bordeaux, Dijon and Montpellier starting in 1999. In a subpopulation of 7,008 citizens, 632 participants developed dementia over the course of the study, and those patients were more likely to have had general anesthesia than those who didn’t develop mental deterioration.

The findings support a theory that post-operative cognitive dysfunction, a common complication in elderly patients in which their thinking and memory is temporarily impaired, is associated with a higher risk of developing dementia. Previous research has suggested that some anesthetics may prompt inflammation of neural tissues, leading to early signs of Alzheimer’s disease including amyloid plaques and protein tangles in the brain.

“Recognition of post-operative cognitive dysfunction is essential in the perioperative management of elderly patients,” Francois Sztark, the lead researcher and an anesthesiologist at the University of Bordeaux, said in a statement. “A long-term follow-up of these patients should be planned.”

The study results were presented at the annual meeting of the European Society of Anaesthesiology in Barcelona.

Link to Bloomberg Businessweek.

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From the Richmond Times-Dispatch:

A cheap regimen of vitamins in use for decades is seen by some scientists as a way to delay the start of Alzheimer’s disease and dementia, a goal that prescription drugs have failed to achieve.

Drugmakers including Bristol-Myers Squibb Co., Pfizer Inc. and Eli Lilly & Co. have spent billions of dollars on failed therapies in a so-far fruitless effort to come up with an effective treatment for Alzheimer’s and dementia.

Now, in the latest of a steady drumbeat of research that suggests diet, exercise and socializing remain patients’ best hope, a study published last week in the Proceedings of the National Academy of Sciences shows that vitamins B-6 and B-12 combined with folic acid slowed atrophy of gray matter in brain areas affected by Alzheimer’s disease.

“You don’t have any other options for these patients, so why not try giving them this cocktail of B vitamins?” says Johan Lokk, a professor and head physician in the geriatric department at Karolinska University Hospital Huddinge in Sweden, who wasn’t involved in the study.

Alzheimer’s disease and dementia affect mostly older people. As people live longer, the number afflicted by the conditions is growing. Delaying dementia with an inexpensive vitamin regimen may help stem the surge in cases, which the World Health Organization predicted would more than triple from 36 million worldwide in 2010 to 115 million in 2050, as well as the cost, estimated at $604 billion in 2010 by Alzheimer’s Disease International.

In the study, researchers tracked 156 people ages 70 and older who had mild memory loss and high levels of a protein previously linked to dementia. Among people with elevated homocysteine, the study found that the amount of gray matter declined 5.2 percent in those taking a placebo, compared with 0.6 percent in those who took the vitamin cocktail. The supplements cost about 30 cents a day in pharmacies and health-food stores.

“It’s the first and only disease-modifying treatment that’s worked,” said A. David Smith, professor emeritus of pharmacology at Oxford University in England and senior author of the study. “We have proved the concept that you can modify the disease.”

The Food and Drug Administration has not cleared new drugs for memory loss conditions in a decade. Approved medicines such as Eisai Co.’s Aricept ease symptoms without slowing or curing dementia.

Vitamin B-12 is found in liver, fish and milk and folic acid in fruit and vegetables. Deficiency of B vitamins and folate is already linked to dementia.

A U.S. study published in 2008 found that people who had moderate or severe Alzheimer’s did not benefit from the supplements.


Link to the Richmond Times-Dispatch.

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From the Statesman-Journal:

 
On any given night more than 300,000 veterans are living on the streets of America.


On this Memorial Day, as we remember those who have died while serving in the United States Armed Forces, it is also a time to remember those who served and are still living.

The military members and veterans with physical wounds are easy to spot, but those with the “invisible war wounds” of PTSD, Traumatic Brain Injury, and mental health issues can be just as severely affected.

These invisible wounds, plus other economic factors (high unemployment and sluggish economy) and cultural factors (lack of understanding and support for those with “invisible wounds”) further aggravate even more problems such as joblessness, homelessness and suicide.

The parades and societal “well wishes” at the airports, or the heart-warming returns seen in TV news stories are all too often followed by a sense of detachment, isolation and failure. Veterans often cannot wait to return to “normal civilian life” when away, but once home often find themselves feeling distant and alone. They often long for who they were before they entered the war zone, and no longer feel attached to their friends, families or their communities. There are many who are either dying or giving up on life because benefits never showed up or simply the struggles are far more than they can endure.

Then there are those veterans still “sitting on the dock of the bay watching time roll away.” According to some estimates, more than 9,000 veterans have been waiting more than a year for some offices to process their applications. Those in major metropolitan areas face far more protracted delays. The total number of claims awaiting adjudication is estimated between 600,000 and 900,000. According to the Bureau of Labor Statistics on unemployment, the average jobless rate for veterans in 2012 was 9.9%. The national average was a full two percent lower. For some the challenges are greater. Female veterans face a 12.5% unemployment rate, and for post 9/11 veterans in the 18-24 age bracket, the unemployment rate is 20%.Joblessness leads to homelessness.


According to a recent study by the National Homeless Organization, 33% of homeless males are veterans. They are twice as likely as any other American to become chronically homeless. On any given night more than 300,000 veterans are living on the streets of America.

Continuing reading.

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From MedPage Today:

State lawmakers are moving quickly to enact traumatic brain injury legislation aimed at protecting young athletes, but those laws are often a step ahead of the available science, researchers reported.

During a 4-year period from January 2009 through December 2011 44 states and Washington, DC enacted traumatic brain injury laws, reported Hosea H. Harvey, JD, PhD, at Temple University Beasley School of Law in Philadelphia.

"Youth sports traumatic brain injury laws have generally taken a one-size-fits-all approach," Harvey wrote online in the American Journal of Public Health. "The laws do not incorporate scientific consensus that youth concussions vary on the basis of age, the type of sport, and whether the athlete is male or female."

Additionally, "there is no agreed-upon traumatic brain injury diagnostic metric, and there are no uniform national traumatic brain injury reporting protocols."

In 2009 lawmakers in Washington state started the trend with a law named after Zackery Lystedt, a 13-year-old who was permanently disabled following a head injury sustained in a football game in 2006. That law mandates that youths showing signs of traumatic brain injury be examined and cleared by a licensed healthcare provider.

The majority of states used the "Lystedt Law" as a template when writing their own laws, Harvey wrote. Every consequent state law copied Lystedt, Harvey wrote, which requires no fewer than 24 hours of no play after a young athlete is sidelined. But research has not established the optimal duration a player should stay out, he wrote.

Only 16 states have liability limits, or exculpatory provisions, within their traumatic brain injury laws, while 29 do not, Harvey noted. Those limits provide legal immunity where health professionals might otherwise be sued by athletes and families, he stated.

Commenting about the legislation, Reed Estes, MD, of the University of Alabama at Birmingham, also noted that state laws focus on secondary hits rather than prevention.

"They go out after that concussion, sustain another hit or similar blow, and then that can be a more serious issue with potentially some future implications or some permanent deficits," Estes said.

Harvey pointed to the lack of longitudinal cohort studies assessing long-term health outcomes.

"It is impossible to precisely determine the causal relationship, if any, between youth-sports injuries and subsequent early onset dementia that has been observed in former professional athletes," he wrote.

Estes called for consensus among the states.

"One of the problems is there's so much variability in who covers the liability for the different healthcare practitioners that are making these clearance decisions," he said. "Is there a mandated or uniform education policy for the parents, the coaches, the athletes to provide a nationwide guideline or consensus for that?"

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From the San Francisco Chronicle:

The number of soldiers discharged from the Army for misconduct has risen to its highest rate in recent times, and some are wounded combat troops who have lost their medical care and other veterans benefits because of other-than-honorable discharges, according to an investigation by the Colorado Springs Gazette.

The newspaper reported Sunday than 25 percent since 2009, mirroring the rise in wounded. Among combat troops, the increase is even sharper.

Total discharges at the eight Army posts that house most of the service's combat units have increased 67 percent since 2009.

"I've been working on this since the 70s, and I have never seen anything like this," said Mark Waple, a retired Army officer who now tries military cases as a civilian lawyer near North Carolina's Fort Bragg. "There seems to be a propensity to use minor misconduct for separation, even for service members who are decorated in combat and injured."

The figures studied by The Gazette include soldiers who have served multiple tours and have been diagnosed with post-traumatic stress disorder and traumatic brain injuries. Some troops were cut loose for minor offenses that the Army acknowledges can be symptoms of TBI and PTSD.

"I see it every day," said Lenore Yarger, a veterans advocate near Fort Bragg. "We have gotten very efficient at getting people to fight wars but are not prepared to deal with the aftermath."

The Gazette found that several soldiers who tested positive for drugs were deployed anyway because the Army needed combat troops. But when they returned, they were discharged for the offense.

In other cases, the soldiers were discharged after suffering severe brain injuries in combat.

Kash Alvaro, a wounded combat soldier at Fort Carson near Colorado Springs, suffered from regular seizures from a traumatic brain injury after a bomb blast in Afghanistan. He was discharged in January 2012 for a pattern of misconduct that included missing medical appointments and going AWOL for two weeks. But because his other-than-honorable discharge barred him from veterans benefits, he soon became homeless and relied on the local hospital emergency room for care.

"It was like my best friend betrayed me," Alvaro said from a hospital bed. "I had given the Army everything, and they took everything away."

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, disagreed that the military is using minor misconduct to discharge veterans as the Army faces required budget cuts and orders to reduce the force.

"I can tell you that 10-plus years of war has placed significant stress on many of our service members, sometimes manifesting itself in their health and even their discipline," he said. "We go to great lengths to try to rehabilitate those who don't meet or maintain required standards prior to initiating separation."

An Army spokesman said the military branch does not track the number of soldiers wounded in war who were later kicked out.
Meanwhile, Maj. Gen. Joseph Anderson, who was Fort Carson's commander until March and is set to become commander of Fort Bragg, said the Army's priority is caring for soldiers. He said the number of injured who are discharged is not a significant figure.

Still, he said, distinguishing injuries from misconduct is nearly impossible.

"It's the hardest thing," he said. "We physically, literally struggle with it every day."

Link to the San Francisco Chronicle.

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From the Colorado Springs Gazette:

Americans are a deeply divided people on many things these days. But there is one issue on which virtually all agree, and that is the nation's enduring obligation, as President Abraham Lincoln put it so eloquently in his second inaugural address, "to care for him who shall have borne the battle and for his widow and his orphan."

To that end, America spends hundreds of billions of dollars every year to provide our veterans with the finest medical care and a helping hand in pursuit of jobs, educations and homes. It is unlikely that any other nation has ever done so much to show its gratitude to those who have served in its military in war and peace. But serious injustices can still sometimes occur in the treatment of service men and women. Such an injustice has been found recently through the reporting of The Gazette's Dave Philipps.

This is an especially tough situation for senior military leaders who are being forced to make decisions with life-changing consequences, often without critically important medical knowledge or diagnostic tools. Even so, since there are always bad apples in any organization, commanders must be able to remove any individual who lowers the combat readiness of their units. Insuring combat readiness trumps every other military management consideration just as victory trumps every other strategic goal.

Thanks to the long years of war in Iraq and Afghanistan, the number of returning soldiers suffering from traumatic brain injury and/or post-traumatic stress disorder has spiraled. The Department of Defense has spent more than $700 million in recent years studying the causes and cures for TBI and PTSD, which are estimated to affect more than half a million Iraq and Afghanistan veterans. Progress has been made, but much remains to be learned.

It's tough enough providing proper medical care for victims of TBI and PTSD, but these wounds have presented the military with another challenge from an unexpected direction. As Philipps reports, "the surge in troops returning with PTSD and TBI after more than a decade of war poses a problem for the military because their symptoms often include bad decision-making, frayed memory and incendiary anger, all of which can be indistinguishable from misconduct. With little guidance, commanders struggle to determine who is badly injured and who is just bad."

The result is a disturbing increase in the number of Marines and Army soldiers diagnosed with severe combat-related medical conditions who are nevertheless kicked out of the service via a bureaucratic technicality known as a Chapter 10. Their numbers are comparatively few, but the affects are no less catastrophic for the individuals involved because they often lose their right to medical care and other services to which veterans are normally entitled.

Philipps chronicles these personal tragedies through the eyes of three men, all decorated war veterans who served gallantly on multiple deployments but came home severely afflicted and eventually found themselves thrown to the street. As one of them told Philipps, "It was like my best friend betrayed me. I had given the Army everything, and they took everything away."

A Chapter 10 is an obscure regulation that allows the DOD to separate an individual for an alleged pattern of violations like being late to formation, missing prescribed medical appointments and showing disrespect to commanding officers, conduct which is often traceable to TBI and PTSD but which can also be a product of bad attitudes and lack of military discipline. The problem is that it can be all but impossible to tell which is which. Based on data obtained through a Freedom of Information Act request, Philipps reports a 60 percent increase Army-wide in misconduct discharges since 2006. Unfortunately, there is no data for the frequency of Chapter 10s across the services.

Multiple factors appear to be converging to produce this result, including the massive increase in head injuries caused by improvised explosive devices (IEDs), the rise in multiple deployments (it is not uncommon these days to encounter soldiers who have served four or five combat tours) and the lack of proven treatment protocols. Then there are the estimated $487 billion in military spending reductions imposed by President Barack Obama and Congress since 2009. The pressure to downsize the military is intense, and nobody should be surprised that soulless bureaucratic shortcuts like Chapter 10 discharges become too common in such an environment.

President Obama and Congress created this problem. Now it's time for them to do whatever is necessary to fix it. No soldier deserves less-than-honorable treatment after sustaining traumatic injuries while defending the common good. The United States and its Army are so much better than this.

Link to Colorado Springs Gazette:

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From Stars and Stripes:

Deployed military personnel who’ve had multiple traumatic brain injuries from roadside bombs or other incidents may be at increased risk for suicide, a new study suggests.
Earlier research had already drawn a link between brain injuries and increased suicide risk, but the study published Wednesday by the Journal of the American Medical Association suggests the risk increases even further in personnel who’ve had more than one brain injury. However, the majority of those with multiple TBIs were not suicidal, the study found.
Study author Craig J. Bryan, a psychologist and former Air Force captain who is now associate director of the National Center for Veterans Studies at the University of Utah, said his findings, gleaned from data on 161 patients who came into his clinic in Balad, Iraq, in 2009, were somewhat surprising.
While the increase in suicidal thoughts among those who’d suffered multiple brain injuries was expected, it was interesting, he said, that the “dose effect” of multiple injuries appeared to level out after two injuries.
“I really was expecting guys who had been blown up or had sustained five or six concussions in their lives, they would probably look even worse or be at greater risk than the guys who had only sustained two TBIs,” Bryan said Tuesday in a phone interview, “but that was not the case.”
Personnel who visited Bryan’s clinic in Iraq after sustaining a suspected head injury, each completed a standardized assessment in which they reported feelings of depression, post-traumatic stress and suicidal thoughts and behaviors, as well as their lifetime history of traumatic brain injury, including concussions they had had as children.
Those who’d never had a TBI reported having no suicidal thoughts or behaviors, while 6.9 percent of those who’d had one TBI reported such feelings. Among those who’d had two or more injuries, 21.7 percent expressed suicidal thoughts or behaviors.
“I think these numbers could be disturbing to some of our servicemembers who know they’ve had brain injuries,” said John D. Corrigan, director of the Division of Rehabilitation Psychology and a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University. He was not involved in the study.
But he cautioned those who’ve had an injury to keep in mind that the study only shows a relationship between TBI and suicidal thoughts and doesn’t consider factors that could mitigate suicide risk.
Like previous research, Corrigan said, the study doesn’t prove that traumatic brain injuries cause suicidal thoughts, but it “inches us there.”
The most interesting finding, Corrigan said, is that, of those who’d never had a TBI, none reported suicidal thoughts. “I’ll be interested in looking a little closer at that.”
Bryan said his best guess for why none of the 18 servicemembers in the zero TBI group reported suicidal thoughts is that there weren’t enough people in the group to render an accurate result. In general, 2 percent to 3 percent of people will report having suicidal thoughts in the past year, he said, which equates to roughly 1 person in 40.
While those with multiple TBIs were “significantly more likely to be suicidal,” Bryan said, “the vast majority, 75 to 80 percent, of those who had multiple TBIs were not suicidal.”
Corrigan said he doesn’t know if this study alone is reason enough for the U.S. military to change its handling of traumatic brain injuries.
Its policy in Afghanistan of requiring personnel caught in vehicle rollovers and bombings to be pulled from the fight to undergo testing for brain injuries “appears to have had a very positive effect in terms of folks being able to heal quickly from the most minor of the traumatic brain injuries.”
“Probably what this does say,” Bryan said, “is that immediately following a head injury, whether from an explosion, a motor-vehicle accident, whatever the case may be, we definitely do need to take people out and give them a break.”
Link to Stars and Stripes.

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From The Examiner.com:

A presentation discussing the future impact of the rise of obesity related dementia was presentedMay 12, at the 20th European Congress on Obesity (ECO) in Liverpool, UK. Study results indicate that those who are obese in midlife to be at greater risk for dementia in later life, and that changing lifestyle patterns in order to maintain a healthy weight, may lead to a decreased risk for developing dementia in the future.

The risk of developing dementia increases with age, and is characterized by declining cognitive function affecting memory, attention and language. As the population ages, people are living longer which adds an increased burden to the healthcare system. While it is commonly understood that obesity increases risk for cardiovascular disease, stroke, cancer, and type 2 diabetes, how it is a precursor to dementia is still unclear, yet most researchers accept a connection does exist.

In Sunday’s presentation, Dr. Laura Webber and Mr. Tim Marsh from the UK Health Forum projected various obesity trends to 2050, estimating the health impact and economic burden of obesity related dementia. They believe that based on available data, England’s current obesity rate of 24% in men and 26% in women will grow to 46% for men and 31% for women by 2050. Citing research such as the 2013 Loef and Walach study that suggests midlife obesity can lead to a doubled risk for later life dementia, Webber and Marsh predict the UK current dementia rate for those over 65 to increase from 4.89% to 6.6% by 2050. According to Alzheimer’s Research UK, this would impact UK’s total current £23bn/year costs associated with dementia to grow to £41bn/year by 2050.

That a greater risk for dementia later in life exists for those obese in midlife, is not an unfamiliar concept for the United States. A 2005 Kaiser Permanente study in Northern California studied 10,276 men and women 40-45 years. This study showed that over a 27 year span, compared to those of normal weight (body mass index (BMI)18.6-24.9), overweight participants (BMI 25-29.9%) were 35% more likely to develop dementia, while those that were obese (BMI ≥ 30) had a 74% increased risk for developing the disease.

While it may be easy to see the effects of an expanding waistline, the unseen long term effects to health have economic ramifications in America as well. According to the Center for Disease Control, United States 2008 medical costs associated with obesity were 147 million.

That there are diseases associated with aging is a fact, yet the information offered at the ECO show that current lifestyle changes can have positive health benefits for the future “We know that age is the biggest risk factor for dementia," says Dr. Simon Ridley, Head of Research at Alzheimer’s Research UK, "and while we can’t change our age, research suggests that lifestyle choices during midlife could help to keep our brains healthy as we age. Maintaining a healthy weight, eating a balanced diet, regular exercise and not smoking could all help to reduce the risk of dementia and are things that people can think about doing at any age.”

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Our second article on studies finding a link between moderate alcohol consumption and improved cognitive performance. Although three glasses a day sounds rather a lot to me, certainly more than the "moderate" amount of alcohol recommended in the previous article.

From The Telegraph:

A regular glass of champagne could improve your memory, according to scientists.

Researchers found that three glasses of bubbly a day could help ward off brain disorders such as dementia and Alzheimer's disease.

They discovered that a compound found in the black grapes, Pinot noir and Pinot meunier, both of which are used for champagne, helps stave off forgetfulness.

Jeremy Spencer, a biochemistry professor at Reading University, said: “Dementia probably starts in the 40s and goes on to the 80s. It is a gradual decline and so the earlier people take these beneficial compounds in champagne, the better.”

It is not the first time scientists have identified health benefits in champagne. In 2009, the same team found that it was as good for the heart as cocoa or red wine polyphenol antioxidants, which are believed to reduce the effects of cell-damaging free radicals in the body.

The memory aid found in champagne is a different compound, phenolic acid.

In the latest study, researchers found that the drink provoked a noticeable boost to spatial memory.

The experiments were conducted on rats, which had champagne mashed into their food every day for six weeks.

Each rat was then left to run in a maze to find an edible treat. Five minutes later, the exercise was repeated to see if the rat had remembered where it was found.

Without champagne, the rats had a 50 per cent success rate, but after a tipple their score shot up to an average 70 per cent.

Prof Spencer told the Mail on Sunday: "The results were dramatic. After rats consumed champagne regularly, there was a 200 per cent increase of proteins important for determining effective memory. This occurred in rats after just six weeks. We think it would take about three years in humans.

"This research is exciting because it illustrates for the first time that moderate consumption of champagne has the potential to influence cognitive functioning such as memory.”

He now hopes to conduct a trial on up to 60 pensioners who will be asked to drink champagne for three years.

A spokesman for the Alzheimer's Society said: "This is an interesting study, especially for those who enjoy a glass of bubbly. However, people should not start celebrating just yet. This is the first time a link between champagne and dementia risk reduction has been found. A lot more research is needed.”

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Results from two new studies say yes, although the second one begs the question "what constitutes 'moderate' drinking?"

The first article is from News Fix:

People who consume between one and six drinks a week have about half the risk of dementia, compared to abstainers.

Alcohol has a number of effects on the brain and its blood vessels so it is unsurprising to learn that levels of consumption may be associated with the risk of dementia. Researchers at the Beth Israel Deaconess Medical Center compared 373 people with new-onset dementia with 373 controls drawn from Cardiovascular Health Study, which covers 5,888 adults aged 65 and older.

Compared to abstainers, those consuming less than one drink a week had a 35 per cent lower risk of dementia, and those consuming between one and six drinks a week had a 54 per cent lower risk. A consumption of between seven to 13 drinks a week was associated with a 31 per cent lower risk. And those consuming more than 14 drinks a week were found to have a 22 per cent increased risk of dementia. The increased risk was most apparent among men carrying the ApoE4 gene, itself a risk factor for dementia.

The link between alcohol consumption and dementia risk was generally similar for both vascular dementia and Alzheimer’s disease. It ties in with other research that shows light to moderate alcohol consumption may confer some benefit on brain function, while heavy consumption impairs it.

Link to News Fix.

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From The New York Times:


A large body of research has linked late-life depression to social isolation, poorer health and an increased risk of death. Now, a new study finds that depression is associated with subsequent vascular dementia and Alzheimer’s disease, conditions poised to expand dramatically with the aging population.

The report, published on Wednesday in the British Journal of Psychiatry, is a meta-analysis of 23 previous studies that followed nearly 50,000 older adults over a median of five years. The researchers found that depressed older adults (defined as those over age 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than similarly aged people who weren’t depressed.

“We can’t say that late-life depression causes dementia, but we can say it likely contributes to it,” said Meryl Butters, an associate professor of psychiatry at the University of Pittsburgh School of Medicine and a co-author of the paper. “We think depression is toxic to the brain, and if you’re walking around with some mild brain damage, it will add to the degenerative process.”

In terms of absolute risk, she said, the data suggest that 36 of every 50 older adults with late-life depression may go on to develop vascular dementia, while 31 of every 50 seniors with a history of depression may eventually be diagnosed with Alzheimer’s.

Previous research has shown that a history of depression is linked to a doubling of the risk that someone will end up with Alzheimer’s disease. But this is the first analysis to demonstrate an even stronger association with vascular dementia, a condition caused by strokes or other interruptions to blood flow in the brain.

That does not mean a causal relationship between depression and dementia has been established; it hasn’t. Nor is there any solid evidence yet that forestalling depression will prevent dementia.

About 20 percent of people with dementia in the United States — between 500,000 and 1 million adults — are thought to have the vascular form of this condition, according to the National Institute of Neurological Disorders and Stroke. Over all, up to 5 percent of adults aged 65 and older have clinical depression; the numbers are higher among those who receive home health care or live in institutions.

What biological mechanisms might account for a relationship between depression and dementia? Some evidence suggests that people who are depressed produce high levels of the hormone cortisol, which in turn has an adverse effect on the hippocampus — a part of the brain responsible for new learning and short-term memory.

“We know that people who are depressed have elevated levels of cortisol, a hormone related to the stress response, and a smaller hippocampus, a brain structure critically important for memory,” said Dr. Raymond Ownby, chair of psychiatry at Nova Southeastern University’s College of Osteopathic Medicine in Fort Lauderdale, Fla., who studies the possible links between depression and dementia.

Other evidence suggests that depression contributes to chronic inflammation that damages blood vessels and impedes blood flow in the brain, leading to the deterioration of neural networks.

“If chronic inflammatory changes are a common feature of depression, that could predispose depressed patients to neurodegenerative changes in later life,” according to a 2007 article in Neurochemical Research.

Some experts have hypothesized that depression may share genetic underpinnings with dementia, be an early signal of dementia, or serve as an emotional reaction to impaired thinking and unreliable memory. Alternately, depression may deplete a person’s cognitive reserves, bringing encroaching dementia to light earlier than otherwise would be the case.

Whatever the underlying mechanism may be, the implications for older adults are clear. “If someone in later life develops depression, they should get early, aggressive treatment, and if they do so and recover, they should try to prevent recurrence,” Dr. Butters said.

While there is no evidence that doing so will prevent dementia, treating depression in older adults at least improves one’s quality of life, relieving suffering and reducing other health risks, several other experts said.


Continue reading.

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We've posted on the benefits of a Mediterranean diet before, but it doesn't hurt to repeat helpful information.

From Web MD:

Large study showed better retention of mental skills in seniors who had followed Mediterranean diet 

Eating fish, chicken, olive oil and other foods rich in omega-3 fatty acids while staying away from meats and dairy -- the so-called Mediterranean diet -- may help older adults keep their memory and thinking skills sharp, a large new U.S. study suggests.

Using data from participants enrolled in a nationwide study on stroke, the researchers gleaned diet information from more than 17,000 white and black men and women whose average age was 64.

The participants also took tests that measured their memory and thinking (cognitive) skills. During the four years of the study, 7 percent of the individuals developed problems with these skills, the researchers reported.

"Greater adherence to Mediterranean diet was associated with lower risk of incident cognitive impairment in this large population-based study," said lead researcher Dr. Georgios Tsivgoulis, from the University of Alabama at Birmingham as well as the University of Athens, in Greece.

There was no evidence of racial or regional differences in response to the diet. However, the diet did not help diabetics ward off mental decline, Tsivgoulis said.

"It may also be that the benefit of a Mediterranean diet differs in people with different diseases," Tsivgoulis said.

Because there are no definitive treatments for dementia, anything people can do to possibly delay the onset of symptoms, such as modifying their diet, is very important, Tsivgoulis noted.

The report was published in the April 30 issue of Neurology.

An earlier study published in the journal last year suggested that foods rich in omega-3s might help guard against Alzheimer's disease by affecting levels of a specific substance in the brain.

Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City, said this latest study "is further support for the benefit of Mediterranean diet."

This important paper should be used to guide clinical practice, he suggested.

"The best way to minimize Alzheimer's disease is with 30-minute sessions three times a week of brisk walking or weight lifting, maximizing mental activity and a Mediterranean diet," Gandy said.

"This is the best prescription for maintaining of mental function that we have in hand right now," he said.

In the study, the investigators found that those who followed the Mediterranean diet were 19 percent less likely to develop thinking and memory problems. This finding was the same for both black and white participants.

The single exception was the 17 percent of the participants who had diabetes. Among these people, the Mediterranean diet didn't appear to prevent thinking and memory difficulties from developing, the researchers found.

Although the study found a lower rate of these symptoms of early dementia in people who followed a Mediterranean diet, it did not establish a cause-and-effect relationship.

Further research is needed to generalize these results to other groups, and to establish how the Mediterranean diet exerts its neuroprotective effects on mental status, Tsivgoulis said.

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From WUFT News:

Sports teams may no longer have to rely on an athlete’s word to diagnose a concussion, thanks to a new traumatic brain injury test.

Banyan Biomarkers is conducting research at the University of Florida on its new test, which detects and measures the severity of traumatic brain injuries, or TBIs, through blood samples.

“The test will be one of the biggest breakthroughs in traumatic brain injuries ever,” said Jackson Streeter, CEO of Banyan Biomarkers. “Right now, there is no way to quantify TBIs. It’s often called the invisible injury.”

For the test, researchers take a blood sample and search for specific biomarkers, proteins from neurons and other cells that are not normally present in the blood.

“These proteins should not be present,” Streeter said. “They’re supposed to be in your brain. They’re not supposed to be in the blood. After you’ve had an injury, these proteins will cross the blood-brain barrier and be detectable in a serum.”

The traumatic brain injury test is the first blood-based one in existence and also allows medical professionals to measure the extent of the injury. The number of biomarkers found in the blood correlate to the severity of the injury with higher numbers corresponding to more serious injuries.

Jay Clugston is a team physician for UF football and the research coordinator for the Gator Study, which involves examination of the test on sports concussions at UF. He reached out to Streeter and his team after hearing about the work the company was doing with brain injuries.

“Most tests require a person to answer truthfully without bias or without trying to lie to get back into a game or for a physician to say whether or not the person has a concussion,” Clugston said.

This can be a problem. Some concussions are obvious and can be easily diagnosed due to the nature of the hit or the response of the athlete, but others aren’t so clear.

Many of the current diagnostic methods involve a baseline test performed before the season. The same test is then repeated after an injury, and the results are compared.

“Those can all be kind of faked or manipulated,” Clugston said. “We have athletes that are savvy enough that they’ll maybe purposely score low on a baseline test knowing that that will allow them to get back to play faster.”

He said researchers have been looking for a more objective way to diagnose concussions.

The Gator Study is specifically looking at sports concussions. The tests are being performed on UF football, soccer and lacrosse players, and the athletes’ participation is voluntary.

For the study, researchers perform a baseline blood test before the season. Within one hour of an injury occurring, a blood sample is taken by sticking the player’s finger. A venous sample is then taken from an elbow or forearm within four hours of the injury.

Gator Study researchers have been collecting data for two and a half years, but the results have not been analyzed yet. They plan to do so in the next six months, and the test has the potential to be an objective way to diagnose sports concussions.

UF is also one of more than 20 centers around the world where Banyan Biomarkers is conducting its Alert TBI trial. This is the final, pivotal stage of testing where the company is experimenting on 2,000 patients to become approved by the Food and Drug Administration. Along with the Gator Study, Banyan Biomarkers is using the Alert TBI trial to complete its research.

Continue reading.

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From The San Diego Union-Tribune:

Brain injury.

Say it with me now.

Brain injury.

Not head injury. Not concussion. Not getting dinged, seeing stars, or having your bell rung.

Brain injury.

That’s what it needs to be called. Every time.

The conversation surrounding sports-related brain injuries has never been louder or more widespread. Even so, the language involved in that conversation must adjust to emphasize the topic’s gravity.

When someone snaps his tibia, we call it a broken leg. When someone tears her ACL, we call it exactly that. And we know if injuries of this nature occur multiple times, the wounded may very well endure a lifetime of suffering.

Same goes for victims of head, er … brain injuries. Sorry. Force of habit.

This isn’t to say that there has been a conscious effort by people to mitigate a brain injury’s severity by using more palatable terms. As Illinois-based neurologist Dr. Julian Bailes said, “I think the word concussion is pretty much embedded in people’s minds as meaning brain injury.”

But Bailes also said that he frequently treats athletes who feel they can play through brain injuries, and as we’ve learned, that can lead to catastrophic consequences. So let’s make an effort to describe the condition as it truly is — to hammer it into people’s heads before more heads get hammered.

Hall of Fame offensive lineman Ron Yary said that whenever he goes back to Canton, Ohio, for the HOF induction ceremony, he asks other former players if they still would have suited up knowing what they know now. They all say yes. However, when he asks if they would let their kids play, they generally give a different response.


To be fair, Yary said that he would still encourage youngsters to play football, which he considers a safe sport. That’s awfully debatable, though, because football’s dangers have presented themselves in clear, sometimes tragic fashions.
We know that copious ex-NFL players were discovered to have had chronic traumatic encephalopathy, a disease linked to depression, memory loss and dementia. We know that Junior Seau and former Bears safety Dave Duerson, both of whom committed suicide, suffered from this very disease.
We know that researchers have found that tens of thousands of high school football players have endured brain injuries, that former college football athletes have claimed that these injuries ruined their lives, and that 2,000 NFL players are suing the league for withholding information on the long-term effects of brain trauma.
Could some of us be overreacting to the data? Maybe. Might some of the NFL plaintiffs see an opportunity for a money grab? Perhaps.
Even so, I have a feeling that if Yary asked a collection of former football players who don’t own Hall of Fame jackets if they still would have played, their answers wouldn’t be so positive.
There seems to be more precaution than ever when it comes to protecting players’ brains, whether it is rule changes in the NFL, or the CIF offering courses on brain injuries and mandating players suspected of sustaining one be removed from a game or practice.

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From The Daily Mail:

There are several types of dementia... including Alzheimer’s disease (AD), vascular dementia, frontal lobe dementia, and dementia with Lewy bodies. Not everyone has all the symptoms of one particular type – some people are diagnosed as having mixed dementia – and they affect individuals to different degrees and progress at different rates. 

Alzheimer’s disease is the most common. It is thought to be due to plaques and tangles in the brain causing brain cells to die faster than they would in normal ageing. The first signs are usually forgetting recent events, repetition, confusing things or getting lost. People may also become depressed and/or irritable, and lose interest in doing things. Eventually they may need help with everyday tasks.

Vascular dementia, the second most common, happens when there is any interruption in the supply of blood and oxygen to the brain, as with strokes. People with high blood pressure, heart problems, high blood lipids (cholesterol and triglycerides) are more at risk so it is important to identify and treat these conditions quickly.

Frontal lobe dementia may not provoke memory problems in early stages. It can cause dramatic personality change, eg, from quiet and unassuming to loud and aggressive.

Lewy bodies are abnormal proteins in the nerve cells of the brain. As well as the symptoms of AD, Lewy bodies dementia can trigger hallucinations, and cause problems with balance and walking. This condition is sensitive to neuroleptic (often called antipsychotic) drugs, which are prescribed for other dementias but can lead to severe side effects, even death, in Lewy bodies dementia.

Mild cognitive impairment (MCI) is not dementia. This diagnosis is given for mild memory problems, when someone is, for instance, becoming forgetful and has difficulty concentrating. MCI does not necessarily lead to dementia.

Link to The Daily Mail.

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