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Jack Sisson's TBI Blog | |
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A hug is duct tape for the soul. |
Saturday, January 14, 2012The black hole of sportsFrom The Boston Globe: “YOU SEE all those brown little things?’’ Ann McKee asked me as I looked through a microscope. I was viewing a slide sample of the brain of Dave Duerson, the Notre Dame All-American defensive back who won Super Bowls with the 1985 Chicago Bears and the 1990 New York Giants. Duerson was a Notre Dame trustee, a National Football League Man of the Year for community service, and an economics major who completed a management program at Harvard Business School. Early in his football retirement, he nearly tripled the annual sales of a meat supply company to $63.5 million. The glory and fortune disappeared in the last decade. An onset of memory loss, hammering headaches, spelling problems, blurred vision, and hot temper led to spousal abuse, divorce, bankruptcy, and, finally, suicide last February at age 50. In the most eerie recognition yet by an ex-football player as to why he was losing his mind, Duerson shot himself in the chest to preserve his head for research. He left behind the now-famous note, “Please, see that my brain is given to the NFL’s brain bank.’’ That brain was sliced open by McKee, a co-director of Boston University’s Center for the Study of Traumatic Encephalopathy. The “brown things’’ were nerve cells filled with tau protein, prevalent in degenerating brains like those in Alzheimer’s disease. There were so many brown spots, with tails curling off them, that the slide looked like a muddy negative of spinning galaxies. In that microscopic universe, we were looking into the black hole of contact sports: Chronic Traumatic Encephalopathy. This was the hole likely blown into Duerson’s head in a career of at least 10 recognized concussions and countless subconcussive hits. This is the void we still let our kids fall into, cheering them all the way. ‘‘If it were a normal person, you would see absolutely none of that,’’ McKee said in her lab at the Bedford Veterans Administration Medical Center, where she also runs brain banks for research on military injuries, Alzheimer’s, and heart disease. She pointed out how the tails of the tau-infested cells made long projections to make contact with other cells, causing short circuits and disordered thoughts. ‘‘Totally chaos,’’ she said. ‘‘I deal with neurodegenerative disease all the time, but you don’t see it in 50-year-olds even if you had a gene for the disease.’’ McKee then showed me a slide of another well-known NFL player who died in his late 70s or early 80s. The constellations of tau were overwhelming. “He’s got disease everywhere,’’ McKee said. “There is no place I can go in this brain that’s just not incredibly diseased. I’ve never seen anything like this. This is the worst case I’ve seen. This guy’s brain is 800 grams, half the size of most players’ brains.’’ ..... A slide from a healthy brain would have had a far more clear background with blue spots. The difference in an injured athlete’s brain is so dramatic that the comparisons should be required viewing for parents and youths contemplating high-contact sports and the coaches, athletic directors, and school principals in charge of them. These images should be pinned on the wall with those of blackened lungs we’ve long used to scare teens from smoking. They just might scare parents and officials into keeping children away from such sports until the sport is changed to minimize head injury. Labels: Chronic Traumatic Encephalopathy, concussion, football, NFL, traumatic brain injury Tuesday, January 10, 2012Notes on the Concussion Crisis: Worker's Compensation and DementiaThis is a really interesting article from a site called "Bloody Elbow." The site focuses on mixed martial arts, something I have to admit I never heard of before. The author of this piece, David Castillo, makes several informed observations and compelling points, some surprising. (Although I live and work in Florida, for example, I did not know our state does not recognize professional athletes as employees.) 2011 was a calender year for many things, but one of the more interesting yet unfortunate stories of the year involved the big business of college sports and the scandals that permeated the public discourse. While the Penn State scandal dominated the airwaves, there was no shortage of cases illuminating a corrupt system with a fundamental problem in ignoring its labor force. Cars, and prostitutes from irresponsible boosters are "chump change" compared to the billion in receipts the Southeastern Conference took in last year, or the $900+ million the Big Ten acquired from television contracts, merchandise, ticket sales, and so forth all while the college athlete got nothing in disclosed income. Bouncing off of Branch's article, and the topic of big business corruption in college sports, Joe Nocero from The New York Times went a step further. Yes, let's pay these athletes. How? Why not lifetime health insurance, for one? College football players are not immune to concussions, and in fact, might be the most vulnerable. With a growing body of evidence indicating the degree to which younger people are at risk for long term damage after a concussion (especially in high school where the brain has not yet fully matured), it's perhaps even scarier to see, as was the case with Owen Thomas (just 21) that nor are they immune to the progressive brain disease known as CTE. The NFL recently dealt with several high profile concussion lawsuits, in part because the NFL has its own sordid history. Dr. Elliot J. Pellman was the league appointed official, trained in the scientific method, but ignorant of the virtue inherent to it, who acted as the mouthpiece for the NFL's former stance on concussions: 'they're not good for you, but don't worry, long term effects are not an ingredient of any given concussion'. Which is, of course, patently false. But the NCAA too, has been the target of concussion lawsuits. Labels: college sports, concussion, football, NCAA, NFL, traumatic brain injury, work-related brain injuries, worker's compensation Friday, January 06, 2012Hormone in Women Linked to Dementia, Study FindsFrom ABC News: Researchers have found a possible connection between a hormone found in body fat and the risk of dementia, adding to the growing evidence on the potential link between the condition and diabetes. A new study found that women with high levels of a hormone called adiponectin were at an increased risk of developing dementia. Scientists say the findings reflect the complicated and still unclear relationships between metabolism, hormones and the brain degeneration that occurs in dementia. The researchers studied frozen blood samples from 840 of the participants from the large Framingham Heart Study, taken after the patients had been monitored for 13 years. In the 159 people who developed dementia, researchers found high levels of adiponectin. Adiponectin helps the body use insulin to deliver fuels like glucose to different cells, such as the neurons in the brain. Study author Dr. Ernst Schaefer, a professor of medicine and nutrition at Tufts University, said he and his colleagues were surprised to find that women with high levels of the hormone had an increased risk of dementia. “Adiponectin is supposed to be beneficial. It’s supposed to decrease your risk of diabetes, supposed to decrease the risk of heart disease. But in this particular study, to our surprise, it increased the risk of dementia,” Schaefer said. The researchers also found high levels of the hormone in the men with dementia, but Schaefer said there were not enough men in the study to establish a link as strong as the one in women. Continue reading. Labels: adiponectin, dementia, Diabetes, hormone Monday, January 02, 2012Acting Out War’s Inner WoundsFrom The New York Times: DEXTER, Me. — The roadside bomb that separated Sgt. Matthew Pennington from his left leg in 2006 also shattered his right leg and scorched his lungs. Those injuries he understood. But then came the ones he did not, the ones inside his head. “With a physical injury — three months, six months, whatever — your cuts will heal,” he said. But post-traumatic stress “is more difficult because people don’t see it.” Like Mr. Pennington, many veterans injured in combat are finding that their invisible psychological and neurological wounds are proving more debilitating than their obvious physical ones. About 1,700 American service members have lost limbs in Iraq and Afghanistan, most in roadside bombings that seared skin, shattered bones and damaged internal organs as well. Most of those troops also came home with traumatic brain injuries and post-traumatic stress disorder, which in many cases were not recognized for months. While advances in prosthetics have made it possible for many lower-limb amputees to regain full mobility, the track record for overcoming brain injuries and chronic P.T.S.D. — both capable of altering personality and hampering mental functioning — is more spotty, experts acknowledge. “I think the limiting factor for these people going back to their lives is not having lost a limb,” said Dr. Douglas Cooper, a neuropsychologist at Brooke Army Medical Center in San Antonio. “The P.T.S.D. symptoms and post-concussive symptoms are the ones that seem to get in the way.” For Mr. Pennington, medications seemed to worsen his depression and therapy did not ease his anxiety. He seemed headed for divorce, isolation and perhaps alcoholism. And there his story might have ended, a case study on the intransigence of war’s psychological scars. But it did not end there. In 2009, an unexpected opportunity landed in his e-mail inbox: a casting call, forwarded by a friend in Nashville, from an undergraduate filmmaker looking for someone to play a combat veteran who had lost a leg, had post-traumatic stress disorder and lived in Maine. This is my life, Mr. Pennington thought. So on a lark, Mr. Pennington — whose last appearance on stage was in middle school and who had become nervous in crowds and, indeed, avoided most human contact — decided that fixing his life depended on performing before a camera. “I thought acting would be so out of the normal that it would force me to deal with things,” he recalled. “I wanted my life back.” The struggle by wounded veterans like Mr. Pennington to reclaim their lives is the unfolding next chapter in America’s wars in Iraq and Afghanistan. Since 2001, 46,000 American service members have been injured in combat, perhaps a third or more seriously. Those veterans now face years of rehabilitation at a cost of billions of dollars annually. In the coming weeks, The New York Times will profile a few of those veterans. Their cases say much about the critical importance of high-quality health care and loving families. But as with Mr. Pennington, they also underscore the individuality of recovery, where the most effective therapies are often discovered by the veterans themselves.Continue reading. Labels: Afghanistan, Iraq War, post-traumatic stress disorder, PTSD, traumatic brain injury, Veterans Wednesday, December 21, 2011Dementia Related Emergency Admissions on the RiseFrom ThirdAge:
Dementia as a cause for emergency hospital admissions has risen by 12 percent in the last five years, a new report from dementia experts shows. According to Yahoo News, 2,000 more dementia-related cases showed up in emergency rooms this year than in 2006.
Researchers believe the numbers reflect a “continued failure by some hospitals to accurately diagnose people with dementia,” Yahoo said.
Common and Complex: Commissioning Effective Dementia Services in the New World recommends that health departments and other stakeholders in the fight against the affliction come up with a standard diagnosis of dementia for 2012. Doing so will save on both costs and time, said Jeremy Hughes.
“For many thousands of people with dementia, being admitted to the hospital is not the best treatment,” said Hughes, who serves as the chief executive of the Alzheimer’s Society. “It is also very costly. Commissioners must invest in services in the community to reduce this number and help people with dementia to live well at home…Change cannot come soon enough.”
According to eMedicineHealth.com, about four to five million people in the United States have some degree of dementia. With the ongoing aging of the population, that number is expected to increase over the next few decades.
In the U.K., the need for change is especially apparent. The National Audit of Dementia criticized British caregivers for their poor treatment of dementia in a report issued this week.
Link here to the just-published U.K. report cited above: Common and Complex: Commissioning Effective Dementia Services in the New World
Labels: Alzheimer's disease, dementia Sunday, December 18, 2011Has the Time Come for Dementia Screening in Primary Care?From NewsWise: Many people with dementia don’t realize they have the disease until it’s at an advanced stage, when everyone can tell something is wrong. Other people might start forgetting dates or names and worry they have dementia, yet their memory problems are just a normal consequence of aging. Having primary care doctors routinely screen patients for dementia at annual check up visits—just like they do for high blood pressure or cholesterol—could identify people in need of dementia care and reassure those who are healthy. That’s what dementia experts argued at a meeting held last month in New York City, as reported on Alzforum (www.alzforum.org). The meeting was co-sponsored by the Alzheimer’s Foundation of America (AFA) and the Alzheimer’s Drug Discovery Foundation (ADDF). The two organizations intend to issue joint recommendations on how to increase dementia detection in primary care practice. The Patient Protection and Affordable Care Act signed into law in 2010 calls for Medicare to start in 2011 to pay for an annual wellness visit that includes the detection of any cognitive impairment—that means, any disorder in which thinking (cognitive) abilities are reduced, including dementia. One argument against this coming prospect is that there isn't much doctors can do for people who test positive for cognitive impairment or dementia. But participants at the AFA-ADDF meeting argued there is some evidence that knowing if someone has dementia helps doctors provide better overall medical care. On the other hand, it will be challenging to add dementia screening and follow-up to an already crowded primary care system. There are many tests that doctors can use to detect dementia, and they do so reliably. Even so, a large proportion of patients who screen positive on those tests do not return for further follow-up.Visit the original source. Labels: Alzheimer's disease, dementia Thursday, December 15, 2011Headaches Hit Children After Brain InjuryFrom Daily Rx: Headaches are surprisingly common for months after children and teenagers suffer a traumatic brain injury such as a concussion.
Brain injury from a whack on the head occurs in more than 500,000 children and teens yearly. Almost 45 percent of them have headaches three months after even a mild traumatic brain injury, said Heidi Blume, MD, MPH, from Seattle Children's Research Institute and principal investigator Fred Rivara, MD, MPH, of HarborviewInjury Prevention and Research Center, University of Washington.
A year after head injury, most headaches had stopped. Writing inPediatrics, Dr. Blume and coauthors say no one knows why girls and teens most often have headaches after a traumatic brain injury. They also have the most migraines and other headache problems,
Dr. Blume and colleagues analyzed the number of headaches 3 and 12 months after mild, moderate or severe traumatic brain injury in children ages 5 to 17. The 402 children with a mild injury had a higher rate of headaches, 43 percent of the group, compared to 37 percent of the 60 children with a moderate to severe injury.
The study's comparison group was patients with arm fractures, and 26 percent of them had headaches.
Concussion is one common brain injury often ignored. The Merck Manualsays concussion involves unconsciousness, loss of memory, or other mental change. These problems last from seconds to several hours. Even a moderate concussion can cause tiredness, nausea, headache or dizziness.
Other possible problems include difficulty concentrating, depression, apathy, anxiety or losing the sense of smell. Symptoms usually go away over weeks to months.
Labels: brain injuries, concussion, headaches, TBI, traumatic brain injury Tuesday, December 13, 2011A national priority: Helping our war veterans
As the end of the wars in Iraq and Afghanistan near, troops will be returning home in droves. The scars remain hidden to many soldiers -- until flashbacks, nightmares and other psychological impacts of combat surface.As Herald editor James A. Jones Jr. pointed out in a report last Sunday, veterans should enroll in the VA health care system upon returning home regardless of the state of their health.East Manatee’s Steve Valley served as an Army sergeant major in Iraq, came back in good health and enrolled upon the recommendation of the military. He now preaches that mantra.“You may not need the VA care now, but who knows in 10 or 20 years? You may develop a problem that could be traced back to your time in Iraq or Afghanistan,” he told Jones.
Labels: Afghanistan, Iraq veterans, military, VA, Veterans, Veterans Administration Saturday, December 10, 2011Puzzles And Bowling Could Slow Progression Of DementiaFrom The Huffington Post: What do puzzles and bowling have to do with dementia?
A small new study in the journal BMC Medicineshows that doing puzzles, bowling and singing help to make dementia-slowing drugs more effective, and seem to be effective at slowing down the brain decline of people with dementia.
HealthCanal reports that researchers from the University of Erlangen-Nuremberg in Germany had 61 dementia patients in nursing homes either take their regular treatment for dementia, or take their regular treatment in addition to doing what is called "MAKS" therapy for two hours a day, six days a week. Everyone did their assigned therapies for one year.
"MAKS" includes motor stimulation, "daily living" activities, cognitive stimulation and a "spiritual element." The therapy includes things like singing, playing croquet, gardening, crafts, preparing snacks, talking about happiness and other mentally stimulating exercises.
Researchers found that the MAKS therapy was effective at stopping the dementia from progressing further, and the people on the MAKS therapy were also able to keep doing their everyday tasks. However, people who only took the dementia-slowing drugs had their dementia progress.
The MAKS therapy seemed to work best on people with mild to moderate dementia, compared with people with severe dementia, researchers reported.
Labels: bowling, dementia, MAKS therapy, puzzles Friday, December 09, 2011Repeat 'Heading' in Soccer Causes Brain DamageWe posted about this subject before, but it's warning can withstand repeating. Brain damage is not something to risk if you can help it. From The Atlantic: This shouldn't come as a surprise, but research shows that repeatedly hitting your head against a fast-moving object can lead to serious brain injuries PROBLEM: Though common sense dictates that hitting your head against objects that move as fast as 34 miles per hour can cause serious injuries, many soccer players repeatedly field balls this way in training drills and games. Curious and perhaps also concerned, researchers led by Dr. Michael L. Lipton wanted to know if there is a threshold level for heading frequency that, when surpassed, results in brain damage. METHODOLOGY: The investigators conducted DTI, an advanced magnetic resonance technique that allows researchers to assess microscopic changes in the brain's white matter, on 32 amateur soccer players who have played the sport since childhood. They estimated how often each of the participants headed the ball annually and then analyzed their brain scans for signs of injury.
RESULTS: Soccer players who headed balls more than 1,000 times a year had significantly diminished fractional anisotropy or FA in regions linked to attention, memory, executive functioning and higher-order visual functions. (FA is a measure that reflects the ability of water molecules in the brain to steadily move along axons, and abnormally low FA within white matter has been associated with cognitive impairment in people with severe brain damage.)
CONCLUSION: Those who head soccer balls with high frequency exhibit brain abnormalities similar to those found in traumatic brain injury patients.
IMPLICATION: Practices involving this wildly popular sport may need to be reevaluated to protect players from brain damage. Lipton notes in a statement, "While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player."
SOURCE: The study, "Making Soccer Safer for the Brain: DTI-Defined Exposure Thresholds for White Matter Injury Due to Soccer Heading," was presented recently at the annual meeting of theRadiological Society of North America.
Labels: brain damage, brain injuries, heading, soccer |
LinksTBI Film ReviewsTBI Book Reviews Traumatic Brain Injury Law Blog Brain Blog NeuroNotes Brain Blogger SoapBlox/Chicago: Protecting Our Troops Head Injury Survival Journal Losing the Physical Self Neuropsych TestsTower of Hanoi: Instructions for this popular puzzle can be viewed simply by clicking the Instructions button on that page. ArchivesMay 2005 June 2005 July 2005 August 2005 September 2005 October 2005 November 2005 August 2006 September 2006 October 2006 December 2006 January 2007 February 2007 March 2007 April 2007 May 2007 June 2007 July 2007 August 2007 September 2007 October 2007 November 2007 December 2007 January 2008 February 2008 March 2008 January 2009 March 2009 April 2009 December 2009 April 2010 May 2010 June 2010 July 2010 August 2010 September 2010 October 2010 November 2010 January 2011 February 2011 March 2011 April 2011 May 2011 June 2011 July 2011 August 2011 September 2011 October 2011 November 2011 December 2011 January 2012
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