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Jack Sisson's TBI Blog

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From Web MD:
Dementia is the loss of mental functions -- such as thinking, memory, and reasoning -- that is severe enough to interfere with a person's daily functioning.
Dementia is not a disease itself, but rather a group of symptoms that are caused by various diseases or conditions. Symptoms can also include changes in personality, mood, and behavior.
In some cases, the dementia can be treated and cured because the cause is treatable. Examples of this include dementia caused by substance abuse (illicit drugs and alcohol), combinations of prescription medications, and hormone or vitamin imbalances.

In some cases, although the person may appear to have dementia, a severe depression can be causing the symptoms. This is known as pseudo-dementia (false dementia) and is highly treatable. In most cases, however, a true dementia cannot be cured.

Dementia develops when the parts of the brain that are involved with learning, memory, decision-making, and language are affected by one or more of a variety of infections or diseases. The most common cause of dementia is Alzheimer'sdisease, but there are as many as 50 other known causes. Most of these causes are very rare.

Because some causes of dementia can be cured or partially treated, it is very important that your doctor is thorough when making the diagnosis, so as not to miss potentially treatable conditions. The frequency of "treatable" causes of dementia is believed to be about 20%.

What Causes Dementia?

There are several things that could cause dementia:

  • Diseases that cause degeneration or loss of nerve cells in the brain such as Alzheimer's, Parkinson's and Huntington's.
  • Diseases that affect blood vessels, such as stroke, which can cause a disorder known as multi-infarct dementia.
  • Toxic reactions, like excessive alcohol or drug use.
  • Nutritional deficiencies, like vitamin B12 and folate deficiency.
  • Infections that affect the brain and spinal cord, such as AIDS dementia complex and Creutzfeldt-Jakob disease.
  • Certain types of hydrocephalus, an accumulation of fluid in the brain that can result from developmental abnormalities, infections, injury, or brain tumors.
  • Head injury -- either a single severe head injury or longer term smaller injuries, like in boxers.
  • Illnesses other than in the brain, such as kidney, liver, and lung diseases, can all lead to dementia.

Alzheimer's disease causes 50% to 60% of all dementias. But researchers have found that two nervous diseases, which were originally incorrectly diagnosed as Alzheimer's, are emerging as major causes of dementia: Lewy body disease and Pick's disease.

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From Web M.D.:
People who have had a traumatic brain injury face a tenfold increase in the risk of having a stroke within three months, according to a new study.

Traumatic brain injury occurs when a blow or jolt to the head causes changes in a person’s normal brain function. It can result from injuries such as falls, vehicle accidents, and violence.

Although previous research has shown that traumatic brain injury can be associated with the future development of epilepsy, Alzheimer’s disease, and psychiatric conditions, this the first study to link it to the future risk of stroke. The study appears in the July 28 online issue of Stroke: Journal of the American Heart Association.

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In the U.S., an estimated 1.7 million traumatic brain injuries occur each year, according to the CDC.

"Stroke is the most serious and disabling neurological disorder worldwide,” Lin notes in the news release. “Our study leads the way in identifying stroke as an additional neurological problem that may arise following traumatic brain injury.”
Read entire article.

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The Act expands insurance coverage for veterans who suffered traumatic injuries and authorizes greater disability compensation for veterans with residual traumatic brain injury.

In October 2010, President Obama signed the Veterans Benefits Act of 2010. The law seeks improvements in various services provided to military veterans, and it especially helps injured veterans by expanding coverage under the Traumatic Injury Protection Under Servicemembers' Group Life Insurance (TSGLI) program and permitting additional disability compensation for traumatic brain injury.

The Veterans' Benefits Act addresses the needs of veterans in several ways, including:

- Improving employment opportunities

- Reducing and preventing homelessness among veterans

- Increasing insurance limits

- Prohibiting wage discrimination against members of the armed forces

- Expanding funeral benefits and plot allowances

- Bolstering education benefits

- Supporting research on Gulf War Syndrome and associated illness

In addition, a significant portion of the Act expands insurance coverage for veterans who suffered traumatic injuries while serving by modifying the terms of eligibility for payments under TSGLI. It also authorizes greater disability compensation for veterans with traumatic injuries resulting in residual brain injury or prosthetic use.

The Veterans Benefits Act of 2010 changed the TSGLI provisions so TSGLI coverage will be provided retroactively to all members of the armed forces who suffered qualifying losses from traumatic injuries occurring between October 7, 2001 and November 30, 2005, regardless of where the injuries occurred and regardless of whether the member had SGLI coverage at the time.

This is a significant change from the previous law that only provided coverage for traumatic injuries suffered in the theater of war in Operation Enduring Freedom or Operation Iraqi Freedom. Under the new law, members of the military may be eligible for TSGLI payments for injuries suffered in non-combat conditions like training or motor vehicle accidents while serving stateside or outside of the operations in Iraq and Afghanistan, according to the U.S. Navy.

The expansion of coverage is effective October 1, 2011 and will apply retroactively to injuries suffered from October 7, 2001 to November 30, 2005.

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From The Independent:
Brain injuries sustained on the battlefield and the gridiron of American football likely boost the risk of dementia later in life, according to two studies released Monday.

In a third study, also presented at an international Alzheimer's conference in Paris this week, researchers unveiled evidence that falling over in daily life may be an early warning sign of the onset of Alzheimer's.

Older war veterans who experienced traumatic brain injury face a doubled risk of developing dementia, according to a study led by Kristine Yaffe, head of the Memory Disorders Program at the San Francisco Veterans Association medical centre.

Reviewing the medical records of 281,540 US veterans aged 55 and older, they found that the risk of dementia was 15.3 percent in those who had had traumatic brain injuries (TBI) compared to 6.8 percent for ex-soldiers who had not.

"This issue is important, because TBI is very common," Yaffe said in a statement.

"About 1.7 million people experience a TBI each year in the United States, primarily due to falls and car crashes."

Such injuries are also known as the "signature wound" of the conflicts in Afghanistan and Iraq, accounting for 22 percent of casualties overall and 59 percent of blast-related injuries.

The research suggests that the death and damage of axons - long cell extensions that form connections among nerve cells in the brain - may be to blame for the higher risk of dementia.
Keep reading.

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Jack recently received some good news and some bad news. The good news is that he does not have Parkinson's Disease, as was diagnosed last year. That erroneous diagnosis was the result of three years of visits to doctors, specialists, tests, and more tests. It was a Parkinson's specialist at Shand's Hospital who delivered the good news. The bad news, however, is that he suffers the onset of dementia, one of the worst things Jack can imagine. He has always prized his independence, and fervently hoped that he would be able to continue to live independently. Maybe he will. Jack has defied the odds before. If I had to bet on this, I'd be putting my money on Jack.

From Internal Medicine News:
PARIS – Traumatic brain injury may double the risk of developing dementia, according to findings from a study of more than 280,000 U.S. veterans.

The risk of dementia over 7 years was 15.3% in 4,902 veterans who had a traumatic brain injury (TBI) diagnosis in 1997-2000, compared with 6.8% in those without a TBI diagnosis. The comparison yielded a hazard ratio of 2.3 for those with any TBI diagnosis after adjustment for age, sex, race, and multiple medical and psychiatric conditions.

The difference was statistically significant for all TBI types, including intracranial injury (the most common form, which accounted for 40% of the injuries among the veterans) as well as for concussion, postconcussion syndrome, head fracture, and unspecified head injury, Dr. Kristine Yaffe and her colleagues reported in a poster on July 18 at the International Conference on Alzheimer’s Disease.

The findings also offer some hope that early treatment and rehabilitation after TBI could help ward off dementia, and they underscore the need for monitoring affected older adults for signs of cognitive impairment following a TBI, Dr. Yaffe said at the conference.

Keep reading.

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From The Hollywood Reporter:
The 75 plaintiffs claim the NFL knew the risks for 90 years but acknowledged them only a year ago.
With the NFL's four-month lockout likely to come to an end within days, the professional football league now finds in the midst of another PR nightmare.

Seventy-five former players are suing the NFL on the grounds that it intentionally hid the risks of concussions suffered during games for 90 years, TMZ reported.

"The NFL knew as early as the 1920s of the harmful effects on a player's brain of concussions; however, until June of 2010 they concealed these facts from coaches, trainers, players and the public," states the suit, which was filed Tuesday in Los Angeles County Superior Court.

The plaintiffs, all of whom claim the sustained injuries due to multiple concussions on the field, include former Miami Dolphins wide receiver Mark Duper and former San Francisco Giants running backs Otis Anderson andRodney Hampton.

In their suit -- which cites fraud, negligence and failure to warn -- they claim a 1994 study commissioned by the NFL, titled NFL Committee on Mild Traumatic Brain Injury, and a 2004 report concluded there was "no evidence of worsening injury or chronic cumulative effects" from suffering multiple concussions.

The plaintiffs also argue that the NFL didn't admit until just last year that concussions can cause memory loss, dementia and other health issues.

In addition to the NFL, the suit named NFL helmer manufacturer Riddell as a defendant. The plaintiffs are asking for unspecified damages.

The news comes on the heels of a report in the Washington Post that players' reps are expected to be presented with a nearly completed deal Wednesday that would end the NFL's lockout. If the deal is approved, the lockout could end as soon as this week.

Original source.

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From Fox News:
As many as 1.7 million people suffer traumatic brain injury each year in the U.S., and tens of thousands die. Those who survive are often left facing years of physical, occupational and speech therapy, mountains of bills and limited insurance options.

Nine months ago, Marie Beattie was awakened at 3 a.m. by a phone call that changed her life.

Her 18-year-old daughter, Corey, suffered a traumatic brain injury, or TBI, when a truck broadsided the car she was riding in.


With her body twisted and broken, it took two hours for rescuers to untangle Corey from the wreckage. She had a broken neck, multiple fractures and, Beattie says, “The brain not only was hit within the impact, it spun within her frame of her skull.”


Doctors say Corey's best chance for maximum recovery is 12 months of intense inpatient rehabilitation. But she was released after only 6 1/2 months.


According to Beattie, her family's health insurance, Independence Blue Cross of Pennsylvania, sent her daughter home too early.


But medical opinions differ over the best treatment for TBI.


In a statement to Fox News, Karen Godlewski, a spokesperson for the insurance company, defended the decision to release Corey: "Corey's transition to home was consistent with the recommendations of the professionals at Bryn Mawr rehab hospital who noted that ongoing therapy could be provided in a less intensive setting."


But Corey's surgeon, Dr. Kennedy Yalamanchili, says 12 months is the best window of opportunity for brain trauma patients. "We try to provide the maximum benefit during the period of time that brain's ability to rehabilitate and regenerate exists."


Corey's battle is just one example of the millions of families left heartbroken and buried in bills.


This also happened to a friend of mine over 20 years ago. Her beautiful 16-year-old daughter was seriously injured in an automobile accident and suffered brain damage. Their insurance policy had a $1 million cap which they blew through in the first year or so. The cost of medical care, therapy, rehab, etc was so expensive they had trouble processing it. Totally depleted family savings, broke up the family and harmed the mom's career because she had to devote so much time to her daughter's care. It was absolutely heartbreaking, and I don't think it's much better today. If anyone has a good story to tell about this, I'd like to hear it.

 
And why is it that some people recover and others do not?

From Science Alert:
The human brain is often referred to as the most complex organ on the planet. It is responsible for an incalculable number of tasks, thoughts and functions every second of everyday of our lives.

The brain controls our emotions, our perceptions and our memories. In short, it is what makes us who we are.

Within the human brain, there are up to one hundred billion nerve cells, each with countless connections to each other. This complexity of connectivity is responsible for the limitless imagination and creativity of the human race.

This same complexity is also the reason for deficits in memory and function following disease and traumatic brain injury, such as those resulting from car accidents or gunshot wounds.

Understanding the brain

Traditionally, the brain was thought to be a static organ incapable of regeneration after the completion of embryonic development.

But in the past few decades, there’s been a radical shift away from this belief: we now know the adult brain is a very “plastic” organ, capable of forming new nerve connections.

It even maintains the ability to continually produce new neurons or nerve cells throughout life.

So where do these new neurons come from? Most readers have undoubtedly heard of stem cells. Unfortunately, most public attention has focused on the controversial use and study of embryonic stem cells.

During development, embryonic stem cells give rise to all our organs, including the brain.

Stem cells' ability to turn into cells with specific roles in the body comes at the cost of the developing embryo and provides the basis for moral and ethical objections.

Much less media attention is given to the remarkable fact that the majority of organs in the adult body retain a small population stem cells specific only to that organ.

In an adult body, these cells continually replenish and replace cells lost during the normal course of living.

It has recently been discovered that the adult brain also contains a population of this kind of stem cell: researchers have identified the presence of neural stem cells in animal brains.

Not only have we shown that these cells are present in adult animals, we have also identified this type of cell in animals of very advanced age.

More importantly, we have demonstrated that it’s possible to activate these cells and produce new neurons after brain injury.

We are now trying to understand how these stem cells are activated – what are the mechanisms that trigger new nerve cell formation?

Answering this question will open up the possibility of developing new treatment strategies for all manner of neurodegenerative diseases, including but not limited to dementia, Huntington’s disease and depression.
Keep reading.

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New Rochelle, NY - A history of psychiatric illness such as depression or anxiety before a traumatic brain injury (TBI), together with other risk factors, are strongly predictive of post-TBI psychiatric disorders, according to an article published in Journal of Neurotrauma, a peer-reviewed journal published by Mary Ann Liebert, Inc.
Journal cover
The article is available free online.

In addition to a pre-injury psychiatric disorder, two other factors are early indicators of an increased risk for psychiatric illness one year after a TBI: psychiatric symptoms during the acute post-injury period, and a concurrent limb injury. Kate Rachel Gould, DPsych, Jennie Louise Ponsford, PhD, Lisa Johnston, PhD, and Michael Schönberger, PhD, Epworth Hospital and Monash University, Melbourne, Australia, and University of Freiburg, Baden-Württemberg, Germany, also describe a link between risk of psychiatric symptoms and unemployment, pain, and poor quality of life during the 12-month post-TBI period.

In the presence of a limb injury, patients who suffered a TBI had a 6.4 greater risk of psychiatric disorders at 1 year, and a 4-fold greater risk of depression in particular, compared to patients without a limb injury. The authors report their findings in the article, “Predictive and Associated Factors of Psychiatric Disorders after Traumatic Brain Injury: A Prospective Study.”
Original source.

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For years we've been praising the media's awakening pertaining to TBIs. Although we often noted its unfortunate genesis in the Iraq and Afghanistan wars, we never considered this possible ramification of the extensive news coverage TBI has received in the last seven to eight years.

From the North County Times:

The media is double-timing down the wrong road in its pursuit of exposing post-traumatic stress disorder and traumatic brain injury, to the grave detriment of most young men and women leaving the military.

While the intentions are pure ---- to prevent combat veterans from being lost to mental health problems, as too many Vietnam veterans were ---- wrong for the right reasons is still wrong.

Journalism exists, in part, to comfort the afflicted and afflict the comforted. Having missed the PTSD and TBI story 40 years ago, reporters dug in to prevent it from happening again.

And daily they uncover compelling stories. Just flip on the TV or open a paper and see for yourselves.

They are true, but are they the truth?

This publicity in the name of the good and true is a tainting lie and bad for the majority of veterans whom journalists have avowed to champion.

Here's the problem: For the sake of argument, let's say that 25 percent of combat troops suffer PTSD or TBI over the course of their lives. That means that 75 percent do not.

-------------------------------

How does this media attention-deficit disorder play out when Sgt. Smith goes looking for a job in the civilian world after faithful service?

Very nearly 50 percent of the companies and corporations, according to a Society of Human Resource Management study, are worried that Sgt. Smith has PTSD or a TBI.

How could they not, after being beat over the head with such stories for a decade?

Keep reading.

I wonder if this has kept any veterans from getting a job, or if it's just over-worrying about a possibility? Should the media be more concerned about this and attempt to balance their reporting with repeated reminders of the true numbers? Or should we just be glad (as we were before reading this) that TBI has finally gotten the public awareness and subsequent dollars for research that we wished for for so many years?

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This sounds like a great idea, one that could be successfully utilized for many other multi-symptom conditions. I wonder why more hospitals don't offer something like this.

From DotMed News:
When it comes to treating Parkinson's disease, deciding which of the many treatments to choose can be overwhelming for both patients and caregivers; the number of doctors, specialists and treatment options available are numerous. While there is currently no cure for Parkinson's, treatment options include medications, surgical procedures and specialized therapies. Use of these treatments has been shown to improve the quality of life, but Parkinson's is a very individualized disease, and personal assessment is necessary for successful treatment. However, a personalized approach to treatment could involve services at multiple locations from multiple physicians, therapists, and other specialists.

The New York Methodist Hospital Center for Parkinson's Disease and Other Movement Disorders simplifies this process by consolidating all services related to the diagnosis and treatment of Parkinson's disease. According to Miran Salgado, M.D., chairman of neurosciences at NYM, "What we have is an interdisciplinary approach to Parkinson's disease." The Center is staffed by an expert specialty care team that includes neurologists specializing in movement disorders, neurosurgeons, neuropsychologists, psychologists, psychiatrists, physician assistants, speech-language therapists and nurses.

The newest addition to the Center's staff is patient care coordinator, who sets up an appointment schedule for patients, provides treatment regimen charts, arranges Access-A-Ride for patients who require assistance getting to NYM, and makes sure that insurance companies cover specific medications.

"The patients can call the coordinator with their concerns and hear a friendly voice; someone who is knowledgeable about the disease, and can provide reassurance for what can be a difficult time," said Salome Macikowski, the patient care coordinator.
Keep reading.

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