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Jack Sisson's TBI Blog
A hug is duct tape for the soul.
Friday, September 30, 2011
Invisible injuries of war to be felt for decades
From Stars & Stripes:
Sixty-six percent of the most seriously wounded soldiers returning from Afghanistan and Iraq have “invisible” injuries of brain trauma or post-traumatic stress, which their families and society will be dealing with at great cost for decades, said Gen. Peter W. Chiarelli, the Army’s vice chief of staff.
“The truth is, because we don’t see these injuries…they don’t receive the same level of attention as amputations, burns, shrapnel injuries,” Chiarelli said. “There is simply a bias – and I really mean that -- there is a bias either conscious or subconscious toward invisible wounds and injuries…It exists everywhere including in the medical community.”
Chiarelli made his remarks Monday at Defense Forum Washington, a one-day conference on support for wounded warriors and families as they struggle to heal and regain stable lives. The annual event is co-sponsored by U.S. Naval Institute and Military Officers Association of American.
Before Chiarelli spoke, April Marcum, wife of retired Air Force Tech Sgt. Tom Marcum, described for attendees how her husband saw that bias from the medical community when he returned wounded from Iraq in 2008. A combat arms training and maintenance specialist with 12 years in service, Tom had been in charge of an armory on Ali Air Base Iraq when a mortar round fired by insurgents exploded 35 yards away, knocking him unconscious.
When he could, Tom called April to say that, except for a headache, he was okay. A medic told him he should rest a couple of days before returning to duty. But when Tom’s tour ended several weeks later and he returned to Moody Air Force Base, Ga., April could tell he wasn’t himself.
“He still had the same headache. He was confused at simple things. He had short-term memory loss. The last straw for me was the day he called me on his way from work … and said, ‘I can’t remember how to get home,’ ” April recalled, tearing up. Tom, at her side, let April speak for the family.
“The local medical community, including the Air Force medical clinic doctor, seemed to be reluctant to help,” April continued. “Tom’s primary care doctor implied Tom was trying to get out of work. This was a slap in the face to both of us” considering that, with two boys to raise, neither Marcum had ever complained during any Tom’s various deployments.
“Then the doctor made this statement: ‘I’ll write you a prescription for Motrin but you really need to suck it up and go back to work,’ ” April said.
They pressed for an appointment with the medical group commander. Eventually Tom got a thorough evaluation at the poly-trauma unit of the VA Medical Center in Tampa, Fla. Doctors diagnosed traumatic brain injury with an orbital wall blowout fracture behind an eye. A shoulder required surgery. Tom also had hearing loss, vision deficit and post-traumatic stress disorder.
He spent months in Tampa and “received outstanding medical treatment,” April said. He was medically retired from the Air Force in May 2010. Three years after returning from war, Tom remains on the temporary duty retirement list awaiting word on whether the Air Force will retire him permanently. April said she had to quit her teaching job to care for her husband and raise their sons. While living on 70-percent disability payment from the Air Force, and Social Security Disability Insurance, the Marcums have exhausted their life savings, she said.
Thursday, September 29, 2011
Depression in Later Life a Harbinger of Dementia
From MedScape News:
Late-life depression, occurring after age 50 years, is associated with a significantly increased risk for dementia, and in fact may be an early sign of cognitive decline, new research shows.
"Studies such as the Rotterdam [Scan] Study in the Netherlands have found that people who had early-life depression had a risk of Alzheimer disease in later life," lead author Ge Li, MD, PhD, from the University of Washington, Seattle, told Medscape Medical News.
"But is depression causing dementia, or is it an early symptom of dementia? We wanted to explore the temporal relationship between the 2 conditions," Dr. Li added.
The study is published in the September issue of the Archives of General Psychiatry.
Early Manifestation of Dementia?
The investigators used data from the Adult Changes in Thought study, a large, community-based, prospective study of people aged 65 years and older who were free of dementia at baseline, and who were followed-up every 2 years for up to 15 years.
Participants in the study were Seattle-area members of the Group Health Cooperative health maintenance organization. The study had 3 phases of enrollment.
The first cohort of 2581 participants was recruited in 1994 to 1996, then 811 participants were enrolled in 2000 to 2002, and another 709 participants were enrolled in 2004 to maintain a cohort of more than 2000 participants at risk for dementia in each calendar year.
Baseline depression was assessed with the Center for Epidemiologic Studies Depression Scale, and participants who scored 11 or greater were deemed to have significant depressive symptoms. The participants were also asked whether they had suffered from depression in the past.
The study showed that during a mean of 7.1 years of follow-up, 658 participants (19.3%) developed dementia.
At baseline, 321 participants (9.4%) had significant symptoms of depression, and 21.2% reported a history of depression.
After adjusting for age, sex, wave of enrollment, and educational level, the researchers found that participants who had a depression score higher than 11 had a 71% higher risk for dementia (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.37 - 2.13).
In addition, the study showed that late-life depression, occurring after the age of 50 years, was associated with an increased risk for all-cause dementia (adjusted HR, 1.46; 95% CI, 1.16 - 1.84). However, early-life depression, occurring before the age of 50 years, was not associated with dementia risk (adjusted HR, 1.10; 95% CI, 0.83 - 1.47).
"We think that depression in later life might be an early manifestation of dementia. Our results confirm that late-life depression is linked to an increased risk of dementia, so if you have a long history of depression, that is probably not causing the dementia. It is more due to something happening in later life," said Dr. Li.
Intervention Studies the "Next Step"
By the time someone meets the criteria for dementia, the disease is in its late stages. Early diagnosis, therefore, is very important, Dr. Li added.
"If depressive symptoms could be an early sign of dementia, this raises the possibility that we might be able to intervene at an earlier stage, where we might have some impact on the outcome," she said.
Anton P. Porteinsson, MD, William B. and Sylvia Konar professor of psychiatry at the University of Rochester School of Medicine and Dentistry, New York, agreed that treating late-life depression might be a way of slowing the progression to dementia.
"We need to do observational clinical trials, but it seems to make sense. It's pretty clear that depression and dementia, the most common neuropsychiatric disorders in the elderly, often co-occur, and this co-occurrence exceeds chance," he told Medscape Medical News. "Depression clearly signals a higher risk of developing both mild cognitive impairment and dementia."
Dr. Porteinsson pointed out that in the Alzheimer's Disease Neuroimaging Initiative study, the presence of depressive symptoms correlated with brain atrophy and white matter damage in the brain.
"We don't know the mechanism and the causative factors, but the correlation is there," he said.
Also not yet known is whether treating the depression will mitigate the risk of progressing to dementia.
"That's going to be the next thing for us to discover. Certainly there are short-term benefits in terms of quality of life, but are there also going to be long-term benefits in terms of better disease load and dementia risk? This is what we need to discover."
Original source (you might need to create a free account to access it).
Wednesday, September 28, 2011
Vitamin B12 deficiency may lead to cognitive problems
From CTV News:
Older people with low levels of vitamin B12 in their blood may be more likely to develop problems with their thinking skills and have more brain shrinkage, a new study suggests. A growing body of research is drawing a link between low B12 and early cognitive decline, a condition that often leads to dementia.
Previous research has found that those people with high levels of vitamin B12 in their blood have lower levels of an amino acid called homocysteine, which some studies have linked to an increased risk of Alzheimer's disease, memory loss, and stroke.
This new study looked at 121 people over the age of 65 in Chicago. Researchers analyzed their blood for levels of vitamin B12 and B12-related metabolites that can indicate a B12 deficiency. The participants also took tests measuring their memory and other cognitive skills.
After an average of four-and-a-half years, the researchers had the participants do the cognitive tests again. They also took MRI scans of the participants' brains to measure their total brain volume and look for other signs of brain damage. They found that having high levels of four of five markers for vitamin B12 deficiency was associated with having lower scores on the cognitive tests and smaller total brain volume.
On the cognitive tests, the scores ranged from -2.18 to 1.42, with an average of 0.23. For each increase of one micromole per liter of homocysteine, the cognitive scores decreased by 0.03 points.
The results appear in the journal Neurology.
According to Health Canada, the recommended daily allowance of vitamin B12 for adults is 2.4 micrograms. More information can be found on the Health Canada website.
Interestingly, the concentrations of all vitamin B12–related markers were linked with better cognitive test scores and higher total brain volume -- but not the blood levels of vitamin B12 itself.
Study co-author Dr. Martha Clare Morris, of Rush University Medical Center, said low vitamin B12 can be difficult to detect in older people when looking only at blood levels of the vitamin. "Looking for vitamin B12 in blood not a good marker," she told CTV News. "We need to have better clinical measures to identify people who have marginal or low vitamin B status."
She said doctors should be testing instead for homocysteine levels. She also said there wasn't enough evidence yet to recommend that all seniors take the vitamin in supplement form.
Monday, September 26, 2011
Preventing falls is important for many older Floridians
Falls are the leading cause of injury, death, and disability for Floridians age 65 and over. As a state that ranks first in the nation in the percentage of its residents who are elders, educating our seniors and their caregivers on how to prevent falls in homes and assisted living and medical facilities is vital to the safety of our population.
The Centers for Disease Control and Prevention estimates that approximately one-third of all Americans age 65 and older will suffer a fall each year. Particularly disturbing is the CDC's estimate of 1,800 annual deaths among nursing home residents from fall-related injuries. The most recent Florida Department of Health data show that in 2009, 1,714 Florida seniors suffered fatal injuries and 42,754 others were hospitalized for nonfatal injuries from falls.
Traumatic brain injuries were associated with 46 percent of the fall fatalities, while hip fractures related to 32 percent of deaths from falls.This issue is so critical in Florida that the state formed a Statewide Senior Falls Prevention Coalition, initiated by Florida's DOH Office of Injury Prevention and the Department of Elder Affairs. The coalition held its first meeting earlier this year.
Sunday, September 25, 2011
Diabetics at Increased Risk of Developing Alzheimer's and Other Dementia
From San Francisco Chronicle:
Patients who had been living with diabetes were 2.05 times more likely to have developed Alzheimer's than individuals with normal glucose tolerance; the researchers adjusted for confounding factors, including age and gender as reported by DiabeticLive.com.
Saturday, September 24, 2011
Poetry provided catalyst in bringing thoughts and words together
From Chanhassen Villager:
Friday, September 23, 2011
NHL Enforcer Job Under Scrutiny
From STLToday.com:In May, Derek Boogaard, a forward for the New York Rangers, died from an accidental overdose of painkillers and alcohol. In mid-August, Vancouver Canucks forward Rick Rypien committed suicide. Two weeks later, retired Nashville player Wade Belak was found hanging in a Toronto hotel room. Officially, the death also has been listed as a suicide.
In July, 2010, former NHL forward Bob Probert, after surviving issues with drugs and alcohol during his career, collapsed and died of heart failure at the age of 45.
An obvious relationship between these deaths is professional occupation. All four were NHL "enforcers," players whose careers essentially were based on a willingness and ability to fight. Connecting the dots from these premature deaths directly to the violent hockey job would be erroneous. Ignoring the common denominator would be irresponsible.
The job specs for "NHL tough guy" surely are among the most mentally taxing in sports. Imagine a job that pays you upwards of $500,000 in salary and makes you instantly recognized and coddled in your host city. While you are expected to train and prepare identically to your co-workers, your job is only marginally related to theirs.
In fact, your job is to enforce a law of the jungle that allows your fellow workers to do their jobs unimpeded. Your job is to engage in hand-to-hand combat, without hesitation. It requires you to fight while standing on ice, supported by a 1/8-inch thick blade, slamming your bare knuckles into the head of someone wearing a hard vinyl nitrile helmet, while he does the same to you. And along with the job comes a peculiar public dynamic, one you can't escape.
A study released by the NHL last March showed that only 8 percent of the league's reported concussions were the result of fighting. Forty-four percent of the incidents were caused by legal hits, while 17 percent were the result of illegal hits. The study also showed 26 percent of reported concussions were the result of accidents, unintentional collisions between teammates or opponents, trips and falls, or being struck by a puck. The remaining 5 percent were undefined.
But Dr. Robert Cantu, a neurosurgeon who heads up a Boston University program to study the brains of athletes in contact-oriented sports, said many enforcers suffer concussions that go unrecognized or unreported.
Tuesday, September 20, 2011
Dose of Laughter Good for Dementia
Laughter really could be the best medicine when it comes to treating older people with dementia.
Nursing home residents with dementia who were treated to amusing visits from a "humour therapist" and cared for by staff under the watchful eye of a "laughter boss" were found to be less agitated than those receiving more straight-laced care.
Four hundred residents from 36 nursing homes took part in the SMILE study led by University of NSW researchers who wanted to see if humour had an effect on people with dementia in terms of their mood, agitation levels, behaviour and social engagement.
The researchers worked with "humour therapist" Jean-Paul Bell, who co-founded the Humour Foundation and works as a "clown doctor" cheering up patients in children's hospitals.
Mr Bell replaced his crazy clown doctor outfit with one of an elevator attendant to become a "humour valet" for half the nursing home residents, most of whom had dementia, for three months.
The remaining 200 residents did not receive any extra doses of humour.
Mr Bell raised a smile or two by chatting away to imaginary people on the end of an old-style telephone handset and waved a magic wand about, asking residents what they wished for.
A member of staff at the nursing homes was also trained to be a "laughter boss" to ensure carers incorporated humour into their daily routines to maintain the cheery atmosphere.
Lead researcher Dr Lee-Fay Low said residents who received humour therapy showed a 20 per cent reduction in agitated behaviour such as aggression, wandering, screaming and repetitive behaviour.
She said she hoped the results would encourage more nursing homes to inject a bit more humour into their care routines.
"There's evidence to show that people with dementia still experience humour and to the same amount of enjoyment as people without dementia but they find different things funny," Dr Low said.
Sunday, September 18, 2011
Push underway to cut drugs for dementia patients
From The Associated Press:
Day after day, Hazel Eng sat on her couch, a blank stare on her face. The powerful antipsychotics she was taking often cloaked her in sedation. And when they didn't, the 89-year-old lashed out at her nursing home's aides with such anger and frequency her daughter wondered if her mother would be better off dead.
Saturday, September 17, 2011
Take Dementia Out with the Trash
From Naples News:
Getting an elderly person to be active by having them help with daily chores like doing the dishes, cleaning the bathroom, and folding laundry might just help prevent them from developing dementia, according to a study reported by HealthDay.com.
This study was published in the Archives of Internal Medicine.
Story provided by
Thursday, September 15, 2011
Most cases of dementia going undiagnosed
From Edmonton CTV News:
A new report is calling on every country to create a national dementia strategy to promote the early diagnosis of Alzheimer's Disease.
Wednesday, September 14, 2011
Aerobic exercise may reduce risk of dementia
From Press of Atlantic City:
Monday, September 12, 2011
Vascular Dementia, The Second Most Common Dementia
When a person is diagnosed with dementia, she has a significant impairment of two or more neurological functions without having lost consciousness. For example, a patient may have impairment in memory and judgment. Several types of dementia exist, which are classified by what areas of the brain they affect, if they result from another condition, and if they become progressively worse.
This type of dementia results when damage occurs to the patient’s blood vessels in her brain. As a result, the brain does not get as much blood, which carries oxygen and nutrients, leading to functional problems.
Sunday, September 11, 2011
Our thoughts and prayers are with the families and loved ones of those who lost their lives in the towers on this day ten years ago. May God bless and keep you all.
Saturday, September 10, 2011
Doctors Argue Against Boxing
From the Lethbridge Herald:
Canadian pediatricians are warning that children and teens who take up boxing face a serious risk of face and brain injuries, and should therefore be banned from the sport.
Thursday, September 08, 2011
The Caregiver’s Bookshelf: A Doctor’s Decline
The New York Times:
It can’t be coincidence that as more of us confront the anguish of dementia, artists are becoming intrigued with shifting memory and altered personality, with dementia’s deeply unsettling effect on the self and on others.
Tuesday, September 06, 2011
When Lapses Are Not Just Signs of Aging
From The New York Times:
Who hasn’t struggled occasionally to come up with a desired word or the name of someone near and dear? I was still in my 40s when one day the first name of my stepmother of 30-odd years suddenly escaped me. I had to introduce her to a friend as “Mrs. Brody.”
One of Dr. Reisberg’s patients is a typical example. In the two and a half years since her diagnosis of mild cognitive impairment at age 78, the woman learned to use the subway, piloted an airplane for the first time (with an instructor) and continued to enjoy vacations and family visits. But she also paid some of the same bills twice and spends hours shuffling papers.
Dr. Ronald C. Petersen, a neurologist at the Mayo Clinic College of Medicine in Rochester, Minn., described mild cognitive impairment as “an intermediate state of cognitive function,” somewhere between the changes seen normally as people age and the severe deficits associated with dementia.
While most people experience a gradual cognitive decline as they get older (only about one in 100 lives long without cognitive loss), others experience more extreme changes in cognitive function, the neurologist wrote in The New England Journal of Medicine in June. In population-based studies, mild cognitive impairment has been found in 10 percent to 20 percent of people older than 65, he noted.
Dr. Petersen described two “subtypes” of the condition, amnestic and nonamnestic, that have different trajectories. The more common amnestic type is associated with significant memory problems, and within 5 to 10 years usually — but not always — progresses to full-blown Alzheimer’s disease, he said in an interview.Continue reading.
Monday, September 05, 2011
Plan eases pressures put on wounded veterans' caregivers
From Florida Today:
Russ Marek, a staff sergeant, was serving in Iraq with the 4th Battalion, 64th Armor Regiment of the Army's 3rd Infantry Division, when he was critically wounded Sept. 16, 2005, by a roadside bomb. His injuries included the loss of his right leg and right arm, a brain injury and burns over 20 percent of his body.
Marek, 40, said he slowly has learned to compensate and do more for himself. But he still cannot live on his own without assistance.
"He can't cook and do a lot of things," said his mother and principal caregiver, Rose Marek. "It's 24-hour care right now."
The Mareks have been approved for the VA's new Family Caregiver program for post-9/11 veterans that provides benefits for the first time to designated family caregivers of eligible severely wounded service members.Continue reading.
Saturday, September 03, 2011
Preventable threats to young lives
FASD is an umbrella term describing the range of effects that can occur in a child whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and learning disabilities.
Shaken Baby Syndrome
Brain damage caused by shaken baby syndrome is another preventable problem.
Shaken baby syndrome, or inflicted traumatic brain injury, is caused by blows to the head, dropping, throwing or shaking a child. Head trauma is the leading cause of death in child abuse cases.
Prior to 2008, SBS fell within a category called severe physical abuse, so statistics for SBS in Ohio and Stark County do not exist. Today, emergency rooms are reporting abuse specific to SBS.
From 2001 to 2005, the Ohio Department of Health estimates that 10 children died each year from SBS, and 150 more had serious injuries.
Shaken Baby Syndrome is controversial, however. In 2008, Discover Magazine published an article on the controversy.
On one side of the courtroom, representing mainstream medical opinion, are those who believe shaken baby syndrome (SBS) is a valid diagnosis. They say that decades of clinical experience and criminal confessions—in which a parent has admitted to shaking a child with symptoms of SBS—bolster their case to the point of near-certainty. On the other side, a growing number of skeptics are now claiming that the evidence for the syndrome rests on dubious medical ground with questionable biophysical models supporting it.
Each side, too, is battling for the moral high ground. Those who give credence to SBS say they are using modern diagnostic technology (magnetic resonance imaging in particular) to catch child abusers who might once have gone unpunished. The skeptics, on the other hand, say that innocent families around the world have been left in ruins by prosecutors and child protective agencies who have wrongfully accused parents and child-care workers of child abuse.Continue reading.
Thursday, September 01, 2011
Caution Needed on Withdrawal of Life Support for TBI Patients
From Medical News Today:
A new investigation in CMAJ (Canadian Medical Association Journal) discovered that death after severe traumatic brain injury is linked with a highly variable incidence of withdrawal of life support at the end of life. The rates at which life support is withdrawn varies greatly from hospital-to-hospital. The authors say that when making the decision to withdraw support, careful attention must be used.
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