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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
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.

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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."


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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.

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From News-Press.com


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.

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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.

Recent results from a longitudinal study conducted in Japan have shown that adults with diabetes are more likely to experience dementia than those with normal glucose tolerance. The research team was headed by Yutaka Kiyohara, M.D., Ph.D., Kyushu University, Fukuoka, Japan. The team analyzed a sample group of 1,017 community-dwelling older diabetics; the findings of the study were published in the journal "Neurology."

The study found that patients who had been diagnosed with diabetes had a 74% greater chance of developing dementia 15 years after the initiation of the study. None of the study participants had dementia when the investigation began, and they all took an oral glucose test at age 60 or older. Researchers followed up with the patients 15 years after the study was initiated to determine if any of them had developed dementia, such as Alzheimer's disease.

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.

Richard Bergenstal, M.D., of the International Diabetes Center at Park Nicollet, Minneapolis, MN, commented that the study's results were interesting in that post-load glucose levels were a statistically significant predictor of dementia status. Study participants who showed high blood glucose levels two hours after eating a meal were more likely to develop dementia later in life.

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From Chanhassen Villager:
It was the morning of Feb. 14, 2005, and Angela Hunt walked down the sidewalk heading to the staff door of the Chaska Library, where she is a librarian.

“I was due at 9:45 a.m. to open,” Hunt said. “I caught my toe on a brick and tripped. The snow was falling and swirling. It was that dry kind of snow. I don’t remember hitting the ground. I do remember though that I saw a gas engine pickup truck heading down the street toward me right before I tripped. But when I got up, I saw it was an idling diesel-engine truck. I remember thinking that was odd.”

Hunt picked herself up. Her glasses were broken, and her ribs hurt. When she entered the library, she noticed that another li-brary employee had already gotten everything — the computers and equipment — up and running.

“I felt a little shook up,” Hunt said. She’d also skinned her knee badly, but attended to it, and then went on with her day.

It was one month later, when Hunt was opening the library, that she realized she didn’t know how to start up the computer.

“I didn’t recognize the people I worked with, or the patrons I know,” Hunt said. “I couldn’t read. I recognized Janet [Karius, the assistant library director] but I couldn’t say her name. Then a friend of mine came into the library, took a look at me and said, ‘She needs to go to emergency.”


OUT COLD

Doctors did X-rays and an MRI. The scans revealed that Hunt had suffered a traumatic brain injury when she tripped and fell in February. She’d been knocked unconscious.

“I have no memory of the fall,” Hunt said. “I do remember that when I picked myself up that morning, there was all this snow covering me. I had thought that was odd at the time. The doctors think I was probably knocked out for 20 minutes.

“And no one saw me lying there,” Hunt said, “because I had my white coat on and a white beret. It was snowing and I blended right in.”

Falling face first, she’d broken her nose, “crushing my sinuses like an accordion,” she said.

And being knocked unconscious explained why the gas pickup truck she’d noticed turned into a diesel truck seemingly in the next instant.

“The doctors said that I had such good coping skills and was so high functioning, it took a month before the brain injury became apparent,” Hunt said. “The brain just continues to function until it stops. I had cracked the bone by my eye, and injured my frontal lobe in a closed head injury. Right after the fall, I had noticed my nose was sore but all the pieces [of that morning] didn’t come to-gether until they did the MRI.”



STARTING OVER

Hunt had been down this road before. In 1995, she suffered a stroke after having surgery. At that time she had to relearn speech and mobility. When doctors at HCMC looked at Hunt’s X-rays and MRI, they saw the earlier brain damage from the stroke.

She worked with physical and occupational therapists for 14 months to help her relearn spatial relationships, manipulating ob-jects, and dealing with her loss of peripheral vision.

“I was spilling and dropping things and poking myself,” Hunt said. “And the sad thing is, if I’d been a housewife, someone who didn’t work outside the home, they would have sent me on my way after a few weeks. If you can read at a fifth-grade level, they con-sider you recovered.

“But I’m a librarian,” Hunt told her doctors. “A librarian has to know and access all this information. It’s what I do. This is the expectation of this profession.”

Hunt had to learn to speak and read all over again. Comprehending what she read took longer.

“I wouldn’t know what I had just read,” Hunt said. “When I’d had my stroke I’d started getting up in the middle of the night to do devotions. I would open my Bible, and I would look at two words and concentrate on them. And then I worked up to three words. And I just kept at it, adding words. So I did that again.

“My doctor encouraged me to go back to work after a month,” Hunt said. “But I didn’t know how I could. It turned out they let me work in the library’s back room, where I scanned bar codes on materials. It helped with my hand and eye coordination, and with my thinking process.

“’When was the last time this material had been checked out?’ ‘Should it go to another branch?’ It helped me so much to learn the collection again.”

A POET EMERGES...

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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.
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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.
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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.



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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.

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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.

Until, in a matter of days, everything seemed to change.

Eng's daughter, Jean Lynch, says her mother was moved to a different section of the Ecumen home in North Branch, Minn., and taken off every drug but her daily aspirin. She now beams as she ambles the hallways, reads the newspaper, tells stories and constantly laughs.

"Now I hope she lives till she's 200 years old," Lynch said. "She's just so happy."

Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive and paranoid behavior related to dementia.

The drugs can limit seniors' ability to effectively communicate, socialize or participate in everyday life. But a series of warnings has prompted a movement of nursing homes trying to reduce the decades-old practice, often resulting in remarkably positive changes.

Still, doctors say the drugs are sometimes the only things that help the small number of dementia patients that display psychotic behavior, making them a danger to themselves and others.

Ecumen's three-year-old program called "Awakenings" isn't just about reducing drugs. Personalized care plans use exercise, aromatherapy, pets and other methods. Patients who were sedated and detached are now playing video games, listening to music and playing balloon volleyball.

"It was quiet before but now it's not," said Eva Lanigan, a nurse who piloted Ecumen's program. "Life is going on here again."

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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.

Researchers from the University of Florida gave 200 people, with an average age of 75, chemically modified water to drink that would help them measure each person's daily caloric output. They then divided the seniors up into three separate groups based on how much energy they used.

It came as no surprise to the researchers that the most active group, comprised of people that burned 1,000 calories a day on average, were more likely to have nimbler minds. In fact, they found that even five years later, the people in the highest activity bracket had a 91% reduction in risk for cognitive decline.

The intriguing finding was that the elderly people who were expending the most calories weren't doing it by working out more—they were just busier. Only 18% of the people in the 1,000 calorie group said that they engaged in regular, energetic exercise.

The study authors say that moving around, doing chores and performing caregiving tasks was the reason that group had such a diminished risk.

Their activity was spread throughout the day instead of being confined to a 30 to 45 minute window. This helped them use more calories and decrease their risk for dementia.

This study was published in the Archives of Internal Medicine.

Story provided by

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A new report is calling on every country to create a national dementia strategy to promote the early diagnosis of Alzheimer's Disease.

Alzheimer's Disease International says most people with dementia receive a late diagnosis, if at all, resulting in a substantial "treatment gap."

The London-based group, which released its 2011 World Alzheimer Report early Tuesday, says as many as three-quarters of the estimated 36 (m) million people worldwide living with dementia haven't been diagnosed.

The report says failure to diagnose Alzheimer's often results from the false belief that dementia is a normal part of aging. But drugs and psychological interventions for people with early-stage dementia, it says, can improve cognition, independence, and quality of life.

The report adds that support and counselling for caregivers can improve mood, reduce strain and delay the institutionalization of people with dementia. In addition, governments, concerned about the rising costs of long-term care linked to dementia, should "spend now to save later."

Based on a review of economic analyses, the report estimates that earlier diagnosis could yield net savings of up to 10-thousand dollars U-S per patient in developed countries.

The main author of the study, Prof. Martin Prince at the Institute of Psychiatry, King's College London, says there is no single way to close the treatment gap worldwide.

What is clear, says Prince, is that every country needs a national dementia strategy that promotes early diagnosis and a continuum of care thereafter.

"Failure to diagnose Alzheimer's in a timely manner represents a tragic missed opportunity to improve the quality of life for millions of people," said Dr. Daisy Acosta, chairwoman of Alzheimer's Disease International.

"It only adds to an already massive global health, social, and fiscal challenge."

The report, titled "The Benefits of Early Diagnosis and Intervention," says in high-income countries, only 20-50 per cent of dementia cases are recognized and documented in primary care. In low- and middle-income countries, this proportion could be as low as 10 per cent.

The 2009 World Alzheimer Report estimated the number of people with dementia was expected to nearly double every 20 years -- from 36 million in 2010 to 115 million in 2050.

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Any exercise that gets the heart pumping may reduce the risk of dementia and slow the condition's progression once it starts, reported a Mayo Clinic study published this month. Researchers examined the role of aerobic exercise in preserving cognitive abilities and concluded it should not be overlooked as an important therapy against dementia.

The researchers broadly defined exercise as enough aerobic physical activity to raise the heart rate and increase the body's need for oxygen. Examples include walking, gym workouts and activities at home such as shoveling snow or raking leaves.

"We culled through all the scientific literature we could find on the subject of exercise and cognition, including animal studies and observational studies, reviewing more than 1,600 papers, with 130 bearing directly on this issue. We attempted to put together a balanced view of the subject," says J. Eric Ahlskog, a neurologist at Mayo Clinic. "We concluded that you can make a very compelling argument for exercise as a disease-modifying strategy to prevent dementia and mild cognitive impairment, and for favorably modifying these processes once they have developed."

The researchers note brain imaging studies have consistently revealed objective evidence of favorable effects of exercise on human brain integrity.

Also, they note, animal research has shown exercise generates trophic factors that improve brain functioning, plus exercise facilitates brain connections (neuroplasticity).

More research is needed on the relationship between exercise and cognitive function, the study's authors say, but they encourage exercise, in general."Whether addressing our patients in primary care or neurology clinics, we should continue to encourage exercise for not only general health, but also cognitive health," Ahlskog says.
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From EmPowHer.com:
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.

The second most common type of dementia is vascular dementia — about 20 percent of all dementia cases are vascular dementia, according to the National Institute of Neurological Disorders and Stroke.
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.

Several conditions can cause vascular dementia: the MayoClinic.com noted that common causes include a stroke that results in a blocked artery in the brain and chronically damaged or narrowed blood vessels in the brain. Damage to the arteries may result from conditions such as diabetes, high blood pressure and lupus erthematosus.

One type of vascular dementia, multi-infarct dementia, results from multiple small strokes. If one stroke causes the dementia, it is called single-infarct dementia. However, the National Institute of Neurological Disorders and Stroke pointed out that not all strokes cause vascular dementia


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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.

 
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.

In a recent joint statement ,the Canadian Paediatric Society (CPS) and the American Academy of Pediatrics advised youth should "participate in sports where the prime focus is not deliberate blows to the head."

Some 273 boxers reported injuries between 1990 and 2007, according to the Canadian Hospitals Injury Reporting and Prevention Program, which is maintained by the Public Health Agency of Canada. Among them, nearly 70 per cent were 18 and under.

Data showed that boxing lead to the most hospital admissions among all combat sports; 58 per cent of those sustained facial fractures, while 25 per cent suffered from closed head injuries, such as concussion.

The program collects data from 15 hospitals across the country, including 10 children's hospitals, which could have skewed some of the data, admitted Dr. Robert Moriartey, CPS board representative for Alberta.

Even so, he said the severity of head injury appears to be worse in youth.
"They have a much longer time to recover, and their neuro-cognitive effects of these concussions or head injuries can last much longer," he said adding generally adults recover more quickly from head injuries.

The long-term effects for a child with a head injury, such as a concussion, could include cognitive impediments that could in turn affect schooling and social interactions. Repeat concussions can result in traumatic brain injury causing memory loss and chronic headache

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From 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.

I’ve come across a song called “Do I Know You?” by jazz singer Cynthia Scott, and a collection of poems about Alzheimer’s disease called “Beyond Forgetting.” The latest novel from the prolific Walter Mosley, whose mother died of dementia, features a 91-year-old protagonist offered a magical (and nonexistent) drug that can restore full mental clarity for a few months, after which it will kill him. In a wonderful memoir called “Keeper,” Andrea Gillies describes her family’s struggles with her demented mother-in-law.

This week I’ve spent several intense hours in the company of a Chicago surgeon named Dr. Jennifer White, who on some days can effortlessly rattle off all the bones and tendons of the hand and on other days can’t recognize her two children or recall that her lifelong best friend has been murdered. The haunting creation of California writer Alice LaPlante, Dr. White narrates the new novel “Turn of Mind.” She is by turns sarcastic, apathetic, funny, tender, aggressive, paranoid. Or perhaps not paranoid: the police suspect her of killing her friend, so they really are out to get her.

Ms. LaPlante, another adult child losing her mother to Alzheimer’s, is less concerned with the detective-novel mystery than with the deeper one: What does it feel like to lose your mind and to know that you are losing your mind? There’s no magic pill for Dr. White, who by the end of the novel has sunk so deeply into her disease that another narrator, nameless, has to take over the tale. Yet Ms. LaPlante renders her with such precision and affection that while Dr. White eventually forgets almost everything, she has become unforgettable.

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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.”

But for millions of Americans with a neurological condition called mild cognitive impairment, lapses in word-finding and name recall are often common, along with other challenges like remembering appointments, difficulty paying bills or losing one’s train of thought in the middle of a conversation.
Though not as severe as full-blown Alzheimer’s disease or other forms of dementia, mild cognitive impairment is often a portent of these mind-robbing disorders.

Dr. Barry Reisberg, professor of psychiatry at New York University School of Medicine, who in 1982 described the seven stages of Alzheimer’s disease, calls the milder disorder Stage 3, a condition of subtle deficits in cognitive function that nonetheless allow most people to live independently and participate in normal activities.
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. 
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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.
 
In a speech Tuesday to the American Legion Convention, President Barack Obama talked about the caregivers program as part of his plan to help veterans.
 
The program includes monthly stipends, health insurance and other benefits for the family caregiver. It also provides counseling and travel benefits when the wounded veteran must go for specialized treatment and other services. Quarterly visits from VA social workers help to ensure the veterans are getting appropriate care.
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From CantonRep.com:
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.

According to Ohio’s Fetal Alcohol Spectrum Disorders Initiative, as many as 40,000 babies are born in the U.S. each year with FASD, costing about $4 billion.

Early diagnosis and treatment is the best way to help children succeed and to lessen secondary disabilities such as disrupted school experience, trouble with the law, inappropriate sexual behavior, alcohol and drug problems and problems with employment.

According to Dr. Roger Vasquez, a neonatologist at Aultman Hospital, diagnosing FASD in newborns is difficult because no test for it exists.

“We are going solely on physical features, and that’s not a really good way,” he said. “We have to be suspicious of it. Maybe the baby is not growing in utero.”

After the process of eliminating other causes of low birth weight, FASD remains a possibility, he said.

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.

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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.
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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. 

Dr. Alexis Turgeon, Laval University, Quebec, wrote:
"We saw that most deaths after severe traumatic brain injury occurred after withdrawal of life-sustaining therapy and that the rate of withdrawal of life-sustaining therapy varied significantly across level-one trauma centers.

We also saw considerable variability in overall hospital mortality that persisted after risk adjustment. This raises the concern that differences in mortality between centers may be partly due to variation in physicians' perceptions of long-term prognosis and physicians' practice patterns for recommending withdrawal of life-sustaining therapy.

Until accurate diagnostic tools are available, careful attention must be used in both estimating prognoses for those with severe traumatic brain injury and in recommending the withdrawal of life-support."

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