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Jack Sisson's TBI Blog
A hug is duct tape for the soul.
Tuesday, January 31, 2012
Could Alzheimer's Disease Be Diagnosed With a Simple Blood Test?
From Science Daily: A pilot study suggests infrared analysis of white blood cells is a promising strategy for diagnosis of Alzheimer's disease.
Spanish researchers, led by Pedro Carmona from the Instituto de Estructura de la Materia in Madrid, have uncovered a new promising way to diagnose Alzheimer's disease more accurately.
Their technique, which is non-invasive, fast and low-cost, measures how much infrared radiation is either emitted or absorbed by white blood cells. Because of its high sensitivity, this method is able to distinguish between the different clinical stages of disease development thereby allowing reliable diagnosis of both mild and moderate stages of Alzheimer's.
The work is published online in Springer's journal Analytical & Bioanalytical Chemistry.
Alzheimer's disease is the most common form of adult onset dementia and is characterized by the degeneration of the nervous system. In particular, as the disease progresses, the amount of amyloid-ß peptide in the body rises.
At present, the most reliable and sensitive diagnostic techniques are invasive, e.g. require analysis of cerebrospinal fluid (the liquid that surrounds the brain and spinal cord). However, white blood cells (or mononuclear leukocytes) are also thought to carry amyloid-ß peptide in Alzheimer patients.
Monday, January 30, 2012
Giffords case raises awareness of traumatic brain injury
The following is an opinion piece from Chron.com (which, I assume, is The Houston Chronicle), written by Kurt Mossberg:
Sunday, January 29, 2012
Men more likely to suffer mild memory loss than women
From Medill Reports:
It’s common knowledge that aging is linked with forgetfulness and in more serious cases, various forms of dementia such as Alzheimer’s disease. But a new study, published in the current online edition of the journal Neurology, has found a twist: Men are more likely to suffer mild memory loss than women.
The study comes as a surprise due to the higher incidence of dementia among women said Dr. Diana Kerwin, geriatrician at Northwestern University’s Feinberg School of Medicine.
But this may also have something to do with the fact that women generally live longer than men. If you’ve recently watched Meryl Streep’s performance of Margaret Thatcher’s battle with dementia, you may remember the Iron Lady outlived her husband.
Researchers from the Mayo Clinic Study of Aging measured the incidence of mild cognitive impairment, or MCI, among 1,450 subjects from the Rochester area of Minnesota age 70 to 89. All subjects were normal at the start of the testing and were evaluated in 15-month intervals.
Dr. Rosebud Roberts, the study author and epidemiologist at the Mayo Clinic, said it was important to remember that mild cognitive impairment affects both men and women. “The fact that the MCI risk is higher in men than women does not mean that MCI does not occur in women. Women should also be aware of risk factors, but men may need to address risk factors earlier,” she said.
Mild cognitive impairment, unlike dementia, is characterized by losses in memory that do not significantly interfere with daily activities. Cognitive abilities may remain stable or even return to normal.
But being diagnosed with MCI is not to be taken lightly. “MCI is thought to be a clinical step prior to someone being diagnosed to dementia,” Kerwin said. “They are not the same thing but two points on a continuum.”
Saturday, January 28, 2012
Stimulating Cognitive Activity Lowers Risk Of Alzheimer's
From Medical News Today:
Findings published Online First by Archives of Neurology, a JAMA/Archives journal, show that people who keep their brain active throughout their lives with cognitively stimulating activities like reading, writing and playing games seem to have lower levels of the β-amyloid protein, which is the major part of the amyloid plaque in Alzheimer disease.
The recently developed radiopharmaceutical carbon 11-labeled Pittsburgh Compound B ([ 11 C]PiB), has enabled researchers to image fibrillar (fiber) forms of the β-amyloid (Aβ) protein.
Susan M. Landau, Ph.D., at the University of California in Berkeley and the Lawrence Berkeley National Laboratory, and her team ... assessed 65 healthy elderly people, with an average age of 76.1 years, and compared them with 11 young participants, with an average age of 24.5 years, and 10 patients with Alzheimer disease (AD) aged on average 74.8 years. The researchers surveyed all participants in terms of their different lifestyle practices, including the frequency in which they participated in cognitively engaging activities at different phases throughout their life, starting from the age of 6 years to their current age.
"We report a direct association between cognitive activity and [ 11 C]PiB uptake, suggesting that lifestyle factors found in individuals with high cognitive engagement may prevent or slow deposition of β-amyloid, perhaps influencing the onset and progression of AD."
According to the findings, a greater participation in cognitively stimulating activities throughout a person's life, particularly in early and middle life, seems to be linked to reduced [ 11 C]PiB uptake. The researchers noted that the [ 11 C]PiB uptake was similar between elderly individuals with the highest cognitive activity and young people in the control group, whilst those with the lowest cognitive activity had [ 11 C]PiB uptake similar to AD patients.
Coping with Post-TBI Emotional Distress
From The Homelessness Resource Center (the article was originally published by BrainLine.org) :
Life after Traumatic Brain Injury (TBI) is not only impacted by the physical and/or intellectual results of the injury, but also deep emotional stress brought on by feelings of isolation and helplessness. This randomized controlled trial finds that people living with TBI are found with higher rates of depression, anxiety, and substance use problems. Understanding the causes of these issues, and strategies for treatment, is the first step to preventing homelessness for people with TBI.
Between 1993 and 1998, the Research and Training Center on Community Integration of People with traumatic brain injury (TBI) interviewed hundreds of individuals about their lives after experiencing traumatic brain injuries. People were eligible to be part of this sample if they viewed themselves as someone who has experienced a brain injury and has a disability. A comparison group of individuals who view themselves as non-disabled was also interviewed. These samples include men and women from all regions of New York State - rural areas, cities, and suburbs. People as young as 18 and as old as 65, of all races, income levels, and life experiences participated in this research. In this TBI Consumer Report, we share some of the insights on emotional stress, resulting from these interviews.
The most commonly experienced emotional problems after TBI were depression, anxiety, and substance abuse/dependency:
Risk Factors for Stroke
Risk Factors for Stroke that Can be Changed
Risk Factors for Stroke that Cannot be Changed
Other Risk Factors to Consider
Wednesday, January 25, 2012
Watch for Signs of Stroke-Related Dementia
Sunday, January 22, 2012
Nursing Home Dementia Patients Three Times as Likely to Fall if on Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) appear to cause risk to rise with higher doses
Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are three times more likely to have an injurious fall than similar people who don’t use these drugs.
The association can be seen in people who use low doses of SSRIs and the risk increases as people take higher doses. The results are published in the British Journal of Clinical Pharmacology.
Many nursing home residents with dementia suffer from depression, and are therefore treated with antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are generally considered the treatment of choice.
"Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills,” said lead author Carolyn Shanty Sterke, who works in the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands.
Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls result in an injury. “Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses,” says Sterke.
Sterke carried out this research by recording the daily drug use and daily falls in 248 nursing home residents with dementia from 1 January 2006 until 1 January 2008.
Data about the residents’ day-by day drug use came from a prescription database, and information on falls and subsequent injuries came from a standardised incident report system. In total, she had collected a dataset of 85,074 person-days.
The mean age of the participants was 82 years, and the prescription records showed that antidepressants had been used on 13,729 (16.1%) days, with SSRIs being used on 11,105 of these days.Continue reading.
Apparently this is something that has been known for at least two years. Here's another article from the same source, published November 23, 2009.
Antidepressants and Sedatives Associated With Risk of Falls for Older Americans
Older adults who take several types of psychotropic medications - such as antidepressants or sedatives - appear more likely to experience falls, according to an analysis of previous studies reported in the November 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Each year, 85 percent of all injury-related hospital admissions and more than 40 percent of nursing home admissions are related to falls, and the annual costs related to falls and their complications are estimated to be in the billions of dollars worldwide.
Both internal and external risk factors contribute to falls, and medications have previously been implicated in the probability of falling and in the risk of sustaining a fracture.
Saturday, January 21, 2012
Canadian freestyle skier Burke dies of brain injuries
Sad news. So sorry to hear this.
From The New York Post:
Canadian freestyle skier Sarah Burke died Thursday, more than a week after suffering severe brain injuries in a training accident in Utah.
"Groundbreaking Canadian freestyle skier Sarah Burke passed away at 9:22AM January 19, 2012 at the University of Utah Hospital from injuries sustained in an accident on the Eagle Superpipe at Park City Mountain Resort on Tuesday, January 10, 2012," her family said in a statement.
The trailblazing 29-year-old, a gold medal hopeful for the 2014 Olympics, was preparing for this month's X Games when she crashed last Tuesday.
Burke had surgery the following day at Salt Lake City's University Hospital to repair a torn vertebral artery that caused bleeding on her brain and sent her into cardiac arrest.
She had remained in critical condition in an induced coma for the past week, but her family said the injuries proved too severe to overcome. The family also pointed out that Burke's condition was not the result of a traumatic brain injury, but rather the lack of oxygen to the brain during cardiac arrest.
"Sarah passed away peacefully surrounded by those she loved," her family's statement said. "In accordance with Sarah's wishes, her organs and tissues were donated to save the lives of others."
Thursday, January 19, 2012
More players join NFL concussion suits; file in PA
A third lawsuit has been filed in Philadelphia by retired NFL players over brain injuries allegedly caused by on-field concussions, a week before U.S. judges decide whether to consolidate similar cases filed around the country.
At least eight related lawsuits have been filed in New York, New Jersey, Georgia and Florida. The lawsuits claim the National Football League hid evidence linking concussions to permanent brain injuries and seek millions in compensation.
Two-time Super Bowl champion Jim McMahon and hundreds of other players have signed on. Many cite symptoms ranging from occasional memory loss to depression to degenerative brain disease, while others are asymptomatic but want to be monitored for brain-related health problems they fear they will develop.
"Rather than warn players that they risked permanent brain injury if they returned to play too soon after sustaining a concussion, the NFL actively deceived players, by misrepresenting to them that concussions did not present serious, life-altering risks," the suit filed Wednesday charges.
The plaintiffs — former Philadelphia Eagles Ron Solt, Joe Panos and Rich Miano, along with four other players and four spouses — alleges an NFL conspiracy to conceal information and seeks at least $75,000 per person.
A similar lawsuit filed earlier this month in Philadelphia seeks more than $5 million for more than 100 former players.
Wednesday, January 18, 2012
Action sports injuries seeing increase as athletes start taking greater risks
From The Post and Courier:
For action sports stars accustomed to leaving fans breathless with acrobatic aerial stunts, those same athletes are now in shock themselves.
Canadian freestyle skier Sarah Burke remains in critical condition at the University of Utah Hospital in Salt Lake City after a seemingly unremarkable fall last week. Burke, a six-time Winter X Games medalist and winner of the Women's Ski Superpipe in 2011, was training in Park City and preparing to defend her title at Winter X Games Aspen later this month.
She landed a jump toward the end of a training run but fell and hit her head. Peter Judge, head of the Canadian Freestyle Ski Association, emphasized that Burke was not trying unusually difficult tricks. "It was nothing out of the norm, nothing on the extreme end of the spectrum." However, within minutes, she was airlifted to Salt Lake City.
Burke underwent surgery to repair a tear in her vertebral artery. "With injuries of this type, we need to observe the course of her brain function before making definitive pronouncements about Sarah's prognosis for recovery," said Dr. William T. Couldwell, the chair of neurosurgery at the University of Utah.
Dr. Safdar Ansari, the neuro- intensivist coordinating Burke's care, addressed her situation later in the week. "With traumatic brain injury, our care is focused on addressing the primary injury and preventing secondary brain damage, as well as managing other injuries sustained at the time of the accident, all of which requires close monitoring and intensive care. At this moment, Sarah needs more time before any prognosis can be determined."
So as we wait to see if Burke recovers, we can wonder why these injuries happen. But honestly, we know the answer to that question. This is the nature of these action sports. The halfpipes are getting bigger. The stunts are becoming riskier, with more height and flips. And yet, it is the athletes themselves pushing to perform more dangerous stunts.
Even if I wanted to do so, there would be no sense for me to argue that the sports' governing bodies should regulate them more closely. These athletes know exactly what they are getting into. Snowboarding star Gretchen Bleiler wrote in espnW.com: "As pro snowboarders, skiers, etc., we all know that what we do is risky. But when accidents produce results like this we're left praying and asking ourselves questions. Is it worth it? Why did this happen? What are we doing?"Continue reading.
Saturday, January 14, 2012
The black hole of sports
From 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.
Thursday, January 12, 2012
Could Heading in Soccer Lead to Brain Injury?
No Clear Link to Chronic Traumatic Encephalopathy, So Far
From Science Daily:
Could heading the ball in soccer lead to degenerative brain disease, like that seen in athletes in other sports?
That's the question addressed by a review in the January issue ofNeurosurgery, official journal of the Congress of Neurological Surgeons.
As yet there's not clear evidence to link heading to short- or long-term brain injury, according to Dr Alejandro M. Spiotta of the Cleveland Clinic and colleagues. However, while research is ongoing, they stress the need for proper heading technique at all levels of organized soccer.
New Review of Evidence on Heading and Brain Injury Risk in Soccer
Soccer (called football outside the United States) is the only sport in which players use their unprotected heads to intentionally deflect, stop, or redirect the ball. Headed balls travel at high velocity both before and after impact, raising concerns about possible traumatic injury.
In 2002, English footballer Jeffrey Astle, known as a "formidable header," died with degenerative brain disease. The damage was consistent with chronic traumatic encephalopathy (CTE): a progressive neurodegenerative disease caused by repeated brain injury, seen in American football players and other athletes. Those reports have prompted concerns about similar risks in soccer players.
Although concussions are common in soccer, they more often result from the head striking another player or the goalpost, rather than heading the ball. But there's still concern about long-term injury related to repetitive trauma from heading.
Detailed biomechanical studies have been performed, showing that heading is a complex task in which significant energy is absorbed by the head. Emphasizing the importance of proper heading technique, studies have shown that anticipation and "pre-tensing" of the neck muscles play a key role in absorbing and redirecting the impact of a headed ball.Continue reading.
Tuesday, January 10, 2012
Notes on the Concussion Crisis: Worker's Compensation and Dementia
This 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.
Friday, January 06, 2012
Hormone in Women Linked to Dementia, Study Finds
From 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.
Monday, January 02, 2012
Acting Out War’s Inner Wounds
From 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.
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