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Jack Sisson's TBI Blog

A hug is duct tape for the soul.


From The Washington Post

As a quarterback in the NFL, Mark Rypien knew well that he put himself at risk of serious injury every time he stepped on the field. He’d seen players suffer broken bones, muscle tears and sprains.
But if you asked Rypien about concussions during his 11-season playing career — six of which he spent with the Washington Redskins, including a Super Bowl MVP campaign in 1991-92 — Rypien would have struggled.
“I didn’t know what they were,” said Rypien, 49. “I knew what the massive ones were . . . the ones that were very, very traumatic, with head bleeding and where you kind of black out. . . . But the ones you shake off and get back in there, and a little later, you have a little confusion . . . and after the off days, where you think you’re feeling better and you tee it up again — I didn’t know what those were.”

That lack of awareness of the risks he faced simply by shaking his head clear after “getting his bell rung” and the long-term effects Rypien has experienced are the reasons he agreed to become the lead plaintiff in a 126-player class-action lawsuitagainst the NFL.

In the suit, filed March 23, Rypien and fellow players contend that the NFL failed to educate them for decades on the risks associated with suffering repetitive tramatic brain injuries and concussions, and instead ignored and concealed the information. Fourteen other former Redskins are part of the lawsuit.
“Our thing is that we make the game safer. Not change the game, but players are faster and stronger, and if we can do certain things to protect [against] head trauma, why not implement those and put them in place?” Rypien said. “And for those that have received that, in this litigation, why not look into making their quality of life better?”
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From The Telegraph:

Learning another language 'rewires' the brain and could help delay the onset of dementia by years, research suggests.

Having to grapple with two languages makes the brain work harder, making it more resilient in later life, say academics.
One study found that, among people who did eventually get dementia, those who were bilingual throughout their lives developed the disease three to four years later.
Dr Ellen Bialystok, of York University in Toronto, Canada, and two colleagues examined hospital records of patients diagnosed with a variety of different types of dementia.
They found: "In spite of being equivalent on a variety of cognitive and other factors, the bilinguals experienced onset and symptoms and were diagnosed approximately three to four years later than the monolinguals.
"Specifically, monolingual patients were diagnosed on average at age 75.4 years and bilinguals at age 78.6 years.
Several other studies found similar results, they noted in the journal Trends in Cognitive Sciences.
While lifelong bilingualism appeared to have the strongest protective effect, any attempt at learning another language was likely to be beneficial, they wrote.
"If bilingualism is protective against some forms of dementia, then middle-aged people will want to know whether it is too late to learn another language, or whether their high-school French will count towards coginitive reserve," they said.
"A related question concerns the age of acquisition of a second language: is earlier better?
"The best answer at present is that early age of acquisition, overall fluency, frequency of use, levels of literacy and grammatical accuracy all contribute to the bilingual advantage, with no single factor being decisive.
"Increasing bilingualism" led to "increasing modification" of the brain, they said.
Brain imaging scans have found that having to switch between two languages helps exercise parts of the brain that carry out taxing intellectual tasks, like multi-tasking and concentrating intensely on a subject for a sustained period of time.
These "executive control" functions tend to be among the first to wane in old age, a process known as "cognitive decline".

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The get-tough-on-crime and mandatory sentencing policies that swept the United States beginning in the 1970s did more than drive up the inmate population and prison costs. They also ensured that inmates who once might have been seen as rehabilitated and given parole would grow old and even die behind bars. As a result, prisons are struggling to furnish costly, specialized care to ever more inmates who suffer from age-related infirmities, especially dementia.

According to a report from Human Rights Watch, in 2010 roughly 125,000 of the nation’s 1.5 million inmates were 55 years of age and over. This represented a 282 percent increase between 1995 and 2010, compared with a 42 percent increase in the overall inmate population. If the elderly inmate population keeps growing at the current rate, as is likely, the prison system could soon find itself overwhelmed with chronic medical needs.

There is no official count of how many inmates suffer from dementia. But some gerontologists say the current caseload represents the trickle before the deluge. They say the risk of the disease is higher behind bars because inmates are sicker to start with with higher rates of depression, diabetes, hypertension, HIV/AIDS and head trauma. Given these risk factors, the dementia rate in prison could well grow at two or three times that of the world outside.

This is a daunting prospect for prison officials whose difficulties in keeping pace with the present dementia caseload were underscored in a recent report by The New York Times’ Pam Belluck. The article portrayed officials in crowded, understaffed correctional facilities scrambling to care for ailing inmates who can no longer feed, dress or clean themselves and who create conflict and disorder because they can no longer follow simple commands.

The Human Rights Watch study said the cost of providing medical care to elderly inmates is between three and nine times the cost for younger ones. Another study found that the annual average health care cost per prisoner is about $5,500; about $11,000 for inmates ages 55 to 59 and $40,000 for inmates 80 or older. A specialized unit for cognitively impaired inmates in the New York state system costs more than $90,000 per bed per year, more than twice the figure for general inmates.

Many inmates, obviously, can never be released, and they will continue to require special care. But the states must pursue other avenues as well. They can foster partnerships between prisons and nursing homes to improve the quality of care; consider compassionate release programs for frail inmates who no longer present a threat to public safety; and, no less important, revisit the mandatory sentencing policies that did away with judicial discretion and filled the prisons to bursting in the first place.

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From The Mirror:

The number of dementia sufferers in the UK has risen by 50,000 in the past year, new figures have revealed.

There are now more than 800,000 victims in Britain, with three out of four becoming anxious or depressed and six out of 10 feeling lonely, according to a new survey.

PM David Cameron yesterday launched a new campaign to tackle the growing crisis – calling it a “scandal”.

But last night his Government was slammed for imposing swingeing cuts which have had devastating knock-on effects.

Shadow care minister Liz Kendall said: “The crisis in dementia cannot be addressed without tackling the crisis in care.

“More than £1billion has been cut from local council budgets for older people’s social care since the Government came to power.

“Eight out of 10 councils are now providing support only for those with substantial and critical needs.
"Charges for vital services for people with dementia, like home help, are increasing and vary hugely across the country. These are a stealth tax on some of the most vulnerable people in society.”

In its most wide-ranging survey of dementia, the Alzheimer’s Society found three out of four people do not think society is geared up to deal with the disease. The same number also feel their carer is not getting the support they need.

Speaking at an Alzheimer’s Society conference, Mr Cameron said yesterday: “Dementia is a terrible disease. And it is a scandal that we as a country haven’t kept pace with it.”

It costs the country about £23billion a year. Mr Cameron said funding for research is to hit £66million by 2015, up from £26.6million in 2010.

Alzheimer’s Society chief executive Jeremy Hughes said: “The announcement by the Prime Minister marks an unprecedented step towards making the UK a world leader in dementia.

"Doubling funding for research, tackling diagnosis and calling for a radical shift in the way we talk, think and act on dementia will help to transform lives.”

* Dementia, from the Latin for “without mind”, was thought a natural part of ageing until US neurologist Robert Katzmann first linked “senile dementia” to Alzheimer’s disease in 1976.

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From USA Today:

The aging of the massive post-World War II baby boom generation in the U.S. is casting light on early onset dementia, a sorrowful subset of younger people experiencing a slow, cruel overtaking of their minds.

About 200,000 Americans under 65 are among the 5.4 million Americans suffering from Alzheimer's disease, according to the Alzheimer's Association. Experts' estimates suggest there's a similar number of younger people with other types of dementia, meaning about a half-million Americans, some as young as their 30s, suffer from early-onset or younger-onset dementia.

The number of people suffering from all types of dementia is rapidly increasing because of the aging of the baby boom generation — the 78 million Americans born between 1946 and 1964 — though there's no sign the percentage of younger people with dementia is going up.

Doreen Watson-Beard is one of the tiny minority. And she has seen the disease from two sides.

The nurse cared for more people with dementia than she could count. She was so moved by her patients that she led Alzheimer's support groups. She knew the warning signs and understood there was no cure.

But the 49-year-old never thought the disease would affect someone her age.

The first clues surfaced around five years ago, when she was 44. She'd forget to pick up her grandchildren at school or plans she made with her husband. She wrote down the wrong medication dosage for a patient. "I have no idea what's going on," she remembered telling her doctor.

Watson-Beard says she was diagnosed two or three years ago; she has trouble remembering the exact time. Forgetfulness was one of her first symptoms; her husband would ask if she was ready to leave and she'd have no recollection they made plans. She became less socially conscious, hanging up abruptly with her boss in the middle of a conversation she thought was finished.

She kept going to work at an assisted living facility near her central Florida home, while caring for her husband, who had liver cancer. She dismissed the symptoms as stress. When her husband died about three years ago, the symptoms continued. She thought it was grief. But it wasn't getting better.

"I thought if I ignored it long enough, it would go away," she said.

Problems at work began cropping up, too. Once, Watson-Beard couldn't figure out how to do a complicated wound dressing — something she'd done many times before. Another time, she wrote down the wrong dosage of a medication on a patient's discharge plan — luckily, that mistake was caught by a pharmacist.

Worried someone might be harmed, she went to the doctor.

She was informed she had dementia, though her doctor has not yet classified it more specifically as Alzheimer's, dementia's most common form. She was told to prepare for the future.

Dr. Marc Agronin, a geriatric psychiatrist at Miami Jewish Health Systems and author of "How We Age," says symptoms of dementia in a younger patient can be glaring. But diagnosis is often complicated by the fact that it's so uncommon in younger patients and that so many other conditions could cause the symptoms.

Agronin sees no evidence of an increasing rate of early-onset dementia, but there is increased interest. At the memory clinic he runs at Miami Jewish, he has seen an uptick in younger patients concerned their memory lapses mean they have Alzheimer's. They're almost always wrong.

When they're not, the diagnosis can be devastating.

"It's very distressing because they come in and they have young spouses and some of them have kids in grade school," Agronin said. "It's frightening to see someone so young becoming so impaired."

Beth Kallmyer, a social worker at the Alzheimer's Association, said younger people with dementia often get incredulous reactions from others when they share their diagnosis. Many don't realize the disease can affect those who aren't very old.

Kallmyer notes it also frequently forces people to quit their job during their top earning years.

"It can be financially devastating," she said.

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From The New York Times:

Four months before a best-selling Alzheimer’s drug was set to lose its patent protection, its makers received approval for a higher dosage that extended their exclusive right to sell the drug. But the higher dosage caused potentially dangerous side effects and worked only slightly better than the existing drugs, according to an article published Thursday in the British Medical Journal.

The drug, Aricept 23, was approved in July 2010 against the advice of reviewers at the Food and Drug Administration.

They noted that the clinical trial had failed to show that the higher dosage — 23 milligrams versus the previous dosages of 5 and 10 milligrams — met its goals of improving both cognitive and overall functioning in people with moderate to severe Alzheimer’s disease.

The single clinical trial of 1,400 patients also found that the larger dosage led to substantially more nausea and vomiting, potentially dangerous side effects for elderly patients struggling with advanced Alzheimer’s disease. The drug was developed by the Japanese pharmaceutical company Eisai but is marketed in the United States in a partnership with Pfizer.

“It doesn’t really have much benefit, but does substantially more harm,” said Dr. Steven Woloshin, one of the co-authors of the journal article and a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

Aricept generated more than $2 billion in annual sales since its first approval in 1996, according to the journal article, but it was set to lose its patent protection in November 2010, opening the door to cheaper generic versions of the drug.

In 2009, Eisai applied for a 23-milligram version of Aricept, a dosage that, the journal authors note, cannot be reached by combining the 5 and 10 milligram dosages, which are available in generic form. “It’s kind of an odd number,” Dr. Woloshin said.

Drug makers often try to fend off competition from generic makers by finding novel ways of extending their exclusive rights to sell a drug — by altering its chemistry slightly, for example, or offering it in extended-release versions. Applying for a new dosage on the same drug is a relatively new tactic and — in the case of Aricept 23 — a dangerous one, said Sidney M. Wolfe, director of Public Citizen’s Health Research Group, which last year asked the F.D.A. to remove the drug from the market.

The F.D.A. had initially said that to be approved, Aricept 23 would have to improve both cognitive and global — or overall — functioning in patients with the disease. But the clinical trial found only a slight improvement on the cognitive measure and no improvement on the global measure.

As a result, a clinical and a statistical reviewer for the F.D.A. each recommended against approving the higher dosage. Nevertheless, the drug was eventually approved by Dr. Russell Katz, director of the F.D.A.’s neurology products division, who acknowledged that side effects from the higher dose “could lead to significant morbidities and even increased mortality,” but concluded that the drug most likely improved overall functioning even though the study did not show that.

“Rarely do we see such a dangerous difference between what pretty much everyone in the neurological division thought and what its leader thought,” Dr. Wolfe said. “That’s a huge slap in the face to all the people who spent much more time reviewing this drug than he did.”

Sandy Walsh, a spokeswoman for the F.D.A., declined to comment because she said the agency was in the process of responding to Public Citizen’s petition.

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From Fox News:

Brett Favre, Cam Newton, Aaron Rodgers and Kurt Warner were targets of the New Orleans Saints’ pay-for-performance scheme, one of many revelations as the league announced sanctions Wednesday.

It wasn’t disclosed by the NFL if the bounties were literally placed on the stars' heads, a scary thought for player safety advocates.

“When you hear about players being targeted, one of the first things you worry about is headhunting,” said Kevin Guskiewicz, professor at the University of North Carolina and member of the NFL’s head, neck and spine committee. “There are numerous ways to knock a player out of a game. I hate to even think that they’d plan that out so methodically.”

Researchers have increasingly uncovered the dangers of traumatic brain injuries and the NFL — maybe a bit late for some experts’ liking — has taken the issue of concussed players more seriously in recent seasons. The NFL has responded by tightening concussion protocols, punishing players for dangerous hits, moving kickoffs forward 5 yards and adding athletic trainers to press boxes to monitor players.

That the Saints, under former defensive coordinator Gregg Williams, instituted a scheme and contributed money to injure other players certainly offset some of the league’s efforts. Maybe it shouldn’t be much of a surprise that the suspensions included Williams (banned indefinitely), Saints head coach Sean Payton (one season), general manager Mickey Loomis (eight games) and assistant head coach Joe Vitt (six games), as well as the loss of draft picks.

“I think it was a really great decision,” said Robert Harbaugh, a neurosurgeon who is also a member of the NFL’s head, neck and spine committee. “The punishment had to be significant. Everybody knew things like there were going on and it shouldn’t be tolerated. This was investigated thoroughly and they made the right decision. I hope this puts an end to it.”

NFL commissioner Roger Goodell is going a step further than just punishing those involved in the bounties that took place the previous three seasons in New Orleans: All 32 teams must certify in writing by March 30 that they don’t have a bounty system in place.

“Bounty programs have no place in our game,” Goodell said in a statement. “They are incompatible with our efforts to promote sportsmanship, fair play and player safety.”

This week’s decision — and the possible punishments for the individual players involved — hasn’t been universally lauded, even by those who have lasting effects from the playing pro football like Dave Pear.

“It’s just a PR stunt,” said Pear, a former lineman and retired player advocate who underwent a hip replacement six weeks ago. “Knowing that declaring bounties on other players (will result in suspensions) is all well and good. Still, the nature of the sport is violent. The biggest concern right now for the league is the lawsuits over brain injuries.”

About 300 lawsuits have already been filed by former NFL players over traumatic brain injury, some going so far as to sue equipment manufacturers along with the league.

Whatever the motivations, Lisa Gfeller likes the message the sanctions sent. Her son, Matthew, was killed after a helmet-to-helmet hit during a high school football game in North Carolina in 2008.

“Everything starts with the NFL,” Gfeller said. “The younger players and their families look up to the NFL. Whatever the league does trickles down to the lower levels. It’s good to see the commissioner take charge. I really hope the he continues with that trajectory.”

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From ABC News:

Older adults with high body mass index, or BMI, and big bellies are more likely to have lower cognitive function than those with a lower BMI.
The study, published in the journal Age and Aging, included 250 people older than 59 who underwent a variety of weight measurement, scans and cognitive performance tests. People between 60 and 70 with the highest BMIs were linked to the lowest cognitive function.
The Korean study showed a particular association between visceral fat, or fat around the torso, and poor mental performance.
“Aging is characterized by lean body mass loss and adipose tissue increase without weight gain, which may not be captured by BMI, and traditional adiposity measures like BMI are less useful in elderly persons,” said Dr. Dae Hyun Yoon, associate professor of psychiatry at Seoul National University Hospital.
Study results changed in adults older than 70, and the high BMI and large weight circumferences were not associated with cognitive decline.
“A higher BMI is related to lower dementia risk in the oldest old. It is possible that persons with low BMI lost their weight because of premorbid dementia,” Yoon said. “It is also possible that a low BMI is the consequence of hyperinsulinemia (high insulin levels), which precedes weight loss and is related to higher dementia risk.”
Dr. Ken Fujioka, director of the Center for Weight Management at Scripps Clinic in San Diego, said the results make sense and are on par with what he sees clinically.
“As patients gain central obesity – that is the key – they increase their level of inflammatory agents and atherosclerotic agents that will wreck havoc on the brain,” Fujioka said.
While it is unclear whether the participants in the study went on to develop dementia or Alzheimer’s disease, past research has shown that excess fat might play a role in a person’s cognitive decline.
“The prevention of obesity, particularly central obesity, might be important for the prevention of cognitive decline or dementia,” Yoon said. “In participants aged 70 years and older, high BMI, waist circumference, and visceral and subcutaneous adipose tissue area, were not associated with poor cognitive performance.”

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It was mid-October 2011 and first platoon had already been fighting for its life for a few days. The 10 Afghans and 26 Americans had withstood repeated assaults by an estimated 300 to 500 insurgents who had crossed the border from bases in Pakistan. Fighters got within five meters of the platoon's battle positions — with some coming through the perimeter wire. They almost overran the position four times — something that has happened before in Kunar province, with deadly consequences. Now the insurgents had the position dialed in on their 82mm mortars.

"Sgt. Sanes got hit with two rounds simultaneously on his position within five meters," platoon Staff Sgt. Anthony Fuentes told TIME a few days after the fight. The rounds landed just as an Afghan Army sergeant was firing a recoilless rifle. The blast knocked him to the ground and his round exploded inside their position. After that, "our weapons squad leader [Sanes] was giving fire commands to a rock. That's what happened in our case. They got nauseous, they couldn't vomit (but they wanted to), they couldn't focus and they had double vision," says Fuentes.

His eyes still somewhat glassy after coming off the mountaintop position of Outpost Shal just four days before, Staff Sgt. Michael Sanes said, "I was a little out of it and I was screaming for my [machine] gunner to get back on the gun and shoot. I was like... 'shoot and shoot,' and he was already shooting. I was a little out of it from the blast. I got my bell rung." It was Sanes' third combat tour. The heavy fighting to take the mountaintop position lasted some eight days and the platoon had to call in multiple danger close artillery missions and airstrikes in which heavy ordnance was dropped within 300 meters of their positions.

The pounding that Sanes and his men took may have been intense but multiply it by hundreds and thousands of incidents over a range of severity and you have the potential causes for what may be a murkily diagnosed set of symptoms affecting U.S. servicemen and veterans. Rep. Bill Pascrell (D-N.J.), co-chairman of the Congressional Brain Injury Task Force, has called Traumatic Brain Injury (TBI) "the signature injury of the wars in Iraq and Afghanistan." Though no clear statistics exist for TBI, it is estimated that there are between 115,000 and 400,000 veterans who now suffer from at least mild versions of it.

TBI may have a role in the case of staff sergeant Robert Bales who allegedly killed 16 civilians. According to his Seattle lawyer, Bales supposedly suffered a concussive brain injury. He reportedly lost part of a foot in another battle-sustained injury. The sergeant was averse to returning to duty, said the lawyer, who described his client as "decorated." Bales, the lawyer said, had just seen his best friend lose a leg the day before. Sources talking to the New York Times described the suspect as having marriage, alcohol and stress related problems and "just snapped." The lawyer, however, denied that alcohol and marital issues were involved in the incident.

On Tuesday, Rep. Pascrell sent a letter on Tuesday to Secretary of Defense Leon Panetta seeking information on the staff sergeant's injury, diagnosis and treatment. "Over the years I have become increasingly concerned about that the [Defense] Department's system for identifying service members with traumatic brain injuries has not been working," Pascrell wrote. "It is critical that we know whether the systems the Department has in place to identify these injuries and provide treatment are adequate and that the needs of our injured soldiers are being properly met," The Star-Ledger reported.

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The aftermath of last week’s killing of 16 Afghans has prompted a flurry of speculation into the mind of 38-year old U.S. combat staff sergeant Robert Bales. In particular, the injuries to it.Traumatic brain injuries are so common among today’s troops that the military has spent over $42 million for a test to detect them, a test that Bales most likely took before his final deployment to Afghanistan. The problem is, that test has failed miserably.

More than a million soldiers have taken the 20 minute computerized test, known as the Automated Neuropsychological Assessment Metrics, or ANAM test. But as we reported last year in a ProPublica investigation, the test has been heavily criticized as an ineffective tool to detect brain injuries.

Many news outlets, including the New York Times, have cited military officials saying Bales was treated for a traumatic brain injury during his past deployments in Iraq. Bales was reportedly injured in Iraq when his vehicle rolled over. The Army Medical Command would not comment on any specifics of Bales’ medical history or testing, but spokeswoman Maria Tolleson said that Joint Base Lewis-McChord, where Bales was stationed, was fully operational with the ANAM testing program.

“It would be expected that a deploying Army service member from that base would have a pre-deployment cognitive baseline completed,” said Tolleson.

Problems have plagued the test since its introduction. Critics charge the military chose the test through a biased selection process and then ignored years of warnings that the test was fraught with problems. They also say the military has not administered the test properly.

Soldiers are meant to take the test twice – once before deployment and then again after a suspected head injury. Soldiers must answer a series of questions that score basic thinking abilities such as reaction time, short-term memory and learning speed. In theory, the initial test serves as a baseline to compare the results of the second test; a discrepancy signals a possible injury and the need for more evaluation.

But the test – which a former Army surgeon general has called no better than a “coin flip” – is rarely implemented that way. The Army was so unconvinced of the test’s accuracy that it issued an order not to send soldiers with a troublesome score for further medical evaluation.While there is no scientific consensus on the best test for traumatic brain injuries, alternatives do exist. Both the Army Special Forces and the National Hockey League chose a different test, called ImPact. Researchers are also developing new technologies to detect brain injuries, but right now the ANAM test remains the prime military TBI test.

The precise nature of Robert Bales’ brain injuries and subsequent testing is one issue, but linking his injuries to his outburst of violence is another matter altogether.

Scientists have not established any clear-cut connection between traumatic brain injures and later violence. This article from Wired explores some of the most recent studies on the topic, while the Los Angeles Times breaks down the many interacting factors that make drawing a clear line from injury to violence nearly impossible.

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For every victim of Alzheimer's -- about 5.4 million U.S. seniors -- there is an exhausted, lonely caregiver, but researchers say yoga may help.

Dr. Helen Lavretsky, professor of psychiatry at the University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, and colleagues said the study involved 49 family caregivers who cared for a relative with dementia ages 45-91 -- including 36 adult children and 13 spouses.

The participants were randomized into two groups. A meditation group was taught a brief, 12-minute yogic practice that included an ancient chanting meditation, Kirtan Kriya, which was performed every day at the same time for eight weeks. The other group was asked to relax in a quiet place with their eyes closed while listening to instrumental music on a relaxation CD, also for 12 minutes every day at the same time for eight weeks.

After eight weeks, the researchers found the meditation group showed significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning, compared with the relaxation group. The meditation group showed a 43 percent improvement in telomerase activity -- slower aging and improved immune cell longevity -- compared with 3.7 percent in the relaxation group.

"We know that chronic stress places caregivers at a higher risk for developing depression. On average, the incidence and prevalence of clinical depression in family dementia caregivers approaches 50 percent," Lavretsky said in a statement. "Caregivers are also twice as likely to report high levels of emotional distress and have an increased rate of cardiovascular disease and mortality."

The findings were published in online edition of the International Journal of Geriatric Psychiatry.

Original source.

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Alex Grimes ascends the two-story climbing wall at the Center for Integrated Brain Health & Wellness with relative ease, quickly rappelling down so he can rise again.

His climb out of the anger, despair and pain after a brain injury while in the Army has been far more grueling – 3 1/2 long years so far.

Diagnosed with post-traumatic stress disorder as well, he's struggling with mood swings, nightmares and seizures as he juggles his treatment with classes at a local community college.

But now that Grimes has a refuge for therapy and counseling, he hopes he's finally found his footing in his recovery. "I'm trying to have a sense of normalcy," he told me. "I'm trying to find some sort of peace."

You can't help but be humbled hearing the stories of veterans like Grimes, and be impressed seeing their rehabilitation. That respect deepens when you think that precisely because of the kinds of wounds they suffered while protecting the rest of us, they could also help society now that they're finally home.

You also can't help but feel some outrage that it has taken so long for the government to get its act together to help vets with traumatic brain injury – the so-called signature wound of the Iraq and Afghanistan wars. It has victimized tens of thousands of the 2.4 million men and women who have fought over the last decade, but it took until the last few years to start properly diagnosing and treating a sizable number.

"Overall, it's gotten a lot better. But the fact remains they came too late to the party," says Tom Tarantino, deputy policy director for Iraq and Afghanistan Veterans of America.

Grimes, 24, suffered a non-combat head injury in 2008 and, after four years in the military, received a medical discharge in 2010. He says he didn't really get the treatment he needed until he came to the Martinez campus of the U.S. Department of Veterans Affairs.

Now, he's one of 350 veterans under care at the new $7.2 million brain health center. In military-speak, it is the "tip of the spear" in combating traumatic brain injury – a one-stop center for both treatment and research, focusing on milder cases. If there's a big breakthrough in the next few years, it could very well happen in the bland-looking building nestled in the hills of Martinez.

And because 1.7 million Americans a year suffer brain injuries from falls, car wrecks and the like – about three-fourths of them also with mild concussions – any advances could have much wider benefits.

In addition, some of the research under way could help scientists studying brain diseases such as Alzheimer's and Parkinson's.

Still, military combat is different. Long and repeated tours in Iraq and Afghanistan increased the risk of being exposed to roadside bombs and other blasts, even multiple times. The effects, especially over the long term, of the brain being rattled inside the skull by explosions are not very well understood; symptoms for vets with mild traumatic brain injury seem to last longer, 18 to 24 months on average.

"It's a difficult thing to get a complete handle on mild TBI," says Daniel Barrows, the TBI social worker at the center. "It's constantly a learning process."

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From MedScape:

Primary head injury can be catastrophic, but the effects of repetitive head injuries must also be considered. Second-impact syndrome (SIS), a term coined in 1984, describes the situation in which an individual sustains a second head injury before the symptoms from the first head injury have resolved.
The second injury may occur from days to weeks following the first. Loss of consciousness is not a requirement of this condition, the impact may seem relatively mild, and the athlete may appear only dazed initially. However, this second impact causes cerebral edema and herniation, leading to collapse and death within minutes. Only 17 cases of confirmed SIS have been reported in the medical literature. Thus, the true risk and pathophysiology of SIS has not been clearly established.
Importantly, even if the effects of the initial brain injury have already resolved (6-18 mo post injury), the effect of multiple concussions over time remains significant and can result in long-term neurologic and functional deficits. These multiple brain insults can still be termed repetitive head injury syndrome, but they do not fit the classification of SIS. True SIS would most likely have a devastating outcome.
A study of American high school and college football players demonstrated 94 catastrophic head injuries (significant intracranial bleeding or edema) over a 13-year period Of these, only 2 occurred at the college level. Seventy-one percent of high school players suffering such injuries had a previous concussion in the same season, with 39% playing with residual symptoms. On the other hand, results from a study of concussion by the National Football League demonstrated no cases of SIS or catastrophic head injury in players returning to play in the same game after resolution of symptoms.
Numerous studies of professional boxers have shown that repeated brain injury can lead to chronic encephalopathy, termed dementia pugilistica.  Likewise, the autopsies of 2 former professional football players with a history multiple concussions demonstrated changes that were consistent with chronic encephalopathy.
Another investigation of retired professional football players showed a 3-fold increase of depression in players with a history of 3 or more concussions. Older studies of American and Australian rules football showed no effect from repetitive mild head injuries. However, more recent studies of collegiate football players showed an association between multiple concussions and reduced cognitive performance, prolonged recovery, and the increased likelihood of subsequent concussions.

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Fort Hood has a new weapon against one of it's greatest challenges.
For the first time ever, soldiers with Traumatic Brain Injury (TBI) are being tested in virtual combat zones, where the very situations that caused their injuries are now helping them move forward.
SFC Jeremy Ricketts is among the first soldiers from Fort Hood's TBI Clinic to go through the new Warrior Readiness Assessment Program this week.
A convoy simulation is preparing him to rejoin his unit after a car accident in Iraq caused TBI, or a blow to the head that alters brain functions.
"The TBI is effecting my vision, my peripheral vision in and out, one of them doesn't focus properly, so now I got prescribed glasses," said Jeremy.
And if it hadn't been for this brand new program, he might never have pin-pointed the problem.
"The only way I understood about my eyes being bad is when I fired the rifle in the simulator, and my eye was not focusing left and right," said Jeremy.
Soldiers and therapists are already learning more about underlying problems for victims like Jeremy.
"There was some slowing in some of the decisions that they made, and they were actually able to self identify things they could brush up on, and so it was a really good assessment in having them do these functional activities," said the chief of Fort Hood's Traumatic Brain Injury Clinic, LTC Scott Mitchell.
It's all about making sure they're at the top of their game, so they can get back to doing what they do best.
"Just to give the soldiers the idea that even if they get injured that they're not broken, and that they can get better, that they know that they can get back and know they're back to the fight," said LTCMitchell.
Jeremy says he's relying on this new training to get there.
"With eagerness comes patience. I really depend on the TBI Clinic to give me that forward step, that confidence I need," he said.
Therapists are on hand during the exercises, in case they become stressful for the soldiers.
Go to

Now is it just me, or does anyone else see a problem with this? It's well known that once a person suffers a TBI, they are more likely to suffer another one. Also, "a 2009 study published by the American Journal of Public Health documents that troops who face multiple deployments are at a 300 percent increased risk of several mental health outcomes." So are they planning to deploy soldiers who've already had at least one TBI back into combat zones where they have an increased risk for another TBI? "...even if the effects of the initial brain injury have already resolved (6-18 mo post injury), the effect of multiple concussions over time remains significant and can result in long-term neurologic and functional deficits."  Check out our next post on Repetitive Head Injury Syndrome. 

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It’s difficult to know just how many of the two million people who have served in the wars in Iraq and Afghanistan have been afflicted with two common combat ailments, post-traumatic stress disorder (P.T.S.D.) and traumatic brain injury (T.B.I.). But a new study of six years of data from the Veterans Health Administration, published this month by the Congressional Budget Office, illuminates not just the extent of the treatment that is needed, but its costs.
In a sampling of nearly half a million veterans of the two wars, 21 percent had P.T.S.D., 2 percent had symptoms of T.B.I., and 5 percent had both. For a variety of reasons, it’s hard to extrapolate these rates to the entire group of those who served.
But the notable finding of the report is this: Taken together, the afflicted group’s first-year treatment costs ran four to six times as high as patients without these conditions.
From 2004 to 2009, the Veterans Health Administration spent $3.7 billion on the first four years of care for all the veterans tracked by the study. Sixty percent of that sum, or $2.2 billion, went for the care of patients with P.T.S.D. or T.B.I., or both. About half of that went for therapies specific to P.T.S.D. and T.B.I.
In the first year of treatment, the cost of treating a typical patient with P.T.S.D. averaged $8,300, one with T.B.I. $11,700, and one with both $13,800. The average cost of the first year’s treatment for a patient with neither diagnosis was $2,400.
In patients diagnosed with P.T.S.D., the first year of treatment with the P.T.S.D.-specific therapy averaged $4,100, or nearly half of the $8,300 spent in total. In the second, third and fourth years of treatment, the average costs per patient went down, but the P.T.S.D. therapy continued to account for about half. The same pattern prevailed generally for patients with T.B.I. or with both problems – the highest costs come in the first year of treatment, costs generally decline in the next few years (once some technical wrinkles in the data are ironed out) and a significant portion of overall treatment costs are for these two conditions.
Total treatment costs were much higher, as would be expected, in one subset of about 500 patients whose injuries were much more far-reaching and who were treated as inpatients at a polytrauma rehabilitation center – about $136,000, on average, in the first year, $42,000 in the second year, $27,000 in the third year, $28,000 in the fourth year. About 95 percent of this group received treatment for P.T.S.D. or T.B.I. And in the polytrauma group, just as in the general Veterans Health Administration population, therapies for P.T.S.D. and T.B.I. accounted for 60 percent of total health care costs.

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From The Chicago Tribune

Former Chicago Bear Dave Duerson’s family today sued the NFL over his suicide last year, claiming the league for decades had known that concussions from playing football cause brain damage but deliberately concealed that information from players, coaches and fans.

Duerson, a Pro Bowl safety, sustained at least three concussions during his 11-year playing career and suffered from progressive, advanced brain damage known as chronic traumatic encephalopathy, or CTE, according to the lawsuit.

“If the NFL would have taken the necessary steps to oversee and protect Dave Duerson by warning him of the dangers of head traumas. . .then (he) would not have suffered dangerous repetitive head trauma, would have recovered more rapidly, and would not have sustained permanent damage to his brain which contributed to his death,” according to the suit.

The suit, filed in Cook County Circuit Court, also identifies six former players who reportedly suffered brain damage from playing football and later committed suicide.

The family’s lawyer, Thomas Demetrio, of the Corboy and Demetrio law firm, said players should pay attention to what happened to Duerson and others who played football.

“Current coaches, trainers and players from the NFL down to the Pee Wee level, need to take heed—avoid concussions as best they can, recognize their significance and when in doubt, sit out,” Demetrio said. “And by all means, don’t simply say “my toe hurts” when it’s really your head.”

Demetrio’s comments were targeted at the tough mind set of players like Bears linebacker Brian Urlacher, who earlier this year told HBO that he would hide concussion symptoms from team doctors.

"If I have a concussion these days, I'm going to say something happened to my toe or knee just to get my bearings for a few plays," he said. "I'm not going to sit in there and say I got a concussion, I can't go in there the rest of the game."

Duerson’s second oldest son, Tregg, is representing his father’s estate in the suit against the NFL and co-defendant Riddell Inc., which provides helmets to most of the league’s players. The suit alleges Riddell failed to warn players that its helmets would not prevent concussions.

The Duerson family suit is the latest in a stepped up legal fight between retired players and their families against the NFL.

More than a dozen suits have been filed around the country since the summer against the NFL and helmet makers. Several of those suits similarly allege that the NFL hid information about the harmful effects to the brain from repeated hits to the head.

Continue reading.

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From Wired:

The “signature wounds” of the wars in Iraq and Afghanistan — post-traumatic stress disorder and traumatic brain injury — are both rooted in traumatic events. Until recently, though, military docs mostly treated them as two different health problems: one physical, the other psychological. That approach might be poised to change, thanks to a new study, which shows that injuries to a specific part of the brain “primed” it for PTSD’s psychological ailments.
Post-traumatic stress disorder is widely known as the psychological condition that’s followed soldiers home from Iraq and Afghanistan. The connection between war and PTSD is simple enough: Soldiers undergo a traumatic experience, if not several, overseas. Those traumas stay with them, and seem to have a profound impact on their stress hormones and brain chemistry. The result? Symptoms like nightmares, paranoia and angry outbursts.
In comparison, traumatic brain injuries (TBIs) seem extremely different. These injuries are caused by a physical trauma — an IED attack, for example — that actually rattles the brain inside the skull. Subsequent brain damage can cause everything from vomiting and headaches to long-term loss of sensation and speech impediments.
Scientists have known for a while that TBIs and PTSD are connected. One 2008 study concluded that 44 percent of personnel with a TBI also suffered from PTSD, compared to 9 percent of those without physical injury. Of course, the link seems obvious: It follows that driving a Humvee that’s suddenly blown to pieces will rattle the skull and also trigger psychological distress.
But researchers now suspect that the link goes even further: They’ve concluded that the physical blow from a TBI changes a key part of the brain, making a soldier more at risk of developing PTSD in the future.

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From The Alzheimer's Society:

Global health expert Professor Peter Piot will announce dementia is one of the largest global health challenges and call for the condition to become a top world health priority. 

Professor Piot, Director of the London School of Hygiene and Tropical Medicine, former Under-Secretary General of the United Nations and former Executive Director of UNAIDS, will take to the world stage at the opening ceremony of the Alzheimer's Disease International (ADI) conference. He will challenge the World Health Organisation to declare dementia a health priority alongside cancer, diabetes, lung disease and heart disease. He will also call for a UN General Assembly special session on mental health and dementia, and ask world leaders to sign up to an action plan to transform millions of lives.
Professor Piot said:
'Dementia is one of the largest neglected global health challenges of our generation, with 36 million people living with the condition today. By 2050 115 million people - almost twice the current population of the UK - will be living with dementia worldwide. What we must learn from the AIDS movement is that by investing now, we will save later. Having a global action plan to defeat dementia is the first step to making a difference to millions of people.'
The action plan proposed by ADI will call on leaders of the world's nations to commit to the following:
  1. Invest in research and coordinate research efforts with other countries
  2. Educate the public and health practitioners to ensure they recognise the signs of dementia. Provide information, support and access to treatment to ensure people can live well with dementia
  3. Record diagnosis rates in their own countries to create an accurate picture of dementia
  4. Conduct coordinated studies on the economic and social impact of dementia
  5. Develop and share health strategies to help people reduce their risk of developing dementia.

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