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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
True, athletic brain injury isn't really a laughing matter -- even expressed in the dry, dry, dry manner of the Saturday Morning Breakfast comic strip. (See the full strip here.)

But you do have to wonder sometimes what's going through the heads not of injured players, but of some college and professional sports administrators and spokesmen. You know, the ones who talk about the importance of their athletic programs, while talking around the by now well-known consequences of repeated blows to the head. Maybe a little laughter would help these benighted souls understand the absurdity of their positions?

The latest NFL player tragedy, coincidentally, played out just a couple of days before the release of a new study. Researchers at Boston University School of Medicine studied the brains of deceased military and football players [abstract]. From CNN:
A study published [December 3] in the journal Brain, the most comprehensive look at CTE [chronic traumatic encephalopathy] published thus far, adds fuel to the discussion, especially as it relates to professional football players

Of the 35 players, 34 of them at the professional level, who had brain tissue sampled posthumously for the study, all but one showed evidence of disease.

CTE begins when repeated blows to the brain are not allowed to heal. With each successive blow, damage builds and a dense, abnormal protein called tau accumulates.

In its later stages, CTE can lead to things like rage, aggression, paranoia, and suicidal thoughts.
It's true that we won't have a chance to study Jovan Belcher's brain. It may be true (or not) that his girlfriend had recently told him he wasn't the father of her child. And maybe in the law's eyes, none of that matters: all that matters is that Belcher's finger pulled the trigger.

But every football player's violent, off-the-field death tacks another big question mark to the claims that football and similar sports do nothing but good for the players (and ultimately the sport). If these people -- the apologists -- were majoring at their own campuses in basic logic, they'd have flunked out long ago. Maybe it's time for a study of their brains: maybe the repeated blows of bad news and contrary facts have simply rendered them unable to connect the dots between A and B. Maybe they're the ones who need the helmets?

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Feeling lonely, as distinct from being/living alone, is linked to an increased risk of developing dementia in later life, indicates research published online in the Journal of Neurology Neurosurgery and Psychiatry.

Various factors are known to be linked to the development of Alzheimer's disease, including older age, underlying medical conditions, genes, impaired cognition, and depression, say the authors.

But the potential impacts of loneliness and social isolation -- defined as living alone, not having a partner/spouse, and having few friends and social interactions -- have not been studied to any great extent, they say.

This is potentially important, given the aging population and the increasing number of single households, they suggest.

They therefore tracked the long term health and wellbeing of more than 2000 people with no signs of dementia and living independently for three years.

All the participants were taking part in the Amsterdam Study of the Elderly (AMSTEL), which is looking at the risk factors for depression, dementia, and higher than expected death rates among the elderly.

At the end of this period, the mental health and wellbeing of all participants was assessed using a series of validated tests. They were also quizzed about their physical health, their ability to carry out routine daily tasks, and specifically asked if they felt lonely. Finally, they were formally tested for signs of dementia.

At the start of the monitoring period, around half (46%; 1002) the participants were living alone and half were single or no longer married. Around three out of four said they had no social support. Around one in five (just under 20%; 433) said they felt lonely.

Among those who lived alone, around one in 10 (9.3%) had developed dementia after three years compared with one in 20 (5.6%) of those who lived with others.

Among those who had never married or were no longer married, similar proportions developed dementia and remained free of the condition.

But among those without social support, one in 20 had developed dementia compared with around one in 10 (11.4%) of those who did have this to fall back on.

And when it came to those who said they felt lonely, more than twice as many of them had developed dementia after three years compared with those who did not feel this way (13.4% compared with 5.7%).

Further analysis showed that those who lived alone or who were no longer married were between 70% and 80% more likely to develop dementia than those who lived with others or who were married.

And those who said they felt lonely were more than 2.5 times as likely to develop the disease. And this applied equally to both sexes.

When other influential factors were taken into account, those who said they were lonely were still 64% more likely to develop the disease, while other aspects of social isolation had no impact.

"These results suggest that feelings of loneliness independently contribute to the risk of dementia in later life," write the authors.

"Interestingly, the fact that 'feeling lonely' rather than 'being alone' was associated with dementia onset suggests that it is not the objective situation, but, rather, the perceived absence of social attachments that increases the risk of cognitive decline," they add.

They suggest that loneliness may affect cognition and memory as a result of loss of regular use, or that loneliness could itself be a sign of emerging dementia, and either be a behavioural reaction to impaired cognition or a marker of undetected cellular changes in the brain.

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From the Daily Mail:

Doctors are using broken wrists to diagnose dementia in elderly patients.

They say brain impairment caused by conditions like Alzheimer's make falling over more likely, yet many older people with broken bones remain undiagnosed.

They often get advice on how to strengthen their bones, but little effort is made to identify problems with dementia, it is claimed.

In a pilot project at Southampton General Hospital, patients over 70 who fracture bones in a fall but do not need to stay in hospital admission are sent from the emergency department to be seen by a team of orthopaedic, osteoporosis and elderly care specialists.

As well as treatment for broken wrists, arms and shoulders, patients are given a basic physical and mental assessment to find out why they are falling to minimise their future risk and prevent more serious fractures of the hips or spine.

There are currently 75,000 cases of hip fracture in the UK every year among people of an average age of 80 years, but experts believe this could be cut by earlier intervention looking at a whole range of health problems.

Dr Mark Baxter, a consultant in elderly care and bone health who is co-leading the initiative at Southampton, said 'About 40 per cent of people who have a hip fracture have got dementia or some form of cognitive dysfunction and, of them, a significant proportion are not diagnosed, probably more than 25 per cent.

'We also know around half of all hip fracture patients have fractured bones before, and between 25 and 30 per cent of all people who break their hip die within a year, so it is clear these patients are extremely vulnerable and, based on current statistics, in need of much wider intervention than they currently receive.' 

Following a full assessment by a consultant geriatrician, those who show signs of being at high risk of falling over again are referred directly to the falls service and, if required, to a specialist dementia clinic.

Simon Tilley, a consultant orthopaedic surgeon and joint project lead, said 'We are going to treat these patients' wrist or shoulder fractures, but the knock-on effect will be that we hope to prevent the more serious and life-threatening fractures later on.

Continue reading.

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From McKnight's Long-Term Care News and Assisted Living:

Some veterans who suffered traumatic brain injuries will have easier access to care through new regulations announced Friday by the Department of Veterans Affairs. Parkinson's disease, unprovoked seizures, some dementias, depression and hormone deficiency diseases related to several glands will be eligible for the expanded benefits. The regulations were set to be published in the Federal Register today.

The new rule could speed up and simplify cases. The proposal, which requires a 60-day public comment period, could open the door for tens of thousands of veterans to file treatment claims with the Veterans Benefits Administration.

More than 250,000 service members — including some on active duty — have received diagnoses of traumatic brain injury (TBI) since 2000, according to the Defense Department. The causes of TBI include blast exposure, vehicle crashes, training accidents and sports injuries.  Currently, veterans need to provide medical evidence that their illness was caused by military service. About 51,000 military personnel receive benefits for service-connected traumatic brain injuries. Veterans of prior conflicts also will be eligible under the new regulations.

The regulations include several major restrictions. Veterans who suffer from Parkinson's, unprovoked seizures, dementias and hormone deficiency diseases will qualify only if their traumatic brain injury was moderate or severe. Only about 2 in 10 are diagnosed at that level.

The new proposal also includes time limits for dementia, hormone deficiency and depression claims.

In a news release, the VA cited a 2008 Institute of Medicine study that concluded that evidence linking mild TBI to the diseases was “limited or suggestive.”

The last time the department significantly expanded benefits — in 2010, for several diseases linked to the Vietnam War defoliant Agent Orange — it prompted a an overflow of new claims. The department has cleared most of those, but still has nearly 900,000 pending claims. VA officials said they do not plan to add extra personnel or have an extreme influx of claims due to the new rule.

Link to McKnight's Long-Term Care and Assisted Living

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From the Chicago Tribune:

Vitamin D and calcium supplements taken together in low doses offered no protection against dementia in a large U.S. study of older women, but scientists are still holding out hope for vitamin D alone.

Past research has suggested that vitamin D might protect against memory loss and overall functional decline in the aging brain, but more than 2,000 women in the study who took 400 international units of vitamin D and 1,000 mg of calcium daily for an average of eight years developed cognitive impairments at the same rates as a comparison group on placebo pills.

But the study's authors, whose report appeared in the Journal of the American Geriatrics Society, said that during the many years of the study researchers gained a better understanding of how calcium and vitamin D might have conflicting effects, so the combination of the two might explain the disappointing results.

"I think the definitive study will just look at the effects of vitamin D," said lead author Rebecca Rossom, from HealthPartners Institute for Education and Research, a nonprofit arm of a health maintenance organization based in Minnesota.

But she added that the current study is still important because it "gets closer to how women take vitamin D now" to build bone density.

Rossom and her colleagues analyzed data on 4,100 women who were simultaneously enrolled in two trials, including the Women's Health Initiative (WHI) Calcium and Vitamin D trial that ended in 2005, and a WHI memory study.

All of the women, who averaged 71 years old at the outset of the studies, were also free of cognitive problems to start.

Half of the women were assigned to take the supplements, and the rest were given identical-looking dummy pills.

Ultimately, about 100 women, or five percent, in each group developed mild cognitive impairment - a term that can include everything from memory trouble to the serious dementia found in Alzheimer's disease.

The researchers noted that since the study ended, guidelines on vitamin and mineral intakes have changed, Currently the U.S. Institute of Medicine suggests getting 600 IUs per day of vitamin D for men and women up to age 70, and 800 IUs for older people. Suggested calcium ranges from 700 mg to 1,300 mg per day, based on age, with an upper limit of 3,000 mg.

In both cases, intake recommendations cover both food and supplement sources. So, the authors say, their findings are specific only to the assigned amounts of vitamin D and calcium taken by women in the study - which are relatively low by today's standards.

"The sum of information does show conflicting evidence," said Katherine Tucker of Northeastern University, who was not involved in the study.

"Some recent studies suggest that too much calcium could have negative effects. The preponderance of evidence shows that vitamin D is protective, but some studies have shown no effect," she told Reuters Health.

Rossom's team acknowledges their study's limitations. In addition to the doses of supplements, the results are strictly limited to women, who were mostly white. Also, the study participants were relatively young.

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From USA Today:

Doctors are studying the causes of memory problems reported by cancer survivors


Two new studies are reviving debate over the causes of "chemo brain," a mental fog that affects up to 75% of cancer survivors.

Cancer patients for decades have complained of feeling forgetful or mentally fuzzy, with many blaming toxic chemotherapy regimens. While the problem feels very real to patients, some doctors have dismissed the issue as imaginary.

Now, new research shows evidence of mental fog in women's brain scans.

A study presented last week at a meeting of the Radiological Society of North America found that chemo can cause brain changes that affect memory and concentration.

Researchers studied 128 breast cancer patients who complained of chemo brain, scanning their brains both before and after treatment, according to the study, presented by Rachel Lagos, a radiology resident at the West Virginia University School of Medicine.

Researchers used tests called PET/CT scans, or positron emission tomography, which captures brain activity by measuring how quickly it uses energy. CT scans, or computed tomography, use multiple X-rays to provide detailed pictures.

Lagos and her colleagues found declines in brain activity in areas involved with long-term memory, as well as problem solving, organizing and prioritizing. "Every single person showed change," Lagos says.

About 20% of cancer survivors complain of persistent memory problems, long after treatment ends, according to the National Cancer Institute. Patients with demanding professional jobs are more likely than others to complain of memory problems.

Scientists so far don't know for sure what might cause these symptoms.

Doctors such as Patricia Ganz, of UCLA's Jonsson Comprehensive Cancer Center, are studying the role of inflammation both in chemo brain and cancer-related fatigue. Her research has found that many women who complain of mental fog also suffer fatigue, depression and sleep problems.

A study by Tim Ahles, of New York's Memorial Sloan-Kettering Cancer Center, suggested that women may be more susceptible to chemo brain if they carry a form of a gene linked to Alzheimer's disease. It's also possible that memory problems and cancer have common risk factors, giving patients a greater chance of both.

Reaction to Lagos' study among breast cancers survivors has been dramatic. She received 800 e-mails from cancer survivors within a day of presenting her findings. Many were relieved that a doctor had confirmed their symptoms were real, Lagos says.

"People I'd never met where sharing their experiences. It was heartbreaking," Lagos says. For patients, being told that their symptoms aren't real "can be even worse than getting the diagnosis in the first place, because people think, 'Oh, I'm crazy.'"

A small study presented today at the annual San Antonio Breast Cancer Symposium, however, suggests that chemo may not be to blame for the women's memory impairments.

That's because women who complained of chemo brain had lower scores on memory tests even before treatment, says researcher Bernadine Cimprich, of the University of Michigan School of Nursing. Her study of 99 people used functional MRIs, or magnetic resonance imaging. Women diagnosed with cancer scored worse than healthy women in a comparison group, both before and after patients' treatment.

Her findings are consistent with earlier studies, which have found that 20% to 30% of patients have lower-than-expected scores, even before chemo.

Women who underwent chemo reported more fatigue than other women, even before receiving the drugs, Cimprich say. The more exhausted women felt, the worse their scores.

That suggests that at least some of the women's memory problems could have been caused by the stress and sleeplessness of being diagnosed with cancer, Cimprich says.

Studies show that other cancer therapies, such as a hormonal drug called tamoxifen, also can cause fatigue, according to the NCI.

Early menopause, which can be caused by chemotherapy or surgery to remove the ovaries, also can cause memory problems, says oncologist Claudine Isaacs, of Georgetown's Lombardi Comprehensive Cancer Center. Hot flashes caused by medications or early menopause can make women lose sleep, affecting their memory.

Cancer centers might be able to relieve women's symptoms by offering more psychological support, Cimprich says, as well as cognitive behavior therapy and mindfulness activities, which can include meditation. Exercise also has been shown to relieve fatigue and give people more energy.

Lagos says women can also cope with their mental fog by making lists and plans. For example, women in an earlier study felt overwhelmed by the task of organizing and cooking a meal.

But the same women were able to function much better after researchers gave them written menus, which helped the women focus their grocery shopping and meal preparation, Lagos say.

"It's critically important to understand the side effects of therapy and minimize them," Isaacs says. "We don't want women to say no to very important therapy because of this."

Link to USA Today.

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From the Huffington Post:


Jovan Belcher, a linebacker for the Kansas City Chiefs shot and killed his girlfriend in front of his mother on Saturday morning (December 1, 2012), and then drove to the Chief's practice facility where he killed himself in front of head coach Romeo Crennel and general manager Scott Pioli in the parking lot. Belcher left behind a 3-month-old baby girl.

What makes this story especially troubling is that Belcher does not fit the typical profile for domestic violence -- not by a long shot. Before being drafted into the NFL, Belcher graduated with a degree in child development and family relations from the University of Maine. While at Maine Belcher joined the anti-violence group Male Athletes Against Violence. As a member of MAAV, Belcher would have signed a pledge which included these lines:


I pledge:
to educate myself on issues surrounding violence while developing personal beliefs against the use of violence
to be a positive role model for my community
to look honestly at my actions in regard to violence and make changes if necessary


Shocked at the news, Belcher's former University of Maine football coach Jack Cosgrove reflected, "I'm hard-pressed to find or recall a young man who had more of an impact in a positive way on his teammates and his football family in my time here. He's truly one of the great stories in the program's history."

Similarly, Belcher's former High School coach Ron Langella said,"He was a good athlete, but an even better person. An unbelievable role model."

So what went wrong? What could cause someone like Belcher to resort to such shocking acts of violence? What could turn such an inspiring role model into a killer?

One possible explanation is traumatic brain injury (TBI), a condition that frequently affects professional football players.

Traumatic brain injury can cause emotional, social, or behavioral problems and changes in personality including disinhibition, inability to control anger, and impulsiveness. Additionally, TBI appears to predispose survivors to psychiatric disorders including substance abuse and clinical depression. According to a study published in the Psychiatric Times, suicidal ideation is not uncommon, and rates of suicide after TBI are increased 2- to 3-fold.

All of this fits with reports surfacing in the aftermath by friends of Belcher claiming that the linebacker was drinking every day and taking painkillers while dealing with the effects of debilitating football-related head injuries.

The combination of traumatic brain injury, alcohol, and handguns make for a deadly combination that not only may be behind Belcher's murder-suicide, but has also been linked to an alarming trend of suicides and violent crime among soldiers returning from combat. Again, we find the same scenario: Good kids who suddenly "crack" and become violent.

While personal responsibility should always play an important role in this type of discussion, it is critical to understand that TBI impairs the brain's ability to make those kinds of moral choices. So we need to seriously ask: Did football injuries turn Belcher into a killer? If so, what needs to change in the NFL to avoid such tragedies in the future?

As Sports Illustrated reports, this past Wednesday -- ironically, just days before the tragic events of this weekend -- former Kansas City Chiefs players and Army leaders said that a change in culture regarding the risks of concussions must start at the top levels in sports and the military.

Their point was tragically underscored by the deadly events of this past Saturday. As more details surface, we will hopefully be able to form a better understanding of what happened, but we should be hesitant to write this off as a case of "one bad apple," avoiding the larger conversation we need to have. When it comes to sports and TBI, peraps it's time we asked ourselves some tough questions about how much are we willing to sacrifice for our entertainment.

Link to the Huffington Post.

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From the New York Times:

The growing evidence of a link between head trauma and long-term, degenerative brain disease was amplified in an extensive study of athletes, military veterans and others who absorbed repeated hits to the head, according to new findings published in the scientific journal Brain.

The study, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury, added to the mounting body of research revealing the possible consequences of routine hits to the head in sports like football and hockey. The possibility that such mild head trauma could result in long-term cognitive impairment has come to vex sports officials, team doctors, athletes and parents in recent years.

Of the group of 85 people, 80 percent (68 men) — nearly all of whom played sports — showed evidence of chronic traumatic encephalopathy, or C.T.E., a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.

Among the group found to have C.T.E., 50 were football players, including 33 who played in the N.F.L. Among them were stars like Dave Duerson, Cookie Gilchrist and John Mackey. Many of the players were linemen and running backs, positions that tend to have more contact with opponents.

Six high school football players, nine college football players, seven pro boxers and four N.H.L. players, including Derek Boogaard, the former hockey enforcer who died from an accidental overdose of alcohol and painkillers, also showed signs of C.T.E. The study also included 21 veterans, most of whom were also athletes, who showed signs of C.T.E.

The study was conducted by investigators at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, in collaboration with the Sports Legacy Institute. It took four years to complete, included subjects 17 to 98 years old, and more than doubled the number of documented cases of C.T.E. The investigators also created a four-tiered system to classify degrees of C.T.E., hoping it would help doctors treat patients.

The volume of cases in the study “allows us to see the disease at all stages of severity and how it starts and spreads in the brain, which gives us an idea of the mechanism of the injury,” said Ann McKee, the main author of the study, who is a professor of neurology and pathology at Boston University School of Medicine and works at the V.A. Boston.

Those categorized as having Stage 1 of the disease had headaches and loss of attention and concentration, while those with Stage 2 also had depression, explosive behavior and short-term memory loss. Those with Stage 3 of C.T.E., including Duerson, a former All-Pro defensive back for the Chicago Bears who killed himself last year, had cognitive impairment and trouble with executive functions like planning and organizing. Those with Stage 4 had dementia, difficulty finding words and aggression.

Despite the breadth of the findings, the study, like others before it, did not prove definitively that head injuries sustained on the field caused C.T.E. To do that, doctors would need to identify the disease in living patients by using imaging equipment, blood tests or other techniques. Researchers have not been able to determine why some athletes who performed in the same conditions did not develop C.T.E.

The study also did not demonstrate what percentage of professional football players were likely to develop C.T.E. To do that, investigators would need to study the brains of players who do not develop C.T.E., and those are difficult to acquire because families of former players who do not exhibit symptoms are less likely to donate their brains to science.

“It’s a gambler’s game to try to predict what percentage of the population has this,” said Chris Nowinski, a co-author of the study and a co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. “Many of the families donated the brains of their loved ones because they were symptomatic. Still, this is probably more widespread than we think.”

Researchers expected the details in the study to dispel doubts about the likelihood that many years of head trauma can lead to C.T.E. The growing connections between head trauma and contact sports, though, have led some nervous parents and coaches to assume that any concussion could lead to long-term impairment. Some doctors say that oversimplifies matters. Rather, the total amount of head trauma, including smaller subconcussive hits, as well as how they were treated, must be considered when evaluating whether an athlete is more at risk of developing a disease like C.T.E.

“All concussions are not created equal,” said Robert Cantu, a co-author of the study and a co-director of the encephalopathy center. “Parents have become paranoid about concussions and connecting the dots with C.T.E., and that’s wrong. The dots are really about total head trauma.”
Link to images of brain injuries in athletes. 

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If you're a repeat visitor to Jack Sisson's Traumatic Brain Injury or Life Ethics blogs, you'll notice some changes over the next several weeks. We're bringing the "look and feel" of the two blogs into alignment with the rest of Jack's site, which recently underwent a complete overhaul. At first the changes will be superficial: background colors, fonts, and so on. When we're done, the menu across the top will be remade, and repositioned down the left-hand side. The sidebar menu on the right side will change significantly, and perhaps be removed altogether.

Most important: the content will not be changing. Each blog will continue to focus on the same issues as always.

Thanks so much for continuing to visit sossisson.com!

 

From EmpowHer:


That poor oral health can cause bad breath, cavities and rotting teeth shouldn’t come as a surprise. An article published by Reuters suggests a link between poor dental health and dementia.

According to a study done by the University of California, “those who reported brushing their teeth less than once a day were up to 65 percent more likely to develop dementia than those who brushed daily.”

In the study it was found that participants who have dementia also have a significantly higher percentage of gum disease bacteria in their brain than those who don’t suffer from it.


The dementia study was also discussed in the United Kingdom, where the details of the study were discussed more thoroughly.

“The researchers found that men who had poor chewing function and did not wear dentures … had a 91% increased risk of dementia compared with men who had enough natural teeth to allow adequate chewing,” the study suggests.

According to United Kingdom's Alzeimer's Society, "There are two main types of dental disease - gum (periodontal) disease and tooth decay (dental caries, more commonly known as cavities). Both can cause discomfort or pain and can lead to the development of infection. Both pain and infection can worsen the confusion associated with dementia."

Women generally brushed their teeth at least once a day. It was found that those who brushed multiple times a day had slimmer percentages of dementia, the 18-year study concluded.

Visits to the dentist may help decrease the chance for dementia as well, since teeth are examined and treated.

Fluoride can be applied to real teeth by a dentist to keep them strong and healthy. In addition, an electric toothbrush and mouthwash may aid in the proper care of the mouth.

When a person does start showing signs of dementia, it is important that he/she is monitored, since dementia patients may have a more difficult time caring for himself/herself.

Often times, people suffering from this disease may forget or not care to brush their teeth, which can worsen the situation.

Drugs used to treat dementia may cause a dry mouth in some patients, which can have an effect on oral health.

Link to EmpowHer.

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