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Jack Sisson's TBI Blog

A hug is duct tape for the soul.


From Take Part:

The cost of TBI to young adults is huge—some $75 billion per year. Here’s how we can prevent and help people recover from these devastating injuries.

Maybe you didn’t realize it, but this month—March—is National Brain Injury Awareness Month. During these 31 days, an estimated 140,000 people in the U.S. will have sustained some degree of traumatic brain injury (TBI), ranging from mild concussions to coma or death. 

Taken together, TBI is among the leading cause of disability and death in people who are otherwise typically the youngest and healthiest Americans, according to the Centers for Disease Control and Prevention (CDC). TBI’s nickname, “The Silent Epidemic,” is certainly an apt one. The costs to society of TBI, however, are huge: Added together, medical bills, chronic or lifelong disability, and indirect costs to society attributable to TBI are estimated at over $75 billion per year.

Concussions: This Is Your Brain on Sports

Maybe you didn’t realize it, but this month—March—is National Brain Injury Awareness Month. During these 31 days, an estimated 140,000 people in the U.S. will have sustained some degree of traumatic brain injury (TBI), ranging from mild concussions to coma or death. 

Taken together, TBI is among the leading cause of disability and death in people who are otherwise typically the youngest and healthiest Americans, according to the Centers for Disease Control and Prevention (CDC). TBI’s nickname, “The Silent Epidemic,” is certainly an apt one. The costs to society of TBI, however, are huge: Added together, medical bills, chronic or lifelong disability, and indirect costs to society attributable to TBI are estimated at over $75 billion per year.

The good news—if you want to call it that—is that over the past decade, TBI has received increasing attention. Why? Unfortunately, it’s because of injuries sustained by athletes in various contact sports, including football, boxing, and hockey, as well as combat-related injuries to our brave military personnel.

Although these are important causes of TBI, they still make up a minority of overall causes of brain injury; car accidents and falls continue to make up over half of these injuries, across all ages and in all areas of the U.S.

So what have we learned about TBI, and more important, what can be done to improve this otherwise grim scenario that continues to hurt our most promising members of society? I propose a three-pronged approach:

'Every Head Counts': Legislating Kids, Sports and Concussions

AWARENESS: It doesn’t just take a single, severe event to really damage your brain. It’s now clear that repetitive mild TBI contributes to the development of a variety of neurological and psychiatric symptoms, ranging from extremely subtle ones to those that are quite severe. (These are collectively referred to as chronic traumatic encephalopathy [CTE].) 

More recent evidence lends support to the theory that even significantly fewer incidents, and perhaps even one mild TBI episode, can result in long-standing structural changes in the brain and possibly cause long-term cognitive effects. As our ability to detect the chronic effects of TBI become more sensitive and sophisticated, we are still learning just how pervasive the neurological and psychiatric effects on TBI patients really are. Only through awareness of the magnitude of this problem can we be called to action.

PREVENTION: Perhaps most important are the steps we can take together to stop these devastating injuries from occurring in the first place, and to minimize the extent of TBI when injuries do occur. Motor vehicle accidents, for instance, remain the most prominent cause of TBI among adolescents, throughout the world.

It’s no wonder that medical students are taught early on in medical school that you can do more during a routine check-up for an otherwise healthy teenager by reminding them to buckle up than by performing any physical screening exams, like listening to their heart and lungs with a stethoscope.  So reminding young people to practice safe driving behaviors—such as stopping texting while driving and not driving under the influence of alcohol or drugs—are likely to have the greatest impact.

Of course, maintaining the highest safety standards during high-risk physical activities and contact sports is a worthwhile endeavor that any family member and/or sports fan can advocate for. You can become involved in a local chapter of the ThinkFirst Foundation, which emphasizes injury prevention and awareness, as well as improving the availability of protective equipment for our athletes. In addition, enforcing safest-practice athletic rules and guidelines for return-to-play on a local, as well as national, level can help minimize the burden of injury to our nation’s rising athletes.

One Small Thing: Cut Sports Concussions Severity by Reporting Injuries

RESEARCH: Although there have been significant improvements in how well those who suffer TBI do following treatment, there are still too few therapeutic approaches for TBI patients, as well as not enough options for neuro-rehabilitation and neuro-restoration. Only through cutting-edge research and quality clinical trials can emerging treatment options be effectively translated into doctors’ offices and hospitals, and offset the degree to which TBI results in permanent disability. You can get involved to help organize and raise funds for TBI research in your hometown. 

There are many ways to become involved in your community, and to champion preventative strategies and campaigns for research efforts in TBI.  Only through increased awareness and teamwork can we make a dent in the degree to which TBI affects our most promising and productive members of society.

Link to Take Part.

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From Fox News Latino:

Researchers have found that the dangers associated with diabetes, highly prevalent in the Latino community, can include cognitive impairments.

A recent study published in the medical journal Diabetes Care shows Mexican-Americans being treated for diabetes are two times more likely to develop dementia and memory loss.

While the trend was more pronounced among Mexican-Americans who were receiving medical treatment, the trend was also present among those who were untreated.

The findings are the result of a decade-long study conducted by Dr. Mary Haan and her colleagues at the University of California, San Francisco.

Using data from the Sacramento Area Latino Study on Aging, researchers monitored 1,617 participants from 1998 to 2008.

With the ages of the participants ranging from 60 to 98 years old, the study looked at how diabetes affected their mental capabilities.

While the study found Mexican-Americans were more likely to develop dementia when coupled with diabetes, it also found that for Latinos overall the mortality rate was higher among those suffering from either of the conditions.

Prior studies have tied type 2 diabetes to a greater risk of dementia and other cognitive impairment in older adults. However, this marks the first time the relationship between the two has been analyzed specifically among Mexican Americans.

Because Latinos are more likely to be overweight, they are at higher risk of developing diabetes. According to data from the Office of Minority Health, Latinos are nearly twice as likely to be diagnosed with diabetes.

Link to Fox News Latino.

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The Defense Department continues to use a controversial tool to assess traumatic brain injury even though the Army Surgeon General in 2010 questioned the tool’s effectiveness, citing a “lack of clear scientific evidence,” the Institute of Medicine reported today.

TBI, considered the signature wound of the wars in Afghanistan and Iraq, results from blasts from improvised bombs. The Defense and Veterans Brain Injury Center reported that 266,810 troops were diagnosed with TBI from 2000 through 2012.

In a May 2008 memo, then assistant secretary of Defense for health affairs Dr. S. Ward Casscells directed all the services to use a computer-based tool the Army developed in 1984, called the Automated Neuropsychological Assessment Metrics, to assess brain damage. In August 2010, Defense kicked off a study of various TBI assessment tools conducted by the National Academy of Neuropsychology. The report was slated for completion in November.

In 2010, the Army Surgeon General was well aware of problems with ANAM, IOM detailed today in its 795-page report, Returning Home from Iraq and Afghanistan: Readjustment Needs of Veterans, Service Members, and Their Families.

According to IOM: “A 2010 comprehensive review of the DOD ANAM program, prepared by the Army’s Office of the Surgeon General, states that the lack of clear scientific evidence supporting ANAM’s effectiveness raises important questions about whether DOD is using the best available technology to assess cognitive function after head injury.”

“Research data raise questions about the accuracy of the ANAM for detecting cognitive dysfunction—and recovery from this dysfunction—after mild TBI,” the report said, with mid TBI commonly described as concussion, which can occur after a blast.

This dovetails with an investigation by Government Executive in May 2010, which described problems with ANAM in assessing TBI.

It doesn’t appear that the Army Surgeon General publicly released the 2010 ANAM review. But, in March 2011, then Army Surgeon General Lt. Gen. Eric Schoomaker told members of the House Armed Services Committee that ANAM had a failure rate of between 25 percent and 33 percent.

IOM identified significant errors for soldiers tested with ANAM. In a 2012 study of 502 troops recently deployed to Iraq or Afghanistan who had self-reported TBI, IOM found that ANAM could not detect changes in cognitive performance by 70 percent of those troops. 

In a December 2011 letter to Army Secretary John McHugh, Sen. Claire McCaskill, D-Mo., noted that the Army Office of the Surgeon General said the selection of ANAM by Defense resulted from a “nepotistic” process, but she did not provide any details.

McCaskill said in her letter to McHugh that even though Army researchers had developed ANAM, the service paid Vista Partners of Parker, Colo., $6 million over three years in license fees for ANAM and another $19 million to subsidiaries of Eyak Corp., an Alaska Native corporation, to administer the test.

IOM also reported that the Military Acute Concussion Evaluation, the most widely used TBI screening tool in Defense, “might fail to detect a large proportion of service members’ concussions.” MACE, IOM said, could only detect concussion from 20 percent to 51 percent of the time when compared to a clinical diagnosis of concussion, the report said.

The IOM report noted that Defense cannot easily track troops diagnosed with TBI: “ANAM is not Web-enabled, and data are not stored in a centralized database; therefore, summary statistics comparing ANAM scores before and after injury are not available.” Pentagon policy requires documentation of all service members who were exposed to potential concussive events and the U.S. Central Command developed an automated reporting module called the Blast Exposure and Concussion Incident Report, but data from that report has yet to be publicly released.

IOM concluded, “There is a lack of readily available, centralized sources of data on the implementation of TBI assessment processes and treatment outcomes. The limited data available suggests that there is a need for improved followup and evaluation of service members and veterans who might have TBI.”

Link to

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From U.S. News and World Report:

But predictive value of finding still needs to be proved, expert says

People newly diagnosed with Parkinson's disease who have minor thinking problems may be on the way to early dementia, according to a new Norwegian study.

Some people with Parkinson's go on to develop dementia, but whether it is possible to predict who will fall into this group hasn't been clear. In this new study, researchers wanted to see if early signs of thinking problems would indicate who these patients might be.

"Mild thinking problems seem to be an important clinical concept for early detection of patients with Parkinson's disease who are at risk to develop dementia," said lead researcher Dr. Kenn Freddy Pedersen, from the Norwegian Center for Movement Disorders at Stavanger University Hospital.

"Specifically, we found that more than 27 percent of patients with thinking problems at diagnosis progressed to dementia during the first three years of follow-up," he said. "Even more interesting, almost half of the patients with persistent thinking problems one year after diagnosis developed dementia during the next two years."

One result was more encouraging: For some patients, thinking ability returned to normal over the course of the study.

Although there is no immediate clinical implication to the new findings, they may be important for trials of drugs that might slow or reverse the process leading to dementia, and the findings may also help in managing patients, Pedersen said.

The report was published March 25 in the online edition of the journal JAMA Neurology.

Dr. Brian Copeland, a movement disorder fellow at the University of Texas Medical School at Houston and co-author of an accompanying journal editorial, said the study indicates that patients with ongoing evidence of thinking problems are at higher risk of getting dementia.

Although identifying patients with thinking problems is easy to do when Parkinson's disease is diagnosed, there isn't a way to accurately classify patients, so it isn't clear whether early thinking problems really predict dementia, he said.

"[The finding's] value in predicting Parkinson's disease dementia is less clear and needs further research," Copeland said.

To map the course of thinking problems in Parkinson's patients, Pedersen's team followed 182 patients for three years. Participants completed a battery of screening exams, including tests of their memory, verbal fluency and color-naming ability.

During the study, 27 percent of patients who had thinking problems at diagnosis went on to develop dementia, compared with 0.7 percent of those who didn't have thinking problems, the researchers said.

For some patients, however, normal thinking returned. Among those with thinking problems, about 19 percent saw their thinking problems clear up, Pedersen's group found.

The progression to dementia was also dependent on how severe the patient's thinking problems were, the researchers noted.

Among patients with the most severe thinking problems at the start of the study and one year later, 45.5 percent went on to develop dementia while only about 9 percent saw their thinking restored to normal, the researchers said.

Although the study found an association between mild thinking problems in patients newly diagnosed with Parkinson's disease and later dementia, it did not establish a cause-and-effect relationship.

Link to U.S. News and World Report.

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From MedScape:

Rapid eye movement (REM) sleep behavior disorder (RBD) is the strongest predictor of determining risk of developing dementia with Lewy bodies (DLB) in men, new research suggests.

A study conducted by investigators at the Mayo Clinic in Jacksonville, Florida, showed such patients are about 5 times more likely to have DLB, the second most common form of dementia, if they experience RBD compared with 1 of the other "core" risk factors currently used to make the diagnosis, which include parkinsonism, fluctuating cognition, or hallucinations.

"The findings strongly suggest that DLB should be added to the list of core features for dementia with Lewy bodies," study investigator Melissa Murray, PhD, from the Mayo Clinic in Jacksonville, Florida, told Medscape Medical News.

The study was presented here at the American Academy of Neurology (AAN) 65th Annual Meeting.

Most Cases Male

Characterized by a loss of muscle atonia that occurs during normal sleep, patients with RBD are able to move during REM while sleeping and "act out" their dreams, which are often vivid and unpleasant, said Dr. Murray.

This can result in violent episodes in which patients can kick and punch during REM sleep, resulting in harm to themselves and/or their bed partners.

Dr. Murray also noted that RBD can present 3 or more decades before a diagnosis of LBD is made and that up to 80% of individuals with the disorder are men.

In the latest consensus guidelines on the clinical and pathologic diagnosis of DLB, which were published in 2005, RBD is classified as a "suggestive feature" of LBD.

However, Dr. Murray noted, a growing body of research suggests RBD warrants consideration as a key feature.

Stronger Predictor Than Current Criteria

The aim of the current study was to determine quantitative differences in cortical atrophy and hippocampal abnormality in autopsy-confirmed DLB in patients with and without probable RBD.

The investigators also wanted to examine whether hippocampal volume, DLB core features, and RBD together can predict the likelihood of DLB.

The researchers examined MRI brain scans on 75 patients diagnosed with probable DLB.

Using DLB consortium pathology criteria, the researchers identified 75 consecutive low- to high-likelihood autopsy-confirmed DLB cases from the Mayo Clinic AD Research Center. All patients had undergone MRI of the brain before death.

Pathologic burden of hyperphosphorylated neurofibrillary-tau, α-synuclein, and β-amyloid from the hippocampus was quantified. Atlas-based quantification of hippocampal volumes and voxel-based analysis of antemortem MRI examinations were performed.

The results revealed that hippocampal neurofibrillary-tau (P =.007) and β-amyloid (P < .001) burden was lower and hippocampal and parietotemporal cortical volumes larger in those with a history of probable RBD than in those without a history of probable RBD.

The investigators also reported that antemortem MRI and DLB clinical features predicting a higher likelihood of autopsy-confirmed DLB showed a trend for hippocampal volume (odds ratio, 1.13; P = .08) and a history of probable RBD increased the odds (odds ratio, 5.78;P = .004) of predicting pathology associated with DLB likelihood.

Parkinsonism approached significance (P = .10) in a model with hippocampal volume and probable RBD but not fluctuations or visual hallucinations.

Screening Important

In light of the fact that RBD is a stronger predictor of DLB likelihood than the currently established core features, Dr. Murray said she is hopeful that this paper, as well as previous research, will be considered when the diagnostic criteria for DLB are updated.

In the meantime, she said, clinicians need to be aware of RBD and its link to DLB and ask patients and their bed partners about sleep disturbances.

DLB, she noted, is on a spectrum that can range from mild to severe. At its worst, patients can injure themselves or others, and obviously this extreme form may be picked up more easily than mild or moderate cases.

This underlines the need to ask about sleep and pay attention to more "subtle" signs of RBD, which can include flailing of limbs during the night or falling out of bed, said Dr. Murray.

She added that screening for RBD can help in the differential diagnosis of LBD and Alzheimer's disease (AD). She noted that in the Mayo Clinic databases, only 2% to 3% of patients with AD have a history of RBD.

Once LBD is diagnosed, patients can benefit from treatment with cholinesterase inhibitors. Although these agents are not disease modifying, they do benefit patients with LBD and are significantly more effective in this population than in patients with AD.

In addition, RBD itself can be effectively treated with the benzodiazepine clonazepam, either alone or in combination with the supplement melatonin.
Link to MedScape.

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From Eureka Alert:

Homeless people have a disproportionately higher risk for TBI compared to the general population

Homeless people and their health care providers need to know more about traumatic brain injuries to help prevent and treat such injuries, a new study has found.

Homeless people have a disproportionately higher risk for TBI compared to the general population, yet little is known about the severity of those injuries, who exactly is suffering from them and what the long-term consequences are.

"A better understanding of TBI, its presentation and characteristics in the homeless is vital in order to enable appropriate interventions, treatments, and case management in the improvement of outcomes for this important segment of the population," said Dr. Jane Topolovec-Vranic, a clinical researcher in the Trauma and Neurosurgery Program at St. Michael's Hospital.

"Reducing the prevalence of homelessness and the incidence of injury and illness among people who are homeless would have significant financial, societal and individual implications."

Recent research has identified high rates of TBI among homeless people, but there has been no detailed review of existing data. Dr. Topolovec-Vranic and her colleagues in the Head Injury Clinic at St. Michael's Hospital reviewed all the recent scientific studies on homelessness and traumatic brain injuries to identify the gaps in knowledge and suggest areas of future research. Their findings were published recently in the journal BMC Public Health.

As many as one in nine Canadians have experienced homelessness or come close to it. Previous research has found that homeless people often suffer from serious health conditions, use the most expensive medical interventions such as emergency rooms, require longer hospital stays than people with homes and are at increased risk of death.

The studies Dr. Topolovec-Vranic and her team reviewed found that anywhere between 8 and 53 per cent of homeless people–mostly men--have traumatic brain injuries. The majority suffered a TBI before becoming homeless, suggesting TBI might be a risk factor for homelessness. It's also possible that impulse control disorders, for example, could predispose individuals to both TBI and homelessness, she said.

Traumatic brain injuries are caused by a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. The severity can range from mild, characterized by a brief change in mental status, to severe, which could include unconsciousness or amnesia. TBI is associated with low subsequent employment rates, which can contribute to a downward spiral into homelessness.

"It is also suggested that in the homeless population, cognitive impairment may increase the risk of remaining homeless, illustrating the potential for TBIs to contribute to the chronicity of homelessness," Dr. Topolovec-Vranic said.

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From Seven Days:

Superior Court Judge Helen Toor can’t say whether she’s seeing more defendants entering her Middlebury courtroom with a traumatic brain injury — or if she’s just noticing them more. She can say, however, that if the accused is found incompetent to stand trial because of a TBI, there’s not a lot she can do with them.

“The state is required to dismiss the charges under our laws,” says Toor, who’s been a judge for 14 years and now presides over Addison County’s criminal division. “And yet, we don’t have a process for monitoring that person to try to avoid future criminal conduct.”

In the last few months, Toor has had to dismiss charges against defendants accused of aggravated assault and repeated stalking because they had TBIs that might explain their inappropriate or violent behavior. In a third case, Toor has yet to rule on the competence of a brain-injured defendant charged with the sexual assault of a child.

This situation differs from other cases involving defendants deemed by the court to lack a rational understanding of the charges, proceedings and their potential consequences. If a defendant has a severe mental illness, such as schizophrenia, a judge may commit that individual to a psychiatric ward for treatment. If it’s effective, he or she may be found competent to stand trial down the road.

A judge can also issue an “order of nonhospitalization,” putting the person under the supervision of a state-funded community mental health facility, such as theHowardCenter in Burlington or the Counseling Service of Addison County. Defendants with developmental disabilities, such as Down syndrome, can be placed under the supervision of the Department of Aging and Independent Living, which presently supervises about 30 Vermonters who have committed violent and/or sexual offenses, according to Commissioner Susan Wehry.

But a TBI is neither a mental illness nor a developmental disability. As a result, Toor asked theBrain Injury Association of Vermont (BIA-VT)to visit her court last week to provide guidance and training to Addison County attorneys who are trying to figure out how to deal with brain-injured defendants once they leave the courtroom.

How common are TBI victims in the criminal justice system? Brain injury experts say they’re much more common than the public or court personnel realize.

Remember Roger Pion, the Newport farmer who became an internet folk hero last year for crushing seven Orleans County sheriff’s vehicles with his monster tractor? It was widely reported at the time that Pion was enraged about his recent marijuana arrest. But Pion’s defense attorney, David Sleigh, now confirms that the court ruled his client was not competent to stand trial, in part because of a history of concussions.

The Office of Court Administrator cannot say how common such cases are. In 2012, there were 772 cases statewide involving “the potential to include a competency issue.” But the judiciary’s decades-old computer system doesn’t gather data on defendants’ mental status or the reasons why some are deemed incompetent.

Defender General Matt Valerio, who oversees Vermont’s public defenders, admits he’s unaware of the extent of the problem. In his 25 years in the criminal justice system, Valerio says that cases involving defendants with obvious TBIs have been “few and far between.” If Vermont’s public defenders are representing brain-injured defendants, he says, those cases aren’t coming to his attention.

Last year, the legislature asked the Vermont Department of Corrections to compile a report on the number of inmates suffering from a “severe functional impairment,” which can include dementia, mood or personality disorders, psychoses and TBIs. As of September, 121 offenders in state custody were known to have severe functional impairment. Only two were on the list for a known TBI.

But that same report also indicates that although the number of TBI cases looks small, “It may be because it’s not commonly assessed in screenings, and patients may not report trauma that they don’t associate with current presentation.”

Screening for TBIs, especially mild ones, is difficult, expensive and not done routinely by the Department of Corrections or Probation and Parole. And TBI experts suggest that many inmates don’t realize that the root cause of their antisocial behavior is a blow to the head they received years ago.
Continue reading.

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From ABC News:

More than a million people are affected by concussions every year, according to a Center for Disease Control and Prevention.

For the first time in nearly 15 years the American Academy of Neurology has changed their guidelines for management of sports concussions.  The new guidelines, published Monday in the online issue of the journal Neurology, have been endorsed by numerous advocacy groups including NFL Players Association, American Football Coaches Association, National Athletic Trainers Association, and the National Association of Emergency Service Physicians.

To explain the new recommendations and get the word out about how to prevent, diagnose and treat concussions, ABC News’ chief health and medical correspondent Dr. Richard Besser hosted a Twitter Chat on the subject Tuesday.  Dr. Christopher Giza, a children’s neurologist at the University of California in Los Angeles and one of the lead authors of the guidelines was a special guest on the chat. Experts from the American Academy of Neurology, Mayo Clinic, as well as clinicians, parents and coaches with personal experience also joined in the one-hour discussion.

Here are five take home points about the new concussion guidelines you need to know.

When in Doubt, Sit it Out
A concussion, usually caused by a knock to the head or violent shaking, is a head injury leading to neurological and physical symptoms — even without loss of consciousness.  The new guidelines recommend that every athlete suspected of having a concussion should be immediately removed from play and not be returned until symptom free, and cleared by a health care professional trained in concussion management.  Old guidelines allowed athletes to return to the game if they only had a “mild” concussion and weren’t knocked out but our expert chatters said there is no such thing as a “small” concussion. Every hit is potentially serious and should be treated conservatively.

All Sports are Risky. Some More than Others.
While football is thought of as the most dangerous sport for concussions, other sports are high risk too. According to Dr. Christopher Giza, one of the authors of the new paper, soccer, lacrosse, hockey and boxing are also considered high-risk sports. So are equestrian sports and cheerleading. Any sport where head trauma is possible, a concussion can occur and therefore, athletes and coaches should be educated about concussion.

Women are at higher risk
Overall 71 percent of all injuries were among males. Yet female athletes are nearly twice as likely to have a concussion compared to males playing the same sport. Most females sustained concussions while playing soccer, basketball or cycling. It’s unknown why females are at higher risk.

Risks are Long Term
Athletes diagnosed with one concussion are far more likely to be diagnosed with another concussion in the future. In fact, previous incidence of concussion is the number one predictor for future concussions. A new study released just last week indicated that even one concussion can lead to permanent brain injury.

Education is Essential
All our expert chatters agreed that more needs to be done to educate athletes, caregivers and coaches about the importance of identifying the signs and symptoms of concussion. They say a larger emphasis should be placed on prevention. They also cautioned that young athletes – high school and below — need greater protection and care since they are the most likely to experience concussion.

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From USA Today:

A new report is raising concerns about the disease's "pervasive" scope and costs.

A new report showing one in three older adults dies with Alzheimer's disease and other forms of dementia is raising concerns about the disease's "pervasive" scope and the spiraling costs of care, the authors say.

Deaths from Alzheimer's and other forms of dementia have increased 68% from 2000 to 2010, according to the report being released today by the Alzheimer's Association, an advocacy group. Meanwhile, deaths from heart disease, HIV/AIDS and stroke have declined. The numbers are taken from Medicare and Medicaid reports.

"Urgent, meaningful action is needed, particularly as more and more people age into greater risk for developing the disease,'' says Harry Johns, president and CEO of the Alzheimer's Association.

The report says dementia is the second-largest contributor to death, after heart failure. Other findings:
  • Payments for health care, long-term care, and hospice care are expected to increase from $203 billion to $1.2 trillion by 2050 for patients ages 65 and older.
  • Medicare costs for an older person with Alzheimer's or other forms of dementia are nearly three times higher than for seniors without dementia. Medicaid payments are 19 times higher. 
  • The stress on caregivers is estimated to result in the more than $9 billion in increased health care costs.
The number of people with Alzheimer's disease is expected to rise from 5.2 million to 13.8 million by 2050, putting an increasing burden on medical costs and caregivers. There is no way to prevent or slow the progression of Alzheimer's or other types of dementia, including vascular and dementia caused by degeneration of brain tissue.

The Alzheimer's numbers "are simply staggering,'' says Francis Collins, director of the National Institutes of Health, the federal agency overseeing research for 233 areas of disease. Alzheimer's is the sixth-leading cause of death in the nation, and the only leading cause without a way to prevent or even slow progression. Among people 65 and older, it is the fifth-leading cause of death.

The report says death certificates often list acute conditions such as pneumonia as the cause of death rather than Alzheimer's, so the number of deaths primarily due to Alzheimer's might be even higher than reported.

Once Alzheimer's symptoms appear — memory loss that disrupts life, inability to plan or solve problems and poor judgment — it's too late to reverse the process, researchers say. Damage to the brain begins 10 to 20 years before symptoms appear.

Although the government set a goal to find a way to prevent the disease by 2025, advocates say funding levels are too low. Research estimates for 2013 are $3 billion for HIV/AIDS, $1.1 billion for diabetes, $1.66 billion for heart disease and $5.4 billion for cancer. Some cancers get additional funding (breast cancer $711 million, for example.) The money available for Alzheimer's research is $529 million.

"We have wanted to see a $2 billion commitment to research, because we've seen what has happened in diseases like HIV/AIDS when a big financial commitment is made," says Maria Carrillo, vice president of medical and scientific affairs at the Alzheimer's Association.

Funding for research "for Alzheimer's is totally insufficient,'' says Luigi Puglielli, an Alzheimer's researcher at the University of Wisconsin-Madison. Alzheimer's alone "is predicted to bankrupt Medicare. It would be wise to invest now and prevent the above scenario rather than deal with it when we get there.''

Link to USA Today.

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Happy Saint Patrick's Day!

March is Brain Injury Awareness Month. What follows is some excellent commentary from a registered nurse in the military. She offers several reminders of simple things we can do to help protect ourselves from traumatic brain injury. It might be nice if we reminded our family and friends, too.

Commentary by By Capt. Laura Gibbons
Walson Medical Support Element

Every month of the year has an awareness theme, with some months having multiple important causes to recognize.

March is Brain Injury Awareness Month. One month is a relatively short time to highlight brain injury awareness, but we need to acknowledge, practice and prevent it year-round. Life, as we know it, is worth the endeavor.

Approximately 1.7 million people sustain traumatic brain injuries each year in the U.S. Out of this population, 52,000 lose their lives, 275,000 are hospitalized and almost 1.4 million are treated and released from emergency departments, according to the Centers for Disease and Control's statistics.

Alarming numbers like these do not stir emotions or behavior change in many people. Think of someone who has dealt with or who is dealing with a brain injury. Maybe it is a family member or friend. Was the injury from an automobile accident, a combat blast injury, a fast ball to the head or a fall on some ice? I would bet that everyone knows someone with an injury, mild or severe. Get personal, because that is when it gets very real.

Traumatic brain injury became very real in my hometown when a well-known family endured the unthinkable. The family's 25-year-old son took a snowboarding trip to the Poconos and fell horribly, changing his family's lives forever.

East Coast mountains are nowhere near the elevation and difficulty for snowboarding compared to other places in the country or world. New and experienced skiers and snowboarders hit the slopes every winter in the Poconos, unfortunately, many choose not to wear a helmet. I am embarrassed to say I was one of them. Even worse, I was stationed in Germany for three years and never wore a helmet skiing the Alps of Germany, Switzerland and Austria. What was I thinking? I am a registered nurse and I have a good head on my shoulders, but to me, the thought anything bad would happen was not real.

I am sure the millions of people mentioned in the CDC's statistics above felt the same way I did. Many people don't even consider using a helmet, and others take the approach I had thinking, "it is only a small mountain," or "I never fall or lose control." It often takes an accident to jolt people into change.

In 2009, a family from my town lost the son who they had come to know as a strong, healthy, intelligent and athletic man who was halfway through graduate school for engineering. He was among the top of his high-school class, an honor student in college with a bright future. He was in my older brother's high-school grade, on his soccer team and one of his close friends, even after college. My brother's friend was snowboarding with a group when he became separated from his friends. He was eventually found, unconscious, down the side of a trail with a severe brain injury and a mix of other injuries.

After waking from a month-long coma, my brother's friend and his mother spent countless hours at medical appointments and therapy. His mother wound up quitting her job to take care of him. The family's home also had to be fitted so that it was wheelchair accessible. It has been three years since the accident and he can only stand and walk with assistance for short distances. The future holds a lot of unknowns for his family, now troubled with medical bills, simply because he was not wearing a helmet.

This family's tragic accident served as a life lesson to myself and everyone around me. Not only do I wear a helmet now, but I convince my friends to rent one if they do not already own one. People cannot stay home in a bubble and not live life. What we have to do is value our life and protect it as much as possible.

I wear a helmet when I ski, ride my bike or visit the range. I put on my seat belt the moment I get in my car. I try incredibly hard to leave my phone in my purse whenever I am in my car. I cannot commute to work and look left and right without seeing someone staring at their phone while driving. I assume people just feel invincible.

I feel pride in being a role model for my friends, my younger sister and my niece. Let us remind ourselves and each other to understand every human, regardless of age or occupation, is at risk. Whether it is combat, falls, contact sports, winter sports, water sports or automobiles, strive to protect yourself and prevent TBI. There are many resources online, to include the Brain Injury Association and the Defense and Veterans Brain Injury Center websites, with articles, resources and many stories relating to traumatic brain injuries, awareness and prevention. The following tips are provided by DVBIC for minimizing the risk of sustaining a brain injury both in combat and at home:

Prevent TBIs in a combat setting:
- Wear a helmet and standard protective gear properly when on patrol or in other high risk areas.
- Wear safety belts when traveling in any motorized vehicles.
- Check for obstacles and loose debris before climbing or descending buildings or other structures.
- Employ the buddy system to improve situational awareness, such as working at heights or on certain missions.
- Be aware of what is on the ground around you to avoid tripping.
- Inspect weapons prior to use and handle them appropriately.
- Verify targets and consider the potential for ricochet prior to firing a weapon.
- Maintain clean and orderly work environments that are free of foreign objects or debris.

Prevent TBIs at home for you and your family:
- Wear a seat belt every time you drive or ride in a motor vehicle.
- Never drive while under the influence of alcohol, drugs or medications that can cause drowsiness.
- Wear a helmet whenever you: ride your bike or motorcycle, participate in winter sports (skiing, snowmobiling, snowboarding, etc.), play contact sports (football, ice hockey, boxing, etc.), use in-line skates, scooters, skateboards or ride horses.
- Always buckle your child into a child safety seat, booster seat or seat belt (depending on the child's height, weight and age) in the vehicle. Also, review local laws for these requirements.
- Use a step stool to reach objects on high shelves.
- Install handrails, window guards and safety gates at home to prevent falls.
- Remove tripping hazards, use non-slip mats in the bathtub and on shower floors and put grab bars next to the toilet and in the tub or shower if needed.
- Store unloaded firearms in a locked cabinet or safe. Store bullets in a separate secure location.

Educate your workplace and educate your family. Lead by example every time, not some of the time. The Brain Injury Association of America's theme is "anytime, anywhere, anyone, brain injuries do not discriminate." March is Brain Injury Awareness Month, but awareness in March is not enough. Prevent head injuries and protect life.



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From Forbes:

The NFL and General Electric (GE) today jointly announced a four-year 60 million initiative to develop novel imaging technology and other tech-based approaches to aid in the prevention, detection and management of traumatic brain injury (TBI) and concussions. The overriding theme, announced in an opening video this afternoon at a press conference at 30 Rock in the GE Building, was that “the better we understand the brain, the better we can protect it”.

This initiative comes almost two months after the Institute of Medicine (IOM) embarked on a large scale study of sports related concussions, especially those in younger people beginning in grade school through adolescence into early adulthood.

An additional study by the CDC revealed that emergency departments in the US treated 173,000 traumatic brain injuries in 2010, including concussions as a results of sports and recreation among those 19 years of age or younger.

In fact, in 2012 the NFL adopted stricter rules to determine when players can return to play (RTP) after suffering a concussion.

While the growing number of lawsuits against the NFL by former players who have suffered concussions may be at least partly responsible for the formation of this joint initiative, there is no doubt that this venture will result in important research that will evaluate the effects of trauma on the brain and brain functioning.

The details of the partnership, which also include a five million contribution from the apparel giant, Under Armour, were the follow-up after an initial announcement of the partnership over the Super Bowl weekend last month in New Orleans.

The commissioner of the NFL, Roger Goodell, along with CEO of GE, Jeffrey Immelt, provided the opening comments to the packed room at 30 Rock in the GE building. Mark Emmert, President of the NCAA, also provided insightful comments regarding the newly formed partnership. A number of team owners including John Mara (New York Giants),Robert Kraft (New England Patriots), and Woody Johnson (New York Jets) also were present for the announcement.

The primary aim of the Head Health Initiative, according to Goodell is “better diagnosis, treatment and prevention of brain injury”. He admitted that “there is a lot more to do” and that any way to “speed up” the process to “develop new technology to better protect the brain” would be in the best interests of all players– but also younger players in high school, college and those much younger”.

Goodell further explained that this initiative is clearly “outside of traditional research models, and will serve to accelerate science and research in a four year time period.” He emphasized that this initiative was “not just for football, but for all sports and may also be a way to “make our troops safer”, acknowledging that brain trauma and concussions are not just an issue in the NFL, but for all sports as well as the military.

Jeffrey Immelt then took the podium to explain more details of the two-part initiative. The first will involve a 40 million research project led by GE to better diagnose mild traumatic brain injury (TBI), and to predict the outcomes over time. The second phase will involve two separate projects, headed up by Under Armour, but available to other innovators and scientists, termed the “open innovation challenge”. The first aspect will address diagnosis and prognosis of TBI, while the second phase will focus on materials and structural design of equipment (helmets) to protect the brain from impacts. The NFL is opening this up to essentially all scientists and innovators to help address this challenging clinical issue—with 20 million in combined funds.

Lieutenant General Patricia D. Horuho of the US Army Medical Command added additional commentary to the discussion, explaining that since 2000 more than 250,000 US Military have suffered traumatic brain injuries, and that 84% of these were not related to deployment.

The CEO of Under Armour, Kevin Plank, explained that a serious issue to address is the tendency of athletes to minimize injuries and head trauma to avoid being removed from a game. Changing the culture of safety is essential in his mind.

A medical panel led by Dr. Nancy Synderman, Chief Medical Editor for NBC News, included Dr. Russell Lonser, Chair of the NFL Head Neck and Spine Committee, Dr. Geoffrey Manley, Chief of Neurosurgery at San FranciscoGeneral Hospital, and Professor of Neurosurgery at UCSF, as well as Richard Hausmann, President and CEO of MR at GE Healthcare.

Important insights to emerge from the panel included the plasticity of the brain in recovering from traumatic injury over time, as well as preliminary studies suggesting that certain genetic mutations may influence susceptibility and recovery after traumatic brain injury as well as early-onset dementia.

Areas for potential research include a search for genetic markers which could reveal a susceptibility to particular types of brain trauma, as well as developing more defined and consistent management and treatment protocols.

Link to Forbes.

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A study of military personnel suggests that individuals who have suffered a mild traumatic brain injury (TBI) are at increased [risk] for addiction-related disorders.

Casserly Whitehead (Wright-Patterson Air Force Base, Ohio) and team found that mild TBI was associated with an increased risk for alcohol dependence up to 180 days after the event, and an increased risk for nondependent abuse of drugs or alcohol, and nicotine dependence within the first 30 days.

"Given the increasing emphasis and awareness of mild TBI in both military and civilian populations, these findings may have far-reaching clinical and military readiness implications," comment the authors in the American Journal of Psychiatry.

The findings come from a study of 5065 active-duty airmen who had sustained a mild TBI resulting in transient confusion or disorientation, memory loss, and/or brief loss of consciousness, and a comparison group of 44,733 airmen who had sustained other types of injury.

After accounting for factors such as gender, marital status, ethnicity, age, deployment status, education level, rank, and career field, the team found that the risk for alcohol dependence was significantly increased in individuals with a mild TBI at 1-30, 31-179, and 180 days post diagnosis compared with those in the comparison group, at hazard ratios (HR) of 3.48, 2.66, and 1.70, respectively.

Individuals with a mild TBI also had a greater risk for nicotine dependence (HR=2.03) and nondependent abuse of drugs or alcohol (HR=2.11) in the first 30 days after diagnosis than those in the comparison group.

The risks for drug dependence, opioid dependence or abuse, and caffeine-related disorders were also increased in the mild TBI group, but the number of cases in the mild TBI group was too small to produce accurate estimates of risk.

Whitehead et al comment: "Any alcohol or drug use after TBI is concerning given the potential for reduction in spontaneous healing, risk of seizure or repeat TBI, and exacerbation of residual cognitive, emotional, and behavioral impairments."

They conclude: "Screening for addiction-related disorders should be considered as part of routine care for mild TBI and might best capture the first 30 days post-mild TBI, with repeat alcohol screening thereafter for at least 6 months following the injury."

Link to

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From Medical XPress.
Dr. Sergei Kirov is a neuroscientist and Director of the Human Brain
Lab at the Medical College of Georgia at Georgia Regents University.
Credit: Phil Jones

Scientists have watched a mild traumatic brain injury play out in the living brain, prompting swelling that reduces blood flow and connections between neurons to die.

"Even with a mild trauma, we found we still have these ischemic blood vessels and, if blood flow is not returned to normal, synapses start to die," said Dr. Sergei Kirov, neuroscientist and Director of the Human Brain Lab at the Medical College of Georgia at Georgia Regents University. 

They also found that subsequent waves of depolarization – when brain cells lose their normal positive and negative charge – quickly and dramatically increase the losses. 

Researchers hope the increased understanding of this secondary damage in the hours following an injury will point toward better therapy for the 1.7 million Americans annually experiencing traumatic brain injuries from falls, automobile accidents, sports, combat and the like. While strategies can minimize impact, no true neuroprotective drugs exist, likely because of inadequate understanding about how damage unfolds after the immediate impact. 

Kirov is corresponding author of a study in the journal Brain describing the use of two-photon laser scanning microscopy to provide real-time viewing of submicroscopic neurons, their branches and more at the time of impact and in the following hours. 

Scientists watched as astrocytes – smaller cells that supply neurons with nutrients and help maintain normal electrical activity and blood flow – in the vicinity of the injury swelled quickly and significantly. Each neuron is surrounded by several astrocytes that ballooned up about 25 percent, smothering the neurons and connective branches they once supported. 

"We saw every branch, every small wire and how it gets cut," Kirov said. "We saw how it destroys networks. It really goes downhill. It's the first time we know of that someone has watched this type of minor injury play out over the course of 24 hours." 

Stressed neurons ran out of energy and became silent but could still survive for hours, potentially giving physicians time to intervene, unless depolarization follows. Without sufficient oxygen and energy, internal pumps that ensure proper polarity by removing sodium and pulling potassium into neurons, can stop working and dramatically accelerate brain-cell death. 

"Like the plus and minus ends of a battery, neurons must have a negative charge inside and a positive charge outside to fire," Kirov said. Firing enables communication, including the release of chemical messengers called neurotransmitters. 

"If you have six hours to save tissue when you have just lost part of your blood flow, with this spreading depolarization, you lose tissue within minutes," he said. 

While common in head trauma, spreading depolarization would not typically occur in less-traumatic injuries, like his model. His model was chemically induced to reveal more about how this collateral damage occurs and whether neurons could still be saved. Interestingly, researchers found that without the initial injury, brain cells completely recovered after re-polarization but only partially recovered in the injury model. 

While very brief episodes of depolarization occur as part of the healthy firing of neurons, spreading depolarization exacerbates the initial traumatic brain injury in more than half of patients and results in poor prognosis, previous research has shown. However, a 2011 review in the journal Nature Medicine indicated that short-lived waves can actually protect surrounding brain tissue. Kirov and his colleagues wrote that more study is needed to determine when to intervene. 

One of Kirov's many next steps is exploring the controversy about whether astrocytes' swelling in response to physical trauma is a protective response or puts the cells in destruct mode. He also wants to explore better ways to protect the brain from the growing damage that can follow even a slight head injury. 

Currently, drugs such as diuretics and anti-seizure medication may be used to help reduce secondary damage of traumatic brain injury. Astrocytes can survive without neurons but the opposite is not true, Kirov said. The ratio of astrocytes to neurons is higher in humans and human astrocytes are more complex, Kirov said.

Link to Medical XPress.

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From the Bangor Daily News:

We love our hearts. But what are our brains — chopped liver? Neal Barnard, an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences, says how we eat can improve not just the function of our tickers, but also the longevity of our noggins.

In his new book, “Power Foods for the Brain” ($27), and his PBS special, “Protect Your Memory” (debuting on public television on Saturday; check local listings), he outlines his nutrition plan to stave off Alzheimer’s and dementia. Barnard took us shopping to point out some smart choices. And, no, chopped liver wasn’t one of them.

Walnuts: Vitamin E can be a brain booster, Barnard says, noting a Dutch study that showed that people with the most vitamin E in their diets cut their risk of Alzheimer’s by 25 percent. The best sources are nuts and seeds. Barnard generally opts for walnuts, which he enjoys shaved over a salad. (That also helps him limit his intake so he doesn’t overdo it with calories.)

Blueberries: “None of these have any cholesterol,” he says, waving at the produce display. And that’s important for the brain because clogged-up arteries translate into reduced mental function. But he’s particularly fond of this antioxidant-rich fruit that’s been shown (in a small study) to help people with memory problems.

Broccoli: Folate sounds like foliage, which is what it is, Barnard says. And in combination with vitamins B6 and B12 (which he recommends taking supplements of), it can eliminate homocysteine — a destructive molecule that messes with the heart and brain.

Sweet Potatoes: Wondering how to get your B6? Throw some of these root veggies into your basket. (Bananas are another good source.) Barnard says they’re a staple in the diet in Okinawa, a place where people have been found to have exceptional brain function in old age.

Wine: Too much vino can mess with memory, obviously. But a glass or two a night has been shown to cut Alzheimer’s risk significantly. In theory, red wine is the better choice, Barnard says, because the resveratrol it contains may be good for your heart. But when it comes to the brain, a glass of any alcohol appears to offer similar protection.

Link to the Bangor Daily News.

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This is the kind of story that makes me crazy. So many people in government positions either have no room to think for themselves or don't believe they do. Just how the residents of Minnesota want their tax dollars used I'm sure. Let's file charges against an 86-year-old woman with dementia who forgot she voted absentee and so voted twice. Why didn't the poll workers stop her? The article says there was an AB (Absentee Ballot) next to her name. Some thing just leave me speechless. Sheesh.

From Fox News:

An 86-year-old Minnesota woman who suffers from dementia is facing a felony voting fraud charge after she says she accidentally voted twice.

Margaret Schneider tells she forgot she had already sent in her absentee ballot when she went to her polling place in November.

"It's very hard to remember everything," Schneider said.

Schneider says the matter is particularly upsetting to her because she considers herself a proud American and has voted in every election.

"I've always voted, ever since I've been old enough to," she said.

The criminal complaint against Schneider says records show she submitted her absentee ballot in July. It claims the roster book at her polling place had the letters "AB" next to her name, signifying that Schneider had already cast an absentee ballot.

This aspect of the case is frustrating for Schneider.

"Why didn't they tell me to go home? That's what I'm trying to figure out," she told

The county attorney tells the station she had no choice but to file charges against Schneider, saying she could even lose her job if she refused to.

"If I have probable cause to believe the crime occurred, I do not have discretion to charge," Michelle Zehnder Fischer said. "I have to charge it."

Fischer says she has no interest in putting Schneider in jail, and she hopes the case is resolved quickly.

Schneider says she never would have intentionally voted twice.

"It's against the law to do that," she said.

Link to Fox News.

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From Bloomberg Business Week:

As the National Football League continues to face scrutiny and litigation over concussions, new evidence shows that brain injuries may be a problem at the collegiate level too. According to a study published today in PLOS One, college football players who sustain hits to the head may experience long-term brain damage even if they aren’t concussed.

Researchers at the Cleveland Clinic used blood tests, brain scans, and cognitive and other tests to assess brain trauma in 67 college football players over the course of the 2011 season. Although none of the players experienced concussions, blood tests showed that the 5 players who absorbed the hardest hits had elevated levels of an antibody linked to brain damage. These players then underwent brain scans at the University of Rochester Medical Center. When the scans were analyzed in a double-blind process, researchers found abnormalities that were predicted by the presence of the antibody.

“This positive correlation could be an early indicator of a pathological process that, with time, could perturb players’ brain health,” says Nicola Marchi, a professor of molecular medicine at the Cleveland Clinic Lerner College of Medicine, who co-authored the study with Lerner colleague Damir Janigro and Rochester’s Jeffrey Bazarian. “All football players have repeated subconcussive hits—throughout the game, the season, and their careers,” he says, but without external symptoms of injury, the hits were hard to measure. The blood tests appear to offer an early warning system.

Concern about brain injuries in football has grown rapidly over the past decade, after evidence of chronic traumatic encephalopathy, or CTE, a degenerative brain disease that causes dementia and depression, was found in several former pro players, including some who committed suicide. The Center for the Study of Traumatic Encephalopathy at Boston University later found the disease in 34 of 35 former NFL players examined.

So far, most of the research and discussion has centered specifically on concussions, which are relatively easy to identify and diagnose. The CDC has reported that 47 percent of high school football players suffer a concussion over the course of a season. A concussed person is at greater risk of long-term brain damage, and every additional concussion increases that risk. The NFL has introduced rule changes to make the game marginally less brutal. It is also now standard procedure to bench concussed players until they are symptom-free.

The Cleveland study released today shows that even players who don’t sustain concussions may be at risk, and it focuses new attention on college football. That in turn suggests that the risks may be far more widespread than previously acknowledged: Around 20,000 men play at the highest levels of college football, compared with the 1,700 players in the NFL.

The NFL has faced criticism about head trauma for years and responded with task forces, rule changes, big fines for particularly hard hits, and financial resources for scientific research as well as for injured players. At the same time, the league is buffered by the fact that it is still the most popular professional league in the world, with revenue of $9 billion last year. While questions remain about how quickly the league has responded to revelations of CTE and how effective its prevention policies are, the league and its fans can always point out that players are consenting adults who are compensated for their work; questions of liability are working their way through the legal process.

College football may not have the same buffers. Academic institutions have a responsibility to their students, and the NCAA was founded “as a way to protect student-athletes,” according to its website. And while football can raise millions for the institutions, players are forbidden to make money from football.

“We are actively collaborating with member institutions and research facilities to improve the health and safety of student-athletes,” Brian Hainline, the chief medical officer of the NCAA, tells Businessweek. Last year, the NCAA made a $400,000 grant to the National Sport Concussion Outcomes Study Consortium to examine the effects of head injuries in college sports.

Meanwhile, spring practice, in which players say they sustain more hits than in games, starts this month.
Link to Bloomberg Business Week.

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Traumatic brain injuries sustained by more than 200,000 U.S. troops may be fueling the military’s suicide crisis, according to a letter co-signed by 53 congressional members who are seeking additional data to investigate the new theory.

In the letter, sent Tuesday to Defense Secretary Chuck Hagel and Veterans Affairs Secretary Eric Shinseki, the lawmakers urged both agencies to provide Congress with a raft of figures, including the number of Iraq and Afghanistan service members and veterans who committed suicide or tried to end their lives after being brain injured by the detonation of an improvised explosive device — “the weapon of choice” in both wars.

“Evidence has suggested that blast injuries, including but not limited to those causing damage to vision or hearing, can have a severe psychological impact ... that can play a major contributing role in suicides,” read the bi-partisan letter.

Between November 2011 and October 2012, there were more than 15,000 IED attacks against U.S. service members in Afghanistan, and 58 percent of all coalition casualties during that span were caused by the hidden bombs, the letter states.

At least three veterans groups, including the Blinded Veterans Association, are backing the congressional push to — as the letter to DOD and VA states — “get a better understanding of the connection between blast injuries and suicide.”

“I’ve talked to a lot of neurologists, military neurosurgeons and trauma surgeons who have all started to ponder if the IEDs that have caused the TBIs are the real cause of the suicides, versus the traditional approach that suicides are all caused by the psychological stresses of combat,” said Thomas Zampieri, head of government relations for the Blinded Veterans Association.

“Let’s collect more information and maybe the epidemiologists will find a way to unlock some of this mystery: Are military suicides actually more related to the brain injuries? I think there may be a big connection,” added Zampieri, who served as a Vietnam-era Army medic. “As the numbers of TBIs go up, the numbers of suicides continue to go up.”

The portion of U.S. service members who sustained TBIs increased each year from 2001 to 2011 — with a total of 266,810 brain injuries diagnosed in American troops between 2000 and 2012, according to the Defense and Veterans Brain Injury Center, part of the DOD. More than 80 percent of those injuries were not deployment-related cases, with many occurring amid crashes of privately owned cars and military vehicles.

Army soldiers account for the vast majority of diagnosed TBI cases, and those injuries range from “mild” (a concussion) to “severe.” Within the Army, the suicide rate among active-duty members has risen from 9 per 100,000 in 2001 to nearly 23 per 100,000 in 2011, according to the American Foundation for Suicide Prevention.

During that same span, according to the DOD’s brain injury center, the number of annual TBI diagnoses among American troops has ballooned from 11,580 in 2001 to 32,609 in 2011 — an increase of 182 percent.

“What is significant is that we are looking at a potential paradigm shift of significant proportion if the link between low-level TBI from IEDs emerges,” said retired Army Col. Bob Morris, founder of the Global Campaign against IEDs.

Continue Reading.

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From PS or
A Blog Entry by Sarah Reed

For older people with dementia, time can be a big issue. Understanding where they are in relation to time can be a cause of deep anxiety

Tick tock, tick tock – in my line of work, the subject of time ticks round quite frequently and takes many different forms. It is often a source of stress.

Time is relative and I find it quite surprising how many different and often complex forms it takes. Consider these for a moment: there is the time that we remember (or don't remember); the time that passes too slowly, or seems to rush by so that there's not enough time to enjoy it; the time when we are young, which seems to stretch so elastically into the future; the time at the end of someone's life which may seem more precious than ever; the time that hangs heavy when we are bored; the time that fizzes when we are waiting with anticipation or excitement; the time that we squander; the time that must be managed; the time that is unmanageable; the morning time that might seem to travel faster; the late afternoon time that takes its time.

As all carers of older people will attest, time may have different dimensions for people at the end of their lives. There is not much time left for them, yet decades of time have passed before.

For older people with a dementia, time can be a big issue. Their understanding of time can alter and it may feel different to them. They may get up in the middle of the night believing it to be daytime, or may repeatedly ask the date and the time, being unable to 'hold' the information from one minute to the next. Understanding where they are in relation to time can be a cause of deep anxiety for them (and shows that clock-watching is not just confined to those who work in caring environments!)

Last year I worked on a UK-wide project that asked 3,000 people living, visiting and working in care homes what would make life better for them. One of the headline answers was 'time'. That is, relational time with others, whether it be with loved ones, those they care for or those in receipt of care.

In truth, we all need time to share and explore our experiences over time. Carers crave more quality time to do what they are paid to do and work that is less task-focused, but still as timely. So often, in a system that may be clocked at every step in one way or another, it can be challenging to deliver this.

Fortunately, there is slowly growing recognition that care delivery ruled by clock-watching is not only inadequate but is also monstrously disrespectful. How are we to overcome this metrics-driven, broken time?

Until we respect time and give ourselves time, nothing can change. It is up to us to cultivate a healthier relationship with it. One way to do this is through mindfulness.

Mindfulness means being truly still and "in the now", or "present" so that we can become more aware of our own existence against the backdrop of time. Mindfulness techniques are simple to learn and do and require little more than a few minutes.

Before I start any REAL Communication workshop, (focussed on improving people's meaningful interaction through reminiscence, empathic engagement, active listening and life story gathering) we always take a few minutes for a physical and spiritual reflection, when participants are invited to give just to themselves. It helps them leave their other (earlier) distractions behind, helps them relax and to brings them into the present. Some tell me that this is their favourite part of the day (which speaks volumes about the levels of stress and complexity they work under and carry with them).

Mindfulness is practically effective as well. To simply be with a person who is living with dementia is widely recognised to be one the most effective and meaningful ways to communicate with them.

When we approach our own days with attention, mindfulness and presence, we are more likely to feel more at peace as we move through the day and we enjoy ourselves more.

If carers were encouraged to practice mindfulness daily, not only would they enjoy the benefits of the feeling and awareness of their life energy being rekindled, they would also feel less stressed. This would translate positively into their work – and this in turn would influence the bottom line – so everyone wins.

Paying attention to what is happening in the present moment takes us out of ourselves, helping us to be less judgmental of ourselves. By reducing our mental clutter, it helps us make better choices. Best of all, time spent in these small ways feels longer and richer than the reality of it and thus our relationship with time – and life – can change for the better, too.

Why not try it for yourself!

Sarah Reed is a dementia communications and reminiscence specialist and a REAL Communication workshop facilitator. After ten years' experience with her mother who had Alzheimer's disease and vascular dementia, and twenty years' volunteering for an older people's charity, in 2008, she left a successful career in film and creative media to start the social enterprise Many Happy Returns. The company designs and develops products, services, skills development workshops for carers and projects that help connect the generations (especially those with dementia) more enjoyably, through more meaningful engagement.

Link to PS.

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From The Daily Citizen:

The human tongue is an extraordinary bit of flesh. It's alternately squishy and tense, at times delicate and others powerful. It helps us taste, talk and tie cherry stems, all the while avoiding two interlocking rows of sharpened enamel that know only how to gnash. Now, it seems the tongue may even serve as a gateway to the human brain, providing us with the opportunity to treat serious afflictions from multiple sclerosis to combat-induced brain injuries.

The tongue is a natural candidate for electrical stimulation, thanks in part to a high density of sensory receptors and the concentration of electrolytes found in saliva. This has allowed researchers at the Tactile Communication and Neurorehabilitation Laboratory at the University of Wisconsin-Madison to develop a pattern of electrodes that can be placed on the tongue and attached to a control box. All together, the system is called a Portable Neuromodulation Stimulator (PoNS).

Once hooked in, patients undergo 20-30 minutes of stimulation therapy, or CN-NiNM (cranial nerve non-invasive neuromodulation), matched to a regimen of physical, occupational and cognitive exercises specific to the ailment being treated. Each exercise corresponds with different patterns of tongue stimulation, which in turn coax the brain to form new neural pathways. These pathways remain active even after the stimulation has been removed, meaning the therapy can have lasting effects.

After treatment with CN-NiNM, patients with multiple sclerosis have been shown to have a 50 percent improvement in postural balance, 55 percent improvement in walking ability, a 30 percent reduction in fatigue and 48 percent reduction in M.S. impact scores (a measure of physical and psychological impact of M.S. from the patient's perspective). Extraordinary numbers by any standard, but if you really want to understand the project's impact, read about Kim Kozelichki ditching her hobbled limp for a healthy jog on the University of Nebraska's Medical Center blog.

Best of all, researchers have reason to believe CN-NiNM can not only slow functional loss, but also restore previously lost functions. It's this promise that has the U.S. Army Medical Research and Materiel Command (USAMRMC) interested. In collaboration with the University of Wisconsin at Milwaukee and NeuroHabilitation Corporation, the Army hopes to harness this emerging technology to "restore lost physical and mental function" for both service members and civilians suffering from traumatic brain injury, stroke Parkinson's and multiple sclerosis.

Link to The Daily Citizen.

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