Mental Health Disorders Common Following Mild Head Injury

A study published in JAMA

Psychiatry reveals that approximately 1 in 5 individuals may experience mental health symptoms up to 6 months after mild traumatic brain injury (TBI), suggesting the importance of follow-up care for these patients.

The study also identified factors that may increase the risk of developing post-traumatic stress disorder (PTSD) and/or major depressive disorder following mild TBI through analysis of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study cohort.

“Mental health disorders after concussion have been studied primarily in military populations, and not much is known about these outcomes in civilians,” said Patrick Bellgowan, PhD, National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), Bethesda, Maryland. “These results may help guide follow-up care and suggest that doctors may need to pay particular attention to the mental state of patients many months after injury.”

For the study, Murray B. Stein, MD, University of California San Diego, San Diego, California, and colleagues investigated mental health outcomes in 1,155 people who had experienced a mild TBI and were treated in the emergency department. At 3, 6, and 12 months after injury, patients completed various questionnaires related to PTSD and major depressive disorder. For a comparison group, the researchers also surveyed individuals who had experienced orthopaedic traumatic injuries, such as broken legs, but did not have head injury.

The results showed that at 3 and 6 months after their injury, people who had experienced a mild TBI were more likely than orthopaedic trauma patients to report symptoms of PTSD and/or major depressive disorder.

At 3 months after injury, 20% of patients in the TBI group reported mental health symptoms compared with 8.7% of patients in the orthopaedic trauma group. At 6 months after injury, mental health symptoms were reported by 21.2% and 12.1%, respectively.

The researchers also used the data to determine risk factors for PTSD and major depressive disorder after mild TBI. The findings revealed that lower levels of education, self-identifying as African-American, and having a history of mental illness increased risk.

In addition, if the head injury was caused by an assault or other violent attack, this increased the risk of developing PTSD, but not major depressive disorder. However, risk of mental health symptoms was not associated with other injury-related occurrences such as duration of loss of consciousness or posttraumatic amnesia.

“Contrary to common assumptions, mild head injuries can cause long-term effects,” said Dr. Stein. “These findings suggest that follow-up care after head injury, even for mild cases, is crucial, especially for patients showing risk factors for PTSD or depression.”

“From my lecture on concussions…”

“There are massive chemical changes that go on in the brain with concussions. These chemical changes create potentially long lasting effects including an increased likelihood of Parkinson’s disease, dementia, depression, etc.…” Craig S. Rubenstein DC CCN DACBN FIACA

Article Reference: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2722564

SOURCE: National Institutes of Health

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TBI Is Associated With Increased Dementia Risk for Decades After Injury

This information has been reported for years in the literature. Not only do many people suffer from post concussion symptoms including headache, dizziness/vertigo, continuous nausea, emotional disturbances and cognitive issues, the risk of dementia as reported in this study is significantly increased.

TBI Is Associated With Increased Dementia Risk for Decades After Injury

January 31, 2018

SAN FRANCISCO — January 31, 2018 — Traumatic brain injury (TBI) increases the risk of a dementia diagnosis for more than 30 years after a trauma, though the risk of dementia decreases over time, according to a study published this week in PLOS Medicine.

Although TBI has been associated with dementia, the details of that risk over time and in different TBI types have not been well studied.

For the current study, Anna Nordström, Umeå University, Umeå, Sweden, and colleagues tracked all diagnoses of dementia and TBI in Swedish nationwide databases from 1964 through 2012.

In a retrospective cohort, 164,334 individuals with TBI were matched with control participants who did not have TBI; in a case-control cohort, 136,233 individuals diagnosed with dementia at follow-up were matched with control participants who did not develop dementia; and in a third cohort, the researchers studied 46,970 sibling pairs with one individual having a TBI.

In the first year after TBI, the risk of dementia is increased by 4- to 6-fold. Thereafter, the risk decreased rapidly but was still significant more than 30 years after the TBI.

Overall, the risk of dementia diagnosis was increased by about 80% during a mean follow-up period of 15 years.

http://dgnews.docguide.com/tbi-associated-increased-dementia-risk-decades-after-injury?overlay=2&nl_ref=newsletter&pk_campaign=newsletter&nl_eventid=15935

http://dgnews.docguide.com/tbi-associated-increased-dementia-risk-decades-after-injury?overlay=2&nl_ref=newsletter&pk_campaign=newsletter&nl_eventid=15935

Saliva Test May Detect Biomarker for Prolonged Concussion

Ricki Lewis, PhD

November 21, 2017

MicroRNAs (miRNAs) may serve as biomarkers of concussion with prolonged symptoms, according to results of a prospective cohort study published online November 20 in JAMA Pediatrics.

More than 80% of concussions follow mild traumatic brain injuries (mTBIs). For one-third of children, symptoms of concussion persist beyond 2 weeks. A tool to predict children at elevated risk for prolonged concussion symptoms (PCS), other than questionnaires to identify clinical risk scores, would be valuable in referring appropriate patients to specialists.

https://www.medscape.com/viewarticle/888983?nlid=119206_4503&src=wnl_dne_171122_mscpedit&uac=178388PR&impID=1490067&faf=1

Brain Imaging Identifies CTE in a Living Person

New research appears to confirm that positron emission tomography (PET) imaging using the [F-18] FDDNP tracer can identify the distinctive brain tau pathology of chronic traumatic encephalopathy (CTE) in a living person.

The neuropathological findings during a brain autopsy of a retired National Football League (NFL) player confirmed the “fingerprint” signature of CTE uncovered by a previous in vivo [F-18] FDDNP-PET scan

https://www.medscape.com/viewarticle/888817

Concussions in Teenagers Tied to Multiple Sclerosis Risk

From the New York Times:

Here’s yet another reason to protect young athletes from head trauma: A large-scale new study found that concussions in adolescents can increase the risk of later developing multiple sclerosis. The risk of multiple sclerosis, or M.S., an autoimmune nervous system disorder with an unknown cause, was especially high if there were more than one head injury.

The overall chances that a young athlete who has had one or more head injuries will develop multiple sclerosis still remain low, the study’s authors point out. But the risk is significantly higher than if a young person never experiences a serious blow to the head.
The drumbeat of worrying news about concussions and their consequences has been rising in recent years, as most of us know, especially if we have children who play contact sports. Much of this concern has centered on possible links between repeated concussions and chronic traumatic encephalopathy, a serious, degenerative brain disease that affects the ability to think.
But there have been hints that head trauma might also be linked to the development of other conditions, including multiple sclerosis. Past studies with animals have shown that trauma to the central nervous system, including the brain, may jump-start the kind of autoimmune reactions that underlie multiple sclerosis. (In the disease, the body’s immune system begins to attack the fatty sheaths that enwrap and protect nerve fibers, leaving them vulnerable to damage and scarring.)
https://mobile.nytimes.com/2017/10/18/well/move/concussions-in-teenagers-tied-to-multiple-sclerosis-risk.html?#_=_

CTE in American Football Players more than Expected

Researchers at Boston University (MA, USA), reported a high prevalence of CTE in American football players.

Post-mortem exams were performed on 202 brain samples, including ex-NFL players, finding CTE pathology in 177 of the 202 samples and more severe pathology was linked with longer playing careers.

https://www.neuro-central.com/2017/07/25/high-prevalence-cte-observed-deceased-american-football-players/

First Claims Are Approved in N.F.L. Concussion Settlement

JUNE 16, 2017
The first two claims in the N.F.L.’s billion-dollar concussion settlement were announced Thursday, a total of $9 million in benefits.
The Federal District Court for the Eastern District of Pennsylvania, which is overseeing the process, was notified Thursday that the claims were approved. The names of the former players were not disclosed as part of the filings.
The payouts were for $5 million for a qualifying diagnosis of amyotrophic lateral sclerosis and $4 million for a qualifying diagnosis of chronic traumatic encephalopathy. Those amounts mean that each individual played a minimum of five N.F.L. seasons and received a diagnosis before his 45th birthday.
https://mobile.nytimes.com/2017/06/16/sports/football/nfl-concussion-settlement.html?emc=edit_tnt_20170616&nlid=72841338&tntemail0=y&_r=0&referer=