A recent study published in JAMA Network Open finds that patients with a history of traumatic brain injury (TBI), including mild TBI (mTBI), are at significantly greater risk of developing chronic cardiovascular, endocrine, neurological and psychiatric disorders. This proved to be true in all age groups, including younger adults (18-40).
This study is important because, as the authors note, “the risks of incident comorbidities in previously healthy patients who sustained mTBI and msTBI (moderate-severe TBI) has not previously been reported.” The most important takeaway of the study is that “patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases.” Read More
Most personal injury lawyers have represented clients suffering from the chronic consequences of concussion and musculoskeletal injuries following a rear end collision that caused minimal damage to the vehicles involved. This blog has reported on countless scientific studies showing that in some patients concussions can have long-term, chronic consequences. The standard defense employed by insurers in minimal damage rear end collisions (which they call “MIST” cases) is to argue that any injury is improbable in these accidents because the forces involved are similar to the forces involved in many activities of daily living (ADLs) where injuries rarely occur (like sitting down in a chair or sneezing.
The insurers and their defense counsel typically have an “accident reconstruction” expert they routinely use (often retired police officers) who calculate the speed change in the crash (the “delta V”) and then compare it to the delta V involved in everyday activities. (The delta V calculations by these so-called experts is often inaccurate, but that is a different issue.) Experience shows that this testimony can be very compelling to a jury, faced with judging the credibility of an injury victim whose injury is not immediately apparent. Read More
So called “mild” traumatic brain injury (“mTBI”) can have long-term, disabling consequences (in both civilian and military populations);
that this injury is heterogeneous in both presentation and clinical outcome (in other words, every injury is different); and
that interventions targeted to the individual presentation of the injury (whether it is predominantly vestibular, cognitive, oculomotor, headache, sleep or mood related, or some combination) can reduce symptoms in otherwise intractable patients.
The message is that ignoring the symptoms and hoping that they will ultimately disappear – the approach often taken in the past – is not wise for either the individual or for society as a whole. Read More
In prior posts I have discussed the growing evidence that traumatic brain injuries, even so-called “mild” traumatic brain injuries (mTBI), can lead to neuroendocrine dysfunction (NED) – most commonly growth hormone (GH) deficiency due to pituitary dysfunction. Although growth hormone deficiency often results in physical symptoms such as loss of lean muscle mass and strength, increased body fat around the waist, and dyslipidemia, other common GH deficiency symptoms overlap with the symptoms of “persistent post-concussion”- such as fatigue, poor memory, anxiety, depression, emotional lability, poor attention and poor concentration.
My earliest post on this issue discussed the August 2012 Department of Defense (DOD) clinical recommendations for screening for neuroendocrine dysfunction in “mild” traumatic brain injury (“mTBI”) cases – where indicative symptoms persist for more than three month or appear within three years. The guidelines contemplated a simple blood test, but subsequent studies, also discussed in this blog, showed that the only reliable means of detecting GH deficiency is provocative testing, which is expensive and takes several hours (the guidelines do suggest further assessment by an endocrinologist, even where the screening test is negative, if symptoms of NED persist.) Read More
Research scientists at the Center for Brain Health at the University of Texas at Dallas have just published a study, funded by the US Department of Defense, supporting the effectiveness of “strategy-based” cognitive training at reducing symptoms of depression commonly found in patients with chronic (greater than 6 months) traumatic brain injury (TBI) symptoms.
The training was an integrative program designed to improve cognitive control by exerting more efficient thinking strategies for selective attention and abstract reasoning. The training did not directly target psychiatric symptoms such as depression, but was nonetheless effective at reducing those symptoms. Read More
As discussed in prior posts on this blog, sleep alterations are commonly found after a concussion or other traumatic brain injury, both short term and in some cases long term. One of the most well documented impacts of concussion, also discussed in prior posts, is an increased risk of mood disturbances, including depression, increased anxiety and increased risk of suicide. In recent years researchers have turned to sleep studies to explore the connection between these symptoms.
There is substantial evidence in the literature of the role healthy sleep plays in the “consolidation” of emotional memories. At first blush, this research is counter-intuitive. If sleep “consolidates” emotional memories, doesn’t this have the potential to increase rather than decrease mood disturbance? The answer appears to be that, although sleep preserves memory of events associated with emotional experience, at the same time it weakens the emotional “charge” coating the experience (referred to in the literature as “valence”) in a process called “habituation.” As one researcher hypothesized, “we sleep to forget the emotional tone, yet sleep to remember the tagged information.”Read More
Several of my traumatic brain injury (TBI) clients have been treated for gut issues – issues that were not present prior to their TBI. Insurers, of course, insist that this treatment cannot be related to the brain injury. The scientific literature indicates otherwise. Researchers at the University of Maryland School of Medicine recently found a two-way link between TBI and intestinal changes.
The findings indicate that this two way interaction may contribute to increased infections in TBI patients and may also worsen chronic brain damage. Read More
A new study published in the Annals of Neurology – the official journal of the American Neurological Association – adds further evidence in support of our growing understanding that TBI, especially moderate/severe TBI or repetitive mild TBI, often triggers a “progressive neurodegenerative process” that accelerates over time. As discussed in prior posts, TBI is now conceptualized as potentially a chronic disease triggered by injury, not as an isolated event. Hopefully this understanding will lead in the future to interventions designed to halt or slow the disease process.
The recent study, published in the April 2015 issue, reports on the results of research at the Imperial College London, where brain scans of over 1500 healthy people were analyzed to develop a computer program that could predict a person’s age from their brain scan. The program was then used to estimate the “brain age” of 113 more healthy people and 99 people who had suffered TBIs. The brains of the TBI patients were on average five years older than their real age would predict. Read More
Two recent peer reviewed papers support the position statement adopted by the Brain Injury Association in 2009 that “Brain Injury” be treated not as static event from which patients gradually recover over time, but as the beginning of a disease process that that can cause symptoms that change over time, in some cases getting worse instead of better, and that can impact multiple organ systems.
The good news is that most people do, in fact, recover. For those who do not, however, the disease model is more consistent with the evolving research. As McCrea, Iverson, McAllister, et. al. noted in their 2009 Integrated Review of Recovery after Mild Traumatic Brain Injury, brain injury science has advanced more in the last few years than in the previous 50, causing us to change the paradigms we have used to understand both the injury and its consequences. Read More
In the study, NYU medical school researchers measured changes in global and regional brain volume over a one year period in 30 patients with “mild” traumatic brain injuries and typical post-injury symptoms including anxiety, depression and fatigue, and other symptoms such as headache, dizziness and perceived cognitive problems.