Blood Protein Test May Help Diagnose Concussions

Doctors in Cleveland, Ohio are currently conducting a study on local college football players, testing their blood for a protein that could indicate they’ve sustained a concussion.  The blood samples are being screened to see if they contain a protein that's known to leak into the blood after sustaining a head injury.

If the study confirms the predictive value of the protein, it could lead to simple blood tests to confirm concussions.  Traumatic brain injury (TBI) accounts for more than 1 million emergency room visits each year throughout the US. 

 

The test could also help track the long-term effects of high-impact sports like football or boxing, and it could be valuable to the military, as soldiers often face head injuries caused by the pressure wave from bomb explosions.

Higher Risk for Dementia for TBI Victims

A new study revealed that Traumatic Brain Injury (TBI), whether mild, moderate, or severe, has been linked to a doubling of risk for dementia.
 

Presented at this year's Alzheimer's Association International Conference in Paris, France, a seven year study of veterans over 55 found that the veterans with TBI were twice as likely to develop dementia over that 7 year period of time, with 15% of the TBI veterans vs 7% of non-TBI veterans developing dementia.

"[The findings] suggest TBI may predispose people to earlier manifestation of [dementia] symptoms and raises hope that treatment or rehabilitation may have a role in preventing downstream dementia," says Kristine Yaffe, MD, professor of psychiatry and epidemiology, University of California, San Francisco and director of the Memory Disorders Program at the San Francisco Veterans Affairs Medical Center.

According to Dr. Yaffe, the most plausible explanation for the relationship between increased dementia in TBI victims is that diffuse axonal injury, or swelling of the axons that form connections between the neurons, would disrupt neuronal communication.

Clinicians need to recognize TBI as a major risk factor for dementia, and individuals who have sustained a head injury constitute a group that should "probably be followed very carefully as they age and be screened for dementia and other cognitive problems," Dr. Yaffe said.

TBI is a widespread problem, far too common among veterans, as well as car accident victims, athletes, people who experience falls, and many others.  The Centers of Disease Control and Prevention estimates that approximately 1.7 million TBI-related deaths, hospitalizations, and emergency department visits occur in the United States every year.

NFL Sued for Concealing Effects of Multiple Brain Injuries on Players

Seventy-five former NFL players filed a lawsuit in Los Angeles Superior Court this week, alleging that the league has covered up the harmful effects of concussions for almost 70 years.  

All of the players in the litigation claim they suffered injuries as a result of multiple concussions.  They contend the injuries left them with problems such as dementia, headaches, memory loss, blurred vision, sleeplessness and ringing in the ears.  Some claim the injuries caused depression, anxiety, "explosive mood changes," poor judgment and substance abuse.

The suit alleges that “the NFL knew as early as the 1920s of the harmful effects on a player’s brain of concussions; however, they concealed these facts from coaches, trainers, players and the public.”  The suit also names helmet-maker Riddell, the NFL's official helmet supplier, as a defendant.

The suit claims the NFL commissioned a study in 1994, titled "NFL Committee on Mild Traumatic Brain Injury" that published a "false, distorted and deceiving" report in 2004, concluding there was "no evidence of worsening injury or chronic cumulative effects" from multiple concussions.

The suit alleges that the NFL finally acknowledged in June 2010 that concussions can lead to dementia, memory loss, and chronic traumatic encephalopathy (CTE).  CTE is a degenerative brain condition that has been linked to the deaths of several former NFL players, including former Chicago Bear Dave Duerson and former Cincinnati Bengal Chris Henry.

Even though this litigation could take years of trials and appeals before any final conclusion, its affect could potentially change the future of the NFL and how players' traumatic brain injuries are assessed and handled.

Mild Traumatic Brain Injury Android Mobile App For Health Care Professionals

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) teamed with the National Center for Telehealth and Technology (T2) to develop a mobile application called the Mild Traumatic Brain Injury (MTBI) Pocket Guide.  It is a free mobile application developed to provide health care professionals with a comprehensive, quick reference that includes clinical practice guidelines for assessing and treating service members and Veterans who have sustained a MTBI. 

App Screenshot

The mobile application is free and available for download on Android smartphones.  It is not yet available for iPhone users.  Since the mobile application was specifically intended for healthcare professionals who care for service members and veterans, it is not currently appropriate for use for other victims of a MTBI.  To download the app, go to: https://market.android.com/details?id=org.t2health.mtbi. 

New MMR Device Approved to Diagnose Traumatic Brain Injuries

A new device was recently cleared by the FDA to help diagnose brain injuries in patients.  The Siemens Biograph mMR system is the first machine to simultaneously perform a positron emissions tomography (PET) scan and a magnetic resonance imaging (MRI) scan.

PET scans involve a radioactive injection that traces blood flow, while MRIs produce images of the brain through the use of magnetic fields.

“The Siemens PET/MRI system allows two tests to run simultaneously without having to move the patient to a different scanning system,” said FDA representative Alberto Gutierrez in a statement.  “Minimizing changes in a patient’s position between tests allows for physicians to compare images more easily and helps them get the most accurate information possible.”

The two-in-one scanner both saves time and reduces radiation levels exposed to patients.  The system has been cleared for anyone who needs diagnostic PET or MRI imaging, with an exception for people with implanted electronic devices like pacemakers or defibrillators.

TBI May Be Helped By Early Nutrition Intervention

A report by the Institute of Medicine, commissioned by the U.S. Defense Department, recommends that in the first 24 hours after a traumatic brain injury (TBI), patients need to receive a level of nutrition that represents more than 50 percent of the injured person’s total energy expenditure and that provides 1 to 1.5 grams of protein per kilogram of body weight.  This nutrition level should be continued for two weeks in order to reduce inflammation and swelling of the brain and provide enough energy to help the brain repair itself.  Early feeding was found to mitigate the effects of head injuries and reduce mortality in critically ill people by between 25% and 50%.

 "The one major [conclusion] is a focus on getting protein and calories in as quickly as possible," said John Erdman, a nutrition researcher at the University of Illinois, who headed the panel of independent experts that produced the report.

 TBI among U.S. soldiers is a growing problem.  The Defense Department says reported cases have tripled to more than 30,000 in the past decade, reflecting injuries from so-called improvised explosive devices, or IEDs, that troops frequently encounter in Afghanistan and Iraq.

 Also, because of the parallels between some types of TBI found in combat personnel and those found in civilian brain injuries, such as concussions from traffic accidents and sports-related injuries, the nutritional interventions explored in this report are relevant for nonmilitary populations.

 Outside the military, some 52,000 people in the U.S. die each year from TBI, and about 1.5 million patients report to emergency rooms annually with head injuries.  As many as 3.8 million people suffer such injuries playing sports each year, says the Brain Trauma Foundation.

 The Institute of Medicine’s committee suggests that more research be conducted on a number of other possible benefits for nutritional interventions in TBI victims, including any long-term benefits of nutrition.

Long-Term Depression Linked to TBI

About 30 percent of traumatic brain injury (TBI) patients will develop clinical depression, a level three times higher than the general population, according to a new study from Vanderbilt University.  By examining more than 100 previously published studies done over several decades on patients that had experienced TBIs resulting from motor vehicle accidents, falls, assaults, and sports injuries, the Vanderbilt researchers were surprised to discover that the incidence of depression seems to hold steady for people with TBIs even years later.

 “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” said Dr. Oscar Guillamondegui, study co-author and professor in Vanderbilt’s Division of Trauma and Surgical Critical Care. “It doesn’t matter where on the timeline that you check the patient population – six months, 12 months, two years, five years – the prevalence is always around 30 percent across the board.  In the general population about 9 percent to 10 percent of people have depression.”

 The study didn’t show a distinction between mild and severe brain injuries, meaning a patient who sustains a concussion might be just as likely to develop depression as one with a fractured skull and severe bleeding on the brain.

 “Nine months out, they may have developed depression as a result of the injury, but because the injury seemed mild they may not have had a visit with a physician who could pick up on the problem,” said study co-author, Melissa McPheeters, a health-care epidemiologist and co-director of Vanderbilt’s Evidence-based Practice Center.

 “Patients and their families need to know about this,” McPheeters said. “They need to know what to look for because they are the ones who will see the changes first.”

 The researchers also suggested that practitioners should ask about whether a patient has a history of TBI, when they are initially seen for symptoms such as irritability, restlessness, anxiety, and sleeplessness, so that both conditions can be treated together.