What Is The Link Between Cte And Dementia
In studies of the brains of former footballers and rugby players that developed dementia, microscopic changes in the brain associated with CTE is present in the majority.
However, there are also often other changes in the brain present alongside those associated with CTE, such as Alzheimers disease pathologies, and the final dementia diagnosis in these former athletes can be a range of disorders, not just CTE.
An important observation though is that CTE pathology is present in large numbers of former contact sports athletes with dementia and that this pathology is uniquely linked to brain injury and head impact exposure, suggesting these are key factors in dementia risk in these former athletes.
Acknowledgements: With particular thanks to Professor William Stewart, Consultant Neuropathologist at University of Glasgow for his support in developing this resource.
When To Seek Medical Care For Head Injury
Any of the symptoms and signs described in the Symptoms section warrants a visit to the persons health care provider. This is true regardless of whether the person has a known head injury. Be sure the health care provider knows about any falls or accidents that could have involved even a mild head injury.
How Brain Trauma And Injuries Can Cause Memory Loss
Whenever a part of your brain is affected by trauma, the chance that permanent damage has occurred is not often overlooked. You may have heard of someone losing short-term memory after a concussion, or someone suffering amnesia after an accident. This is not uncommon, considering swelling in the brain can cause memory lapses that are typically temporary. Once the swelling subsides, memory will generally return. However, if the part of the brain that is damaged cannot heal properly after a traumatic brain injury, chances are the memory loss could be permanent and long-term.
What exactly causes memory loss during a traumatic brain injury? There are millions of nerves in our brain, and when one of them is damaged or abruptly traumatized, you can expect them not to function as they are supposed to. If the brain cannot heal itself back to its previous state, it will not function properly and endure minor or substantial memory loss.
Memory loss after a traumatic head injury to the brain will typically return after the initial swelling goes down. This can take anywhere from a few weeks to even a few months, and in some cases, can be permanent. Stress can also cause memory loss, and after a stressful event, sometimes short-term memory can be lost. This is typically temporary, as well.
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How Can Contact Sports Be Made Safer
Whilst researchers work to understand this important issue, contact sports must be played as safely as possible.
Keeping physically active is a key way to reduce our risk of dementia. Sports like football and rugby are loved by millions across the UK and enable people to keep active. We would not discourage anyone from playing football or rugby.
We must strike a balance between ensuring people play the sports they love to keep fit and active with many health benefits and doing so in a safe way.
Sports governing bodies are encouraged to make every effort to reduce head injury risk and, where these might occur, make sure they are managed appropriately.
The general advice in concussion management across sports and activities is if in doubt, sit them out’.
How Do Brain Injuries Cause Dementia
Medical experts believe that brain injuries can cause chemical changes in the brain. These chemical changes can possibly lead to Alzheimers and other dementias. Some studies show a higher likelihood of dementia from head injuries based on certain genetic variations in some people. Not everyone who experiences a severe or moderate head injury will get dementia. But for some people, a head injury can increase the risk.
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Head Injury 25 Years Later: Study Finds Increased Risk Of Dementia
- Date:
- University of Pennsylvania School of Medicine
- Summary:
- New research shows that a single head injury could lead to dementia later in life. This risk further increases as the number of head injuries sustained by an individual increases. The findings also suggest stronger associations of head injury with risk of dementia among women compared to among men and among white as compared to among Black populations.
Head injury in the United States is common, with over 23 million adults age 40 or older reporting a history of head injury with loss of consciousness. Many head injuries can be caused by a host of different situations — from car and motorcycle accidents to sports injuries. What’s more, it has become increasingly recognized that the effects from head injuries are long-lasting. New research led by the Perelman School of Medicine at the University of Pennsylvania shows that a single head injury could lead to dementia later in life. This risk further increases as the number of head injuries sustained by an individual increases. The findings also suggest stronger associations of head injury with risk of dementia among women compared to among men and among white as compared to among Black populations.
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Brain Injury And Dementia: Conclusion
While there appears to be a link between brain injury and dementia, this should not cause you to stress about the future. The likelihood of developing dementia is still relatively low, even for those who have suffered a severe TBI in the past. All you can do is work on what you can change right now.
To reduce your risk of dementia after brain injury, it is crucial to stay physically and mentally active, eat healthily, and socialize with others. This will all keep your body and mind in shape, and improve your quality of life.
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What Is The Medical Treatment For Dementia In Head Injury Cases
The head-injured person who has become demented benefits from emotional support and education. This may include any of the following:
- Behavior modification
- Family or network intervention
- Social services
One goal of these interventions is to help the head-injured person adapt to his or her injury mentally and emotionally. Another is to help the person master skills and behaviors that will help him or her reach personal goals.
- These interventions also help family members learn ways that they can help the head-injured person and themselves cope with the challenges a head injury poses.
- These interventions can be especially important in establishing realistic expectations for outcome and pace of improvement.
Behavior modification
Behavior modification is very helpful in the rehabilitation of brain-injured persons. These techniques may be used to discourage impulsive, aggressive, or socially inappropriate behavior. They also help counteract the apathy and withdrawal common in head-injured persons.
Cognitive rehabilitation
In general, cognitive rehabilitation is based on the results of neuropsychological testing. This testing clarifies problems and strengths in persons with dementia. The goals of cognitive rehabilitation are as follows:
- Encouraging recovery in functions that can be improved
- Compensating for areas of permanent disability
- Teaching alternative means of achieving goals
Medication
Family or network intervention
Head injuries often cause substantial family distress.
Medications For Dementia After A Head Injury
There are no medications formally approved by the FDA specifically to treat dementia in people who have sustained a traumatic brain injury. Persons with a head injury may require medication to treat symptoms such as depression, mania, psychosis, impulsivity-aggression, irritability, mood swings, insomnia, apathy, or impaired concentration. Headaches may also get better with drug treatment.
Drugs used to treat such symptoms are called psychotropic or psychoactive drugs. Doctors do not fully understand how exactly they work, but it is thought that they help to dampen down the activity of brain areas where there is too much excitation and help regulate the activity of brain regions involved in thinking, behavior, mood regulation and impulse control. Head-injured persons are more sensitive to drug side effects. Doses and schedules may require frequent adjustment until the best regimen is found.
Most people with dementia due to head injury are treated with the same drugs used to treat dementia caused by other diseases. In many cases, these drugs have not been specifically tested in persons with head injury. There are no established guidelines on psychotropic drug treatment after head injury.
Antidepressants after a head injury
These drugs are used to treat depressive symptoms due to head injury.
Dopamine-raising drugs
Dopamine enhancers may interact with antidepressants to improve mood swings.
Antipsychotic drugs
Antiepileptic drugs
Mood stabilizers
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How Does Tbi Affect The Brain
Disrupted function of brain cells and their connections after TBI are believed to be caused by the vigorous mechanical strains and deformations that are sustained during impact.7 Experimental data from animal model studies by our group, as well as others, show that concussions induce the inflammatory response in the brain as soon as a few hours after injury.8 These inflammatory signals activate immune cells, which may persist for months in the brain, creating a sustained chronic inflammatory environment.9 Whereas acute inflammation is necessary for tissue healing and repair, chronic inflammation of the brain may result in prolonged injury to neurons and axons. This may eventually trigger degeneration of the brain and thus lead to dementia.10,11
In addition to chronic inflammation, injured neurons also undergo cellular stress and disrupted metabolism that may result in an abnormal production and/or inefficiency in the clearance of toxic proteins, leading to their accumulation in the brain. One such toxic protein is phosphorylated tau .
Search Strategy And Selection Criteria
Research included in this review was collected through PubMed and recent academic conferences using the search terms tau, amyloid-beta, cerebrovascular function, TBI, AD, ischemia, csf, blood, plasma, serum, cerebral blood flow, pathology. Information was included when related directly to the relationship between TBI and AD and cerebrovascular dysfunction. Mostly articles published in English between 2012 and 2017 were included. An exception was made for Martland’s paper PUNCH DRUNK for its historical relevance considering the scope of the review.
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Treatment For Dementia In Head Injury
Head injuries often bring an abrupt “coping crisis.” The sudden adverse changes that go with a head injury inevitability cause many emotions. Anxiety is a common response, and the person may become demoralized or depressed. Damage to the brain may impair the personâs ability to cope at a time when the need to adapt is greatest. Persons with head injury typically are more distressed and have more difficulty coping with their injury than persons who have other types of injuries.
Usually, a particular family member assumes most of the responsibility for the injured personâs care. Ideally, more than one family member should be closely involved in caregiving. This helps family members share the burdens of providing care and helps the primary caregiver keep from becoming isolated or overwhelmed. Caregivers should be included in all significant interactions with health care professionals.
Caregivers must encourage and expect the injured person to be as independent and productive as possible. At the same time, caregivers need to be patient and tolerant. They should accept that the person may have real limitations and that these will likely worsen if the person is tired, ill, or stressed. Emphasizing what the person can still do, rather than what seems to be lost, is helpful.
With head injuries, the greatest improvement is expected in the first six months, but delayed improvement is possible as long as five years after the injury.
Research On Brain Injury And Dementia
Research seems to indicate that brain injury and dementia are somehow linked, though the exact reason behind it remains unclear. While researchers may be unclear on why brain injury can lead to dementia, there are some facts we do know.
The following are the major conclusions of several studies on brain injury and dementia:
- The more severe the brain injury, the higher the risk of dementia. One major study in Denmark found that a single moderate TBI increased a persons chances of developing dementia by 24 percent, and the chances increased to 35 percent after a severe TBI. Other studies have made similar findings.
- Repeated mild traumatic brain injury increases your chances of developing dementia. Researchers discovered this fact in the 1920s when professional boxers started showing signs of mental decline after a few years in the ring. Back then it was called dementia pugilisticaor punch drunk syndrome. Nowadays its referred to as CTE.
- A single mild traumatic brain injury rarely leads to dementia. Most of the research out there seems to show that a single concussion or mild brain injury will not greatly increase the risk of dementia. However, the study in Denmark did find a connection.
- Traumatic brain injury might trigger Alzheimers by releasing a protein. A protein that is found in Alzheimers patients, called beta-amyloid, is also released after a severe TBI, which may explain why theres a connection between brain injury and dementia.
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Relationship Between Dementia And Traumatic Brain Injury
Depending on the severity of the head injury the symptoms can clear up fast, last a long time, or fail to go away altogether.
Keep in mind that symptoms a person experiences after an injury usually do not become worse over time which is usually the case with dementia.
Dementia affects about 47 million people worldwide and we expect the numbers to double in the next two decades.
Over 50 million people across the globe experience traumatic brain injury yearly.
Memory Problems And Tips
Short-term memory loss is very common after a brain injury thankfully there are plenty of coping strategies available. Typical situations include forgetting people’s names, losing a train of thought, getting lost at the shops, repeating or forgetting past conversations, misplacing objects and difficulty learning new skills.
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What Evidence Is There Linking Head Injuries To Risk Of Dementia
In 2020, a group of world-leading researchers listing 12 lifestyle and health conditions that are known to be associated with an increased dementia risk but could be prevented. Traumatic brain injury was included in this list of risk factors we can modify or reduce.
This team of researchers reviewed the highest quality evidence that considered a potential link between brain injury and dementia risk including several large population studies.
- A study in Denmark showed an increased risk of dementia over a period of 10 years after their head injury in people over the age of 50 that had experienced head injuries. They also found risk of dementia increased with the number of head injuries received.
- A study in Sweden showed a similar relationship with brain injury and dementia risk increasing risk with the number and severity of head injuries.
Its important to remember that observational studies can identify patterns, links and trends. Although they may show an association, they cannot tell us whether head injuries were the direct cause of the increased risk of dementia. They do, however, help us to identify key questions that need further exploration.
Does Heading A Football Increase The Risk Of Dementia
There have been calls by many to explore the role of brain injury and head impacts as possible risk factors.
Head injuries in football are relatively rare compared to some other sports, like rugby, but head impacts are common in football through heading the ball.
While research continues to try and understand exactly the relationship between head injury and dementia in sport and what other factors might contribute to dementia risk, researchers believe that reducing head injury risk and head impact exposure might reduce risk. This is one reason why football associations have been reviewing heading in youth football.
As yet we dont know whether restricting heading or introducing concussion replacements, could reduce the risk of dementia.
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What Are Signs Of Dementia Following A Brain Injury
Some of the possible signs of dementia following a brain injury include:
- Memory loss
- Depression
- Insomnia.
There may be other symptoms as well. After an accident in which you hit your head, always get checked out by a doctor, even if you dont think you were hurt. If your loved one was in an accident, had a head injury, and begins showing any of these signs, seek medical guidance.
According To The Researchers At University Of Eastern Finland Individuals With Alzheimers Disease Have A Higher Risk Of Experiencing Head Injuries
Published in Journal of Epidemiology and Community Health, researchers from the University of Eastern Finland have found that individuals with Alzheimers disease have approximately 30% higher risk of head injuries, and 50% higher risk of traumatic brain injuries than individuals without Alzheimers disease.
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How To Help A Loved One With Dementia And Brain Injury
If your loved one has been diagnosed with dementia following their brain injury, you probably have a lot of questions regarding how you can help. The following are a few tips to help improve your interactions:
- Ask simple questions. Make sure you only ask one question at a time, and preferably ones with yes or no answers. In addition, it can help to refrain from giving them too many options. For example, instead of asking what they would like to eat, give them two or three options only.
- Speak slowly and clearly. Use simple words and sentences, and speak in a reassuring tone. If they dont understand the first time, repeat your message patiently. Also, be sure to use the names of people and places instead of pronouns.
- Break down activities into steps. This can help make tasks more manageable. If your loved one struggles to remember how to do an activity, gently remind them of each step they need to take or write down the steps on an easy-to-find place, such as a whiteboard.
- Distract and redirect. If the person becomes upset or agitated, try changing the subject or moving them to a new environment. For example, you might ask them for help with something or suggest going for a walk.
These are just a few simple ways to help make things a little easier for dementia patients. For more suggestions, talk to your family doctor or a specialist.