15 Jul Concussion Expert Discusses Recent Study of Repeated Brain Injury and Risks of Depression, Cognitive Issues
MedicalResearch.com Interview with:
Dr. Steve Erickson, MD
Concussion Expert at Banner
University Medicine Neuroscience Institute
MedicalResearch.com: What is the background for this study?
Response: The study compared depression and cognitive function of adults (middle aged and older) who have had repetitive head impacts (RHI) and/or TBI to adults without a history of these.
MedicalResearch.com: What are the main findings?
Response: In general, the study found that adults with repetitive head impacts (RHI) and/or traumatic brain injury (TBI) had higher depression scores and showed cognitive difficulties on some cognitive tests. Those with both RHI and TBI with loss of consciousness (LOC) had the worst depression symptoms and cognitive performance. The many problem with this study is that it lumps all forms of TBI together. I certainly agree that with moderate and severe TBI there is the possibility of long-term sequel including persistent cognitive deficits and psychiatric illness.
The study participants did not have baseline cognitive testing before their injury or injuries so I think that based on the data presented here it is a stretch to say that repetitive head trauma or multiple episodes of mild traumatic brain injury results in cognitive deficits later in life.
MedicalResearch.com: What should readers take away from your report?
Response: A cross-sectional analysis of participants 40 years or older who consented to participate in the Brain Health Registry self-reported past histories of RHI and TBI with or without LOC. Mild TBI was defined as TBI w/o LOC or with less than 30 minutes LOC. They completed a 15-item y/n depression scale (Geriatric Depression Scale) and two online computerized neuropsychological test batteries. 16.4% of the sample reported clinically meaningful depression symptoms, which is similar to community samples of older adults. Those with TBI had slightly (.75 points for LOC, .43 points for no LOC) higher scores than the control/no TBI/RHI group. Thus with RHI had scores 1.24 points above the control group. On some cognitive tests, the RHI and TBI w/ and w/o groups performed worse.
Readers should not conclude from this study that everyone with repetitive head trauma or TBI will have neurocognitive deficits and/or psychiatric issues later in life. This study does not document if the study participants received any treatment for their injuries. It is possible that patients who are not treated for mild traumatic brain injury until all of their neurocognitive deficits have resolved and go on to sustain additional injuries may develop persistent cognitive deficits.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This study grouped all TBIs with LOC into a single group, meaning that the differences in performance with the TBI group could be driven by those who sustained moderate to severe brain injuries. The study would be improved by examining LOC <30 minutes as a separate group from the moderate and severe (LOC >30 minutes) groups. Further, variables were dichotomous notations of presence or absence of RHI, TBI w/ LOC, or TBI wo LOC, which fails to examine the effect of potentially important modifiers of outcome: number of insults to the brain and timing/spacing of these injuries. Age when injuries were sustained, another variable that has been considered potentially important in prior research, was also not addressed. It is also unclear the clinical significance of a .43 to 1.24 point difference in depression scores on a 15-point scale. If the differences are present but are not meaningful enough to be functionally different, is it still reasonable to describe the differences as “increased depression?” The study would benefit by examining not only statistical differences in scores, but the functional impact on the lives of the respondents. In such a large sample, it is not difficult to find significant differences in variables.
MedicalResearch.com: Is there anything else you would like to add?
Response: Although studies such as this provide insight into potential long-term outcomes from TBI / RHI, the studies should be considered in context of their methodologies. In the recent decades, that would post-date many of the injuries sustained by the sample, concussion management has evolved with the goal of improving long-term outcomes from injury.
The most important take-away from this and similar studies is the importance of quick identification and proper management of head injuries, including immediate removal from play and no return to activity until the athlete or injured person is asymptomatic at rest, with exertion, and normal on all objective medical, neurocognitive, balance, and other objective tests. As concussion identification and management evolves, it will be important for large studies such as this to continue to track long-term outcomes.
Michael L. Alosco, Yorghos Tripodis, Zachary H. Baucom, Jesse Mez, Thor D Stein, Brett Martin, Olivia Haller, Shannon Conneely, Michael McClean, Rachel Nosheny, Scott Mackin, Ann C McKee, Michael W Weiner, Robert A. Stern. The Late Contributions of Repetitive Head Impacts and TBI to Depression Symptoms and Cognition. Neurology, 2020; 10.1212/WNL.0000000000010040 DOI: 10.1212/WNL.0000000000010040
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