Vets with Head Injury More Likely To Develop Dementia

MedicalResearch.com Interview with:
Deborah E. Barnes, PhD, MPH Professor, UCSF Weill Institute for Neurosciences Departments of Psychiatry and Epidemiology & Biostatistics University of California, San Francisco: http://profiles.ucsf.edu/deborah.barnes Research Health Sciences Specialist, San Francisco VA Medical Center Senior Investigator, Tideswell at UCSF: http://www.tideswellucsf.org/ Deborah E. Barnes, PhD, MPH

Professor, UCSF Weill Institute for Neurosciences
Departments of Psychiatry and Epidemiology & Biostatistics
University of California, San Francisco: http://profiles.ucsf.edu/deborah.barnes
Research Health Sciences Specialist
San Francisco VA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

  • Previous studies have found a link between moderate to severe head injuries and increased dementia risk.
  • The association between mild head injuries and dementia – especially mild head injury that doesn’t result in loss of consciousness – is less well established
  • We examined the association between mild head injuries with and without loss of consciousness and dementia diagnoses in nearly 360,000 Veterans receiving care in the VA health care system.
  • We found that Veterans with a head injury diagnoses were two to four times more likely to be diagnosed with dementia than those without head injury diagnoses.
  • The risk of dementia diagnosis was doubled in Veterans who experienced head injury without loss of consciousness compared to those with no head injury. 

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Head Injuries and Concussions Common in Theater Work and Performing Arts

MedicalResearch.com Interview with:

Jeffrey A. (Jeff) Russell, PhD, AT, FIADMS Science and Health in Artistic Performance Division of Athletic Training, School of Applied Health Sciences and Wellness Ohio University Athens, OH 45701

Dr. Jeff Russell

Jeffrey A. (Jeff) Russell, PhD, AT, FIADMS
Science and Health in Artistic Performance
Division of Athletic Training, School of Applied Health Sciences and Wellness
Ohio University
Athens, OH 45701

MedicalResearch.com: What is the background for this study? What are the main findings?

 

 

Response: Everyone knows that enormous attention is given to concussions in sports today. Those involved in performing arts experience many head impacts, too; yet, they receive neither the attention nor the specialized care for concussions that athletes do.

At Ohio University’s Clinic for Science and Health in Artistic Performance (SHAPe Clinic) that I direct, we were seeing a number of theater students suffer concussions. So, Brooke Daniell and I decided explore this trend more closely. This is the first known published research to evaluate the prevalence of head impacts in theater personnel. In the sample we studied, which comprised predominantly those involved in various aspects of theater production, the prevalence of receiving at least one head impact in a theater career was 67%. Of those who sustained at least one head impact from theater, 77% reported three or more head impacts, and 39% reported more than five impacts. More troubling, of those who said they had received a head impact that was accompanied by concussion-like symptoms, 70% indicated that they continued their work, and half of those did not report the incident to anyone.

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Rates of Invalid Baseline Concussion Testing May Be Alarmingly High

MedicalResearch.com Interview with:

Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario

Dr. Christopher Abeare

Christopher Abeare, Ph.D.
Associate Professor
Clinical Neuropsychology
Department of Psychology
University of Windsor
Windsor, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning.

However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering).

As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years.

We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one.  Continue reading

Single Head Injury Linked To Parkinson’s but Not Alzheimer’s Disease

MedicalResearch.com Interview with:

Paul K. Crane, MD MPH Professor Department of Medicine Adjunct Professor Department of Health Services University of Washington

Dr. Paul Crane

Paul K. Crane, MD MPH Professor
Department of Medicine Adjunct Professor
Department of Health Services
University of Washington

MedicalResearch.com: What is the background for this study?

Response: The background is that the most common experience of head injury with loss of consciousness is an apparent recovery. Sometimes this is very fast, sometimes it takes somewhat longer, but typically people return to their prior baseline. Nevertheless there is concern that the head injury may have set in motion processes that would lead to late life neurodegenerative conditions. Previous research has focused especially on Alzheimer’s disease. A more limited research has focused on Parkinson’s disease.

We used data from three prospective cohort studies that included more than 7,000 people to study the relationship between head injury with loss of consciousness and subsequent risk of Alzheimer’s and Parkinson’s disease. We collected head injury exposure data at study enrollment, at a time when we administered cognitive tests and knew they did not have dementia, so our exposure data are not biased. Each of these studies also performed brain autopsies on people who died, and we evaluated data from more than 1500 autopsies.

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Which Patients on Warfarin Need Repeat CT Scan after Head Injury?

MedicalResearch.com Interview with:
Dr Lim Beng Leong MBBS, MRCS (A&E), FAMS

Jurong Health Services
Emergency Department, Singapore 

Medical Research: What is the background for this study? What are the main findings?

Dr. Leong: It is common in the emergency department to see patients with warfarin who suffer a minor head injury (HI) with GCS >13. It is standard practice according to international guidelines to perform a plain CT scan of the head. What is contentious in the literature is the subsequent management of those patients with a normal initial CT scan. Practice is heterogeneous and includes a mandatory second CT scan at 24 hours mark or observation and repeat CT scan at the discretion of the attending doctor.

We have found in our study that the “observe and repeat CT scan for symptomatic cases” approach only was safe as abnormal second CT scans were rare (1 in 295 cases). We traced the patients’ course 2 weeks post discharge and none of the patients were re-admitted for reasons of delayed intra-cranial hemorrhage (ICH).

However, the cohort of patients consist largely of geriatric patients with falls. More than 50% of these patients were hospitalized for more than 3 days; the longest of 2-3 weeks. They were likely to have various reasons that required longer hospitalizations apart from observation for delayed ICH, such as assessing for risk, etc.

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Study Finds No Link Between Head Injuries and Parkinson’s Disease

MedicalResearch.com Interview with:
Line Kenborg, MSc, PhD

Survivorship Unit
Danish Cancer Society Research Center
Copenhagen

Medical Research: What is the background for this study? What are the main findings?

Response: The hypothesis that head injuries increase the risk for Parkinson disease has been examined in many studies during the past decades, but the findings have been highly inconsistent. We have previously examined the hypothesis in a study based on information on head injuries and Parkinson disease from the Danish National Hospital Registry. In this study, we found a positive association between a hospital contact for a head injury in middle or late adulthood and a diagnosis of Parkinson disease. The reported association, however, was almost entirely due to injuries that occurred during the months preceding the first hospital contact for Parkinson disease. Because we used information from registries, we lacked detailed diagnostic information to distinguish Parkinson disease from other types of parkinsonism, and we had no information on milder head injuries and head injuries in early life. So we wanted to study whether head injuries throughout life increased the risk for Parkinson disease in the largest interview-based case-control study to date including patients with a verified diagnosis of Parkinson disease. The main finding of our study is that we do not find any association between head injuries and Parkinson disease.

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Novel Eye-Tracking Technology Might Take Guesswork Out of Head Injury Diagnosis

Uzma Samadani, M.D., Ph.D. Assistant Professor; Departments of Neuroscience and Physiology NYU Langone Medical CenterMedicalResearch.com Interview with:
Uzma Samadani, M.D., Ph.D.
Assistant Professor
Departments of Neuroscience and Physiology
NYU Langone Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Samadani: Research dating back as early as 3,500 years ago suggests the eyes serve as a window into the brain, with disconjugate eye movements — eyes rotating in different directions — considered a principal marker for head trauma. Current estimates suggest up to 90 percent of patients with concussions or blast injuries exhibit dysfunction in their eye movements.

We wanted to find a way to objectively track and analyze eye movements following a head injury to measure injury severity and replace the current “state of the art” method of asking a patient to follow along with a finger. CT-scans and MRIs may not necessarily reveal concussion or traumatic brain injury (TBI) in the absence of structural damage, presenting a need for a diagnostic measure of head injury severity.

In a study published earlier this year in the Journal of Neurosurgery, my team at the NYU Cohen Veterans Center tested our novel eye-tracking technology on military veterans, and found our device and tracking algorithm could reveal edema in the brain as a potential biomarker for assessing brain function and monitoring recovery in people with head injuries.

Our latest paper, published January 29 in Journal of Neurotrauma, looked at a civilian population of patients admitted to the Bellevue Medical Center emergency department in New York City, with whom the NYU School of Medicine has an affiliation agreement. We compared 64 healthy control subjects to 75 patients who had experienced trauma that brought them to emergency department. We tracked and compared the movements of patients’ pupils for over 200 seconds while watching a music video.

We found that 13 trauma patients who had hit their heads and had CT scans showing new brain damage, as well as 39 trauma patients who had hit their heads and had normal CT scans, had significantly less ability to coordinate their eye movements than normal, uninjured control subjects. Twenty-three trauma subjects who had bodily or extremity injuries but did not require head CT scans had similar abilities to coordinate eye movements as normal uninjured controls.

Among patients who had hit their heads and had normal CT scans, most were slightly worse at 1-2 weeks after the injury, and subsequently recovered about one month after the injury. Among all trauma patients, the severity of concussive symptoms correlated with severity of disconjugacy.

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Pediatric Trauma Center Reviews Youth Ice Hockey Injuires

MedicalResearch.com Interview with:
Stephanie F. Polites, MD
Department of Surgery and

Michael B. Ishitani, MD
Department of Pediatric Surgery
Mayo Clinic, Rochester, Minnesota

MedicalResearch: What are the main findings of the study?

Answer: Though most injuries were in boys, 20% of the injuries occurred in girls. Extremity fractures and head injuries were the most common injuries with older children and boys more likely to sustain extremity fractures while younger children and girls were more likely to have head injuries or concussions. Life threatening injuries were rare, which is reassuring.
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