Dr. Kevin Most: Concussions and pain pill addiction

Dr. Kevin Most

We have talked many times about the brain. We have discussed strokes, brain bleeds, brain tumors, strokes and concussions each many times. The study of the brain and illness associated with the brain have increased more than dramatically over the past 10 years. The work done on Parkinson’s with deep brain stimulation, the work down with brain tumors and vaccines, the work done with concussion diagnosis and prevention….. the list goes on. One of the biggest struggles we have seen with researchers is the issue of Dementia or Alzheimer’s. Many feel we have not seen the advances that we would have seen by now. It is aggravating to those who have a love one struggling with this that we don’t have a medication to treat or prevent it. This is an area that is being highly researched. The past few months we have had some interesting studies come out that we all should know about.

Research has shown that moderate and severe traumatic brain injuries (TBI) are associated with an increased risk of dementia and Alzheimer’s as well as an earlier onset for these illnesses as well. The big question has always been where does this risk begin, do you need to have major concussions or multiple major concussions? A study from the VA, just published last week has some concerning results. The study of 350,000 veterans looked at veterans with and without traumatic brain injuries including mild traumatic brain injuries where there was no loss of consciousness. The study determined that the individuals who received mild concussions without loss of consciousness had more than a 2 fold increase in the risk of having a dementia diagnosis. This number was validated after removing other medical conditions that may impact the rate.

We have talked about the impact of concussions on the chance of Dementia. A study like this is difficult to do in the general public as patients records are not kept in one place as they are treated, nor does one group have the information for a large number of patients to study. The VA system does and they just completed their review of medical records from 350,000 veterans. They took the medical records of these soldiers and had close to 180,000 who had been diagnosed with TBI, they then compared that group to another 180,000 who had no history or record of TBI. All of the patients had been treated between 2001 and 2014. When they compared these groups they noted that individuals who had mild TBI without any loss of consciousness were more than 2 times as likely to develop dementia when compared to the control group.

The study also showed that those individuals with more severe TBI, where consciousness was lost, had four times the chance of dementia than the control group.

This same study showed that the incidence of Parkinson’s also rises dramatically with the history of a concussion. It showed not only a higher incidence but also an earlier onset of Parkinson’s as well.

Now researchers and other physicians do not have a specific reason that TBI would lead to a higher and earlier incidence of Dementia, but it is thought that the inflammation may lead to more opportunities for amyloid plaque to develop.

Now this study was completed with 100% military personnel so taking the data and comparing it to the general public is probably not great research technique. This study did not prove that head injuries cause dementia, but it does raise the concern that concussions are certainly one of the more important risk factors for the early onset of Dementia. Some researchers feel that the cause of the concussion should not be separated out from military blasts, to car accidents to football injuries, the mechanism on the brain is the same.

Another study out last week from Boston University, and published in The Annals of Neurology, showed that playing tackle football before the age of 12 may lead to earlier onset of cognitive and emotional symptoms by as much as 13 years. This study looked at autopsy results of 211 football players that were noted to have Chronic Traumatic Encephalopathy. In this study they found that those individuals who started tackle football before the age of 12 had earlier onset of symptoms by a dramatic amount and that each year played earlier showed a 2.4 year earlier onset of symptoms. This study looked at the brains of 246 football players who donated their brain following their deaths for this research. Of the 211 that were found to have CTE, 76 were amateurs and 135 were professionals.

The study collected data from phone call interviews with family members that discussed the onset of symptoms as well as playing activity. The collection of this data showed that for each year younger that the individuals began to play tackle football predicted earlier onset of cognitive problems as well as behavioral and mood problems by 2.5 years.

This study will certainly raise some questions regarding sports injuries and concussions possibly leading to an earlier onset and higher incidence of Dementia. This is a difficult study to reproduce in the general public, however databases like the “All of Us” project may allow for more exact and elegant review of individuals and athletes in the general public.

Many, may have missed the story in late February or early March on the concussion blood test. The FDA for the first time approved a blood test that can be used to evaluate concussions, even mild concussions in adults. It is not a test to diagnose concussions but to hopefully help with the management of concussions. The test known as the Banyan BTI is a blood test that measures the level of 2 proteins that are released into the blood following a brain injury. These proteins are released within 12 hours of the injury. The results will allow doctors to see if a patient may need a CT scan as well. Currently almost all individuals with a concussion who seek medical treatment receive a CT scan. This test will predict the need for the CT which would show more damage in the brain, or conditions that need additional treatment. It will eliminate the need for CT scans in many patients. The elimination of this test not only eliminates some cost but also decreases the amount of radiation the individual is exposed to. The goal for this test is not to diagnose a concussion but is to help eliminate the need for a CT scan. Future tests may be able to make the diagnosis or help in the decision to return to play following a concussion.