Mild TBI Causes Cognitive Impairments

Neuroscientists at Newcastle University in the U.K. have investigated the cognitive capacities of 44 people with mild TBI vs. 9 normal controls. They found that for a period of one year following their accident the mildly brain injured subjects performed 25% worse on memory and cognitive testing than the controls due to white matter brain damage confirmed through Tensor Diffusion MRI scans. Healing of brain injury was correlated with a return to normal memory and cognitive functioning. This was a small study, but it provides confirmatory evidence that so called “concussions” can have a significant affect on memory and thinking, and that such complaints are not just “made up” for litigation purposes.

James Sumowski, PhD and colleagues at the Kessler Foundation in New Jersey have published research on 10 patients showing the effectiveness of a new memory therapy for people with severe TBI The Archives of Physical Medicine & Rehabilitation Volume 95, Issue 2 (390-396) February 2014. The research showed that RP (retrieval practice) was superior to two older methods of strengthening memory in severe TBI patients known as MR (massed restudy) and SR (spaced restudy). RP works by testing how well severe TBI patients recall the content of paragraphs immediately after they read them. Although the results appear promising a group of just 10 test subjects without a control group is not sufficient to validate the technique. More studies involving larger samples will be done in the future.

In July 2014 researchers from the Biomedical Engineering Department of Rutgers University in New Jersey demonstrated their novel “Brain-on-a-Chip” microsystem to study how brain trauma damages axons. Using the system they can get a 3D picture of how living axons are strained or even sheared by external force of varying strengths and vectors. They can also test experimental drugs to see which ones reduce mitochondrial damage after application of external force, and in this way find candidates for post-TBI drug therapy in the hospital. The lead scientist on this project is Martin Yarmush MD, Ph.D.

A large team of investigators led by Kate A. Yurgil has just published an article in JAMA Psychiatry online (71(2):149-157. doi:10.1001/jamapsychiatry.2013.3080) called “Association between TBI and Risk of PTSD in Active-Duty Marines. The investigators from UC San Diego and the V.A. studied a group of 1,648 marines at Camp Pendleton in San Diego for four years between June 2008 and May 2012. What they wanted to know was why some marines are more vulnerable to PTSD and some are more resistant to it. What they found was that PTSD is the strongest predictor of PTSD even when controlling for pre-existing symptoms and combat intensity. Moderate to severe brain trauma raised PTSD symptom scores by 71% while mild TBI raised scores by 23%. The researchers also found a strong association between TBI and chronic pain suggesting that TBI dysregulates the brain’s ability to tolerate pain.

A study published on January 15, 2014 in the online version of JAMA Psychiatry says that people with severe TBI are at three times the risk of premature death due to depression, behavioral problems, and crime. The determination was made by researchers at the Karolinska Institute in Stockholm who looked at medical records of 218,300 brain injury survivors and 150,513 siblings of brain injury survivors. Almost two million people matched by sex and age and picked from the general population formed the control group. Although the reason for spurred risk of premature death was not clear, researchers speculated it could be linked to damage to brain areas crucial for judgment, decision-making and risk-taking. The lead researcher psychiatrist Dr. Seena Fazel of Oxford said that long term monitoring and management of people with severe TBI is in order in light of these findings.

On June 25, 2014, the Waco Tribune reported that a significant number of people exposed to the blast from the explosion of the West Fertilizer Co. on April 17, 2013, sustained concussions, hearing problems or both. Of the 252 people with non-lethal injuries 46 patients had ear injuries or hearing problems, while 53 had concussions or traumatic brain injuries, according to the emergency room records. Doctors believe the actual numbers were higher due to under-diagnosis. If you or a loved one is exposed to a man-made blast due to negligence you should get a thorough medical and neurological exam, and if it turns out that you did sustain neurological injury, then it makes sense to file a claim against the wrongdoer. Fertilizer companies, mining companies and other companies that deal with explosive materials must carry sizable liability insurance coverage.