Long-term consequences of repetitive brain trauma

rising concern over Former football players' at risk of degenerative brain diseases.

Rising concern over former football players’ risk of degenerative brain diseases

Two Beaumont experts weigh in on research from Boston University that found more evidence supporting a link between repeated knocks to the head and chronic brain disease.

Researchers examined the brains of 85 former athletes and soldiers who sustained multiple mild head injuries over their lives found the condition they developed causes depression and erratic behavior and has attracted public concern in recent years following the high-profile suicides of former professional athletes.

Read more from our chief of pediatric physical medicine and rehabiliation and director of neurotrauma.

Neal Alpiner M.D. FAAP, FAAPMR
Section Chief Pediatric Physical Medicine and Rehabilitation
Beaumont Health System
Assistant Professor OUWB Medical School

The airways are abuzz with the latest documentation regarding the long-term effects of repetitive head trauma. The journal, Brain, in its latest edition reported extensive findings linking persistent and at times fatal effects of repeated head trauma. Many people are aware of these findings but the present journal magnifies the issue with the sheer number of autopsy evidence.  The authors highlight the repetitive nature of the injury and the cumulative toll the injuries take. What needs to be emphasized for active players is at times it is difficult to recognize what is a head injury or concussion as they are the same. Something can only be defined as being repetitive if it’s identified, treated and documented as such.

What remains elusive and very difficult for players, coaches and parents is the understanding that head injury or concussions have many faces. One player with a concussion may present very differently from their teammate, or themselves may present with different symptoms upon subsequent re-injury. A rule of thumb is if you think you, your child or a player may have had a concussion it must be treated as if they have.

Teenagers are more prone to sustaining a concussion due to their developing brain; transitioning from childhood to adulthood. Several prominent articles point to the fact that children present differently than adults when concussed. This is poignantly noted  in the article referenced above , as autopsy findings were from individual as young as 17 years old. Meaning they  must have had repetitive injuries at a very early age.

What is not known by current literature is how many head injuries constitutes repetitive, which means every concussion is serious.

Daniel B. Michael, M.D., Ph.D.
Director of Neurotrauma, Beaumont Hospital, Royal Oak
Professor of Neurosurgery, OUWB Medical School

Dr. Mckee  and colleagues at Boston University School of Medicine have published the largest observational study to date describing cellular and molecular changes at autopsy in the brains of 85 patients known to have sustained repetitive head injuries during life. Some of the findings raise intriguing questions regarding the link between head injury and dementia in later life e.g.: are some of these mechanisms shared with Alzheimer’s disease?

The study does not tell us how many minor head injuries humans can sustain before the changes associated with chronic repetitive encephalopathy are inevitable. In an interview on PBS news last night, Dr. Mckee indicated this answer will require a longitudinal study, likely following “thousands “ of persons at risk for years and making use of biomarkers of brain injury. While such a study would be very expensive to conduct, the NFL may be interested in funding such work for many reasons.

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