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NEW ORLEANS — Although traumatic brain injury (TBI) has been in the spotlight recently as a result of athletes being found to have chronic traumatic encephalitis (CTE) from repetitive sports-related head injuries, TBI has long been a significant cause of injury and death in the United States.
In his presentation at the 2017 Psych Congress, George Grossberg, MD, Director of the Division of Geriatric Psychiatry at St. Louis University School of Medicine, St. Louis, Missouri, reflected on the personal and societal burden of TBI, particularly as it affects the elderly.1 “One-third of injury-related deaths are linked to TBI,” Dr Grossberg remarked. “And falls are the leading cause of TBI at 40.5% and also the leading cause of nursing home admittances.” Other leading causes of TBI include motor vehicle accidents and assault, with nearly one-fifth of TBI being due to an unknown cause.
TBI as a result of multiple instance of minor head trauma (concussions) has been found to result in CTE. Historically, CTE was attributed to repeated blows to the head sustained by boxers. More recently, Omalu and colleagues reported on neuropathologic and neuropsychologic changes evident in professional football players.2 Further research estimates that as many as 71% of players sustaining concussions will develop CTA.3 As a result of these and other data linking contact sports with TBI, numerous US schools have been abandoning football programs and enforcing the use of protective head gear in soccer.
TBI is also a significant cause of morbidity and mortality in the elderly. According to data from the Centers from Disease Control and Prevention, elderly patients with chronic deficits from TBI are at increased risk for dementia and are more likely to experience depression, agitation, and irritability. TBI is a risk factor for both early-onset and late-onset Alzheimer’s disease. Dr Grossberg reported data from a recent autopsy study that found TBI to be a risk factor for Lewy body accumulation and Parkinson’s disease.4 TBI has also been associated with depression, suicidal ideation, and attempted suicide.5
Although not all TBIs are preventable, there are relatively simple steps one can take to guard against their occurrence. Avoidance of activities that may lead to TBI, use of helmets and seatbelts, and fall prevention efforts aimed at the elderly are all effective methods of protection. “There are a lot of opportunities for intervention,” concluded Dr Grossberg. “Preventing [TBI and] CTE is a goal that is attainable, but nobody says that it is easy. It is going to take time.”
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1. Weiss RD. Advancing the long-term management of substance use disorders through medication-assisted treatment strategies. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.-880.
2. Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. 2015;57(1):128-134.
3. Grossberg GT, Olson EC. Concussions: a growing psychiatric epidemic. Available at: https://www.psychiatryadvisor.com/home/topics/neurocognitive-disorders/concussions-a-growing-psychiatric-epidemic/. Published February 5, 2016. Accessed September 16, 2017.
4. Crane PK, Gibbons LE, Dams-O’Connor K, et al. Association of traumatic brain injury with late-light neurodegenerative conditions and neuropathologic findings. JAMA Neurol. 2016;73(9):1062-1069.
5. Fisher LB, Pedrelli P, Iverson GL, et al. Prevalence of suicidal behavior following traumatic brain injury: longitudinal follow-up data from the NIDRR Traumatic Brain Injury Model Systems. Brain Inj. 2016;30(11):1311-1318.