Mild Traumatic Brain Injury

In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”

In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”

Despite study after study demonstrating long term effects from mild traumatic brain injury (concussions), it is astounding that defense courtroom doctors still maintain that there are no permanent residuals from mild traumatic brain injury. A new studyImaging Correlates of Memory and Concussion History in Retired National Football League Athletes, published in JAMA Neurology once again debunks this myth that everyone gets better.

The objective of the study, according to the abstract was “to assess the relationship of hippocampal volume, memory performance, and the influence of concussion history in retired NFL athletes with and without mild cognitive impairment.” The design of the study was a retrospective cohort study assessing differences between groups, mean hippocampal volumes, and memory performance by computing age quintiles based on group-specific linear regression models corrected for multiple comparisons for both athletes and control participants. The study utilized 28 former NFL athletes who were compared with 27 control participants. The mean age was 58.1 for the former athletes and 59.0 for the control participants.

The study found that retired athletes with concussion history, but without cognitive impairment, had normal, but significantly lower, California Verbal Learning Test scores compared with control participants. However, those with a concussion history and mild cognitive impairment performed worse when compared with both control participants and athletes without memory impairment. Among the athletes, 17 had a G3 concussion and 11 did not. Older retired athletes with at least one G3 concussion had significantly smaller bilateral hippocampal volumes compared with control participants.

The authors concluded that “prior concussion that results in loss of consciousness is a risk factor for increased hippocampal atrophy and a development of mild cognitive impairment. In individuals with mild cognitive impairment, hippocampal volume loss appeared greater among those with a history of concussion.”