How concussions affect mental health (12/5/19 newsletter)

Dec 8

We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:

Editor: Galen Moller
Contributors: Olivia Collis, Kenta Hikino, Evie Kortanek, Ben Preiss, Katie Taylor, and Trinh Tieu

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Education

Three Utah children experience concussions every school day

An article published by Deseret News warns that three Utah children experience concussions every school day. The Utah health department reported that 1,521 students from kindergarten through 12th grade suffered a concussion in school between 2016 and 2019, averaging 14 concussions per week. Most of those were reported during September, October, and November. Additionally, male students suffered 59% of those concussions, and 37% happened during lunch, recess, or physical education classes. A student was most likely to sustain a concussion while running, while the next common activities were tied between football and walking.

Sports

Death from neurodegenerative diseases are higher among professional soccer players than the general population

The New England Journal of Medicine recently published a study concluding that mortality rates from dementia and other neurodegenerative diseases are higher among retired professional soccer players than the general population. Researchers Daniel F. Mackay et al. from the University of Glasgow compared the medical records of 7676 Scottish players with those of 23,028 members from the general population. The study focused on male players born between 1900 to 1976 and age- and sex-matched members of the general population, with similar levels of “social deprivation.” The Washington Post, reporting on the study, highlighted that the general risk of developing neurodegenerative diseases is still low: researchers found that 1.7% of professional soccer players died compared to 0.5% of the common population—over three times at risk, but not as widespread as one might initially conclude.

The study did not focus on the causes of neurodegenerative diseases. Researchers could not find differences in mortality rates between goalkeepers and outfield players; however, goalkeepers were prescribed fewer dementia-related medications. While goalkeepers head the ball significantly less than the average outfield player at the professional level, experts pointed to years of repeated heading as the main cause. The University of Glasgow’s study adds to years of research calling for governing bodies of European soccer to make rule changes on concussion injury protocol. The researchers noted that the study results do not call for change in the amateur or youth levels, as it centered only on professionals.

Cannabis

Walmart and Target among major retailers discreetly exploring CBD product lines

A New York Post article by Lisa Fickenscher claims that top executives at major chains have been “quietly meeting” with CBD product manufacturers, and requesting samples, lab results, and pricing information. According to Fickensher, retailers such as Walmart, Target, Kroger, and Safeway, are all “angling for a piece of the exploding CBD industry, which is expected to more than double to $2.1 billion by next year.” This is in spite of the FDA’s December statement that it is illegal to infuse CBD or THC into food or beverages or transport marijuana-infused products across state lines.

There are already “a few bigger chains, including Walgreens, CVS, and GNC,” along with many smaller companies, that are selling CBD-infused topical creams in states where they’re legal, such as New York. Until the FDA releases a permanent ruling on marijuana-based products, most major retailers are not selling CBD products. Still, Fickenscher assures, “they’re busy getting ready for the day when they can.”

Diagnostics

Long-term effects of concussions persist one year after athletes return to play

One year after they receive medical clearance to return to play, athletes may not be fully recovered from a concussion, according to a longitudinal study by Nathan W. Churchill et al. They followed 24 athletes with concussions and gave them three MRI scans over the course of the study: one in the week after their mTBI, another when they received clearance to return to play, and the last scan one year after returning to play. They also had 122 athletes without concussions undergo MRI scans before the start of the season.

According to the results reported by Healio, “Patients with concussions who returned to play had a significantly reduced blood flow in the brain one year later, compared to athletes who did not have concussions. Patients with concussions also showed signs of brain tissue swelling 1 year after returning to play.” However, signs of brain connectivity were normal in patients with concussions a year after returning to play. These long-term effects varied depending on the athlete’s severity of symptoms and the duration they took to return to play. Athletes who had more severe symptoms and took longer to return to play had a higher chance of developing long-term brain injuries. Researchers note that recovery for these patients may take longer than the current suggested instructions for medical clearance. The study was published in Neurology.

Therapies

Post-TBI memory improvement and seizure prevention following interneuron transplant in mice

An investigation by Bingyao Zhu et al., published in Nature Communications, tested a novel cell therapy for TBI in mice involving the transplantation of inhibitory interneurons into the hippocampus. Inhibitory interneurons are a type of brain cell that controls activity in brain circuits. The mouse TBI induced in this study had been found to result in substantial interneuron loss in the hippocampus (a brain region involved in learning and memory) as well as memory problems and seizures. Bingyao Zhu et al. transplanted interneuron progenitors into the mouse hippocampus to investigate whether they could form fully functional interneurons at the site of injury and, if so, whether that incorporation could prevent post-traumatic memory and seizure disorders in mice.

They found that the transplanted progenitor cells migrated to the site of brain injury, incorporated into existing neural circuits as interneurons, and survived long-term. This is a significant finding, as transplanted cells often do not survive, fail to migrate, or fail to develop into functional neurons, as highlighted in a recent ScienceDaily article. Brain-injured mice with the transplant demonstrated a long-lasting improvement in memory as well as a long-lasting reduction of seizures compared to brain-injured mice without the transplant. These results demonstrate the ability of transplanted interneuron progenitors to incorporate into injured circuits and encourage the development of similar therapies to treat post-TBI memory and seizure disorders in humans.

Veterans

Veterans with traumatic brain injuries have a higher suicide risk

According to a recent study published in The Journal of Head Trauma Rehabilitation, veterans who have suffered moderate to severe TBI are 2.45 times more likely to commit suicide compared to those without a TBI diagnosis. Furthermore, among suicide victims, using a firearm as a means of suicide is also more likely in those with a history of TBI. The researchers reviewed electronic medical records of more than 1.4 million military veterans who received care from the Veterans Health Administration (VHA) between Oct. 1, 2005, and Sept. 30, 2015. Combining these records with National Death Index data, they evaluated the severity of TBI, and diagnoses of psychiatric and other medical conditions.

During the period of their study, the rate of suicide was 86 per 100,000 person-years for those with TBI compared with 37 per 100,000 person-years for those without TBI. Of those in the sample who died by suicide, 68 percent used firearms. Veterans with moderate or severe TBIs had the highest proportion of suicides by firearms at 78 percent. The researchers, Lisa A. Brenner et al. write, “these findings underscore the importance of understanding veterans' lifetime history of TBI to prevent future deaths by suicide, and support the implementation of screening initiatives for lifetime history of TBI among all individuals utilizing the Veterans Health Administration.”

Mental Health

Sports-related concussions may increase the risk of suicide in high school students

In a study published by the Journal of Affective Disorders, Dale S. Mantey et al. analyzed data from more than 13,000 responses to the 2017 Youth Risk Behavior Surveillance Survey to investigate whether sports-related concussions are associated with risk factors for suicide completion in high school students. They found that high school students who reported sports-related concussions in the past year were 20% more likely to report depressive symptoms, 25% more likely to demonstrate suicidal ideation, and 60% more likely to have attempted suicide compared to their peers without a history of concussions.

The researchers urge sports programs to monitor suicidal risk factors in participants following concussion diagnoses and suicide prevention programs to consider concussions as a risk factor for suicide completion in youth. These results reflect previous findings that suggest concussions are a risk factor for suicide in adults and demonstrate a need for additional education and treatment plans for concussion patients of all ages.

Statistics

History of concussion linked to increased risk of injury in college football players

A recent study presented at the 2019 National Athletic Trainers’ Association Clinical Symposia & AT Expo showed a correlation between sports-related concussion history and greater musculoskeletal injury risk. The study, performed at the University of Tennessee at Chattanooga, consisted of screening 89 NCAA D-I football players with a visuomotor test in which they had to hit illuminated buttons as fast as they could. They examined four potential risk factors: playing five or more games, a visuomotor reaction time of 745 milliseconds or more, a whole-body reactive agility time of 101 seconds or more, and a history of sports-related concussions.

They found that the presence of two or more of these factors showed a significant positive correlation with injury risk. The authors Shellie N. Acocello et al. explained, “slow visuomotor and whole-body reactive agility are risk factors for injury that can be compounded by the presence of concussion history. While we cannot justify a cause-effect relationship with this study, our results clearly support other research showing a link between concussion and injury risk.”

Women's Health

Sex differences in the structure of brain cells and their impacts on female athletics

In an article published by The Telegraph, Nicola White shares her prolonged symptoms after sustaining a concussion during a hockey match in March of 2018. In the twenty months since the impact, she has struggled with confusion, dizziness, headaches, and chronic migraines. This is not an isolated incident in which female athletes struggle to recover from concussions. Three months after sustaining a concussion in a cycling incident, Kelly Catlin took her own life at the age of 23. US studies have demonstrated that females are more likely to suffer from concussions than males and have a higher frequency of prolonged symptoms after concussions.

There is not yet a singular reason for this difference. Some researchers have pointed to weaker neck musculature, but newer studies cite sex differences within the brain as the root of these disparities. According to Dr. Douglas H Smith, when a brain suffers a significant impact, rotational stretching in the brain damages axons, nerve cells in the brain. These axons contain microtubules that are normally protected by the protein tau. During rapid stretching, the microtubules slide past each other, and tau cannot discharge quickly enough to prevent rupture of the microtubule. This rupture disrupts the transport of tau, causing a buildup of the protein that can eventually lead to the death of the axon as a whole. According to Dr. Smith, men, on average, have larger and more complexly-structured axons than women. This protects male brains more effectively from microtubule rupture and axon damage.

Culture

Marine veteran battling traumatic brain injuries and PTSD deported to El Salvador

A Marine veteran with PTSD and traumatic brain injuries was deported to El Salvador last month, an article from NBC News reported. 38-year-old Jose Segovia Benitez, who was deployed to Iraq and received several military awards, shared some of his feelings regarding his struggles: “I was messed up in the head. I felt I should have died in Iraq and that guilty feeling that I’m not supposed to be here.” Benitez said he never received adequate treatment for his mental health issues and brain injury. He added, “Waking up every day with this feeling, the sweats, the helplessness the hopelessness. All that is part of my everyday life and I have been dealing with it.”

After serving time for domestic violence and drug-related felonies, Segovia Benitez was suddenly deported despite having legal status, applying for citizenship, and numerous deportation appeals. One of Segovia Benitez’s case’s attorneys, Thomas Sanchez, argues for how his military service, PTSD, and traumatic brain injury information was withheld from the jury during a case of domestic violence. He also mentioned that Segovia Benitez would have only been charged with misdemeanors instead of felony convictions had he been able to afford a lawyer. “The U.S. Department of Veterans Affairs had failed me,” Segovia Benitez said. His supporters, organizations such as Green Card Veterans, and his attorneys are pushing for reopening his immigration case.