Parkinson’s Disease and Brain Injury (5/14/20 newsletter)

May 16

We are pleased to have Carleton College students and alumni working with Concussion Alliance. Contributors this week:

Editor: Malayka Gormally.
Contributors: Eloïse Cowan, Conor Gormally, Malayka Gormally, Julian Szieff, and Zachary Touqan.

Do you find the Concussion Update helpful? If so, forward this to a friend and suggest they subscribe.

See the COVID-19 section of our website for a comprehensive list of recommended resources.

Education

Webinars: helping your child with PCS, and teleworking for people with disabilities

Concussion Legacy Foundation is presenting a two-part webinar, Helping Your Child Cope with Post-Concussion Syndrome. Part 1 of the webinar is today, May 14, at 4 pm EST. Part 2 of the webinar is on May 28, at 4 pm EST.

A webinar on Teleworking for People with Disabilities will be presented on May 21, 10-11 am, PST. One of the four panelists will be Anne Forest, PhD, who is “one of the nation’s leading patient advocates for people with traumatic brain injury. She lives with persistent symptoms from a mild TBI.” The Washington State Office of Financial Management is producing the webinar in “celebration of Global Accessibility Awareness Day (GAAD).

Sports

Increase in cumulative head impacts associated with increase in risk of death

Researchers from Syracuse University published a study in Jama Network Open that attempts to correlate a novel index for cumulative head impacts in professional American football with the hazard of death in former players. Brittany Kmush et al. calculated a “professional football cumulative head impact index (pfCHII)... measured by combining cumulative padded practice time and games played... [with] a player position risk adjustment from helmet accelerometer studies.” The authors tested for a correlation between an increase in pfCHII and an increased hazard of death for 13,912 NFL athletes who played between 1969 and 2017.

The authors found a statistically significant correlation (controlling for player BMI, height, and year of birth) between the two factors. A 25% increase in pfCHII is associated with a 16% increase in hazard of death. For context, the authors state that “to increase the pfCHII by 25%, a 1-season player would need to add only half of a regular season of gameplay and practice time the next season.”

Cannabis

The concerning link between cannabis, cytokine storms, and Covid-19 misinformation

With the growing amounts of misinformation regarding Covid-19, the question of medical cannabis carries even greater weight today. Recently, Project CBDdrew attention to current research regarding cannabis and cytokine storms, a potentially fatal syndrome of viral pulmonary infections and severe cases of Covid-19. The article highlights that CBD and THC have been documented to show anti-inflammatory effects that reduce cytokine and immune response. In contrast, however, research from Louisiana State University in 2014 found that cannabis can have a pro-inflammatory effect, boosting the number of white blood cells, which is “the exact opposite of what’s needed to mitigate a viral-induced cytokine storm.”

What must be understood is that research needs to come a long way before making claims about cannabis’ effect on immunity due to the amount of novel, conflicting data. Project CBD takes the opportunity to highlight that cannabis research could progress further if Congress reduced restrictions. Also, industry workers and clients would be safer during the pandemic if cannabis industries were legal on a federal level, which would eliminate the need for cash transactions.

According to the International Association for Cannabinoid Medicine (IACM), “there is no evidence that individual cannabinoids – such as CBD, CBG or THC – or cannabis preparations protect against infection … or could be used to treat COVID-19, the disease produced by this virus... But the IACM also emphasizes ‘there is no evidence that the use of cannabinoids could increase the risk of viral infection.’”

Diagnostics

Ventricular size and drainage may provide a new biomarker for TBI and aging

Research at the Kyoto University School of Medicine and RIKEN Center in Kobe recently produced a study, published in Brain (A Journal of Neurology), looking at changes in the structure and fluid flow after TBI. This study specifically examined how age and TBI affect the size and fluid flow in the ventricles, the fluid-filled cavities in the brain. The study suggests that ventricular size increases with age potentially due to a change in the rate of drainage from the ventricles.

An article in Medical Xpress explains that this increased ventricular size and decreased drainage were found to be correlated with TBI, but the effect decreased with age. This supports the theory that TBI accelerates or overlaps the normal aging process. The researchers Toshihiko Aso et al. note that while increased ventricular size may be asymptomatic, understanding changes in brain structure and fluid movement in the brain after TBI may tell us if these measures are a useful biomarker for TBI severity or brain aging.

Therapies

Blue light may improve post-concussion depression symptoms

William Killgore, from the University of Arizona College of Medicine, announced details of his recent research into the use of blue light therapy for treatment of post-concussion depression symptoms, according to ScienceDaily. After six weeks of daily blue light usage, patients showed a marked decrease in depression symptoms. The group not using the blue light device showed a slight increase in depression symptoms. This study is limited by its small sample size (32) and a lack of differentiation between clinical and subclinical depression; nonetheless, it provides evidence warranting further investigation into the usefulness of blue light as a treatment for some concussion symptoms.

For more info on the use of blue light to treat concussion, refer to this Medscape article and our newsletter from February discussing Dr. Kilgore’s blue light sleep-related findings from a separate study.

Veterans

TBI and PTSD associated with increased risk of Parkinson’s Disease

In an effort to see if TBI and PTSD are risk factors for Parkinson’s Disease (PD), Donna L. White PhD, MPH, et al. conducted a matched case-controlled study of a nation-wide cohort of military service veterans over the course of 14 years. The study, conducted at VA health care facilities and published in Annals of Neurology, found that mild TBI (mTBI), non-mild TBI, and PTSD were significantly and “independently associated with increased relative PD risk.”

In addition, the study found a “potential modest synergistic excess risk” in those who had both TBI and PTSD. This excess, or additional increased risk, was true for those who had mTBI and PTSD, and those who had non-mild TBI and PTSD. The researchers suggest that “Longitudinal research is needed to confirm these suggestive findings.”

Mental Health

Approaching mental health now and in a post-Covid reality

Mental health has become a focus for many over the course of the pandemic. Many of us can likely relate to how most virtual connections with friends and loved ones begin with an emotional wellness check. People are becoming more aware and concerned with the mental health of themselves and others, as described in an article in Forbes; it can only be hoped that mental health awareness will carry over into the future post-Covid reality.

Still, some groups are disproportionately affected by the current times and should not be overlooked, according to an article in Scientific American. These groups include frontline healthcare workers, the homeless, those at risk for major depression, and people who are already experiencing suicidality, which is only made worse by the crisis. People who have experienced a concussion are at increased risk for depression and suicide (refer to a previous newsletter) and so may be particularly vulnerable to the effects of the pandemic.

A memo released by the World Health Organization elucidates many of the important considerations to keep in mind during the pandemic. Included are sections relating to the general population, healthcare workers, child carers, the isolated, and the high-risk population, including those with underlying health conditions.

Statistics

Head injury may lead to more severe Parkinson's symptoms

The University of California at San Francisco recently released a study, published in Neurology, further examining the relationship between traumatic brain injury and neurodegenerative diseases. A group of scientists led by Dr. Ethan Brown examined the link between head injury (mild, moderate, and severe) and Parkinson's disease (PD).

Examining the records of more than 25,000 PD patients, they found those with a previous head injury had significantly greater self-reported cognitive impairment than those without previous head injury. Additionally, participants with a history of head injury reported a significantly higher average number of motor symptoms, such as tremor, rigidity, slow movement, and balance problems. This study establishes a correlation between head injury and an increased risk for more severe PD symptoms; however, research is needed to understand how head injury may increase the risk for more severe PD.

In an article in Neurology Today, Dr. Brown commented, "The mechanisms of this relationship are unclear, though researchers have suggested that chronic inflammation may play a role." Dr. Brown suggests that a large scale, "prospective study could better help us understand the association between traumatic brain injury and Parkinson's disease."

For now, patients with a history of head injury should be screened for PD at a younger age. Furthermore, preventative measures should be advised for these patients to prevent the onset of PD disease or its severity; these measures could include mental practice such as learning a new language and otherwise staying mentally engaged in middle or older age.

Women's Health

Researchers are studying how the pandemic is increasing rate of intimate partner violence (IPV)

Researchers from the United States, the Netherlands, Italy, and Germany have co-authored a commentary, published in EClinical Medicine, entitled COVID-19: Reducing the risk of infection might increase the risk of intimate partner violence. “Many of the strategies employed in abusive relations overlap with the social measures imposed during quarantine,” including physical isolation, social isolation from family and friends, functional isolation, surveillance, and control of daily activities. Increased economic insecurity and increased alcohol abuse are also factors. Also, school closures can result in children being exposed to IPV “with harmful outcomes in the immediate term and later adulthood.” The authors N. van Gelder et al. suggest a series of proactive steps to mitigate this crisis.

The authors reference other recent working papers on IPV and the pandemic: Pandemics and Violence Against Women and Children, by Amber Peterman et al., published by the Center for Global Development; and The psychological impact of quarantine and how to reduce it: rapid review of the evidence, by Samantha K Brooks PhD et al., published in The Lancet. Also referenced is an excellent article in The New York Times, Where Can Domestic Violence Victims Turn During Covid-19?

Culture

Purple Hearts awarded to 29 soldiers who suffered mTBI in Iranian ballistic missile attack

The Iranian ballistic missile attack on the U.S. Al-Asad Air Base in Iraq in January resulted in 110 troops being diagnosed with mild traumatic brain injury, or mTBI. This week, 29 of these soldiers were awarded the Purple Heart, out of 80 who were recommended for the award. The attack and the rising number of concussion diagnoses over several weeks raised awareness about the severity of this misunderstood injury and prompted a nationwide discussion of the long-term consequences of mTBI. An article in The Hill suggests that “Recognizing the severity of TBIs as [being] on par with visible wounds actually enhances the prestige of the award because it encourages medical professionals and service members alike to be proactive in their treatment of brain injuries, thus preventing greater health and wellness complications later on.”

According to a Task and Purpose article, to be eligible for the Purple Heart, “soldiers must be treated – not just examined – by medical professionals. For mild TBI, the definition of medical treatment includes being referred to a neurologist or neuropsychologist to treat the TBI or concussion; having to go through physical therapy or some other form of rehabilitation; and being restricted from full duty for longer than 48 hours.” Concussion Alliance covered this issue in a February 22 blog post.