Chronic traumatic encephalopathy.
ABSTRACT Traumatic brain injury is the leading cause of death and disability among young adults. Clinical evaluation is of limited value in the assessment of patients with traumatic brain injury and is often inaccurate in determining the extent of brain damage. Neurophysiological techniques and neuroimaging can provide valuable prognostic information and are useful in monitoring for seizures and other causes of secondary brain damage and in tracking the effects of therapy. More recently, cognitive electrophysiology and functional magnetic resonance imaging have shown that many patients clinically deemed to be in vegetative or in minimally conscious states are, in fact, aware. This opens new frontiers for further research into establishing communication with otherwise unresponsive patients.
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ABSTRACT: To determine the relative influence of current exercise and diet on the late-life cognitive health of former Division I collision-sport collegiate athletes (ie, football players) compared with noncollision-sport athletes and non-athletes. Graduates (n = 400) of a Midwestern university (average age, 64.09 years; standard deviation, 13.32) completed a self-report survey to assess current demographics/physical characteristics, exercise, diet, cognitive difficulties, and physical and mental health. Former football players reported more cognitive difficulties, as well as worse physical and mental health than controls. Among former football players, greater intake of total and saturated fat and cholesterol and lower overall diet quality were significantly correlated with cognitive difficulties; current dietary intake was not associated with cognitive health for the noncollision-sport athletes or nonathletes. Hierarchical regressions predicting cognitive difficulties indicated that income was positively associated with fewer cognitive difficulties and predicted 8% of the variance; status as a former football player predicted an additional 2% of the variance; and the interaction between being a football player and total dietary fat intake significantly predicted an additional 6% of the total variance (total model predicted 16% of variance). Greater intake of dietary fat was associated with increased cognitive difficulties, but only in the former football players, and not in the controls. Prior participation in football was associated with worse physical and mental health, while more frequent vigorous exercise was associated with higher physical and mental health ratings. Former football players reported more late-life cognitive difficulties and worse physical and mental health than former noncollision-sport athletes and nonathletes. A novel finding of the present study is that current dietary fat was associated with more cognitive difficulties, but only in the former football players. These results suggest the need for educational interventions to encourage healthy dietary habits to promote the long-term cognitive health of collision-sport athletes.The Physician and sportsmedicine 09/2011; 39(3):11-22. DOI:10.3810/psm.2011.09.1916 · 1.49 Impact Factor
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ABSTRACT: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at <72 hours, 14 days, and 30 days or greater after concussion. A similar number of age- and gender-matched controls were evaluated at a single time point. ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at >30 days after SRC. Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.PEDIATRICS 11/2011; 129(1):28-37. DOI:10.1542/peds.2011-2083 · 5.30 Impact Factor
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ABSTRACT: To examine the ethical and legal issues physicians face when evaluating and managing athletes with sports-related concussions, and to offer guidance to physicians as they navigate these situations.RESULTS: This position paper reviews and compares the components of sports-related concussion laws, including education, removal from play, and clearance for return to play. It highlights the challenges privacy laws present relevant to providing care to concussed athletes and suggests ways to help physicians overcome these obstacles. The report also explores the ethical considerations physicians should bear in mind as they evaluate and manage concussed athletes, addressing them through a framework that includes considerations of professionalism, informed decision-making, patient autonomy, beneficence, nonmaleficence, conflicts of interest, and distributive justice.CONCLUSIONS: Physicians caring for concussed athletes have an ethical obligation to ensure that their primary responsibility is to safeguard the current and future physical and mental health of their patients. Physicians have a duty to provide athletes and their parents with information about concussion risk factors, symptoms, and the risks for postconcussion neurologic impairments. Physicians should facilitate informed and shared decision-making among athletes, parents, and medical teams while protecting athletes from potential harm. Additionally, including concussion evaluation and management training in neurology residency programs, as well as developing a national concussion registry, will benefit patients by the development of policies and clinical guidelines that optimize prevention and treatment of concussive head injury.Neurology 07/2014; 83(4). DOI:10.1212/WNL.0000000000000613 · 8.30 Impact Factor