Head Injury Leading Killer Among All-Americans
WASHINGTON — Concerns about the long-term effects of repeated head trauma go far beyond military personnel injured in battlefield blasts. More than 50,000 Americans, most of them civilians, die each year from TBI, according to experts speaking at a recent symposium.
“That is greater than breast cancer. This is a major public health problem,” said Daniel Perl, MD, director of the Military Brain Injury Studies program. Perl was among the medical experts who spoke at the TBI symposium held by the Uniformed Services University of the Health Sciences and the Henry M. Jackson Foundation for the Advancement of Military Medicine.
One important area of discussion was how the long-term effect of concussions in National Football League (NFL) players may offer clues about the impact of repeated head trauma to troops. That is why military scientists are increasingly turning their attention to a condition known as Chronic Traumatic Encephalopathy (CTE), which afflicts some NFL players. The condition, thought to be linked to brain trauma, is a progressive degenerative disease that causes erratic behavior, memory impairment, depression and problems with impulse control. Eventually, the symptoms may progress to full-blown dementia.
“In the last couple of years we are beginning to see what a career playing football is doing to the brain. The real question for us is what is happening to our combat veterans in terms of their exposure to IEDs (improvised explosive devices) and TBI?” Perl said.
CTE is not new. It was known to affect boxers as early as the 1920s and was named dementia pugilistica. In 2002, neuropathologist Bennet Omalu, MD, detected a similar condition for the first time in a former NFL player who had experienced progressive symptoms of dementia before he suddenly died at age 50. Since then, other NFL players have been discovered to have had CTE when their brains were examined postmortem, which is the only way in which the condition can currently be diagnosed.
The symptoms of CTE are headaches, poor concentration, poor decision-making, inability to plan, abrupt mood swings, despondency, despair, memory loss, sleep disturbances, substance abuse and compulsive acts such as suicide.
Scientists have noticed a unique pattern of tau deposits in the brain and a history of repetitive head trauma in those who have received a postmortem diagnosis of CTE. They also have found that the individuals often function normally initially, but that symptoms sometimes appear years after the original head traumas.
“When we look at this process, we are beginning to think that we have the multiple TBIs, and this sets one up for this latency period, which can be very variable. Then, finally tangles are formed, and then this triggers a cascade of neurodegneration with increasing and increasing and increasing tau accumulaton,” Perl said.