SPECIAL REPORT: TRAUMATIC BRAIN INJURY
The growing understanding of the sequelae of traumatic brain injury (TBI), including post-concussive syndrome and chronic traumatic encephalopathy, has raised interest in improving care for patients with these conditions. Strategies such as pre-concussion testing for athletes create consistency in defining TBI-induced deficits.
Research examining the clinical and pathological phases of TBI has provided insight into the mechanisms of neural damage. Efforts to identify interventions that could improve patient outcomes are still in early stages—with effective therapeutic strategies yet to be defined. The Neurology Times Special Report focuses on updates in TBI.
TBI in an elderly population
While TBI in athletes has received a great deal of attention, this condition affects other populations as well. Elderly patients, in particular, may have unrecognized clinical effects of TBI, with symptoms that can be mistaken for other comorbid conditions.
For example, dementia and TBI can produce similar physical, cognitive, and emotional effects, making it difficult to know if a patient with dementia has developed consequences of head trauma. In addition, dementia itself can predispose to the types of trauma that induce TBI in elderly adults.
It is important for neurologists and other physicians to recognize TBI in elderly patients. While therapeutic options remain limited, detection is essential for patient safety as families work with the health care team to manage a patient’s activities of daily living. See: The Growing Epidemic of TBI in Older Patients.
TBI is rarely fatal, but there is an increased predisposition to suicide among survivors. Suicide after TBI has been among the condition’s most publicized effects.
Suicide prevention relies on a number of strategies. Counseling, as well as medical management of symptoms such as pain and depression, may diminish the risk of suicide for some survivors of head injury. Patients, families, and the entire health care team need to know which acute signs to watch out for—and to date, such clues are not well defined.
In addition, there is not a specific post-injury interval associated with a drop in the increased risk of suicide. Because the risk can linger for years after the injuries are sustained, it is important to remain vigilant about suicide prevention. See: TBI and Suicide: From Science to Prevention Strategies.
One proposed treatment strategy involves the use of supplements. As the microscopic characteristics and physiological mechanisms of brain damage in TBI are becoming better understood, reversing these mechanisms of injury on a molecular level is being studied.
New research examines whether pharmacological substances may counteract the molecular damage of TBI, thereby alleviating neurological impairment. Several vitamins, including vitamins D and E, and magnesium have been proposed to potentially mitigate the inflammation and oxidative damage incurred during and after TBI.
TBI is not new. Attitudes have changed toward this disorder, however. Defining clinical signs of the disease objectively has already given patients and their families a sense of legitimacy when it comes to the vague clinical symptoms. Focused research that examines the pathology may provide valuable insight and direction as therapeutic options are developed in coming years. See: Complementary and Alternative Therapies for TBI: Key Points for Clinicians.
Dr Moawad is a neurologist and Clinical Assistant Professor at Case Western Reserve University and John Carroll University in Cleveland, OH. She is the Editor in Chief of Neurology Times.