July 05, 2018, Kitchener, Ontario
Posted by: Robert Deutschmann, Personal Injury Lawyer
Did you or a loved one suffer a ‘mild TBI’? You are thankful that nothing more happened – it could have been so much worse. We found out last month that even ‘mild’ TBI without the loss of consciousness is associated with an increased risk of dementia.
JAMA Neurology reported that a mild TBI without unconsciousness is associated with the long term risk of developing dementia. This is bad news for the many of us who have had mild TBI, and a clear caution for many who partake in high risk activities to take any blows to the head, TBI, and concussion seriously.
Looking at military veterans who are an easily identified group with consistent medical care and reporting researchers posed the question:
Is mild traumatic brain injury without loss of consciousness associated with an increased risk of dementia diagnosis in veterans?
The goal of the study was to examine any association between TBI severity, loss of consciousness, and dementia diagnosis. What they found was not expected. Even mild traumatic brain injuries that do not result in loss of consciousness might have long-term neurodegenerative consequences. In fact, the rate of dementia was double in those with mild TBI and no loss of consciousness over the group without TBI. The study included more than 350,000 veterans.
This finding goes towards other studies which have suggested that the damage done to brain continues on long after the actual causal event occurs.
Any time you suspect a concussion/TBI has occurred you should seek medical care immediately and follow the physician’s advice. These findings also underscore the importance of “return to play’ protocols in all sports, and the supports the conclusion that even one concussion/TBI is too many.
You can read the whole article here
From https://jamanetwork.com/journals/jamaneurology/article-abstract/2679879Key Points
Question Is mild traumatic brain injury without loss of consciousness associated with an increased risk of dementia diagnosis in veterans?
Findings In this propensity-matched cohort study of more than 350â€¯000 veterans with and without traumatic brain injuries, mild traumatic brain injury without loss of consciousness was associated with more than a 2-fold increase in the risk of dementia diagnosis, even after adjusting for medical and psychiatric comorbidities.
Meaning Even mild traumatic brain injuries that do not result in loss of consciousness might have long-term neurodegenerative consequences.
Importance Traumatic brain injury (TBI) is common in both veteran and civilian populations. Prior studies have linked moderate and severe TBI with increased dementia risk, but the association between dementia and mild TBI, particularly mild TBI without loss of consciousness (LOC), remains unclear.
Objective To examine the association between TBI severity, LOC, and dementia diagnosis in veterans.
Design, Setting, and Participants This cohort study of all patients diagnosed with a TBI in the Veterans Health Administration health care system from October 1, 2001, to September 30, 2014, and a propensity-matched comparison group. Patients with dementia at baseline were excluded. Researchers identified TBIs through the Comprehensive TBI Evaluation database, which is restricted to Iraq and Afghanistan veterans, and the National Patient Care Database, which includes veterans of all eras. The severity of each TBI was based on the most severe injury recorded and classified as mild without LOC, mild with LOC, mild with LOC status unknown, or moderate or severe using Department of Defense or Defense and Veterans Brain Injury Center criteria. International Classification of Diseases, Ninth Revision codes were used to identify dementia diagnoses during follow-up and medical and psychiatric comorbidities in the 2 years prior to the index date.
Main Outcomes and Measures Dementia diagnosis in veterans who had experienced TBI with or without LOC and control participants without TBI exposure.
Results The study included 178â€¯779 patients diagnosed with a TBI in the Veterans Health Administration health care system and 178â€¯779 patients in a propensity-matched comparison group. Veterans had a mean (SD) age of nearly 49.5 (18.2) years at baseline; 33â€¯250 (9.3%) were women, and 259â€¯136 (72.5%) were non-Hispanic white individuals. Differences between veterans with and without TBI were small. A total of 4698 veterans (2.6%) without TBI developed dementia compared with 10â€¯835 (6.1%) of those with TBI. After adjustment for demographics and medical and psychiatric comobidities, adjusted hazard ratios for dementia were 2.36 (95% CI, 2.10-2.66) for mild TBI without LOC, 2.51 (95% CI, 2.29-2.76) for mild TBI with LOC, 3.19 (95% CI, 3.05-3.33) for mild TBI with LOC status unknown, and 3.77 (95% CI, 3.63-3.91) for moderate to severe TBI.
Conclusions and Relevance In this cohort study of more than 350â€¯000 veterans, even mild TBI without LOC was associated with more than a 2-fold increase in the risk of dementia diagnosis. Studies of strategies to determine mechanisms, prevention, and treatment of TBI-related dementia in veterans are urgently needed.