Soldiers, athletes could improve outcomes from traumatic brain injuries

September 4, 2019

Science Daily/Purdue University

A traumatic brain injury is often easily suspected and can be confirmed and treated if necessary following an injury using a blood analysis, but scientists are reporting that even one mild blast to the brain can cause very subtle but permanent damage as well. Urine analysis taken within one week of a mild to traumatic brain injury also can provide faster diagnosis and treatment for such injuries. 

"We're finding that even a mild blast can cause long-term, life-changing health issues," said Riyi Shi, a professor of neuroscience and biomedical engineering in Purdue University's Department of Basic Medical Sciences. "The individual appears to be fine, and it's difficult to tell if you just look at a person. But the fact is that these types of hits are multiplied over years and often ignored until someone reaches an age when other factors come into play. Identifying and treating these incidents sooner can help mitigate issues later in life."

 A study led by Shi reports that checking the urine within seven days following such an injury, even a mild injury with no immediately obvious symptoms, could be less invasive, faster and help reduce the risk of long-term health issues including Parkinson's disease.

 "Even at one day post injury, a simple urine analysis can reveal elevations in the neurotoxin acrolein. The presence of this "biomarker" alerts us to the injury, creating an opportunity for intervention," said Shi, who has appointments in Purdue's College of Veterinary Medicine and Weldon School of Biomedical Engineering. "This early detection and subsequent treatment window could offer tremendous benefits for long-term patient neurological health."

 The research paper, titled "Acrolein-mediated Alpha-synuclein Pathology Involvement in the Early Post-injury Pathogenesis of Mild Blast-induced Parkinsonian Neurodegeneration," was published in July in the Journal of Molecular and Cellular Neuroscience.

 "Most people have heard that traumatic brain injuries are linked to Parkinson's, Alzheimer's and other neurodegenerative diseases, dating back as far as to Muhammad Ali and even earlier," Shi said. "The seriousness of this relationship is readily apparent; however, we want to, for the first time, implement a mechanism or protocol capable of connecting brain injuries to these diseases. We can accomplish this by testing for acrolein, which is well-researched and already recognized as a very important pathological factor in Parkinson's disease. This study establishes a solid link between the two and opens the door for faster treatments utilizing acrolein urine tests during the days following a traumatic episode."

 In the research study, a urine analysis tested for an increased elevation of acrolein or oxidative stress within one week following a neurological injury.

 "What's important is that urine tests can be performed much easier than blood tests or other more invasive medical procedures currently available," Shi said. "And it has been shown that individuals who experience brain injuries are three times more likely than their age-matched peers to develop neurological disease. If we can establish a protocol to routinely test urine following a traumatic brain injury, we can improve treatment options earlier and potentially offer better long-term outcomes."

 More than 500,000 people in the U.S. are currently living with Parkinson's disease, and another 50,000 people are diagnosed with this neurodegenerative disorder every year, according to the National Institutes of Health.

https://www.sciencedaily.com/releases/2019/09/190904154005.htm

People over 65 with traumatic brain injuries hospitalized four times as often as younger people

July 6, 2015

Science Daily/St. Michael's Hospital

Rate of seniors being hospitalized with TBI increased 24 percent from 2006-07 to 2010-11

A disproportionate number of people hospitalized in Canada with traumatic brain injuries are 65 years or older, a new study has found. While that age group represents only 14 per cent of the Canadian population, it accounted for 38 per cent of hospitalizations for TBI between 2006-07 and 2010-11.

While that age group represents only 14 per cent of the Canadian population, it accounted for 38 per cent of hospitalizations for TBI between 2006-07 and 2010-11, according to the study published in the Journal of Trauma. That's 3.8 times greater than for people under 65.

Furthermore, the rate of seniors being hospitalized with TBI increased 24 per cent from 2006-07 to 2010-11. In contrast, hospitalization rates declined 8 per cent among those under 65 and there was a significant decrease in those in the 15-24 age group. Together, these trends resulted in an increase in the median age of hospitalized TBI patients from 48 to 56 years.

The researchers looked at data from the Hospital Morbidity Database to examine nationwide trends in TBI hospitalizations and deaths. There were 116,614 TBI-related hospitalizations in Canada during the study period, resulting in 10,185 deaths.

"During this study period, hospitalization rates remained steady for children and young adults, but increased significantly among adults ages 65 and older," said author Terence Fu, a medical student with the Injury Prevention Research Office of St. Michael's Hospital.

"Elderly adults were most vulnerable to falls and experienced the greatest increase, 29 per cent, in fall-related hospitalization rates. Young adults were most at risk for motor vehicle collisions, but experienced the greatest decline in MVC-related admissions."

Falls and motor vehicle collisions were the most commons causes of TBI, representing 51 per cent and 27 per cent of hospitalizations. However, TBI hospitalizations due to falls were on the rise -- increasing 24 per cent over the study period -- while hospitalizations due to motor vehicle collisions dropped 18 per cent. People over 65 were most vulnerable to fall-related TBIs, with 61 per cent of all falls occurring in that age group. Falls accounted for 82 per cent of hospitalizations among the elderly but only 32 per cent of hospitalizations among those under age 65.

The rise in fall-related TBI among the elderly likely relates to the rapid growth in this age group combined with the fact that people are living longer with more complex health issues and the likelihood of taking multiple medications. The oldest segment of the population is also most at risk of death following hospitalization for TBI, with a 1.4 to 2.0 fold higher risk of dying in-hospital compared to those ages 0-4.

Dr. Michael Cusimano, a neurosurgeon and the senior author on the work, said that the numbers also show that those who are admitted to hospital with TBI are sicker and more severely injured than they used to be so, hospitals and health care professionals should be prepared to manage more severe TBIs and older patients with more complex comorbidities. Declining rates of motor vehicle collisions, especially for children and young adults (ages 5-24) may be attributable to increased awareness and successful injury prevention policies. Over the past 15 years most Canadian provinces have introduced some form of graduated licensing programs, which includes requirements for adult supervision, lower demerit point thresholds and zero blood alcohol concentration limits for new and young drivers. Stricter federal impaired driving laws and improved enforcement over the study period could have further contributed to reduced motor vehicle collision rates. The increased use of child safety seats and recent introduction of federal child safety seat legislation could account for the decline in MVC rates among very young children.

http://www.sciencedaily.com/releases/2015/07/150706114357.htm

Marijuana use associated with lower death rates in patients with traumatic brain injuries

October 2, 2014

Science Daily/Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed)

A survey of patients with traumatic brain injuries found those who had used marijuana were more likely to survive than those who had not used the illicit substance. The findings suggest THC, or tetrahydrocannabinol, may help protect the brain in cases of traumatic brain injury, the researchers said.

The findings, published in the October edition of The American Surgeon, suggest THC, or tetrahydrocannabinol, may help protect the brain in cases of traumatic brain injury, the researchers said. The study included 446 patients who suffered traumatic brain injuries and underwent a urine test for the presence of THC in their system. The researchers found 82 of the patients had THC in their system. Of those, only 2.4% died. Of the remaining patients who didn't have THC in their system, 11.5% died.

"Previous studies conducted by other researchers had found certain compounds in marijuana helped protect the brain in animals after a trauma," said David Plurad, MD, an LA BioMed researcher and the study's lead author. "This study was one of the first in a clinical setting to specifically associate THC use as an independent predictor of survival after traumatic brain injury."

The researchers noted that the timing of their study was "pertinent" because of current efforts to decriminalize marijuana and other research that has shown THC can increase appetite, reduce ocular pressure, decrease muscle spasms, relieve pain and alleviate symptoms associated with irritable bowel disease. But they noted that their study has some significant limitations.

"While most -- but not all -- the deaths in the study can be attributed to the traumatic brain injury itself, it appears that both groups were similarly injured," Dr. Plurad said. "The similarities in the injuries between the two groups led to the conclusion that testing positive for THC in the system is associated with a decreased mortality in adult patients who have sustained traumatic brain injuries."

http://www.sciencedaily.com/releases/2014/10/141002123722.htm