Depression intensifies anger in veterans with PTSD

May 13, 2015

Science Daily/American Psychological Association (APA)

The tendency for veterans with post-traumatic stress disorder to lash out in anger can be significantly amplified if they are also depressed, according to new research.

"Our study findings should draw attention to anger as a major treatment need when military service members screen positive for PTSD or for depression, and especially when they screen positive for both," said lead author Raymond Novaco, PhD, professor of psychology and social behavior at the University of California, Irvine. The study appeared in the journal Psychological Trauma: Theory Research, Practice and Policy.

The researchers studied the behavioral health data of 2,077 U.S. soldiers (1,823 men and 254 women) who were deployed to Iraq and Afghanistan and subsequently sought behavioral health services at a large military installation. They screened the participants for PTSD and major depressive disorder, placing them in one of four groups: PTSD-only, MDD-only, PTSD and MDD combined or neither. They also measured the veterans' anger and whether they said they were considering harming others.

Anger and self-rated risk of harm were both significantly higher in the group with both PTSD and MDD compared to the other three groups. The researchers also found that PTSD was commonly paired with depression. Approximately 72 percent of those who screened positive for PTSD also screened positive for MDD.

One reason the authors chose to conduct this research is that anger has been given insufficient attention as a clinical problem among combat veterans and trauma populations in general, said Novaco. "PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders," he said. "There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention."

Previous studies conducted with both military members and civilians who have experienced trauma have shown anger in the context of PTSD to be far more than a symptom; it can predict PTSD severity but also interfere with PTSD treatment. A 2010 study of more than 18,000 soldiers returning from Iraq found approximately 40 percent had physical bursts of anger, more than 30 percent threatened someone with physical violence and over 15 percent got into a physical fight.

"Anger is a driver of violent behavior but it is responsive to anger-focused psychological treatment," said Novaco, adding that this is one reason why soldiers presenting with PTSD, depression or, most important, both should receive treatment focusing on anger. He noted that numerous studies have been published on the effectiveness of cognitive behavior therapy for anger treatment, including anger treatment done with combat veterans.

http://www.sciencedaily.com/releases/2015/05/150513111859.htm

Self-harm, suicide ideation tightly linked in Iraq, Afghanistan veterans

May 8, 2015

Science Daily/Veterans Affairs Research Communications

Non-suicidal self-injury -- that is, purposefully hurting oneself without conscious suicidal intent -- is relatively common among Iraq and Afghanistan veterans, and it is a strong risk factor for suicidal behavior, according to research.

http://images.sciencedaily.com/2015/05/150508091602_1_540x360.jpg

Moreover, the study found that those who deliberately hurt themselves were more likely to engage in suicidal behavior. The researchers hope that NSSI could serve as a marker for identifying which veterans are most likely to attempt suicide.

For the study, Kimbrel and his colleagues recruited Iraq and Afghanistan veterans at the Central Texas VA Health Care System. The researchers excluded those with schizophrenia or bipolar disorder, but they included a higher-than-average proportion of veterans with PTSD. In the final study group, 35 percent had PTSD, 21 percent had depression, and 8 percent had alcohol use disorder. More than 90 percent of group was male and 67 percent were white.

After identifying suicidal ideation via a standardized screening questionnaire, the researchers further classified the participants as having either passive or active suicidal ideation.

Passive suicidal ideation could be described, says Kimbrel, as wishing you would go to sleep and not wake up. Active suicidal ideation is characterized by actually thinking about specific ways to end one's life.

Kimbrel found that NSSI was most strongly associated with active suicidal ideation. Specifically, Iraq and Afghanistan veterans who reported a history of NSSI were five times more likely to engage in active suicidal ideation, compared with veterans without a history of NSSI.

"These are people who are purposefully engaging in bodily harm, but the intent is not to commit suicide," says Kimbrel. "There are many reasons why they do this, but this behavior is associated with increased odds of eventually attempting suicide."

Kimbrel points to cutting oneself as the most commonly thought-of form of NSSI. "But there are a wide range of non-suicidal self-injurious behaviors that Veterans might be engaging in that clinicians should be aware of, such as burning or hitting oneself," notes Kimbrel.

Another recent study by Kimbrel's team that was published in the Journal of Traumatic Stress in 2014 found that more than half of 214 male Iraq and Afghanistan veterans seeking treatment for PTSD reported engaging in NSSI during their lifetime. Forty-five percent reported NSSI during the previous two weeks.

Those same veterans were nearly four times more likely to engage in suicidal ideation, compared with veterans seeking treatment for PTSD but without a history of NSSI.

"Among veterans, burning and hitting appear to be the specific forms of NSSI most strongly associated with suicidal ideation," says Kimbrel. Veterans who reported burning themselves were 17 times more likely to engage in suicidal ideation, compared with similar veterans who did not report NSSI. Veterans who reported hitting themselves were nearly eight times more likely to have suicidal ideation.

"Obviously, the rates of suicidal ideation that we identified among veterans engaging in these forms of NSSI were much higher than what we typically see among patients seeking treatment for PTSD," says Kimbrel.

According to Kimbrel, NSSI may increase a person's capacity to commit suicide. This ties in with a theory originally described by Florida State University's Dr. Thomas Joiner in his 2005 book Why People Die By Suicide. The theory is that suicide essentially requires two components to align, a desire and a capacity.

According to Kimbrel, NSSI, along with the kind of violence often encountered in combat, can increase people's capability for suicide by mitigating some of their natural, innate responses to injury.

Kimbrel's hope is that by expanding suicidal assessments of veterans to include NSSI information, providers can better identify those at high risk for suicide long before they ever make an attempt.

"If we can identify veterans engaging in NSSI early on, then hopefully we can begin to change their trajectory and put them onto a more positive course," says Kimbrel. "There are treatments that can help. The most important thing is to get veterans at increased risk for suicide into treatment as soon as possible."

http://www.sciencedaily.com/releases/2015/05/150508091602.htm

Post-traumatic stress disorder linked to accelerated aging

May 8, 2015

Science Daily/University of California, San Diego Health Sciences

People with PTSD may also be at risk for accelerated aging or premature senescence, research suggests. The researchers noted that there has not been another study that links PTSD, a psychological disorder with no established genetic basis, to a basic biological process such as aging.

Writing in the May 7 online issue of American Journal of Geriatric Psychiatry, researchers at University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System suggest that people with PTSD may also be at risk for accelerated aging or premature senescence.

"This is the first study of its type to link PTSD, a psychological disorder with no established genetic basis, which is caused by external, traumatic stress, with long-term, systemic effects on a basic biological process such as aging," said Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences and director of the Center on Healthy Aging and Senior Care at UC San Diego, who is the senior author of this study.

Researchers had previously noted a potential association between psychiatric conditions, such as schizophrenia and bipolar disorder, and acceleration of the aging process. Jeste and colleagues determined to see if PTSD might show a similar association by conducting a comprehensive review of published empirical studies relevant to early aging in PTSD, covering multiple databases going back to 2000.

There is no standardized definition of what constitutes premature or accelerated senescence. For guidance, the researchers looked at early aging phenomena associated with non-psychiatric conditions, such as Hutchinson-Gilford progeria syndrome, HIV infection and Down's syndrome. The majority of evidence fell into three categories: biological indicators or biomarkers, such as leukocyte telomere length (LTL), earlier occurrence or higher prevalence of medical conditions associated with advanced age and premature mortality.

In their literature review, the UC San Diego team identified 64 relevant studies; 22 were suitable for calculating overall effect sizes for biomarkers, 10 for mortality.

All six studies looking specifically at LTL found reduced telomere length in persons with PTSD. Leukocytes are white blood cells. Telomeres are stretches of protective, repetitive nucleotide sequences at the ends of chromosomes. These sequences shorten with every cell replication and are considered a strong measure of the aging process in cells.

The scientists also found consistent evidence of increased pro-inflammatory markers, such as C-reactive protein and tumor necrosis factor alpha, associated with PTSD.

A majority of reviewed studies found increased medical comorbidity of PTSD with several targeted conditions associated with normal aging, including cardiovascular disease, type 2 diabetes, gastrointestinal ulcer disease and dementia.

Seven of 10 studies indicated a mild-to-moderate association of PTSD with earlier mortality, consistent with an early onset or acceleration of aging in PTSD.

"These findings do not speak to whether accelerated aging is specific to PTSD, but they do argue the need to re-conceptualize PTSD as something more than a mental illness," said first author James B. Lohr, MD, professor of psychiatry. "Early senescence, increased medical morbidity and premature mortality in PTSD have implications in health care beyond simply treating PTSD symptoms. Our findings warrant a deeper look at this phenomenon and a more integrated medical-psychiatric approach to their care."

Barton Palmer, PhD, professor of psychiatry and a coauthor of the study, cautioned that "prospective longitudinal studies are needed to directly demonstrate accelerated aging in PTSD and to establish underlying mechanisms."

http://www.sciencedaily.com/releases/2015/05/150508082346.htm

Sleep problems prevalent for military members

April 7, 2015

RAND Corporation

Improving the quality and quantity of US military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

http://www.sciencedaily.com/releases/2015/04/150407095639.htm

Can light therapy help the brain?

April 2, 2015

Veterans Affairs Research Communications

An innovative therapy that applies red and near-infrared light to the brain is now being tested for Gulf War Illness, traumatic brain injury, and PTSD.

Following up on promising results from pilot work, researchers at the VA Boston Healthcare System are testing the effects of light therapy on brain function in veterans with Gulf War Illness.

Veterans in the study wear a helmet lined with light-emitting diodes that apply red and near-infrared light to the scalp. They also have diodes placed in their nostrils, to deliver photons to the deeper parts of the brain.

The light is painless and generates no heat. A treatment takes about 30 minutes.

The therapy, though still considered "investigational" and not covered by most health insurance plans, is already used by some alternative medicine practitioners to treat wounds and pain. The light from the diodes has been shown to boost the output of nitric oxide near where the LEDs are placed, which improves blood flow in that location.

"We are applying a technology that's been around for a while," says lead investigator Dr. Margaret Naeser, "but it's always been used on the body, for wound healing and to treat muscle aches and pains, and joint problems. We're starting to use it on the brain."

Naeser is a research linguist and speech pathologist for the Boston VA, and a research professor of neurology at Boston University School of Medicine (BUSM). She is also a licensed acupuncturist and has conducted past research on laser acupuncture to treat paralysis in stroke, and pain in carpal tunnel syndrome.

The LED therapy increases blood flow in the brain, as shown on MRI scans. It also appears to have an effect on damaged brain cells, specifically on their mitochondria. These are bean-shaped subunits within the cell that put out energy in the form of a chemical known as ATP. The red and near-infrared light photons penetrate through the skull and into brain cells and spur the mitochondria to produce more ATP. That can mean clearer, sharper thinking, says Naeser.

Naeser says brain damage caused by explosions, or exposure to pesticides or other neurotoxins--such as in the Gulf War--could impair the mitochondria in cells. She believes light therapy can be a valuable adjunct to standard cognitive rehabilitation, which typically involves "exercising" the brain in various ways to take advantage of brain plasticity and forge new neural networks.

"The light-emitting diodes add something beyond what's currently available with cognitive rehabilitation therapy," says Naeser. "That's a very important therapy, but patients can go only so far with it. And in fact, most of the traumatic brain injury and PTSD cases that we've helped so far with LEDs on the head have been through cognitive rehabilitation therapy. These people still showed additional progress after the LED treatments. It's likely a combination of both methods would produce the best results."

The LED approach has its skeptics, but Naeser's group has already published some encouraging results in the peer-reviewed scientific literature.

Last June in the Journal of Neurotrauma, they reported the outcomes of LED therapy in 11 patients with chronic TBI, ranging in age from 26 to 62. Most of the injuries occurred in car accidents or on the athletic field. One was a battlefield injury, from an improvised explosive device (IED).

Neuropsychological testing before the therapy and at several points thereafter showed gains in areas such as executive function, verbal learning, and memory. The study volunteers also reported better sleep and fewer PTSD symptoms.

The study authors concluded that the pilot results warranted a randomized, placebo-controlled trial--the gold standard in medical research.

That's happening now, thanks to VA support. One trial, already underway, aims to enroll 160 Gulf War veterans. Half the veterans will get the real LED therapy for 15 sessions, while the others will get a mock version, using sham lights.

Then the groups will switch, so all the volunteers will end up getting the real therapy, although they won't know at which point they received it. After each veteran's last real or sham treatment, he or she will undergo tests of brain function.

Naeser points out that "because this is a blinded, controlled study, neither the participant nor the assistant applying the LED helmet and the intranasal diodes is aware whether the LEDs are real or sham. So they both wear goggles that block out the red LED light." The near-infrared light is invisible to begin with.

Besides the Gulf War study, other trials of the LED therapy are getting underway:

·      Later this year, a trial will launch for veterans age 18 to 55 who have both traumatic brain injury (TBI) and posttraumatic stress disorder--a common combination in recent war veterans. The VA-funded study will be led by Naeser's colleague Dr. Jeffrey Knight, a psychologist with VA's National Center for PTSD and an assistant professor of psychiatry at BUSM.

·      Dr. Yelena Bogdanova, a clinical psychologist with VA and assistant professor of psychiatry at BUSM, will lead a VA-funded trial looking at the impact of LED therapy on sleep and cognition in veterans with blast TBI.

·      Naeser is collaborating on an Army study testing LED therapy, delivered via the helmets and the nose diodes, for active-duty soldiers with blast TBI. The study, funded by the Army's Advanced Medical Technology Initiative, will also test the feasibility and effectiveness of using only the nasal LED devices--and not the helmets--as an at-home, self-administered treatment. The study leader is Dr. Carole Palumbo, an investigator with VA and the Army Research Institute of Environmental Medicine, and an associate professor of neurology at BUSM.

Naeser hopes the work will validate LED therapy as a viable treatment for veterans and others with brain difficulties. She foresees potential not only for war injuries but for conditions such as depression, stroke, dementia, and even autism.

"There are going to be many applications, I think. We're just in the beginning stages right now."

http://www.sciencedaily.com/releases/2015/04/150402161648.htm

Antioxidant therapy may have promising potential in concussion treatment

April 1, 2015

Federation of American Societies for Experimental Biology (FASEB)

Antioxidants may play a key role in reducing the long-term effects of concussions and could potentially offer a unique new approach for treatment, a new study suggests. Common among athletes and soldiers, it is estimated that 3.4 million concussions occur each year in the United States. The development of a readily available oral supplement would have the potential to improve brain function in a percentage of concussion sufferers.

Common among athletes and soldiers, it is estimated that 3.4 million concussions occur each year in the United States. The development of a readily available oral supplement would have the potential to improve brain function in a percentage of concussion sufferers.

The study adds to recent findings that concussions can lead to chronic traumatic encephalopathy. Head injuries often lead to chronic traumatic encephalopathy, a disease associated with long-term brain damage and behavioral symptoms including memory loss, impulsive behavior, depression and aggression. The number of retired athletes and veterans diagnosed with chronic traumatic encephalopathy has climbed in recent years.

"Concussions can contribute to long-term changes within the brain and these changes are the result of cell death, which may be caused by oxidative stress," said Brandon Lucke-Wold, a M.D./Ph.D. student at West Virginia University's Medical School who conducted the research. "This study shows that antioxidants such as lipoic acid can reduce the long-term deficits when given after a concussion."

In Lucke-Wold's research, rats were divided into three groups: a non-concussed control group, a group that experienced concussive injury and another concussed group that received lipoic acid supplementation. Seven days after the concussion, the rats were tested for seemingly impulsive behavior through an elevated maze. The rats exposed to concussion without lipoic acid had increased impulsive behavior, and spent more time exploring open spaces indicative of risk taking behavior.

"This increase in impulsive behavior was an indication of underlying brain damage," said Lucke-Wold, who will present the research at the American Society for Pharmacology and Experimental Therapeutics (ASPET) Annual Meeting during Experimental Biology 2015.

Analysis of brains of the group receiving supplementation showed markedly decreased impulsive behavior. "These findings make sense because lipoic acid works to help reduce toxic free radicals that can damage cells," said Lucke-Wold.

"By understanding the mechanisms behind brain injury following concussion, we can more effectively target treatment interventions to reduce these damaging effects," he added.

http://www.sciencedaily.com/releases/2015/04/150401132752.htm

Study adds evidence on link between PTSD, heart disease

March 26, 2015

Veterans Affairs Research Communications

In a study of more than 8,000 veterans in Hawaii and the Pacific Islands, those with posttraumatic stress disorder had a nearly 50 percent greater risk of developing heart failure. The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

"There are many theories as to how exactly PTSD contributes to heart disease," says Dr. Alyssa Mansfield, one of the study authors. "Overall, the evidence to date seems to point in the direction of a causal relationship."

Mansfield was senior author on the study while with the Pacific Islands Division of the National Center for PTSD of the Department of Veterans Affairs (VA). She is now with the VA Pacific Islands Health Care System and also an assistant adjunct professor of epidemiology at the University of Hawaii.

The study tracked 8,248 veterans who had been outpatients in the VA Pacific Islands system. The researchers followed them an average of just over seven years. Those with a PTSD diagnosis were 47 percent more likely to develop heart failure during the follow-up period. The researchers controlled for differences between the groups in health and demographic factors.

Out of the total study group, about 21 percent were diagnosed with PTSD. Of the total 371 cases of heart failure during the study, 287 occurred among those with PTSD, whereas only 84 cases occurred among the group without PTSD.

Combat service, whether or not it led to a full-blown PTSD diagnosis, was itself a strong predictor of heart failure. Those Veterans with combat experience were about five times more likely to develop heart failure during the study period, compared with those who had not seen combat. Other predictors of heart failure were advanced age, diabetes, high blood pressure, and overweight or obesity.

The authors of the study say they didn't have access to a full range of data that would have provided further clues as to the PTSD-heart disease link. For example, they were not able to distinguish in the data between those who had served in the Gulf during 1990 and 1991, and those who served more recently in Iraq or Afghanistan. Nor were they able to analyze whether racial or ethnic identity plays a role one way or the other, as that information was not complete for most veterans in study.

Nonetheless, the authors point out that the work is the "first large-scale longitudinal study to report an association between PTSD and incident heart failure in an outpatient sample of U.S. veterans."

Heart failure, in which the heart grows weaker and can't pump enough blood to adequately supply the body's needs, affects about 5 million Americans in all, with some 500,000 new cases each year. People with the condition feel tired with physical activity, as the muscles aren't getting enough blood.

The new results, says Mansfield, provide further potent evidence of the nexus between mental and physical health. The practical upshot of the findings, she says, is that veterans with PTSD should realize that by treating their PTSD, they may also be helping to prevent heart disease down the road.

By the same token, the authors point out that VA and other health care systems may need to step up efforts to prevent and treat heart failure among those with PTSD.

http://www.sciencedaily.com/releases/2015/03/150326130958.htm

Head injury patients show signs of faster aging in the brain

March 25, 2015

Imperial College London

People who have suffered serious head injuries show changes in brain structure resembling those seen in older people, according to a new study. The brain injury patients in this study were estimated to be around five years older on average than their real age.

Researchers at Imperial College London analysed brain scans from over 1,500 healthy people to develop a computer program that could predict a person's age from their brain scan. Then they used the program to estimate the "brain age" of 113 more healthy people and 99 patients who had suffered traumatic brain injuries.

The brain injury patients were estimated to be around five years older on average than their real age.

Head injuries are already known to increase the risk of age-related neurological conditions such as dementia later in life. The age prediction model may be useful as a screening tool to identify patients who are likely to develop problems and to target strategies that prevent or slow their decline.

"Your chronological age is not necessarily the best indicator of your health or how much longer you will live," said Dr James Cole, who led the study, from the Department of Medicine at Imperial College London. "There is a lot of interest in finding biomarkers of aging that can be used to measure a certain aspect of your health and predict future problems."

The study, published in the April issue of Annals of Neurology, used magnetic resonance imaging (MRI) to study changes in brain structure. The researchers used a machine learning algorithm to develop a computer program that could recognise age-related differences in the volume of white matter and grey matter in different parts of the brain.

The model was then used to estimate subjects' ages based on their brain scans. The study included 99 patients with traumatic brain injuries (TBI) caused by road accidents, falls or assaults, who had persistent neurological problems. The scans were taken between one month and 46 years after their injuries.

In healthy controls, the average difference between predicted age and real age was zero. In TBI patients, the difference was significantly higher, with a bigger discrepancy in patients with more severe injuries. Bigger differences in predicted age were associated with cognitive impairments such as poor memory and slow reaction times.

There was also a correlation between time since injury and predicted age difference, suggesting that these changes in brain structure do not occur during the injury itself, but result from ongoing biological processes, potentially similar to those seen in normal aging, that progress more quickly after an injury.

"Traumatic brain injury is not a static event," said Dr Cole. "It can set off secondary processes, possibly related to inflammation, that can cause more damage in the brain for years afterwards, and may contribute to the development of Alzheimer's or other forms of dementia."

The researchers believe the age prediction model could be applied not just to TBI patients, but might also be useful to screen outwardly healthy people.

"We want to do a study where we use the program to estimate brain age in healthy people, then see if the ones with 'old brains' are more likely to get neurodegenerative diseases. If it works, we could use it to identify people at high risk, enrol them in trials and potentially prescribe treatments that might stave off disease," said Dr Cole.

http://www.sciencedaily.com/releases/2015/03/150325082347.htm

Call for more research on brain damage in American football

March 24, 2015

Science Daily/BMJ

More research is needed to identify how athletes sustain brain injury from American football, and also to develop strategies to protect them, write experts. Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome that can affect athletes. It is thought to result from concussion and brain injury following repeated blows to the head.

But the topic of brain damage in football is controversial. The National Football League, for example, does not acknowledge any association between football and brain injury.

CTE symptoms include memory problems, depression, poor impulse and motor control, anger and apathy. But diagnosis can be confirmed only with an autopsy.

Over the course of the last 60 years, just 63 cases of CTE have been identified. When compared to the millions of football players, this number is very low, explain the authors, and this makes research "challenging" as definitive conclusions are difficult to make based on small samples.

Consequently, it will take time and further research to make American football safer, but it must remain a top priority, they argue.

All cases of confirmed CTE following autopsy suggest that the condition is linked to repetitive blows to the head.

But not all of these persons had a history of concussion and this suggests that undiagnosed subconcussive blows may also contribute to CTE, they explain, and call for more research into how the condition develops and to determine other risk factors.

Previous research has shown that retired NFL players demonstrated more cognitive impairment if they had started playing football at a younger age, and this suggests the role of long term injuries to the head.

The development of new technologies that can measure subconcussive blows would benefit research, add the authors. For example, helmet mounted accelerometers can measure these blows and has shown that high school players can sustain over 1,000 head impacts per season. But the NFL recently stopped its use because of difficulties and questions over the reliability of such data.

Risk reduction of head injuries has included legislation requiring injured athletes to be medically assessed before returning to play and changing rules to avoid or reduce head trauma. But long term studies still need to assess whether these strategies are effective, they add.

Protective equipment, such as helmets, have been implemented, but have mixed results and more mechanisms to reduce trauma and to treat injuries should be developed and evaluated, they argue.

"We are still lacking a clear clinical picture because there have been no long term prospective studies of the disease spectrum from diagnosis to death," write the authors. "It is unclear whether any treatment could slow progression of the disease if it was recognised early."

http://www.sciencedaily.com/releases/2015/03/150324210049.htm

Exercise results in larger brain size and lowered dementia risk

August 2, 2016

Science Daily/University of California - Los Angeles Health Sciences
Regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia. It particularly affected the size of the hippocampus, which controls short-term memory, and its protective effect against dementia was strongest in people age 75 and older

Using the landmark Framingham Heart Study to assess how physical activity affects the size of the brain and one's risk for developing dementia, UCLA researchers found an association between low physical activity and a higher risk for dementia in older individuals. This suggests that regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia.

The researchers found that physical activity particularly affected the size of the hippocampus, which is the part of the brain controlling short-term memory. Also, the protective effect of regular physical activity against dementia was strongest in people age 75 and older.

Though some previous studies have found an inverse relationship between levels of physical activity and cognitive decline, dementia and Alzheimer's disease, others have failed to find such an association. The Framingham study was begun in 1948 primarily as a way to trace factors and characteristics leading to cardiovascular disease, but also examining dementia and other physiological conditions. For this study, the UCLA researchers followed an older, community-based cohort from the Framingham study for more than a decade to examine the association between physical activity and the risk for incident dementia and subclinical brain MRI markers of dementia.

The researchers assessed the physical activity indices for both the original Framingham cohort and their offspring who were age 60 and older. They examined the association between physical activity and risk of any form of dementia (regardless of the cause) and Alzheimer's disease for 3,700 participants from both cohorts who were cognitively intact. They also examined the association between physical activity and brain MRI in about 2,000 participants from the offspring cohort.

What this all means: one is never too old to exercise for brain health and to stave off the risk for developing dementia.

Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/08/160802103723.htm