Free e-book: Concussions, CTE and Football

From the Introduction:

When You Watch Your Next Football Game...

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From high school to college to professional levels, football dominates American sports and exposes millions to head traumas on practically every play.

It is a paradox of wide proportions. From opening day in September to the Super Bowl in February, the National Football League (NFL) dominates American sports and wins television ratings far beyond any other program--sports or otherwise.

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Increasingly, though, discussions of football (and other sports) include the medical terms concussion and chronic traumatic encephalopathy (CTE), a long-term degenerative and incurable brain disease. Although military personnel and others are vulnerable to the disease, the highest risk is among athletes involved in contact sports in which hits to the head are considered “part of the game.”

Ten years ago, few would have predicted that the movie “Concussion” starring Will Smith would be made. Fewer would have predicted that brain injuries would one day dominate the sports headlines. When former NFL star Junior Seau committed suicide in May 2012, the media focused almost entirely on whether the thousands of head blows he endured during his 19-year career as a middle linebacker were a contributing factor.

More than 3,000 former NFL players sued the league for allegedly misleading them about the risks of brain injury. The players and the league settled for more than $1 billion in damages. New policies and studies aimed at protecting the brains of athletes seem to be announced every week. But it’s not just professional athletes who are the focus of attention. No fewer than 40 states have passed laws requiring athletes in schools and recreational programs to schedule a doctor’s appointment when a concussion is suspected.

A progressive, degenerative brain disease, CTE can present itself  in athletes and others with a history of repetitive brain trauma months, years, or even decades after injury. Memory loss, confusion, depression, aggression, impaired judgment or impulse control, and, eventually, progressive dementia may result.

With this increasing awareness about the dangers of concussion, parents face tough choices about which sports their children should be allowed to play. Some of the more

New rules have since been designed to lessen brain trauma; but with every new horror story that emerges on the sports pages, parents worry even more.

dangerous sports for the brain, such as football, soccer, ice hockey, and lacrosse, are also the most popular. Although everyone agrees that brain trauma may have lasting and debilitating effects, and science continues to make slow progress toward understanding the disease, we cannot yet entirely quantify those effects. As a result, parents and even medical professionals are left to search their hearts and scour Web sites for answers. But a decade’s worth of research has made one thing clear: We need to find better ways to protect the brains of athletes.

Difficult to Measure

Concussions suffer from a perception problem. On the surface, they might not seem to have a lasting, serious impact. (In fact, sports programs and commentators continue to celebrate the most impactful “hits,” using euphemisms such as “getting your bell rung.”) They are an invisible injury: There is no blood, there are no displaced bones, and the patient rarely complains. Even when an athlete is knocked unconscious and observers react with panic, the concern quickly fades. Ninety-nine percent of concussed athletes wake up in seconds or minutes and then seem fine. When symptoms persist beyond the day of injury, in the vast majority of cases they dissipate within a month. The injury seems as if it is gone forever, leaving no scars or overt indication that it ever happened.

Children at Risk

Most brain trauma in the industrialized world occurs in children playing sports. Since participation is voluntary, and the rules of recreational sports are malleable, it seems reasonable to make every effort to reform each individual sport....

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Large declines seen in teen substance abuse, delinquency

Surveys over a decade indicate positive behavioral shifts

Summary:

In recent years, teens have become far less likely to abuse alcohol, nicotine and illicit drugs, according to researchers. Teens also are less likely to engage in behaviors like fighting and stealing, and the researchers believe the declines in substance use and delinquency are connected.

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More than a decade of data indicates teens have become far less likely to abuse alcohol, nicotine and illicit drugs, and they also are less likely to engage in delinquent behaviors, such as fighting and stealing, according to results of a national survey analyzed by researchers at Washington University School of Medicine in St. Louis.

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Learn about how the brain governs our health.

The data come from the National Survey on Drug Use and Health, an annual survey of 12- to 17-year-olds from all 50 states that is sponsored by the Substance Abuse and Mental Health Administration, an agency of the U.S. Department of Health and Human Services. The data include information from 2003 through 2014, the last year for which survey numbers are available. A total of 210,599 teens -- 13,000 to 18,500 each year -- were part of the study.
The findings are reported Oct. 25 in the journal Psychological Medicine.

The researchers found that the number of substance-use disorders among 12- to 17-year olds had declined by 49 percent over the 12-year span, along with a simultaneous 34 percent decline in delinquent behaviors, such as fighting, assault, stealing, selling drugs or carrying a handgun.

The drop in substance abuse among teens parallels findings in other recent surveys, but until now no one has looked at how the drop-off may be linked to other behavioral issues.

"We've known that teens overall are becoming less likely to engage in risky behaviors, and that's good news," said first author Richard A. Grucza, PhD, a professor of psychiatry. "But what we learned in this study is that the declines in substance abuse are connected to declines in delinquency. This suggests the changes have been driven more by changes in adolescents themselves more than by policies to reduce substance abuse or delinquent behavior."

Other researchers have found that teens are delaying sex and using seat belts more often than their parents and grandparents. Grucza's team focused on substance-use disorders -- involving alcohol, nicotine, marijuana, opioids and the abuse of other prescription drugs or nonprescription drugs -- and delinquent behaviors.

"It's not clear what is driving the parallel declines," Grucza said. "New policies -- including things like higher cigarette taxes and stricter anti-bullying policies -- certainly have a positive effect. But seeing these trends across multiple behaviors suggests that larger environmental factors are at work. These might include reductions in childhood lead exposure, lower rates of child abuse and neglect, and better mental health care for children."

Although heroin and opioid abuse have become epidemic in many areas of the United States, the use among teens has fallen, according to the survey data.
"Opioid problems continue to increase among adults," he said. "But among the 12- to 17-year-old population, we saw a drop of nearly 50 percent."

Based on the survey data, Grucza and his team estimated that in 2014 there were nearly 700,000 fewer adolescents with substance-use disorders than in 2003. And because it's possible for a person to be addicted to nicotine while abusing alcohol or marijuana, the researchers estimate the total number of substance-use disorders among adolescents declined by about 2 million.

Source:

Washington University School of Medicine

Concussions are serious

From our new book, Healing the Brain, we look at the danger from concussions and CTE. Parents need to decide whether to allow their children to play football or soccer, among other threats.

It is fairly remarkable that “Concussion,” the movie, exists. Ten years ago, the public did not know much about concussions and other forms of brain trauma. People weren’t watching football games and thinking about the long-term neurological effects of the brutal body contact. A veil was lifted on a topic rarely discussed as more and more football players reported disturbing neurological symptoms after their careers had ended. A disturbing series of suicides were reported. Around 2009, the National Football League (NFL) started getting criticism for its outdated concussion policies. In 2013, a book and corresponding documentary that tackled the issue, “League of Denial,” were released. At the end of 2015, Hollywood brought us a major motion picture that stars Will Smith as a neuropathologist fighting to reveal the truth about head trauma in football players.

Parents around America began to reconsider their willingness to allow their children to play the sport, one that plays a major role in the sports and cultural life of the country.

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.

Concussions Are Serious

Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious.

Chronic traumatic encephalopathy (CTE) is the term used to describe brain degeneration likely caused by repeated head traumas. CTE is a diagnosis only made at autopsy by studying sections of the brain.

CTE is a very rare condition. It has been found in the brains of people who played contact sports, such as football, as well as others. Some symptoms of CTE are thought to include difficulties with thinking (cognition), physical problems, emotions and other behaviors.

The condition is a very controversial condition that is still not well-understood. Researchers do not yet know the frequency of CTE in the population and do not understand the causes. There is no cure for CTE.

Some of the possible signs and symptoms of CTE may include: difficulty thinking (cognitive impairment), impulsive behavior, depression or apathy, short-term memory loss, difficulty planning and carrying out tasks (executive function), emotional instability, substance abuse, and suicidal thoughts or behavior

Other suspected symptoms may include: irritability, aggression, speech and language difficulties, motor impairment, such as difficulty walking, tremor, loss of muscle  movement, weakness or rigidity, trouble swallowing (dysphagia), vision and focusing problems, trouble with sense of smell (olfactory abnormalities), and dementia

The full list of symptoms of people with CTE at autopsy is still unknown. It is unclear what kind of symptoms, if any, it may cause. Little is known right now about how CTE progresses.

When to See a Doctor

CTE is thought to develop over many years after repeated brain injuries (mild or severe). However, see your doctor in case of the following:

• Suicidal thoughts. Research shows that people with CTE may be at increased risk of suicide. If you have thoughts of hurting yourself, call 911, your local emergency number or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255).
• Head injury. See your doctor if you have had a head injury, even if you didn't need emergency care. If your child has received a head injury that concerns you, call your child's doctor immediately. Depending on the signs and symptoms, your doctor may recommend seeking immediate medical care.
• Memory problems. See your doctor if you have concerns about your memory or other thinking (cognitive) or behavior problems.
• Personality or mood changes. See your doctor if depression, anxiety, aggression or impulsivity occur.
  
  
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Depressed post-Trump? Know the signs.

Depressed after the recent election? Many Americans are. When does just having the "blues" turn into something serious, worthy of medical attention? Read this excerpt from our new book, Healing the Brain.

Scientists have long acknowledged the brain’s circuitry and biochemical processes as integral aspects of depression, specifically as these processes control neurotransmitters that control mood. Beginning in the 1970s, neuroimaging technologies rapidly advanced the study of how brains function – or fail to function. Functional magnetic resonance imaging (fMRI), which became available to researchers over the past 20 years, gives cognitive neuroscientists a 3-D view of neural activity within the brain.

Studies using this technology demonstrate the role of neurotransmitters serotonin, norepinephrine, and dopamine as they regulate mood in the human body. Scientists still aren’t exactly sure why individuals with depression have low amounts of these neurotransmitters, yet they do know that for some, antidepressants that specifically target how the brain balances these these neurotransmitters are an effective therapeutic intervention.

Studies show the benefits of combining medication and psychotherapy.

Yet much controversy surrounds the issue of prescribing antidepressants, with some claiming that too often an individual is prescribed a pill without receiving the benefits of psychotherapy or talk therapy. Leigh Matthews, psychologist and director of Urban Psychology in Brisbane, Australia, treats adult clients for depression. There is an abundance of studies evidencing the efficacy of the combination of medication and psychotherapy.

But psychology, Matthews said, tries to first focus on treatment without medication, so it’s not always respected by other disciplines, such as general practice physicians or psychiatrists. But the process of psychotherapy and its outcomes last far longer than simply prescribing medication. Yet there are times when medication is absolutely essential, according to Matthews, who also supervises psychologists-in-training at the University of QLD, and those completing their internships through the Australian College of Applied Psychology.

She said when clients are so depressed that they can’t get out of bed, think rationally, or use any of the strategies proposed in session, then it’s time for medication. Or when clients verbalize suicidal ideation and intent indicating severe depression, then medication is absolutely required.

Also if an individual has a long history of depression, or a strong family history suggesting a genetic basis, then “perhaps they, like a diabetic requiring insulin, need long-term pharmacotherapy to rectify neurochemical imbalances.”

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