Part 8: Traumatic Brain Injuries
In this series, we are taking an in-depth look at the various types of dementia and how to improve treatment in a long-term care setting. There are several lesser known dementias affecting our seniors. As part of their care team we need to educate ourselves on how to better understand and meet their needs.
Today we will examine traumatic brain injuries. Thanks to the Alzheimer’s Association, TraumaticBrainInjury.com, and Health Central for providing the information for this article. Visit these organizations online for further information.
Traumatic Brain Injuries
Traumatic brain injuries (TBI) are becoming a greater topic of conversation due to sports related concussions. As we enthrall ourselves with the excitement of the Super Bowl, we are reminded of the dangers those players place themselves in every day. The NFL has made several changes from improving helmets to modifying concussion protocols as the long-term effects of the sport are coming to light.
TBI not only affects athletes but can include others involved in car/motorcycle accidents, falls, repeated blows to the head, etc. It is hard to ignore the short term and immediate signs and symptoms of TBI, but many people are still unaware of the long-term concerns, like dementia. The Alzheimer's Association defines TBI as "an impact to the head that disrupts normal brain function. Traumatic brain injury may affect a person’s cognitive abilities, including learning and thinking skills." Dementia caused by TBI is relatively low, only about 5 percent of cases, but those with dementia sustaining a traumatic brain injury are high.
Falls are the leading cause of TBI in persons over the age of 75. Therefore, fall prevention plans are very important. Due to the risk of brain injuries, many long-term care communities have policies requiring that 911 is called after a resident hits their head during a fall. It's easy to observe the immediate signs of a head injury including loss of consciousness, blurred vision, confusion and nausea, but these symptoms might not develop for days or even weeks after the fall. Persons who sustain a head injury may require extra monitoring beyond the standard 3-14 days.
The severity of the symptoms will vary depending on if the injury was mild, moderate or severe. Some sources, like traumaticbraininjury.com, only classify mild and severe. Severe can be defined as anything from losing consciousness for more than 30 minutes to over 24 hours. Health Central does a wonderful job of summarizing the correlation between TBI and dementia.
Traumatic Brain Injury and Incidence of Alzheimer's Disease
"Traumatic Brain Injuries (TBI's) affect an estimated two to three million people in the United States each year. Between 400,000 and 500,000 people are hospitalized. It is difficult to find accurate statistics on how many people with a TBI go on to develop significant dementia, but there are three areas that we need to consider. The first is the link between Alzheimer's disease and TBI; the second, post traumatic dementia affecting the elderly and thirdly dementia pugilistica, (also known as chronic traumatic encephalopathy).
There has been a lot of discussion about the association between a higher incidence of Alzheimer's disease following a serious TBI, but the link remains controversial. Both autopsy and experimental studies show apolipoprotein beta deposits and tau pathology following a head injury. This could support the link between traumatic brain injury and dementia. However, further studies are needed before more definite conclusions can be reached.
Dementia pugilistica, (also called chronic traumatic encephalopathy, punch drunk) is a dementia that occurs following cumulative and repetitive head trauma. It mostly affects career boxers, but can also be seen in people doing other contact sports. Symptoms begin around 16 years later and are characterized by Parkinsonism, poor coordination and slurred speech. Like Alzheimer's, the pathologic findings include neurofibrillary tangles and Beta-amyloid deposits
Dementia and Chronic Subdural Hematoma
A type of post TBI syndrome that affects the elderly is chronic subdural hematoma (SDH). This can occur immediately after an injury but can also be a chronic condition where symptoms of apathy, confusion, lethargy, memory impairment and problems with activities of daily living (executive functions) fluctuate. Those at greatest risk are people over the age of 60 years, have frequent falls, gait disturbances and are on anticoagulant therapy.
Traumatic brain injury is the leading cause of cognitive impairment (problems with thinking, memory, understanding, reasoning, and communicating) in young adults. Young adults are particularly affected because TBI is most commonly caused by falls and motor vehicle accidents. Males are most at risk because of more risky behavior in their youth. The elderly are most at risk of TBI from falls. Alcohol can also play a significant role in accidents leading to TBI in both groups.
Symptoms of Dementia Following Traumatic Brain Injury
Symptoms of Dementia following TBI include:
Poor concentration and difficulty in thinking clearly
Slower thought processes
Changes in behavior including mood swings, irritability, impulsive/inappropriate behavior
Restlessness or agitation
Problems with activities of daily living (executive functions)
Treatment of Traumatic Brain Injury
Treatment involves dealing with the acute effects of the traumatic injury to try to reduce permanent damage.
Physical and occupational rehabilitation needs to be intensive.
Speech therapy will help improve communication skills.
Psychological and psychiatric treatment can help with post traumatic and behavioral problems. As with Alzheimer's, antipsychotic medications may be prescribed to help but some people following a traumatic brain injury are sometimes more prone to their side effects, so close frequent medical contact is required.
Anticonvulsant medications are often used to prevent epileptic convulsions. These may also help with mood regulation and aggression."