In concussion's wake, sadness and anxiety thrive

In the year following a traumatic brain injury, roughly half of survivors likely experience a bout of clinical depression -- a rate almost eight times higher than that found in the general population, says a study published Tuesday in the Journal of the American Medical Assn. And those whose head trauma was followed by depression reported significantly more pain, greater mobility problems and more difficulty carrying out their usual responsibilities than those who were not plagued by post-injury depression.

Traumatic brain injury, or TBI, is sometimes called concussion. Often called the "silent epidemic," it affects some 1.5 million Americans yearly. Its symptoms are often subtle -- including personality changes, problems of memory and concentration, headaches and mood disturbances. While for most, the effects of a head trauma will clear within a year, many have more lasting effects. For at least 80,000 people a year, major disability will follow.  

The 559 participants in this study had all come to a trauma center in the Seattle area with a head injury, signs of brain trauma that could be detected by a CT scan, and at least a few complications -- including loss of consciousness, disorientation or other factors that qualified them as scoring at most a 13 on the 15-point Glasgow Coma scale. Over the next six months, and then again at eight, 10 and 12 months after the participant's injury, researchers conducted a detailed telephone interview to gauge his or her mood state and ability to function. The result, said the researchers, was likely to yield a conservative picture of how many suffered from depression.

Past efforts to measure the rate of post-brain injury depression have been limited in their usefulness and yielded estimates that ranged from 10% to 77%. While this study included participants whose injuries ranged widely in severity, its findings clearly suggest that even those thought to have had a relatively mild injury had far higher rates of subsequent depression than would be expected had they remained unhurt. Among those whose injury was considered mild to moderate, 51.9% and 51.6% suffered from subsequent depression. Among those with severe brain injury -- as measured by the Glasgow Coma Scale -- 57.1% did.

In fact, the measures that physicians use to diagnose and treat brain injury were not very good predictors of whether a survivor would go on to suffer depression. Whether or not a victim had suffered bleeding in the brain or cortical contusions -- essentially, bruises of the brain's gray matter -- didn't make much difference in the likelihood of post-injury depression. That fact underscores the limits of what is understood about brain injury and its outcomes. (You can read more about what physicians are learning about brain injury -- much of it from the experience of U.S. troops in Iraq and Afghanistan but also on the playing fields of professional and college sports too -- here, here and here.)

Brain injury survivors who were depressed near or at the time of their accidents, who had suffered post-traumatic stress disorder or had any other past psychiatric diagnosis, and those who were intoxicated on cocaine or methamphetamine had far higher rates of post-injury depression. And victims were more likely to report depressive symptoms after their injury if they fit any of the following categories: they were African American, had not completed high school, or their injury was caused by violence (as opposed to a vehicular crash, fall or recreational injury). Also, those who were engaged in litigation associated with their injury were more likely to be depressed (65.5% vs 52.2%) than those who were not.

To learn more about TBI and its sometimes-persistent effects, this comprehensive website can't be beat. To learn about local support groups and national and state efforts to improve life for those with TBI, check this website out.  

--Melissa Healy

Rodent of the Week: Reversing age-related memory loss

In a truly exciting area of neuroscience, researchers reported this week that they were able to identify specific changes in the brain that impair age-related memory and learning in elderly mice. These are the kind of gradual memory glitches that humans begin to experience in their late 40s and continue during the aging process. It appears that epigenetic changes -- changes in the way genes function but that do not involve changes in DNA -- cause this type of memory decline. But reversing these changes may yield treatments for cognitive loss.

Researchers in Germany determined that memory decline became impaired in aging mice around 16 months of age. Examining the mice, they found changes in the proteins that control gene expression in their brains. One particular change was found in enzymes called histone acetyltransferases. When the researchers treated the mice with a drug that reinstated the change in the enzymes and in the gene expression, they saw improved memory function in the mice. The study was published Thursday in the journal Science.

"This study presents a major advance in thinking about the role of histone modifications in synaptic plasticity and memory formation," J. David Sweatt, chairman of the University of Alabama at Birmingham department of neurobiology, said in a commentary accompanying the study. Sweatt, in a paper published recently, showed that drugs that affect histone acetyltransferases also benefit mice with Alzheimer's disease.

"These studies will hopefully lead to more effective prevention strategies to improve quality of life in the aged, as well as contribute to a better understanding of memory," Sweatt said in a news release.

-- Shari Roan

Photo: Advanced Cell Technology Inc.

Dementia in one spouse increases risk in the other

Married adults who have a spouse with dementia are much more likely themselves to develop dementia, according to a study published Wednesday in the Journal of the American Geriatrics Society. The study suggests that either the stress of being a caregiver or something about the shared environment of the couple contributes to
the second case of dementia.

Researchers from Utah examined 2,442 married people ages 65 and older, none of whom had dementia at the start of the study. They were monitored for 12 years. During that time, 125 cases of dementia were diagnosed in husbands and 70 cases in wives and 30 cases in which both the husband and wife were diagnosed. The analysis showed that people with a spouse with dementia were at six times higher risk of developing dementia themselves. The risk, however, was much higher for men caring for their wives than for wives caring for their husbands.

"On the positive side, the majority of these individuals with spouses who develop dementia did not themselves develop dementia," the lead author of the study, Dr. Maria Norton, of Utah State University, said in a news release. "More research is needed to explore which factors distinguish those who are more vulnerable."

-- Shari Roan

Photo credit: Dushan Milic / For The Times

Little evidence that anything works to prevent cognitive decline

Older Americans spend a bundle in search of programs, devices and products that may help them stave off cognitive decline, including Alzheimer's disease. But an independent panel of experts on cognitive decline cautioned Wednesday that there is little substantive proof that any of the popular strategies --including nutritional supplements, diet, cognitive games, computer programs and exercise -- work.

Some of these strategies may eventually prove to be helpful, the panelists stated, and research is ongoing on several prevention approaches. But none is currently backed by rigorous scientific evidence of effectiveness.

The panel's findings, while disheartening, are aimed at being straightforward with Americans, who may spend large amounts of money on cognitive enhancement or may even be persuaded to use products or practices that could be harmful.

"I think the public should have the information we have," said Dr. Evelyn C. Granieri, chief of the division of geriatric medicine and aging at Columbia University, who served on the panel. "The state of the science is: We don't have instruments or information that allows us to prevent the development of this."

"We're not trying to take anyone's hope away or make people feel helpless," said Dr. Carl C. Bell, a professor in the department of psychiatry and the school of public health at the University of Illinois, Chicago, who served on the panel. "We have to go with the hard science. That is not to take away from people's personal choices or what they wish to pursue."

Consumers should discuss prevention strategies with their doctors in order to protect against taking any substances that might be harmful to their health, the panelists urged.

The remarks were made Wednesday at the conclusion of a "state of the science" conference, convened by the National Institutes of Health, entitled "Preventing Alzheimer's Disease and Cognitive Decline." The committee was charged with assessing the available evidence on preventing cognitive decline and preparing a report on its findings.

Some preliminary research suggests that a few prevention strategies could emerge as helpful, according to the report. These include programs that train people in memory, reasoning and speed of thinking as well as omega-3 fatty acid supplementation, physical activity and a diet low in saturated fat and high in fruits and vegetables.

Look at the bright side, even if it doesn't help protect your brain, exercise and a healthy diet certainly won't hurt.

-- Shari Roan

Photo: Omega-3 fatty acids, found in fish, may help prevent cognitive decline, but the link is inconclusive so far. Credit: Christine Cotter  / Los Angeles Times

Book Review: 'The Roadmap to 100' by Walter M. Bortz II and Randall Stickrod

What if you could live to 100 and not just survive but thrive -- even in your elder years? Dr. Walter M. Bortz II and Randall Stickrod, authors of "The Roadmap to 100," say it's not only possible but probable that many of us will do so.

There will be as many as 6 million centenarians in the world by the middle of this century -- most of them healthy, functional and largely independent, Bortz and Stickrod write. But conversely, there's also a large population that may die at a younger age than the previous generation and be in poorer health while alive, putting a strain on healthcare resources, they say. 

Which of these groups people fall into largely is not determined by hereditary factors but by lifestyle choices, they write. "Longevity is neither an accident nor an isolated phenomenon. It is a product of specific healthy behaviors, a direct consequence of health maintenance."

With "Roadmap," Bortz and Stickrod say, they are "issuing a clarion call to reclaim ownership of our health, to learn to take responsibility for it and not rely blindly on medical technology to repair the damage we do to ourselves."

They present a persuasive case, backed up by numerous studies, and outline specific behaviors people can adopt to live longer and live well. However, they may be preaching to the choir. Their science-oriented book is geared to an educated reader who probably already knows the components of a healthy lifestyle. 

Bortz is no stranger to the topic. He's former co-chairman of the American Medical Assn.'s Task Force on Aging, former president of the American Geriatric Society and author of "Dare to Be 100." Stickrod, a science and technology publisher and writer, was the founding executive publisher of Wired magazine.

The two have examined studies and writings on aging, exercise, obesity, nutrition and disease and come up with several factors they believe contribute to longevity. Their top prescription for a long and productive life might be summed up in two words: Move more.

More evidence of a link between hospitalization and dementia

Spending time in a hospital can make you crazy (in a manner of speaking).

Studies have shown that older people who are hospitalized for critical illnesses often suffer from cognitive impairment. But without comparing those patients with older people who managed to steer clear of hospitals, it’s hard to say whether hospitalization itself increases the risk.

So a group of researchers from the University of Washington and the Group Health Research Institute in Seattle and the University of North Carolina in Chapel Hill decided to examine the records of 2,929 senior citizens participating in the Adult Changes in Thought study. All of the volunteers were screened for dementia when they enrolled in the study and every two years thereafter.

From 1994 to 2007, 41 of the volunteers were admitted to a hospital for critical illnesses, and five of them went on to develop dementia. An additional 1,287 were treated in a hospital for a noncritical illness, and 228 of them developed dementia. Those rates were higher than for the 1,601 patients who were not hospitalized during the course of the study.

After adjusting for factors like age, sex and years of education, the researchers found that volunteers who were hospitalized for a noncritical illness were 40% more likely to develop dementia than their counterparts who were never hospitalized. The risk was even higher – more than double – for patients who experienced critical illnesses, but those results weren’t statistically significant (perhaps because there weren’t enough patients in this group to nail down the link).

The results will be published in Wednesday’s edition of the Journal of the American Medical Assn.

The researchers said they weren’t sure why being a hospital patient appears to increase the risk of cognitive decline. In fact, hospitalization itself may have nothing to do with it. Perhaps the illnesses that land patients in the hospital also cause changes in the brain that lead to dementia, they wrote:

“The mechanisms through which critical illness may contribute to neurocognitive impairment are multiple, with evidence suggesting that hypoxemia, delirium, hypotension, glucose dysregulation, systemic inflammation, and sedative and analgesic medications all may potentially play a role.”

— Karen Kaplan

Photo: Could a stay in a hospital room increase your risk for dementia? Credit: Stefano Paltera/For The Times