Sep 24, 2010

Chronic Traumatic Encephalopathy, Physical Education, and Alzheimer's Disease

I really think we need to pay MUCH more attention to brain injuries occurring to young children. My gut feeling is that they may be playing a much bigger role in senior dementia than anyone realizes.....
By Max Wallack
Alzheimer's Reading Room

As many of you may know, I spent this summer working at the Boston University Alzheimer’s Disease Center. I began some of the first two weeks being trained to work in the Alzheimer’s Research Lab.

After the first two weeks, I became involved in various activities. I helped with the HOPE (Health Outreach Program for the Elderly) Study. This involved learning to administer and score various memory tests. It was very interesting. I spent two weeks at the Jamaica Plain Veterans Hospital. There, I participated in dementia clinic, cervical dystonia clinic, and botox (used to treat muscular problems) clinic. I also learned to read EEG’s.

The part of the summer that turned out most interesting and most educational to me was unexpected. I was invited to participate in a weekly CTE (Chronic Traumatic Encephalopathy) Journal Club meeting. Each week we were assigned 2-3 research articles involving concussions and brain injuries, and we met to discuss them. Early on, I realized that I had the opportunity to learn a great deal about the workings of the human brain. Only later in the summer, did I begin to realize the importance of what I was learning and how relevant the study of CTE is to the study of dementia. All of this culminated in several visits to the Bedford Brain Bank, where I was able to help dissect, hold in my own hands, and see with my own eyes, the effects of CTE and Alzheimer’s on the human brain.

Lately, I have been thinking a great deal about the possibility that some brain injuries early in life, perhaps even undetected injuries, may be at the root of many cases of dementia, and even Alzheimer’s disease, later in life. I have seen the tau in the brains of CTE patients, and I have seen the tau in the brains of Alzheimer’s patients. I cannot help thinking that tau tangles are the results of brain injuries.

Today, I read an article by Gretchen Reynolds entitled Phys Ed: Looking at How Concussions When Young Influence Later Life. Reynolds talks about a study at the University of Illinois last fall that measured the electrical activity in the brain of 90 college athletes as they worked on cognitive tests. About half of these athletes had experienced at least one concussion, but all the students were doing well in college, and the students who had experienced a concussion did equally well on the cognitive tests as those with no history of concussions.

HOWEVER, according to Steven Broglio, a professor of kinesiology and community health at the University of Illinois, when the electrical activity of the brains of the students who had experienced concussions was studied, the area of the brain having to do with attention was less active. So how did it happen that the students scored equally well on the cognitive tests?

According to Reynolds’s article, Dr. Broglio speculates that the injured athletes had to work harder and use more of their “mental reserves” to achieve the same level of success. Dr. Broglio explains,
“All of us start with an inborn mental reserve and then lose some of our mental resources with age.” He goes on to say that concussions may reduce our reserves and “accelerate the process.”

Apparently, Dr. Broglio and his colleagues have done a more recent study on these college athletes who had experienced concussions. His group found that
“college athletes who suffered concussions years in the past now displayed small deficits in their balance or walked differently than uninjured athletes. They kept both feet on the ground just a little bit longer, as if they were trying to steady themselves with each step.”


The article goes on to discuss how concussions might affect children, perhaps as young as 10 or younger. The accepted theory is that young people are more resilient. Dr. Giza, an associate professor of pediatric neurology and neurosurgery at U.C.L.A, says that:
“There’s strong evidence that children recover better” from catastrophic brain injuries like strokes and brain surgery. However, Dr. Giza cautions, “But concussions may be different. Children’s brains generally have higher metabolic rates than adult or even teenage brains. When a person experiences a concussion, the metabolic rate within the brain increases even more. Neurologists wonder whether the added metabolic demands on a child’s brain after a concussion – on top of the already large energy demands of a young brain generally –may be more problematic than they would be for an adult.”

Dr. Mark Halstead, assistant professor of pediatrics at Washington University, says that if a young child suffers a concussion, he or she “needs not only physical rest but also almost complete brain rest.”

According to Dr. Jeffrey Kutcher, director of the Michigan Neurosport Concussion Clinic, the cognitive development of children is “a moving target . . . Who can tell whether a child now earning a B in math after a concussion would otherwise have been receiving a B+?”

At this point, I digress and tell you about my own experience as a young child. One day when I was about 6 or 7, taking a Tae Kwondo class, we were doing sparring. There were many students in the room. The instructor assigned his assistant, a 17 year old high school student, to monitor my sparring match. She paired me up with a much taller 10 year old who proceeded to give me repeated kicks to the head, as I cowered into a corner, with no assistance from anyone in charge. I suffered a concussion that day, and vomited repeatedly for the next 12 hours.

Now, let me share with you a story that I heard many times about Great Grams’s youth. Back in Poland, when Great Grams was born, she had several older sisters. In an effort to have time to cook and clean, her mom took Great Grams and pinned up the apron of her 8 year old sister, put Great Grams inside, and sent the 8 year old out to play. How many falls did that 8 year old have? How much jumping rope happened with an infant in her apron? How much early brain damage was Great Grams subject to?

Obviously, we will never know the answers to these questions. However, I really think we need to pay MUCH more attention to brain injuries occurring to young children. My gut feeling is that they may be playing a much bigger role in senior dementia than anyone realizes.
Max Wallack is a student at Boston University Academy. His great grandmother, Gertrude, suffered from Alzheimer's disease. Max is the founder of PUZZLES TO REMEMBER. PTR is a project that provides puzzles to nursing homes and veterans institutions that care for Alzheimer's and dementia patients.
More About the Alzheimer's Reading Room

Original content Max Wallack, the Alzheimer's Reading Room