When the immediate effects clear, how much damage remains?
Research into traumatic brain injury (TBI) and more specifically, concussion, has greatly increased over the past 15-20 years. Much of this attention has focused on the world of competitive sports, as doctors, certified athletic trainers, and others have become more cognizant of the effects of these injuries beyond the playing field.
That said, experts admit there is still so much unknown about concussion and the details surrounding susceptibility, recovery and the lasting effects of the injury. Great amounts of time, money, and research go into furthering the knowledge so future generations may reap the benefits of our increased knowledge. For now, we know that concussions can have impacts that last anywhere from a few hours to indefinitely. With that in mind, here is a look at a few of the longer-lasting implications of concussion.
Post-Concussion Syndrome: The loose definition of “post-concussion syndrome” is the continuation of initial concussion symptoms—typically, headaches and dizziness for an extended period of time after the injury. For some people, this means several weeks; for others, symptoms can persist for a year or even longer. Headaches, by far the most common symptom of post-concussion syndrome, typically appear within the first seven days of the injury.
Often, the first instinct is to describe this as “a particularly serious concussion” but that description is inaccurate. In fact, the likelihood of developing post-concussion syndrome seems to be totally unrelated to the seriousness of the initial injury.
Some experts believe the condition is a result of a disturbance in the brain caused by the impact that caused the injury, while others think post-concussion symptoms denote a psychological component. They reason that the most common symptoms, such as headache, dizziness, and sleep disturbances—are similar to the effects of depression, post-traumatic stress disorder and other psychological diagnoses.
As with all other aspects of concussion, further research is needed for more conclusive observations, but current knowledge does indicate some degree of connection between the development of post-concussion syndrome and certain psychological factors. In other words, a history of depression, anxiety, poor social support system, and other factors are more common with those people who develop post-concussion syndrome and those who don’t. This is by no means conclusive, nor does a lack of these factors preclude a person from developing the condition.
Memory Loss: In the years before concussion research began to develop toward its current levels, the most common reference was to ask a person suspected of having a head injury “what day is today?” or “how many fingers am I holding up?” While the simplistic nature of these questions underscores many of the problems with past treatment of concussion, the truth is we still aren’t sure of the long-term effect of TBI and concussion on memory.
The simplest answer, as with most effects relating to concussion, is that memory loss is possible, though not necessarily likely, in the long term. While it is unlikely that a singular episode would cause amnesia over a period of years, the risk of certain side effects does increase with repeated trauma.
A considerable amount of the research—and probably the majority of published research—concerning long-term effects of trauma related to memory loss focuses on athletes in contact sports, specifically boxers and football players. While there is some emerging evidence that some retired athletes who competed at the highest levels of these sports show cognitive impairment disproportionate to their age, the repeated trauma factor plays a considerable role as well.
CTE: Chronic Traumatic Encephalopathy (CTE) is a degenerative brain disease typically found in people with a history of repeated brain trauma. Until very recently, this was inferred to mean ‘a history of concussions’; however, very recent research indicates that repeated hits to the head are the leading cause of CTE—whether they cause a concussion or not.
In the past, this condition was known as dementia pugilistica, or colloquially as ‘punch-drunk syndrome’ and was thought to be primarily present in boxers, due to taking repeated punches to the head throughout their careers. However, recent years have seen an uptick in research of the condition, yielding a more scientific description of the condition.
CTE symptoms, generally speaking, begin to develop years after an individual sustains repetitive, mild TBI (again, whether diagnosed as concussions or otherwise.) A buildup of tau protein in the brain forms and begins to spread, compromising brain cells in specific regions of the brain. While early symptoms have been observed to present as young as age 17, the most noticeable signs of CTE begin to emerge in a person’s 40s or 50s, generally speaking.
The most commonly observed symptoms include impulse control issues, increased aggression, paranoia, and depression. Even without further head trauma, symptoms can progress with age in some patients, while others may stabilize after a period of worsening.
Memory loss, confusion, and poor judgment can eventually emerge, ending with progressive dementia in some patients.
SOURCES: Concussion Legacy Foundation
