TRAUMATIC BRAIN INJURY BACK IN THE NEWS!

Over the past decade, a lot has been written about traumatic brain injuries and the consequences that develop many years later. The discovery of Chronic Traumatic Encephalopathy (CTE), a late effect of repeated trauma to the head, has altered the approach to concussion taken by football coaches, teams, trainers, leagues, and athletic organizations.

Over the past four years, I have written four blogs on the subject of head injuries and concussions, most often associated with football injuries. One blog reported that football head injuries were actually on the decline. It is true that CTE is a real entity, and continues to manifest itself in middle-aged former professional football players. Recently, there haven’t been any high profile players who were affected by CTE so there has been less media attention. 

The concussion suffered by Tua Tagaviloa, the quarterback of the Miami Dolphins, however, drew a lot of media criticism for the lack of recognition and attention to the seriousness of his injury shown by the Dolphins medical staff. He was allowed to return sooner than he should have and was thought to be less seriously injured than he was. That situation will likely recur because there is no doubt he will suffer another head injury in the coming years of his career and will likely exhibit cognitive changes many years from now.

The ongoing concern shared by neurologic researchers is the cognitive effect occurring decades later in these athletes. Cognitive effects refer to “attention and executive function…” as well as memory and mental processing speed. Processing refers to the ability and speed with which an individual can answer questions that require reasoning and a conclusion. 

A study of 16,000 older adults who were give cognitive tests concluded that experiencing 3 or more mild traumatic brain injuries is linked to poorer cognitive function decades later. At baseline in the study, many of the participants who had had TBI’s as a youth were already showing a decline in brain function when compared to others without TBI’s. They did not decline further, however. Those participants who had not experienced TBI’s fared better on testing. The degree of cognitive decline correlated directly with the number and severity of TBI’s suffered by the person. The more TBI’s, the worse the performance. As mentioned previously, three TBI’s was the point after which cognition was affected.

The conclusions reached by this study are important for today’s athletes. As few as three mild concussions have been shown to reduce cognitive function late in life, and the more times you injure your brain, the worse your brain function could be as you age. Head injuries must no longer be taken lightly. The Tua Tagaviloa scenario should never occur again. Concussions/Traumatic Brain Injuries are serious problems that demand the player be sidelined for as long as it takes to relieve the symptoms. But just the fact that an injury occurred says he may well have future problems.

The overall benefit here is that players with concussions will be observed and examined more closely before returning to play. The brain takes time to heal so the team’s success may suffer because the player may not play for several games. Player safety, though, is more important  than a won-loss record. Wins and losses are forgotten quickly, but when a player develops CTE, it is a daily reminder of the sacrifice the player made to achieve that record. A player’s long term health is more important than that.  

Reference: NEWS & ANALYSIS: “Even Mild Concussions Tied to Worse Cognition Later in Life” JAMA 2023 Feb 28;329(8):623.