Hey, I just heard that there is a Super Bowl coming up! (I know, I haven’t been following sports one whit this year; no judgment please). Football, our national pastime, means different things to different people – from wearing foam hats to betting wagers at the office. Full disclosure, I’ve watched my share of games, pumping my fist into the air and jubilantly yelling “Touchdown!” from the stands. I live in Texas after all…
But as a neuro nurse, I’ve seen the ugly downside of head injuries and their long-term consequences. An impact injury to the brain, with or without a helmet, cannot be compared to an injury in any other part of the body. It’s not like a bruise or a scrape or even a broken bone. And the long-term effect of repeated small blows can eventually lead to the tragic cases we’ve heard about with former-professional players.
Boxer’s Dementia: A History Lesson
Long before the widespread recognition and long-awaited acknowledgement of what we now call “chronic traumatic encephalopathy” (CTE), scientists credited punch drunk syndrome to the violent sport of boxing. Back then it was casually known as “boxer’s dementia”. Studying boxers’ brains, researchers noticed a loss of neurons in the cortex along with an expansion of the brain’s cavities (ventricles), hallmarks of CTE.
These unfortunate fighters also possessed tangled deposits of a protein called tau in their brains. Tau is present in all of us and is usually folded into soluble molecules which stabilize the structures of neurons involved in transferring proteins from one end to another. But in a traumatized brain, the tau folds abnormally into tangled filaments inside neurons. And this is where cognition begins a slow death march as the mechanisms for brain cell communication become blocked, not unlike Alzheimer’s dementia.
What CTE does and How the Disease Spreads
CTE is a cruel master. Not only does it impair thinking and memory but it can wreak havoc on a person’s emotional health. Symptoms include difficulty thinking, Impulsive behavior, depression, short term memory loss, emotional instability, substance abuse, and suicidal thoughts or behavior.
Like Alzheimer’s, CTE is definitively diagnosed at autopsy. But unlike Alzheimer’s, it’s not a disease of age. Like it or not, CTE’s biggest risk factor is a history of playing contact sports. It’s an accumulative disease – the longer a person plays sports or the younger they are when they start taking head hits at practice , the more the process of CTE is speeded up. As the tau tangles spread, more and more neural damage occurs.
Subconcussions: The Missing Piece
We’ve all heard of concussions, blows to the head that result sometimes in unconsciousness and followed by headache, confusion, pain or other symptoms. But it’s easy to miss a “subconcussion”, a hit to the head which shakes the brain but quite so forcefully as a concussion. Examples include most tackles and collisions in football, headers in soccer and body checks in lacrosse. There is still impact but it might not be immediately noticeable.
To make matters worse, according to the Concussion Legacy Foundation, evidence now suggests that subconcussive impacts, not concussions, are the driving force behind CTE. The Foundation advises delaying the age of playing contact sports, modifying and eliminating contact in drills and practices when most head injuries occur.
From my perch, the brain is the most valuable real estate a person will ever possess. While you’re masking up to face the world these days, don’t forget to do what you need to do to protect the brain. Wear a helmet, buckle the seat belt, keep your smarts by not doing stupid things.
Mind your head,
Meredith