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Episode 58: Brain Injury Is A Disease

I’m working on a presentation I will be making this September on the economic consequences of brain injury and came across a very compelling position paper “Conceptualizing Brain Injury as a Chronic Condition” issued by The Brain Injury Association of America, published in March 2009 and some other articles on the long- term consequences of brain injury.

Brain Injury can last a lifetime.

The purpose of the BIAA paper is to encourage the classification of Traumatic Brain Injury, (TBI), not as an event or as a final outcome, but rather as the beginning of a disease process. 

The paper provides the scientific data to demonstrate that brain injury is not a static event, but the start of a disease process that can affect multiple organs or systems. 

The resulting brain damage that takes place following a traumatic brain injury is more than a singular event.

Medical professionals have begun to recognize traumatic brain injury of any severity is a chronic condition associated with increased risks of cardiovascular, endocrine, neurological, and psychological disorders that may last a lifetime.

Using hospital based data to examine over 4,000 individuals classified as having a mild traumatic brain injury, researchers in Boston found increased an increased risk of hypertension, diabetes, endocrine disorders, and stroke in study published in the Journal of the American Medical Association this April.

Persons with a brain injury who survive the initial event, must deal with the multiple aspects of their condition which should be viewed as a “disease”

What does the evidence show?

There is a reduced life expectance for those who have sustained a traumatic brain injury, because of long-term neurological conditions and other disorders that may develop.

Long term consequences following a traumatic brain injury include:

Seizure Disorders and Epilepsy:

Traumatic brain injury is a major cause of epilepsy.  Numerous studies have shown that individuals who sustain the full spectrum of brain injury, from what is initially considered a “mild” brain injury through severe brain injury are more likely than the general population to develop seizures and epilepsy.  Theses seizure may take days, weeks, or even years to develop.

Parkinson’s Disease:

Movement disorders are linked to traumatic brain injury with TBI considered a major risk factor for developing Parkinson’s Disease. 

Vision Disorders:

Vision disorders are common after a brain injury.  Vision difficulties include visual field deficits, vision loss, blurred or double vision, and difficulty with eye movements, focus, and tracking.

Studies show that over 40% of Traumatic Brain Injury patients suffer visual dysfunction, yet vision problems are overlooked during the initial treatment of a brain injury.

Sleep Disorders:

As many as 70 % of brain injury patients report sleep complaints that may last for years.  This includes difficulties falling asleep, staying asleep, or sleeping too long.  These sleep disorders impact an individual’s day to day functioning.

Alzheimer’s Disease:

Studies have shown that brain injury is a risk factor for developing Alzheimer’s Disease. 

Chronic Traumatic Encephalopathy:

Chronic Traumatic Encephalopathy, commonly called CTE is a distinct pathological finding in the brain caused by repetitive head trauma.  Once called “dementia pugilistica” or “punch drunk” because of its association with boxing and boxer’s, it has now been found in the brains of athletes exposed to repetitive head trauma in a variety of sports including football, soccer, and hockey.  This condition begins with a deterioration of memory, concentration, and attention and progresses to include gait disturbances, speech impairment and mental health issues including behavior disturbances and suicide.

Neuroendocrine Disorders:

TBI is associated with many neuroendocrine disorders include decreased pituitary functioning known as hypopituitarism resulting in increased fatigue, impaired exercise tolerance and depression.  Other neuroendocrine disorders include grown hormone deficiency and impaired functioning of the thyroid gland leading to weight gain and cardiac disorders.

Urinary Issues:

Brain damage has been associated with impaired ability to control bladder functioning resulting in urinary incontinence, the inability to control the flow of urine.

Psychiatric Disturbances:

Mental health issues including psychiatric disturbances such as depression, anxiety, mood disorders, bipolar disorder, suicidal ideations, are strongly associated with a traumatic brain injury. 

Homelessness, domestic violence, substance abuse including drugs and alcohol also frequently follow a brain injury.

Let me read from the summary set forth by the Brain Injury Association of America:

“Historically, individuals living with a brain injury have been referred to as brain injury survivors.  No one knows how that term came to be used in this situation.  Perhaps the concept of merely staying alive was used because as little as 30 years age, the majority of individuals with a moderate to severe TBI succumbed soon after heir injury.  Perhaps it was used to imply that the individual outlived their injury and persevered despite the hardship of the trauma.” 

“This term, however, does not address the reality of brain injury.”

What does all the mean?

Developing these chronic conditions can complicate the course of recovery, add to the health costs associated with TBI, and impact the quality of life for traumatic brain injury survivors and their families. 

It is imperative that more attention be given to the chronic effects of traumatic brain injury so better screening, diagnosis, and treatment can be provided to brain injury survivors. 

For many individuals brain trauma is a condition that will last a lifetime causing lifelong brain injury disease.  

It’s time public health officials and insurance carriers recognize the long-term consequences of brain trauma and classify traumatic brain injury as a disease entity.

Audio version

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