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Report: Mild TBI linked to multiple ailments

A review of about 2,000 studies reveals that service members with mild traumatic brain injuries — or concussions — are more susceptible to depression, aggression, memory problems, dizziness and irritability.

And according to the review by the Institute of Medicine of the National Academies, those who suffered a moderate or severe brain injury are more likely to have dementia, Parkinson’s disease, endocrine dysfunction, growth hormone insufficiency, long-term social function problems such as unemployment or diminished relationships, and premature death.

The researchers also found evidence suggesting connections between people with moderate or severe head injuries and diabetes, psychosis and neurocognitive issues; and between mild head injuries and seizures, visual deterioration, Alzheimer’s disease, Parkinson’s and post-traumatic stress disorder.

There also may be a link between decreased drug and alcohol use and traumatic brain injury, as well as suicides. The scientists said more research needs to be done in those areas.

“The committee found many instances of long-term outcomes of TBI, although some acute outcomes resolved or lessoned over time, whereas other [conditions] become more apparent several years after injury, such as psychiatric outcomes,” the report states.

At least one study of New Zealanders with mild traumatic brain injury showed that some symptoms worsened in the year after the head injury. Compared with symptoms at six months after the injury, headaches, fatigue, dizziness, and sleep disturbances all increased at the 12-month mark, though poor concentration, poor memory, and irritability decreased at 12 months.

The Institute of Medicine review committee looked at the research after determining no comprehensive review of blast-induced head injuries had been done, and that 75 percent of the injuries in the wars in Iraq and Afghanistan come from blasts.

Among troops injured in an explosion, 59 percent had brain injuries, with 56 percent of those having moderate to severe injuries and 44 percent having mild traumatic brain injuries.

According to the Defense Department, 5,500 troops have had traumatic brain injuries as of January 2008, but according to a recent report from Rand Corp., the numbers may be in the hundreds of thousands because many service members with mild TBI went undiagnosed because the effects may not be immediately evident.

There has been a question as to whether someone can suffer a head injury just from blast waves, as opposed to the head being slammed with an object. The institute would like to lay that question to rest: The skull is not enough to protect the brain from blast waves.

“Despite recent clinical findings, experimental findings, and experience in contemporary military operations that substantial short-term and long-term neurologic deficits can be caused by blast exposure without a direct blow to the head, the old belief prevails in the professional literature and in civilian clinical practice,” the report states. “Although [explosion] is one cause of in-theater injuries, it is often under-diagnosed.”

Based on the almost 400-page report, the Institute came up with several recommendations:

• The Defense Department should use the Brief Traumatic Brain Injury Scan and the Military Acute Concussion Evaluation on any service member who has been involved in a blast, even a low-intensity one.

• The Defense and Veterans Affairs departments should conduct more research into long-term effects of TBI, as well as factors that improve or worsen the symptoms

• Animal studies should be done to determine differences among the three levels of injuries — mild, moderate and severe.

• VA should include in a Traumatic Brain Injury Veterans Health Registry injured people without TBIs to serve as a control group.

• All troops should undergo pre-deployment neurocognitive testing.