Concussions are very common and can cause long-term problems

Concussions are very common and can cause long-term problems

Lydia Denworth

Fifteen years ago, I slipped on a wet patio deck, fell backwards, and hit the back of my skull against a post. I saw stars and felt nauseous for a moment. But I pulled myself together, made sure I wasn’t bleeding, and went about my daily life. I had pain in the back of my head for several days, but I had no residual symptoms and did not seek medical attention.

Still, these symptoms I experienced could be signs of a concussion, a common term for mild traumatic brain injury (TBI). Injuries like this are much more common than you think and can cause long-term problems. After carefully questioning more than 600 average middle-aged people in the UK and Ireland about past accidents in which they may have sustained a blow to the head, researchers found that a third had suffered some form of traumatic brain injury. And nearly 3 million people in the United States are officially diagnosed with a traumatic brain injury each year in an emergency department or hospital. Approximately 75% to 80% of injuries are said to be mild.

But it turns out that “mild” can affect many people years later. For example, in the 2023 multicenter TRACK-TBI study, of more than 1,200 people, 33 percent of people with mild TBI and 30 percent of people with moderate or severe TBI reported 1-7 years post-injury. It was revealed that the symptoms were worsening. Complaints may include sleep disturbances, headaches, and memory or psychiatric problems. In the long term, traumatic brain injury can cause dementia and can also lead to some types of cardiovascular disease.

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“What we need to do is pay more attention to what happens in the months and years after the injury.” —David Sharp imperial college london

Physicians have often misunderstood and misdiagnosed these problems due to outdated views and ideas about concussions. For 50 years, doctors have classified traumatic brain injuries as mild, moderate, or severe based on patient reports and observed symptoms such as loss of consciousness or changes in motor skills or language. However, this system is not very accurate in predicting short-term or long-term outcomes.

Experts have been calling for change for years. The first recommendation in the 2022 National Academies report is to reclassify these three grades based on stronger evidence. “We know these terms aren’t accurate. They’re not accurate. In fact, they can be a real problem for patients,” says the National Institute of Neurological Disorders and Stroke (NINDS) Trauma. says Nsini Umo, director of the Sexual Brain Injury Program.

Currently, the field is taking some steps to address this issue. Following a January 2024 conference hosted by NINDS, experts are proposing a new diagnostic and classification system that provides neurobiological details rather than vague terms such as “mild.” This model, called the CBI-M model, includes clinical symptoms (C), blood-based biomarkers (B), imaging (I), and modifiers (M). The last item includes social determinants of health, such as access to care.

If physicians use this model, concussions and their treatment require a different approach. For example, breast cancer patients are not told whether their cancer is mild or severe, but they are told things such as the exact size of their tumor and whether it is estrogen receptor positive. People who may have a traumatic brain injury can get that level of detail. The proposed guidelines would result in a TBI score on a scale based on responsiveness to clinician questioning (as it is today), blood biomarker results, and possibly imaging results. Biomarkers are proteins released in the brain in response to injury. New techniques can measure the concentration of these proteins in the bloodstream. The U.S. Food and Drug Administration has approved two tests for the proteins GFAP and UCHL1 that can predict whether intracranial lesions are present in the brain and whether a CT scan is warranted to confirm them.

People with no visible changes on imaging and low blood biomarkers are said to have a good prognosis for recovery. Those with more concerning indicators may be asked to follow up with a specialist over several months or even years. Physicians adjust these risk assessments based on modifiers. For example, people with a history of mental health problems are at higher risk than those without.

“What we need to do is pay more attention to what happens in the months and years after injury,” said David Sharp, a neurologist at Imperial College London. “The way we do that is by doing blood tests for certain things that we think are relevant.”

Non-protein biomarkers are also becoming clearer. Audrey Lowe, a neuroscientist at the University of Cambridge and the Mayo Clinic, used diagnostic imaging to uncover signs of cerebral small vessel disease, a risk factor for dementia. One such sign, small chronic brain bleeds called microbleeds, has been associated with past traumatic brain injury. The more people who have a traumatic brain injury, the more likely these microbleeds will occur. “Introducing more standardized tools to screen for traumatic brain injuries could be a way to detect these,” Lowe says. Such screening allows doctors to better assess your risk of dementia.

Fortunately, medical professionals are now taking mild traumatic brain injuries much more seriously than in the past, when people would say, “It’s OK because the bell rang.” says an Indiana neuropsychiatrist. Thomas W. McAllister says: University School of Medicine. Thanks in part to modern concussion protocols (which require several days of cognitive and physical rest followed by other supervised treatment), if properly diagnosed, most patients recover within weeks or months. You’ll feel better. And the new method should help even more.

This is an opinion and analysis article and the views expressed by the author are not necessarily those of the author. scientific american.