Why are we more susceptible to developing dementia after brain injury?

BY: SOPHIA VOUMVAKIS

A post on this blog by Alison discussed research which suggests that those of us who have sustained a Traumatic Brain Injury (TBI) have a higher risk of developing dementia, including Alzheimer’s, one of the causes of dementia.

Alison also provided some great advice on maintaining a healthy lifestyle and how participating in key activities can help reduce the risk of dementia from Alzheimer’s.

I’ve also read that those who have sustained a TBI are at higher risk of developing dementia. To clarify, dementia is a set of symptoms that consistently occur together. It is not a specific disease. Dementia is caused by damage to the brain cells, Alzheimer’s disease is the most common cause of dementia. Other causes are Parkinson’s disease, Multiple Sclerosis, Huntington’s Disease and stroke.

1

I recently came across some interesting new research which sheds light on the possible cause of increased risk of Alzheimer’s in people who have sustained a TBI, and a couple of more suggestions we can employ to reduce the risk of dementia caused by Alzheimer’s.

The Glymphatic Network – A New Discovery

The research is out of the University of Helsinki in Finland, and its findings were published in the Washington Post on May 21, 2017. Like many breakthrough discoveries in science, this finding was accidental.

Kari Alitalo, a scientist at the University of Helsinki had studied the lymphatic network for two decades. The lymphatic network carries immune cells throughout our body and removes waste and toxins. For over three hundred years it was believed that the lymphatic network stopped at the brain. It was accepted wisdom.

Three years ago, Alitalo wanted to develop a more precise map of the lymphatic network. To do this, he used genetically modified mice, whose lymphatic vessels glowed when illuminated by a specific wavelength of light.

When viewing the modified mice under the light, a medical student in Alitalo’s lab noticed that the heads of the mice also glowed. This went against the common wisdom that the lymphatic network did not extend to the brain. At first the scientists suspected that there was something wrong with their equipment, and when they repeated the experiment, they got the same result – the lymphatic network does indeed include the brain.

3

Working independently, several scientists, including Maiken Nedergaard at the University of Rochester and Jonathan Kipnis of the University of Virginia School of Medicine, have also shown that the lymphatic vessels extend into the brain.

This discovery has major implications for a variety of brain diseases, such as Alzheimer’s, Multiple Sclerosis, and stroke which cause dementia. It also provides an explanation of why those of us who have sustained a TBI may be more susceptible to developing Alzheimer’s.

Researchers have identified two networks: the vessels that lead into and surround the brain, and those in the brain itself. The first network is the lymphatic system for the brain, and the second is called the glymphatic system – the addition of the “g” is for the glia neuron, that makes up the lymphatic vessels in the brain.

The glymphatic vessels carry cerebrospinal fluid and immune cells into the brain and remove cellular trash from it. The analogy that Nedergaard employs to describe this system is a dishwasher for the brain. When the lymphatic and glymphatic systems do not function properly, the brain can become clogged with toxins and suffused with inflammatory immune cells. Over decades, this process may play a key role in Alzheimer’s disease, Huntington’s disease, Parkinson’s disease and other neurodegenerative diseases.

Nedergaard told the Washington Post, “This is a revolutionary finding. This system plays a huge role in the health of the brain.”

2

Malfunctioning of the Lymphatic and Glymphatic Systems and the link to Alzheimer’s Nedergaard and Helene Benveniste, a scientist at Yale University, have found evidence that links the malfunctioning of the lymphatic and glymphatic systems to the development of Alzheimer’s. In a study of mice, they found that glymphatic dysfunction contributes to the buildup of amyloid beta, a protein that plays a key role in the disease.

In 2016, Jeff Iliff, a neuroscientist at Oregon Health & Science University, along with several colleagues examined post mortem tissue from 79 human brains. They zeroed in on aquaporin – a key protein in glymphatic vessels. In the brains of those with Altzhiemer’s, this protein was jumbled – in those without the disease, the protein was well organized. This suggests that glymphatic breakdown plays a key role in the disease.

The link to TBI

How does all this relate to TBI and an increased risk of Alzheimer’s? The scientists have shown that in mice, a TBI can produce lasting damage to the glymphatic vessels, which are quite fragile. Mice are a good model, Nedergaard explains, because their glymphatic systems are very similar to humans. She has found that months after a TBI, the brains of these animals were not clearing waste efficiently, leading to a buildup of toxic compounds, including amyloid beta. Returning to the dishwasher analogy, Nedergaard likens it to using only a third of the water required, you’re not going to get clean dishes!

Strategies to improve the functioning of our Glymphatic System Sleep

Important to the healthy functioning of the glymphatic system is sleep. Nedergaard has demonstrated, at least in mice, that the system processes twice as much fluid during sleep than it does during wakefulness. She suggests, that over time, sleep dysfunction may contribute to Alzheimer’s and other brain diseases. We clean our brain when we are sleeping – this is probably an important reason we sleep.

Man sleeping on his side

Nedergaard and Benveniste have also found that sleep position is crucial. In an upright position – sitting in a chair – waste is removed less efficiently. Sleeping on your stomach is not very effective; sleeping on your back is somewhat better, while sleeping on your side proves to be the most effective, although why this is the case isn’t known.

Other ways to improve glymphatic flow

Other ways to improve glymphatic flow are also being studied. In January, Chinese researchers reported that in mice, omega-3 fatty acids improved glymphatic functioning. I relate this to other advice about staving off the risk of dementia I’ve come across – following a “Mediterranean” diet, which is high in omega-3 fatty acids.

Benveniste is also examining the anesthetic dexmedetomidine’s ability to improve glymphatic flow, while in a separate, small human study, researchers have found that deep breathing significantly increases the glymphatic transport of cerebrospinal fluid into the brain.

Alitalo is experimenting with growth factors – these are compounds that can foster regrow the of vessels around the brain. He is currently using this to repair lymphatic vessels in pigs, and is now testing this approach in the brain’s of mice who have a version of Alzheimer’s.

Currently, there are no clinical therapies in treating Alzheimer’s and other brain diseases, however this particular mechanism of brain disease has only just been discovered and as Alitalo says “give it a little time.”

In the meantime follow Alison’s advice on strategies to prevent, slow down, and possibly even reverse cognitive decline and remember to include good sleep hygiene and a diet rich in omega 3 fats, and take some deep breaths.

Source: Washington Post


Since her TBI in 2011, Sophia has educated herself about TBI. She is interested in making research into TBI accessible to other survivors.

Advertisements

Why seniors are at risk of acquiring brain injury

BY: RICHARD HASKELL

It’s often been said that in life there are two things that are inevitable – death and taxes. Well, to that short list, I’d like to add “aging.” We can’t avoid getting older, and with any luck, old age will be a period in our lives (if it isn’t already) when we enjoy reasonably good health, discover new pleasures and continue to find contentment in the company of family and friends.

Nevertheless, aging can also bring new challenges. Energy levels drop, flexibility, strength and endurance aren’t what they use to be and some may experience issues with hearing and eyesight. As a result, seniors may find themselves more susceptible to head injuries.

7267002470_c277924efa_b
photo credit: 10040059 via photopin (license)

Feminist author Alix Kates Shulman describes in  her novelTo Love What Is: A Marriage Transformed how her husband acquired his traumatic brain injury at the age of 75:

On a moonless summer night my husband fell nine feet from a sleeping loft to the floor and did not die. … He did not die, though X-rays taken several hours later showed that he had broken most of his ribs and both feet; punctured both lungs, causing perilous internal bleeding; and suffered so many blood clots in his brain that each CAT scan of that precious organ resembled an elaborate filigree.

In the U.S., the Centers for Disease Control and Prevention (CDC) reports that more than 1.7 million people suffer brain injuries every year (statistics are not available for Canada, but correlating the differences between the U.S. population and Canada, and including rates of concussion, it is estimated that 587,025 acquire a brain injury each year here.)

People over the age of 75 tend to have the highest rates of ABI-related hospitalization. They are also slower to recover and their ensuing injuries are ultimately more serious and life-threatening. Falls are the leading cause of TBI, and rates are highest for children aged zero to four years and for adults aged 75 years and older.

Close to half-a-million Ontarians currently live with an ABI, with 18,000 new cases added every year, at an estimated cost of $1 billion annually. The Canadian demographic itself is aging, and as a result, medical practitioners are not only witnessing a greying of the population, but also a greying of the ABI-survivor population

photo credit: as if time stops.. and stay via photopin (license)
photo credit: as if time stops.. and stay via photopin (license)

Seniors with newly acquired brain injuries – how does it affect them?

Evidence is not entirely conclusive, but medical practitioners have come to feel that ABIs may accelerate the aging process. Those living with an ABI may suffer from increased losses in strength, greater fatigue, difficulties with problem solving and memory, and may also experience an increased loss of hearing and vision. In addition, any psychological and behavioural problems which follow an ABI will undoubtedly persist into older age and will increase as an individual ages.

But what about people who suffer an ABI as an older adult? Does the trauma affect them any differently than it would a younger person?

A 2008 study by the CDC found that in 2005, acquired brain injuries resulted in nearly 8,000 deaths and 56,000 hospitalizations for those aged 65 and older. That was ten years ago, and the numbers have risen since.

Dr. Ileana Arias, the Director of the National Center for Injury Prevention and Control (NCIPC) in Atlanta, Ga., agrees the incidents of seniors acquiring brain injury is rising.

“As more baby boomers reach retirement age, these types of injuries will increase demands on the health care system unless action is taken to prevent the injuries,” Dr. Arias said.

Most of the injuries are caused by falls, with traffic accidents a distant second.

Elderly people with an ABI may also have a higher risk of serious complications such as a blood clot on the brain and because they lack the physical strength and stamina of a younger person, the process of rehabilitation may take considerably longer.

photo credit: No Photos, Please via photopin (license)
photo credit: No Photos, Please via photopin (license)

Symptoms of an ABI in an elderly person may include the following:

  • Headaches that get progressively worse
  • Increased confusion
  • Listlessness, tiring easily
  • Crankiness
  • Sad or depressed mood
  • Change in eating habits
  • Change in sleeping patterns
  • Lack of interest in routine activities
  • New vision problems
  • Loss of balance or unsteady walking
  • Failure to identify brain injuries is a common problem: a mild traumatic brain injury diagnosis is often missed when other serious injuries are present.

Another problem is that many seniors tend to ignore the warning signals, relegating them to another sign of getting older. In older adults, brain injury symptoms may take days or weeks to appear. Over that time, the signs indicating a decline in mental facility may appear only gradually. But symptoms which interfere with the basic tasks of day-to–day living such as bathing, dressing, routine chores or taking care of financial matters should be taken seriously and should be dealt with by a specialist.

Older adult ABI survivors are also at risk a greater degree of social isolation. If they happen to be living on their own they may be dependent upon others for help but what happens when the caregivers become sick themselves and are unable to provide the help needed?

Living with ABI as an older adult

An ABI is life altering and even more so for older adults. Physical recovery is only half the battle, and the survivor must be ready to deal with the possibility of cognitive or behavioural changes down the road. But there are an enormous number of resources available in Ontario, all of them geared to helping those affected regain a degree of independence.

Elderly people with an ABI should be treated in a manner that allows them as much independence as possible and there are a number of ways to make life easier. For example, the contents of drawers or supplies in a medicine cabinet might be labelled to help with memory issues. Simple steps for tasks or a written schedule could be created thereby providing the ABI survivor some degree of flexibility while helping them to remain as active as possible. The schedule might include activities such as therapy, visits to medical practitioners or socializing with family and friends. As with many ABI survivors, there will likely be days when a senior with an ABI may not feel like doing anything, so it is important that they be kept engaged as much as possible.

How seniors can reduce the risk of falls and improve safety in the home

There are certain steps seniors can take to reduce the risk of falls, which in turn may lead to brain trauma. Here are some tips via Brainline:

  • Encourage Exercise. Exercise is one of the best ways to reduce older adults’ chances of falling. Exercises that improve balance and coordination are especially important, but check with the older adult’s doctor about which exercises are safest and best for them
  • Remove items from stairs and floors that might cause tripping
  • Remove small throw rugs or use double-sided tape to keep the rugs from slipping
  • Place items used often within easy reach, so that a step stool is not needed
  • Install grab bars next to the toilet and in the tub or shower
  • Place non-stick mats in the bathtub and on shower floors
  • Add brighter lighting and reduce glare by using lampshades and frosted bulb
  • Be sure there are handrails and lights on all staircases
  • Be sure the older adult wears shoes that give good support and have thin, non-slip soles.
  • Remind loved ones to avoid wearing slippers and socks or going shoeless

 

Sources: BrainlineCenters for Disease Control

BIST family retreat – FREE

Family in Park

Seven Habits of Highly Effective Families:

Strategies for Navigating the Journey After ABI

Facilitated by Caron Gan,  Registered Marriage and Family Therapist

Life after an acquired brain injury (ABI) can bring about many challenges, including learning about the ABI, learning different coping strategies, dealing with changes in the family, juggling multiple responsibilities, and dealing with the emotional adjustments.

This workshop will highlight the major challenges facing individuals and families after an ABI. Survivors and families will have an opportunity to network with others and to share helpful strategies for coping and rebuilding their lives. Building on the research on family resilience and decades of clinical experience with families, the presentation will highlight “Seven Habits of Highly Effective Families.” 

Thank you to our Sponsors:

Singer KwinterGlucksteinLerners

 

 

 

Retreat Details

Date: Saturday May 31st, 2014

Time: 9:00—12:30pm

Location: Holland Bloorview Kids Rehabilitation Hospital

150 Kilgour Road, Toronto, ON M4G 1R8 (Map)

Registration Deadline: Friday May 23rd, 2014

Registration is required.  Please contact: 416-830-1485 or connections@bist.ca

Aging and ABIs: A Challenging Journey

aging_0_0

This is an abbreviated article posted on the Brain Injury Society of Toronto’s website. To read the full article, click here.

“In youth, we run into difficulties. In old age, difficulties run into us.”

The above quotation, by the renowned American soprano Beverly Sills, contains more than a grain of truth. In 1900, the North American life expectancy was 48. By 1930, it had risen to 61, and by 1950, to 71. Today, it sits at 78. Improvements in medicine and healthier lifestyles have greatly extended the average lifespan. Yet at the same time, those lucky enough to live into their 70s or 80s  – the so-called “golden years” –  may suddenly find themselves facing a whole new set of physical and intellectual challenges. Bones become more brittle, mobility decreases, joints and muscles begin to ache, and the memory is certainly not as sharp as it once was. These are all challenges that have to be faced – and very few go through life without facing some of them.

But what about those who suffer an acquired brain injury (ABI) earlier in life? As they advance in years, the normal effects of aging interact with the disabling conditions caused by their brain trauma. At this point, medical practitioners are not only witnessing a greying of the population, but also a greying of the ABI-survivor population.

Many ABI survivors live adequately on their own, or in congregate living conditions. Yet what happens to those who suffer brain injuries in their 20s or 30s, and who were forced to return home to live with their parents or other family members? Over time, those looking after them may begin to develop health issues of their own, and are less readily able to deal with the requirements of an ABI survivor.

Steps for Improving the Lives of Aging ABI Survivors

Dr Paul Aravich and Ms. Anne McDonnell, both from  the department for aging and rehabilitative services of the Eastern Virginia Medical School, recommend the following steps that an ABI survivor might consider to ensure optimal health at this time in their lives:

  • Engaging in moderate physical exercise
  • Engaging in brain stimulation, and promoting mental health
  • Avoiding tobacco, alcohol and other drugs of abuse
  • Avoiding social isolation
  • Reaching out to other individuals with ABIs for moral support
  • Protecting the brain from further trauma

By Richard Haskell, BIST Communications Committee member.

To read this article in its entirety, click here.