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Review shows computerized training can help TBI and stroke victims

  • The first review of computerized training programs to improve attention in those who have suffered a brain injury has reported favorably.

A systematic literature review of computerized training for attention and executive function in adults who suffered a brain injury (TBI or stroke) has concluded that there is encouraging evidence that such programs can help.

The review found 23 of 28 studies reported significant improvements in attention and executive function, with the remaining five showing promising trends. The studies included 11 that focused on TBI, of which 8 reported significant improvement; 5 that focused on stroke, of which all 5 showed significant improvement; 12 mixed-populations, of which 10 showed significant improvement.

Further studies are needed to confirm these results, as various methodological issues, such as a small number of participants, and inadequate controls, need to be addressed. The 28 studies included 9 that were rates as "class I" (the highest standard), 9 class II, and 7 that were class III (no controls). Almost all (26/28) of the studies involved fewer than 50 participants, with some having as few as 1 to 4. Most studies didn't specify how severe the injuries were, something which makes a big difference to treatment and expectations. Over a third of the studies (11) didn't have any control group, and only a few used the best sort of control - a comparable activity (as opposed to, say, no treatment). Only four studies provided any long-term follow-up.

As you can see, a lot of work is needed yet. Moreover, most programs were unique to the study, so we're still some way off producing recommended protocols. Only one program was used on multiple occasions (5): Cogmed QM (originally called RoboMemo).

Still, notwithstanding all these caveats, the review does support the value of specific training for those suffering brain injury.

http://www.eurekalert.org/pub_releases/2016-02/bumc-cra021016.php

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Why rest is critical after a concussion

  • A mouse study shows how repeated concussions affect the brain, and confirms the value of having several days of rest after injury.

In the study, mice were repeatedly given extremely mild concussive impacts while anesthetized. The brain's response to a single concussion was compared with an injury received daily for 30 days and one received weekly over 30 weeks.

Mice with a single insult temporarily lost 10-15% of their neuronal connections (dendritic spines), but there was no inflammation or cell death. With three days rest, all neuronal connections were restored.

However, those given daily concussions did not show a loss in dendritic spines, and it's thought that the brain habituates to the repeated shocks. It's further suggested that the loss of synapses is actually a protective effect, allowing the brain to regain normal calcium flow. The long-term effect of this not happening is unknown.

Those given a week of rest between each insult did show the normal dendritic spine loss, however.

Additionally, when a mild concussion occurred each day for a month, there was inflammation and damage to the white matter, and this damage continued for months after the last impact.

These findings are consistent with what has been seen in humans, where white matter inflammation has been found to be a long-lasting consequence of TBI.

On a more positive note, in this model of very mild concussion, there was no increase in tau tangles, suggesting this might be limited to more serious injuries.

http://www.eurekalert.org/pub_releases/2016-02/gumc-fse012816.php

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Tau tangles why TBI increases risk of Alzheimer's

  • Mouse study shows tau tangles may be behind increased Alzheimer's risk for those who have suffered a traumatic brain injury.

We know that traumatic brain injury increases the risk of later developing neurodegenerative disorders such as Alzheimer's disease, but we haven't known why. New mouse studies suggest a reason.

In the research, mice who had a toxic form of tau protein (taken from mice who had suffered TBI) injected into their hippocampus, showed impaired memory and cognition. Moreover, levels of the aggregated tau protein not only increased in the hippocampus, but also in the cerebellum (which is quite some distance away from the hippocampus). This is consistent with other research showing that tau tangles spread from the initial injection site, using mice modeling Alzheimer's disease.

The study followed on from previous research showing that this form of tau protein increases after a traumatic brain injury and may contribute to development of chronic traumatic encephalopathy (a condition experienced by many professional athletes and military personnel).

The findings support the hypothesis that many of the symptoms of TBI may be down to an increase in these tau tangles, and that this may also be responsible for the increased risk for neurodegenerative disease. As an obvious corollary, it also suggests that the tau tangles are an important therapeutic target.

http://www.eurekalert.org/pub_releases/2016-01/uotm-tbi011216.php

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Reduced blood flow in brain after clinical recovery from concussion

  • Some athletes who experience sports-related concussions have reduced blood flow in parts of their brains even after clinical recovery.

Adding to evidence that the standard assessments are inadequate to determine whether concussed athletes are fit to return to action, an advanced MRI technique that detects blood flow in the brain shows that hat brain abnormalities persist beyond the point of clinical recovery after injury.

The study compared 18 concussed players and 19 non-concussed players. For the concussed players, MRI was taken within 24 hours of the injury and eight days afterward. Baselines were taken before the football season.

While clinical assessments showed that the concussed players were back to normal at the eight day mark, the MRI demonstrated a significant blood flow decrease at eight days compared to the first post-injury MRI.

While the significance of this is still not clear, it may be that the brain is more vulnerable to another injury.

The study was presented at the annual meeting of the Radiological Society of North America (RSNA).

http://www.eurekalert.org/pub_releases/2015-11/rson-rbf112315.php

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Brain connectivity changes with working memory after TBI

  • A brain imaging study reveals how working memory is impaired after traumatic brain injury.

Brain imaging while 11 individuals with traumatic brain injury and 15 healthy controls performed a working memory task has revealed that those with TBI showed greater connectivity between the hemispheres in the fronto-parietal regions (involved in working memory) and less organized flow of information from posterior to anterior parts.

The study used a new task, known as CapMan, which allows working memory capacity and the mental manipulation of information in working memory to be distinguished from each other.

The discovery may help in the development of more effective therapies.

http://www.eurekalert.org/pub_releases/2015-10/kf-njs102015.php

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Childhood concussions impair brain function two years later

  • A small study found children who had experienced a sports-related concussion two years earlier still showed cognitive impairments, with younger children showing greater deficits.

A study involving 30 children (aged 8-10), of whom 15 had experienced a sports-related concussion two years earlier, and all of whom were athletically active, found that those with a history of concussion performed worse on tests of working memory, attention and impulse control, compared to the controls. This impaired performance was also reflected in differences in brain activity. Additionally, those who were injured at a younger age had the largest cognitive deficits.

All of this points to a need for focused and perhaps prolonged interventions, especially for younger children.

http://www.eurekalert.org/pub_releases/2015-12/uoia-scc121815.php

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Concussion not well understood, but widely feared

  • A survey of US adults suggests worry about concussion goes hand in hand with a lack of understanding.

An online national survey of 2,012 adult Americans (of whom 948 were parents) has found that, while the vast majority (87%) don’t know the definition of a concussion and many don’t know the injury is treatable, there is a high level of concern and even fear across the country.

  • 89% believe concussions are a moderate to severe health concern
  • 32% of parents live in fear that their child will get a concussion
  • 25% of parents do not let their kids play some contact sports because of fear of concussion
  • while 57% have personal experience with concussions, 26% did not see a health care professional when someone in their family had one
  • 37% admit that they are confused about what a concussion truly is
  • headaches, and dizziness/motion sensitivity are recognized as symptoms by 58%, and cognitive difficulty by 55%
  • only 34% recognize fatigue as a symptom, and only 13% recognize changes in mood as a symptom
  • 79% incorrectly believe or are unsure that there is no real way to cure a concussion; the symptoms can only be lessened
  • 81% aren’t comfortable that they would know how to manage or treat a concussion if they sustained one
  • only 49% know that a person doesn't need to stay awake for 24 hours after sustaining a concussion
  • only 25% understand that safety equipment—such as helmets or mouth guards—cannot prevent the majority of all concussions

http://www.futurity.org/concussions-fear-survey-1018432-2/

The full report can be downloaded at http://rethinkconcussions.com/wp-content/uploads/2015/09/harris-poll-report.pdf

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Stroke speeds age-related cognitive decline

  • A large study shows stroke is associated not only with an immediate drop in cognitive ability, but also with faster declines in some cognitive functions.
  • The finding points to a need for better long-term care.

Data from 23,572 Americans from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study has revealed that those who survived a stroke went on to have significantly faster rates of cognitive decline as they aged.

Participants, who were aged 45 years or older, had no history of cognitive impairment at the beginning of the population-based study. Over the next five to seven years, 515 of them (2%) had a stroke.

Stroke was associated with an acute decline in global cognition, new learning, and verbal memory. Those who had a stroke showed faster declines in global cognition and executive function (but not new learning nor verbal memory) over the next years.

Global cognition was assessed using the Six-Item Screener [SIS]; new learning by the Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; verbal memory by the Word-List Delayed Recall; executive function by the Animal Fluency Test.

The findings suggest a need for better long-term follow-up care for stroke survivors, including therapy to retain or even regain cognitive ability.

http://www.eurekalert.org/pub_releases/2015-07/uomh-mt070715.php

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Diabetes and tau tangles linked independently of Alzheimer's

  • Type 2 diabetes is known to increase the risk of Alzheimer's disease.
  • In a reasonably large study, diabetes was found to be linked with higher levels of tau protein, regardless of the presence of dementia.
  • Diabetes was also linked with greater brain shrinkage.
  • The finding adds to evidence that diabetes increases the risk of cognitive impairment in old age.

A study involving older adults has found that diabetes was associated with higher levels of tau protein and greater brain atrophy.

The study involved 816 older adults (average age 74), of whom 397 had mild cognitive impairment, 191 had Alzheimer's disease, and 228 people had no cognitive problems. Fifteen percent (124) had diabetes.

Those with diabetes had greater levels of tau protein in the spinal and brain fluid regardless of cognitive status. Tau tangles are characteristic of Alzheimer's.

Those with diabetes also had cortical tissue that was an average of 0.03 millimeter less than those who didn't have diabetes, regardless of their cognitive status. This greater brain atrophy in the frontal and parietal cortices may be partly related to the increase in tau protein.

There was no link between diabetes and amyloid-beta, the other main pathological characteristic of Alzheimer's.

Previous research has indicated that people with type 2 diabetes have double the risk of developing dementia. Previous research has also found that those who had been diabetic for longer had a greater degree of brain atrophy

The findings support the idea that type 2 diabetes may have a negative effect on cognition independent of dementia, and that this effect may be driven by an increase in tau phosphorylation.

http://www.eurekalert.org/pub_releases/2015-09/aaon-dab082715.php

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Mental imagery training improves multiple sclerosis patients' cognition

  • Difficulties in remembering past events and imagining future ones are often experienced by those with multiple sclerosis.
  • A trial involving patients with MS has found that training in mentally visualizing imaginery scenarios can improve their ability to recall past events.
  • Deficits in event memory and imagination have also been found in older adults, so this finding might have wider application.

Training in a mental imagery technique has been found to help multiple sclerosis patients in two memory domains often affected by the disease: autobiographical memory and episodic future thinking.

The study involved 40 patients with relapsing-remitting MS, all of whom were receiving regular drug therapy and all of whom had significant brain atrophy. Participants were randomly assigned to one of three groups, one of which received the imagery training (17 participants), while the other two were controls — a control receiving a sham verbal training (10) and a control receiving no training (13). The six training sessions lasted two hours and occurred once or twice a week.

The training involved:

  • mental visualization exercises of increasing difficulty, using 10 items that the patient had to imagine and describe, looking at both static aspects (such as color and shape) and an action carried out with the item
  • guided construction exercises, using 5 scenarios involving several characters (so, for example, the patient might start with the general idea of a cook preparing a meal, and be guided through more complexities, such as the type of table, the ingredients being used, etc)
  • self-visualization exercises, in which the patient imagined themselves within a scenario.

Autobiographical memory and episodic future thinking were assessed, before and after, using an adapted version of the Autobiographical Interview, which involves subjects recalling events from earlier periods in their life, in response to specific cue words. The events are supposed to be unique, and the subjects are asked to recall as many details as possible.

Only those receiving the training showed a significant improvement in their scores.

Those who had the imagery training also reported an increase in general self-confidence, with higher levels of control and vitality.

Remembering past events and imagining future ones are crucial cognitive abilities, with more far-reaching impacts than may be immediately obvious. For example, episodic future thought is important for forming and carrying out intentions.

These are also areas which may be affected by age. A recent study, for example, found that older adults are less likely to spontaneously acquire items that would later allow a problem to be solved, and are also less likely to subsequently use these items to solve the problems. An earlier study found that older adults have more difficulty in imagining future experiences.

These results, then, that show us that people with deficits in specific memory domains can be helped by specific training, is not only of interest to those with MS, but also more generally.

http://www.eurekalert.org/pub_releases/2015-08/ip-mvi082515.php

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