December: Avoid head injury

Research shows that brain health is promoted by taking steps to avoid head injury, for example from falls and sports.

Our thanks to Dr Jackie Broadbent for her help with this month's topic. Jackie is a geriatrician working at Burwood Hospital for Canterbury DHB.

Traumatic brain injury happens when some external force such as a knock to the head causes damage to the brain.
The symptoms of traumatic brain injury depend on the type of injury and how severe it is.
Concerning signs and symptoms after a traumatic brain injury include:
one pupil being larger than the other
sleepiness or being unable to wake up
a headache that gets worse
slurred speech
weakness
numbness
decreased coordination
repeated vomiting or nausea
shaking or twitching such as from a seizure
unusual behaviour
black out (loss of consciousness)
Some people develop longer term symptoms such as:
- headaches
- dizziness
- sensitivity to light and/or noise
- difficulties with vision (such as blurred vision)
- fatigue
- epilepsy
Mild injuries usually do not need treatment, but a person may need monitoring for some hours after an injury to make sure they recover well. Severe injuries need to be treated in hospital, with medication and sometimes surgery.
Repeated so-called “mild” injuries such as mild concussion may result in more serious symptoms. Any concussion is a sign that the brain has been injured.
It is estimated that there are more than 100 cases of traumatic brain injury each day in New Zealand. The most common causes of brain injury are falls, road traffic injuries, assaults and sports.

A possible link between traumatic brain injury and dementia was raised many years ago after it was noted that some former boxers developed brain disease at a younger age than might be expected.
Some studies have shown traumatic brain injury is a risk factor for dementia but other studies have not supported this. Better quality studies are needed.
The Lancet Commission report update highlights two large studies that each included data from more than 3 million people, one in Sweden and one in Denmark, that have found that traumatic brain injury increases the risk of a diagnosis of dementia, especially soon after the injury. Another large study of 178779 veterans found that the more severe brain injuries were associated with a higher risk of dementia.

Increasing attention is being paid to preventing head injury, for example in occupational or sports settings.
This includes measures such as wearing a seatbelt when in a vehicle, and wearing a helmet when cycling or appropriate head gear when playing sport.

Traumatic brain injuries experienced by people with dementia are often caused by falls resulting in a bump on the head. If a person with dementia experiences a brain injury, they may have a drop in brain function, or a temporary period of increased confusion (delirium). This may improve with time but in some people it does not. It is important to seek a medical review to rule out other causes of worsened confusion.
Strategies to reduce falls and head injury may assist in conserving brain function for people with dementia. Reducing the risk of falls is important but this needs to be balanced against the need to maintain exercise and a good quality of life.