Dr Gershon Spitz in the lab. Credit: Hynesite photography.
Monash University-led research, believed to be the first of its kind, has used blood tests and MRI scans to show that the effects of traumatic brain injuries (TBI) can last decades.
Published in Brain, and involving researchers from the University of Melbourne and Austin Health, the Monash-Epworth Rehabilitation Research Centre (MERRC) TBI Ageing Study integrated a range of techniques to understand the enduring consequences of moderate to severe TBI.
They included imaging to measure the integrity of the brain microstructure, blood biomarkers to determine ongoing brain pathology, and cognitive tests to understand how blood markers might be linked to a person's cognitive health and clinical condition.
It's one of few global studies on participants with moderate-severe TBI due to a single incident and have also been living with their injury for an average of 22 years, as opposed to experiencing repetitive injury.
Senior author Professor Sandy Shultz, from the Monash School of Translational Medicine, said, "Our finding of chronic pathology in the brains of traumatic brain injury survivors, and the ability to identify this with imaging and blood tests, not only provides us with methods to detect these changes but also a foundation to develop treatments that might prevent or slow evolving pathology and improve recovery."
While TBI is a potential risk factor for neurodegenerative disorders, including Alzheimer's Disease and Parkinson's Disease, there is a critical need for comprehensive knowledge about long-term impacts. This involves delineating the biological and clinical characteristics of any lasting neurodegeneration and identifying who is at risk, and then using this information to develop long-term management strategies.
First author Dr Gershon Spitz, from the Monash-Epworth Rehabilitation Research Centre (MERRC), the Monash School of Psychological Sciences, and the School of Translational Medicine Department of Neuroscience, said the findings supported the hypothesis that the effects of a moderate-severe TBI could be felt decades following the initial injury.
"We found that elevated levels of blood biomarkers are related to poorer brain microstructure and poor cognition," Dr Spitz said.
"Traditionally, TBI was viewed as an isolated event with a fixed recovery trajectory. Over the last decade, TBI has been redefined as a chronic, ongoing health condition. This redefinition is a crucial first step in overhauling our healthcare models, which presently allocate the bulk of resources to the immediate post-injury phase and leave long-term symptoms inadequately treated."
Dr Spitz said further work was needed on the connection between blood biomarkers and symptoms/improvement. "We need to see whether the biological signatures of possible ongoing neuropathology can also tell us about people who may be at higher risk of experiencing progressive decline in functions like memory," he said.
Case Study - Bruce Powell
Dr Bruce Powell, 57, suffered a traumatic brain injury in 2018 as a result of a terrible cycling accident. He remembers very little of the first year or so after the accident, and said that perhaps he is lucky in that respect.
"I never thought for a moment about my life and how lucky I was. How often do we only notice the gifts we have, when we lose them? I spent a long time being angry and even longer feeling low and lost," Dr Powell said.
Before his accident, Dr Powell was an anaesthetist, and former director of Western Australia's organ-donation program, DonateLife. He said after his TBI he tried to return to his old life but he couldn't cope with the cognitive demands nor the responsibility.
"I have lost my career and my identity due to the accident and that has been very tough. I miss medicine. I loved caring for people and I devoted my whole career to that aim. It's hard to find a replacement for that privilege. It was who I was and I am not that now. Finding meaning in this new life of mine is the hardest thing of all," he said.
"I suffer with flashbacks and an illogical fear of many things. PTSD I guess people call it. I'm no fan of labels but it is difficult to overcome sometimes. Fractures heal and wounds close up, but the brain injury has left me emotionally unstable, unpredictable and occasionally disinhibited.
"I have to concentrate hard to control my behaviour and that can be exhausting on its own. My working memory is poor and if I am not concentrating, or tired, the day can slip past without me recalling much about it. I have to accept those things and move on."
Dr Powell said that after his TBI he worried about dementia as a result of the injury and being pointless, lost and unseen.
"I want to do important things, good things and I don't want people to notice me for my brain injury," he said. "I'm done with being a patient although I will always struggle with the fatigue and memory challenges.
"Brain injury is much more common than we think and the long-term risks of chronic brain deterioration are confronting and important. Since we may not see the actual clinical impact upon people's lives until the process is advanced, if we can identify it early we may be able to alter the course of the disease. The implications for sport, insurance and lifestyle are immense and they may creep up on us unless we start to figure out how to identify the warning signs."
Read the full paper in Brain: Plasma biomarkers in chronic single moderate - severe traumatic brain injury. DOI: https://doi.org/10.1093/brain/awae255
