Dementia Aware  

Dementia and concussion

What you need to know about concussion and the risk of developing dementia

Football players, soccer players, ice hockey players and soldiers have one thing in common.

They are all at increased risk of experiencing repeated concussions, also called traumatic brain injury, and consequently, have an increased risk of developing dementia, early onset Alzheimer’s disease or chronic traumatic encephalopathy (CTE).

For decades, it was generally accepted that most boxers develop punch-drunk syndrome or boxer’s syndrome (dementia pugilistica) because of the number of blows to the head (concussions) they sustained in the ring.

However, little thought was given to the long-term effect of concussions on other athletes until 2005 when a neuropathologist, Dr. Bennet Omalu revealed that NFL players were at increased risk of developing CTE.

Despite attempts to downplay the significance of Omalu’s research, in 2007, two significant events occurred:

  • A post-mortem test was performed on the brain of Justin Strzelczyk, a 36-year-old NFL player who had died three years previously in a high-speed police chase. Analysis of his brain tissue revealed significant brain damage likened to severe dementia.
  • Canadian wrestler Chris Benoit, 40, committed suicide after killing his wife and son. For years, he had experienced depression and anger problems. An autopsy found that his brain was so severely damaged that it was comparable to the brain of an 85-year-old man with severe Alzheimer’s disease.

Both men had sustained multiple blows and hits to the head (concussions) throughout their professional careers; both men had chronic traumatic encephalopathy (CTE).

Unfortunately, CTE is not limited to professional contact sports; it can also affect anyone involved in any sport where a concussion can occur. The youngest person reported to have CTE is 17-year-old Nathan Stiles who died after sustaining a concussion at his high school homecoming football game.  

Throughout high school, he experienced multiple concussions, but as there was no post concussion protocol implemented at the school, he never took a sick day and continued to play, year after year, hit after hit, until that fateful day in October 2010.

His autopsy revealed he had CTE.

What you need to know about concussion:

  • It can affect anyone, at any age, at any any time, anywhere
  • It can knock a person unconscious, cause memory loss, nausea and vomiting, headaches, dizziness and ringing in the ears. It can also impair one’s ability to think and speak clearly
  • It occurs when a person experiences a blow to the head, or the head shifts too suddenly, causing the brain to move through the cerebral fluid (CSF) and hit the inside of the skull with force
  • Falls and motor vehicle accidents are the most common cause
  • It is rarely detected on x-rays or MRI
  • It often results in post-concussion syndrome: anxiety, headaches, dizziness, memory lapses, difficulty sleeping and concentrating and can last up to six months
  •  If a second concussion occurs within minutes/days/weeks after initial concussion, second impact syndrome occurs where the brain and its arteries swell dangerously resulting in death

Concussion is graded level 1, mild; 2, moderate; and 3 severe:

Grade 1, mild: 

Temporary disorientation, blurred vision, possible nausea and vomiting without unconsciousness. Symptoms disappear within 15-30 minutes. Medical attention is not usually required, unless symptoms worsen. If you have sustained multiple grade 1 concussions, medical assessment is recommended.

Grade 2 moderate:

As above, except symptoms can last from 30 minutes to 24 hours. Twenty-four hour observation in hospital/home is recommended.

Grade 3 severe:

The classic concussion. It is the most serious with loss of consciousness lasting mere seconds to five minutes. Immediate medical attention is required

How to reduce your risk of concussion:

  • Wear a seatbelt
  • Wear a helmet when skiing, cycling, skateboarding
  • Ensure environment is well lit and free of tripping/slipping hazards
  • Wear correct footwear
  • If playing a contact sport, wear protective headgear/equipment and follow designated concussion protocol

Besides all the obvious dangers of concussions, increasing evidence shows that repeated concussions can lead to early onset dementia. With three or more concussions, the risk of early onset Alzheimer’s disease or CTE increases five-fold.

Chronic traumatic encephalopathy (CTE) is a progressive degenerative disease of the brain usually caused by a history of repetitive brain trauma, e.g. concussions. Trauma to the brain can cause a build up of an abnormal protein called tau which slowly kills healthy brain cells, the neurons (see 5 common dementias).

The most common signs of CTE are mood and behavioural changes, memory loss, slurred speech, parkinsonism and gait impairment, and impairment of executive dysfunction (planning, thinking, behaviour control) (concussionfoundation.org).

Effects of concussion on the person with dementia:

People with dementia are at increased risk of falling and/or hitting their head, which frequently result in concussion and an increased risk of developing a brain bleed (subdural hematoma). Of note, people with dementia who are taking anticoagulants (Warfarin) are at increased risk of a brain bleed after sustaining any blow to the head.  

A subdural hematoma occurs when blood vessels burst in the space between the brain and the dura mater, the outer layer that covers the brain. The bleeding forms a hematoma, which put pressure on the brain tissue and the person with dementia may experience:

  • Headache
  • Vomiting
  • Drowsiness and dizziness
  • Increased confusion
  • Increased blood pressure
  • Weakness on one side of body
  • Unequal pupils
  • Slurred speech
  • Seizure
  • Unconsciousness

There is no evidence that a single concussion increases risk of dementia and similarly, not everyone with a history of repeated concussions will develop early onset Alzheimer’s or CTE. However, the more injuries to the head one experiences, the more susceptible that person is to develop some form of dementia.

Therefore, promoting and ensuring safe brain health should be high on everyone’s list: young and old.

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About the Author

Tracey Maxfield, RN, BSN, GNC(c), DDS, is a dementia educator, consultant and advocate with over 35 years working with dementia populations in the U.K. and Canada.

She has worked in a variety of heath-care settings: acute care, palliative care, community care, residential care, physicians offices and community health centres.

Tracey has appeared on the U.S. radio shows Caregivers With Hope and Alzheimer’s Speaks, and has a dementia column in an on-line medical and holistic magazine, The Scrutinizer. 

She is a the Purple Angel Dementia Ambassador for the Central Okanagan, and sits on the board of directors for Seniors Outreach Society, and is a committee member of the Better At Home program.

She can be reached at [email protected].

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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