An acquaintance of Charlie's suffered a concussion when he was in a car accident a month ago. The accident has produced memory difficulties. During the first week there were periods when he did not recognize his wife and was incapable of recalling his past as well as his present. Thankfully, the situation has improved some and he is scheduled for a neurological exam in the next few weeks.

I'd like to help...but...Am reluctant because I feel that Charlie and I are walking testimony of their 'worst case scenario'. Could someone who has experience with A/D brought about by concussion please give me an idea of how to direct their efforts? I worry that because of his fear of A/D the gentleman who is at least 62 and may opt for early retirement rather than seek disability.

Cherie,

Are you sure Charlie's acquaintance is really suffering from AD? Could it be a closed head brain injury that has led to swelling and possibly some internal bleeding? If this is the case, the usual AD treatments would not be appropriate. I think he really needs to follow his doctor's advice on this one. If you just want to offer him support, I would suggest plenty of rest and no strenuous activity.

Since he is scheduled to see a Neurologist, I would assume he is in good hands. From what I have read, the effects of memory impairment from concussions can last from minutes to a week.

Here is a very good, recent article on this, in regards to WWII soldiers and athletes with multiple concussions.

http://www.salon.com/env/mind_reader/2009/01/13/sports_concussions/index.html

There are also previous posts in our archives about concussions. I do think much depends on his follow-up exam, though.

John---They are following their doctor's orders. To rule out internal bleeding and to assess swelling a CAT scan or MRI has been done...Results are not yet available.

I hope that Charlie's acquaintence does not have A/D. Have not mentioned the possibility. My support has taken the form of offering moral support, sharing food stockpiled in our pantry, and transportation to appointments when the wife feels that it is safe for her to return to work.

Cheri, how do you feel about therapeutic cloning? You see, I'd like to make a bunch of you, and move them in next to me!

An abrupt onset of change in cognition, processing, memory, etc., is caused by the neurological insult to the brain secondary to injury. Sometimes this clears somewhat, sometimes therapy is needed to regain as much prior function as possible, and sometimes the person remains the same without progression of symptoms. This is far different from AD and does not have the same factors which cause AD.

However, that being said; the literature does appear to support that any head injury at any point can indeed increase one's chances of developing AD in later life. This is not an absolute, it just increases chances.

But as for the changes seen right now? Unlikely that it is AD.

We will all wish the very best for him and hope that as time moves on, he will regain much of what he has "lost."

Best wishes to all,
Johanna C.

As a non-professional expert on concussion and cognitive decline/dementia, let me put in my two cents.

There is a statistical connection between MTBI (Mild Traumatic Brain Injury), PCS (Post Concussion Syndrome) and AD. The simplest explanation is that an injured brain is always an injured brain, even when there appears to be a "full" recovery. Such residual injury will add to any AD symptoms and magnify them.
If AD would not be clinically symptomatic until 70 in a non-MTBI subject, it may be clinically symptomatic at 65 or earlier in a MTBI subject. A similar comparison can exist in a subject who has has a general anesthesia vs one who has not had a general anesthesia.

The true question hear is does the acquaintance have symptoms of AD or are they symptoms of a MTBI. My suggestion is it is an MTBI. As a 62 yo, his ability to recover from an MTBI is much less and much slower.

A general neurological exam will most likely not show a vast differential between AD and MTBI symptoms. In fact, most neurologist are very poor at diagnosing MTBI. They do not have any imaging systems to identify MTBI if there is not any brain bleeding or other swelling that is evident on an MRI or CT. As such, they must rely on the self-reported symptoms of the patient.

He may be referred to a neuro-psychologist.

The article on Salon has very misleading and erroneous information about MTBI symptomatology, diagnosis, and outcome. This is common because it relies on standard grade neurological understandings, not that developed by MTBI/PCS specialists. It also has a bias in favor of returning athletes to the game as soon as possible.

As the MTBI community knows, neurologists can only diagnose that which they can image, such as tumors, bleeds, embolisms, and epilepsy.

The subjective complaints of MTBI/PCS leaves them clueless.

The man could benefit from an evaluation by a Physiatrist/Rehabilitation specialist M.D. They are often listed in the Yellow Pages under either Physical Medicine or Rehabilitation Medicine. Even then one needs to be selective and get referred to a specialist with skills with MTBI/PCS.

If the neurologist does not do a thorough MMSE (Mini-Mental Status Exam), his diagnosis should be discounted. I was seen by a Work Comp neurologist for my cognitive complaints and he did not do a MMSE. The neurologist claimed that the impact was not severe enough to cause any cognitive problems. This concept has been disproven long ago, but some neurologist still believe that impact forces are directly related to outcome.

His post traumatic amnesia is a strong indicator of brain trauma. His on and off symptoms are also a concern. If the only forces he was subjected to were whiplash, he can still have a serious MTBI.

Sometimes, these ongoing symptoms will resolve spontaneously over the next six weeks or so. If they do not, he can expect a higher probability of long term or permanent symptoms.

Regarding early retirement vs disability, he should look at the financial differential. SSDI will take time to get approved, but once approved, if it is greater than his SS retirement amount, it will prevail after retirement age.

Some company retirement plans will grant full retirement status for early retirement due to disability. You need to check this one out.

At his age, there is no Social Security expectation of ability to do "other" work. Over 50 workers are considered to not be retrainable and not tolerant of work place changes.

skericheri,
I hope this is helpful to you friend. The wife should find a brain injury support group. Most are good at helping caregivers. This will help her understand how to support him and not over-react to his behaviors. Same as with AD, except some of the behaviors can be more pronounced.

Been there, done that, living with a permanent MTBI condition that is expected to progress into AD.

BTW, My condition is deteriorating at a much slower rate than a normal presentation of AD. I have had maybe a 10 percent increase in symptoms in the last 8 years. I have time to do long range planning and preparation.

Everyone---Thanks for the replies.

Alan---Thanks for the undeserved compliment...By nature I am a selfish, willful woman who learned one important lesson from her mother. That lesson was: "If someone goes out of their way for you, you should do the same thing for them". Charlie's acquaintance has come through for us several times in the last 3 years and never waited around long enough for even a simple thank you.

Mark---I especially appreciate the time, thought and effort that you put into your reply. It gave me a jumping off point for potential suggestions and was everything that I had hoped for when I started this thread. Reading that your rate of decline was slower than 'garden variety' A/D confirmed a thought that I had about PCA and A/D.

To Mark in Idaho,
I enjoyed your explanation of mild traumatic brain injury. I see from your tag line that you had a concussion and apnea related cognitive decline. Were you also diagnosed as AD? If so, how was the distinction made between AD and the induced cognitive declines?


Iris L.

I am not currently diagnosed as AD. My symptoms of dementia are similar to many in early stages of AD. My doc says to expect AD in my future. My dad and my wife's dad both passed from AD.

At this point, I do not care if I ever get an AD diagnosis. I just know my dementia will progress similar to AD, although maybe slower. So why worry about a diagnosis.

My current condition is similar to my dad's when he was two to three years before his clinical AD diagnosis.

I find more connection with the AD community that the MTBI/PCS community since I will not get any better. We both have many of the same difficulties living in a normal society.

The MTBI/PCS community has many members who are constantly complaining about wondering when they will get better. Many do not care to make any changes in their life. The AD community accepts their condition more readily and have a better outlook on learning to live with their condition. Plus, I am of the same age as many in the EOAD community.

Mark---Is there a MTBI/PCS community forum outside of the one located at: neurotalk.psychcentral.com/

If so...Please, post a link.

No, The only one I follow is at Neurotalk.psychcentral.

There are some MTBI/PCS mini forums/blogs, not necessarily moderated, on some of the local brain injury support group sites. I think there is one in Seattle. There are two oriented to Christians and talk about the spiritual side of MTBI.

To Mark:
I found this link when I was searching for some info about lupus. I thought you might be interested.



| Can Sleep Apnea Cause Alzheimer's? An Interview with Neurologist, Dr. Mack Jones
Mar 17, 2009 09:24AM - 2 comments
Tags: alzheimer's, Sleep Apnea, obstructive sleep apnea, dementia


Join me tonight (3/17 at 8 PM Eastern) as I interview Dr. Mack Jones, a neurologist and sleep apnea sufferer, on the association between Alzheimer's and obstructive sleep apnea. He'll give some convincing reasons for this link that most doctors are unaware of. Dr. Jones will be discussing how this common sleep disorder is a likely cause of Alzheimer's and possibly a host of other neurologic conditions.

To register and receive the teleconference call in number, click http://www.westside-ent.com/teleseminarsignup.html

If you can't make it, register anyway and you'll get a link to the recording afterwards



Iris L.