Study shows first case of chronic traumatic encephalopathy in blast-exposed military personnel

Investigators from Boston University (BU) and the Veterans Affairs Boston Healthcare System have shown evidence of chronic traumatic encephalopathy (CTE) in brain tissue from blast-exposed military service personnel. Laboratory experiments conducted by the investigators demonstrated that exposure to a single blast equivalent to a typical improvised explosive device (IED) results in CTE and long-term brain impairments that accompany the disease. They also found that the blast wind, not the shock wave, from the IED blast leads to traumatic brain injury (TBI) and long-term consequences, including CTE.

This research, which represents the first case series of postmortem brains from U.S. military personnel who were exposed to a blast and/or a concussive injury, will be published online May 16 by Science Translational Medicine.

Lee Goldstein, MD, PhD, associate professor at Boston University School of Medicine (BUSM) and Boston University College of Engineering, and Ann McKee, MD, professor at BUSM and director of the Neuropathology Service for VA New England Healthcare System, led this international collaborative study and are the senior co-authors.

CTE, which can only be diagnosed postmortem, is a progressive neurodegenerative brain disorder that has been reported in athletes with multiple concussions or subconcussive injuries. In early stages, CTE is characterized by the presence of abnormal deposits of a protein called tau in the form of neurofibrillary tangles, glial tangles and neuropil threads throughout the brain. These tau lesions eventually lead to brain cell death. CTE has clinical features in common with TBI, including psychiatric symptoms and long-term cognitive disability involving memory and learning deficits. TBI can impact military personnel exposed to an explosive blast and may affect approximately 20 percent of the 2.3 million servicemen and women deployed since 2001.

In this study, investigators performed comprehensive neuropathological analyses on brain tissue from four military service personnel with known blast exposure and/or concussive injury. They compared these results with brain tissue samples from three young amateur American football players and a professional wrestler, all of whom had a history of repetitive concussive injury, and four samples from comparably-aged normal controls with no history of blast exposure, concussive injury or neurological disease.

The investigators found that CTE neuropathology in the brains of blast-exposed military veterans was similar to that found in young athletes with repetitive concussion and consistent with what has previously been observed in brain samples from other athletes with a history of repetitive concussive injury.

"Our results showed that the neuropathology from blast exposure, concussive injury, or both were virtually indistinguishable from those with a history of repeat concussive injury," said McKee, who is the director of the Brain Banks for BU's Alzheimer's Disease Center and the Center for the Study of Traumatic Encephalopathy, which are based at the Bedford VA Medical Center. McKee said that these findings indicate that TBI caused by different factors may trigger similar disease pathways in the brain.

"The neuropsychiatric symptoms of CTE that have previously been associated with athletes diagnosed with CTE could also be attributed to military personnel who were exposed to blast," said Goldstein, who also is affiliated with the BU Photonics Center and served as the study's lead author.

To examine the impact of a single blast exposure, the investigators collaborated with leading experts in blast physics, experimental pathology and neurophysiology at Boston University, VA Boston Healthcare System, White River Junction VA Medical Center, New York Medical College, Fraunhofer Center for Manufacturing Innovation, University of Massachusetts Lowell, Lawrence Livermore National Laboratory, Massachusetts General Hospital and the University of Oxford. The team's experimental data showed that one blast comparable to that experienced by military service personnel in the field resulted in both neuropathological and behavioral evidence of CTE. Surprisingly, the long-term impairments in brain function, including impaired learning and memory, were observed just two weeks after exposure to a single blast.

The blast wind from an IED can reach a velocity of up to 330 miles per hour, which is greater than the largest wind gust ever recorded on earth. "The force of the blast wind causes the head to move so forcefully that it can result in damage to the brain," said Goldstein.

Based on the results, the investigators went a step further and explored how they could prevent the brain injury. They demonstrated that immobilizing the head during a blast exposure prevented the learning and memory deficits associated with CTE that occurred when the head was not immobilized.

"Our study provides compelling evidence that blast TBI and CTE are structural brain disorders that can emerge as a result of brain injury on the battlefield or playing field," added Goldstein. "Now that we have identified the mechanism responsible for CTE, we can work on developing ways to prevent it so that we can protect athletes and our military service personnel."

The study results provide a pathway for the development of novel diagnostic strategies for blast-related brain trauma, as well as to treat and rehabilitate those who have been exposed to blast and/or a concussive injury.

Time: "The Army Venn Diagram from Hell"

Yikes.

Read more:

The Army Venn Diagram from Hell | Battleland | TIME.com

PTSD? PTS? PTSI?

Words have power. Is "post traumatic stress disorder" the right name? Does the word "disorder" lead to misconceptions and stigma? Instead, should it just be called "post traumatic stress" or maybe, as Gen. Peter Chiarelli suggests, "post traumatic stress injury"? Trauma causes an actual physical change to your brain. The term "injury" makes sense.

What do you think?

Read more:
Army General Calls for Changing Name of PTSD | PBS NewsHour

On a similar note, here's an image often used by Fearless Nation PTSD Support:

Sleep disorders and PTSD

In a new study, nine in ten vets with PTSD or TBI were "hypersomniacs," meaning they were tired during the day. That's because more than half had sleep apnea and almost half had insomnia. (It's not clear if those numbers overlap.)

Interestingly, the vets with no physical injuries suffered from greater levels of sleep apnea. TBI caused by blast injuries caused higher levels of insomnia.

Read more:

Sleep disorders plague vets with head trauma or PTSD | Reuters

Employers' Misconceptions About PTSD

According to a survey cited by Lisa Stern of the Department of Labor’s project America’s Heroes at Work program, 46 percent of HR managers believe PTSD poses a "hiring challenge" -- namely that people with PTSD or TBI are not efficient or create a potential problem for violence in the workplace. But Stern said these assumptions are myths, and no evidence backs them up.

In His VA blog Vantage Point, Alex Horton summarizes some of the advice Stern had for hiring vets and other people with PTSD:

• Consider flexible work hours
• Put instructions in writing instead of just relying on verbal communication
  

Stern also said that the act of working can by itself help reduce PTSD symptoms.

Read more:

Debunking Employers’ Misconceptions About PTSD and TB 

What other myths about PTSD have you encountered in the workplace? Discuss them in the comments.

Can video games trigger PTSD?

The Hawaii-based PTSD organization Stay Strong Nation is arguing that the combat simulation aspects of the newest Call of Duty video game can serve as "volatile triggers for veterans suffering from PTS[D]."

Gresford Lewishall, vice president of the organization, said in a prepared statement, "Veterans either play or have exposure to the games and subsequently feel like they're back in Afghanistan or Iraq in life or death situations. Their heart beat accelerates and they feel a sense of unease come over them."

Read more here.

96% of 9/11 Survivors Suffer PTSD Symptoms

A survey of 3,271 evacuees of the World Trade Center found that almost all of them -- 95.6% -- had displayed at least one symptom of PTSD.

A full 15% of survivors tested positive for PTSD in the 2-3 years following 9/11.

"PTSD risk was greater among survivors who experienced serious life threat as defined by location in the towers, time of evacuation initiation, or dust cloud exposures," said the study's first author, Laura DiGrande, in a prepared release. "As one would expect, individuals who were exposed to several of the most troubling and life-threatening events during the disaster were at the greatest risk of PTSD."

The study found a few interesting statistics: lower-income survivors were more likely to develop PTSD, as were blacks and Hispanics. People whose employers were killed also seemed to develop PTSD at a greater rate.

Meanwhile, exactly what each of these survivors encountered seemed to affect their changes of developing PTSD. Some where injured, some saw "horror," others were caught in the dust cloud, some were on very high floors of the Twin Towers. Those who experienced more than one of these situations had significantly greater levels of PTSD, to the point where the authors could even come up with a mathematical formula for the risk of PTSD based on the number of factors the individuals encountered.

The study appears in the online edition of the American Journal of Epidemiology. The full paper is behind a subscription firewall, but you can read the abstract here.

Smartphone helps patients track their moods

Are you more anxious today than you were yesterday? More or less sad? Tired? Worried? A new smartphone app can help you track these feelings from day to day, charting the results for either yourself or you and your therapist.

The T2 Mood Tracker, available for Android smartphones, tracks the user's mood and general well-being. You can track how you're feeling each day:

...then use the app to see how your mood and emotions are changing over time:

In addition to adding a number value to their emotions, the user can also add notes about how they are feeling on a certain day.

The categories themselves change a bit depending on if the patient is monitoring stress, depression, brain injury, PTSD, or general health.

The free program was developed for and released by the Department of Defense to help service members and vets, who, statistically, are using their phones more than their laptops.

Perry Bosmajian, the psychologist who helped to develop the Mood Tracker, told the News Tribune: "The very first question a doctor or a therapist asks is 'How have you been doing since I saw you last?' Everything that follows is based on that answer. With this, it's all documented, how you're feeling."

Click the links above to find out more. And if you've used the T2 Mood Tracker, comment below and let everyone know what you think!

Online tool helps train employers how to support people with PTSD

The U.S. Department of Labor’s Office of Disability Employment Policy and the Veterans' Employment and Training Service, along with several other agencies and organizations, have come up with an online training tool to help employers learn how they can best work with and support employees suffering from PTSD and TBI.

The online training tool takes about 45 minutes. Here's a more detailed description:

The U.S. Department of Labor (DOL) is educating employers about TBI and PTSD, and working to dispel some of the myths associated with these common conditions. Not all TBIs and PTSD cases are the same, nor are most severe - and simple workplace supports can often help individuals with TBI and/or PTSD succeed in their jobs.

This online training resource is not designed to be a diagnostic tool or a substitution for professional/clinical advice. It is designed to educate and inform HR professionals, hiring managers and employers about TBI and PTSD, and how these injuries may impact employment, while illustrating that employment can play a vital role in the recovery of our wounded warriors. Basic clinical information about TBI and PTSD is offered in addition to scenario-based learning and links to tools and resources. We encourage you to use and share these resources to help ensure a successful employment environment - for employers, employees and co-workers who may be experiencing the impact of TBI and/or PTSD.

For more, click here.

PTSD and its effect on the family

How does PTSD affect the entire family unit? From spouses to children to parents, it can be devastating.

JD News, a newspaper out of Jacksonville, is running a two-part series on the effects of PTSD on military families. Here's part one:

Families also suffer from effects PTSD

And here's part two:

Programs help educate families about PTSD

(Some of the resources listed in part two are just for people in the Jacksonville area, but others are nation-wide, and all of the advice is worth reading.)

Paws and Stripes - Helping Dogs Help Heroes

A new non-profit called Paws and Stripes is helping to match New Mexico-area veterans with PTSD and TBI with service dogs.

Local news site KOB.com has a profile of the organization and its founder, veteran Jim Stanek.

Accupuncture as treatment for PTSD

A unique program at Camp Lejeune called the Wounded Warriors Battalion brings helps vets with PTSD and traumatic brain injuries through acupuncture, all at no cost to the veterans or the Marines. Soldiers interviewed in this article say the treatments help them to deal with stress, anger, and memory issues.