Is there a difference and if not, can ex boxers such as Meldrick Taylor (cannot post links yet but search for Chavez VS Taylor HBO Legendary Nights on youtube, watch all three parts or skip to part 3 to see how he is now) be treated with processes such as LENS?

If not, why?

Also, and this may be a bit of an stupid question, but what about actual dementia and its differences to PCS and/or chronic boxer’s encephalopathy? Are symptoms of dementia just similar to some cognitive effects of PCS, but the root cause inside the brain is different?

Gets a bit unclear since head injury is linked with dementia and the symptoms being similar in some cases.

Apologies for the negative topic and if I've asked any ignorant questions.

Thanks for posting on this topic. Yes, it's not a happy one, but I, too, really need to understand this.

My neuro (he's a peach) laughed at my cognitive therapy. He said that it couldn't get me anywhere near back to where I was before and, at best, it might be slightly stalling the "inevitable". The inevitable? When I pressed him on when I could expect this inevitable dementia to set in, he backed off.

As the survivor of a serious spiral injury, am I doomed? If my future holds drool and diapers, I'd rather have died in my truck.

Yes, there is a difference between PCS and Chronic Encephalopothy (CE). CE is a neurodegenerative disease that is similar to Alzheimers. The brain begins to accumulate tau proteins from years of serious insults and these proteins degrade brain tissue. These insults are not just minor bumps or jostles to the head that set off symptoms, they are serious blows coming from a punch or another helmet in the case of football. So, the chances of you developing this are pretty slim unless you continue to engage in activities that will cause you to receive blows to your head. Some docs believe that there is actually a genetic component to it because the majority of professional boxers and football players don't develop this disorder. Most likely, these people would have developed Alzheimers later in life regardless of how many head injuries they had. But that is just a theory and hasn't been proven true or false.

Also, doctors have yet to establish a link between concussions and dementia. Although, logically speaking, the two may be linked they have yet to definitevely establish a relationship. Another thing to keep in mind is that most of the people you hear about on the news regarding PCS and dementia never did anything to heal their brains. So, doctors don't know what the long term effects would be from someone who took the time to do the appropriate therapies for their brains. There are some that have though. Ever heard of a guy named Troy Aikmen? It is speculated that he did a ton of therapy, including neurofeedack, vision therapy, vestibular therapy, HBOT, etc., after he retired to get his brain back into shape. He was in pretty bad shape too, reporting having had 8 concussions that he was aware of. Doctors estimate that he probably had more like 20. He is now an emmy award winning broadcast analyst for fox.

Another thing to keep in mind is that we luckily live in the age of rapidly advancing medicine. So, doctors should have a treatment and/or cure for all neurological diseases within the next 10 years. So, even if you did start to go down that road, it may be treatable by that time.

I have never heard this comparison between CE and AD. I know there is a direct comparison in that both will show up as reduced brain volume in an MRI or such. There are different progression lines between CE and AD.

My memory is failing me as to the specifics but it goes something like this. In one, AD I think, memory deteriorates first with executive functioning deteriorating later. In CE, the pattern of deterioration is the opposite, executive function goes first, memory later.

My father passed away from CE but was lazily diagnosed as AD. His progression of symptoms was CE related from a statistical basis. He had to take early retirement at fifty-eight because his executive functions were failing him. He was a rocket engineer and could no longer prepare the status reports to required standards. His memory was still sharp and remained that way for another 10 to 15 years. This delayed his diagnosis of 'AD' until the last two years.

His CE was most likely caused by thirty to forty years of undiagnosed central sleep apnea. He would frequently stop breathing for two to three minutes at a time with this cycle repeating every six minutes or so. He refused to be tested in a sleep lab. He was a very independent and self sufficient man. The brain damage due to sleep apnea is diffuse similar to a diffuse axonal injury.

We all envied how he could take naps during the day with ease. Now we understand why he could.

There needs to be caution when considering the long term effects of PCS and CE. History of multiple head traumas are leading indicators of minimal recovery. Boxers have a different form of brain injuries that football players. Boxer have more axial damage. That means they get their brain twisted inside their skulls. This is a result of a hook to the chin. This quick rotation of the skull creates a vast amount of shearing and bruising action within the skull as the brain is grated against the protuberances inside the skull.

Studies have been done that show this axial damage is far worse for the amount of energy released against the skull. A straight on jab is far less damaging that the hook of equal force. It is understandable if one watches a boxing match and observes the punishment that can be taken on from straight on jabs and even an upper cut. Then a lone hook to the jaw and the opponent goes down.

There is also a big difference between quarterback concussions and those suffered by linemen. The linemen get repeated smaller impacts over the time of a single game. The quarterback gets infrequent impacts with most concussions coming from an impact to the back of the head as it hits the ground. Studies show that the repeated lesser impact have a more devastating result than the infrequent (less than one per game) hard tackle of the quarterback.

Troy Aikman may have substantial neuro-psychological deficiencies that do not show up in his football commentary. This would likely be due to what is called "over-learned skills." Over-learned skills are the last skills to be lost to dementia. They have been learned so many times and accessed in memory so many times that the memory access routes in the brain or many fold. This is how a person with a severe concussion can still walk easily or do manual tasks but may have problems learning new physical skills.

Troy was a lifelong student of the game. This provides for a great ability to recall and understand the football discipline.

I understand this personally because I suffer from this problem. I have high levels and numbers of over-learned skills but can struggle to learn a new skill.

Reading comprehension will require that I read an article three or more times before I retain the information. I have excellent retention once this critical mass of repetitions is exceeded. I also have excellent use of over-learned disciplines learned over a lifetime. Just don't expect me to learn anything after just the first try. It aint gonna happen. Been there. Done that. It is very frustrating.

It is important to understand that different brain functions have different abilities to withstand impact and recover. Redundancy is very common in memory functions. It is not so common in processing functions. Learning new ways to process is of greater likelihood that establishing the redundant memories.

I can substitute auditory memory for weaknesses in visual memory. This is a common outcome of occupational, speech and other therapies. Some will try to call this 'rewiring' but it is more like using a Stillson wrench when you have lost you Crescent wrench. Both will get the job done. The Crescent wrench is just easier to use.

Is it the case then that an accumulation of subconcussive blows are more damaging than a small number of concussions? I guess that depends how severe the concussions were.

From what I've read though the indication is a history of concussion makes you far more likely to develop dementia. You say in the case of CE that 'the brain begins to accumulate tau proteins from years of serious insults and these proteins degrade brain tissue', but isn't damaged brain tissue damaged for good, or does therapy actually heal it? I was under the impression therapy just helps the brain adjust to its new formation, so any implication's of the original damage would remain. Your example of Troy Aikman seems to imply therapy helped avoid CE and/or dementia, but I may be getting the wrong message there. If therapy did lower the risk of later complications would it be logical to say the sooner you get it the better?

One would hope so but I remain pessimistic given the complexity and uncertainty regarding the brain, and the current prognosis for dementia sufferers.

Thought provoking stuff.

Edit: Mark, you certainly answered my question about acummulative blows to the head.

The increase in risk of dementia or Alzheimer's Disease is anywhere form twice as likely to as much as 18 times more likely. The NFL players with strong histories of concussions develop Alzheimer's at 18 times the normal rate.

pbob, I am glad to see you use the term sub-concussive blows. That is a new term that has been promoted by just a few doctors. These doctors have noticed that many concussion subjects will develop symptoms from minor impacts that do not cause any concussion symptoms at the time of the impact.

They have coined the term sub-concussive because of the lack of immediate symptoms. Their research and direct experience shows that there is substantial damage done by these sub-concussive blows, especially when there are multiples of them.

There is research with soccer players that shows more injury from the many sub-concussive blows of a heading drill than the occasional strong header. Soccer research also shows that soccer players who routinely head the ball have a 10% lower IQ.

The important issue to understand with concussions or other impacts to the head is that they defy logic. The long held belief that degree of impact was directly related to degree of injury has been shown to be wrong. Even length of Loss Of Consciousness (LOC) has minimal impact on degree of injury, except when this LOC leads to a coma. Post Traumatic Amnesia (PTA) also has no direct relationship to degree of injury, especially residual injury.

The recent studies of sports concussions has suggested that only one in ten concussions is reported. Many are so short term in immediate symptoms that they are dismissed by the player as not a concussion.

The NFL is looking at a helmet system that records the impact forces. Dr Robert Thatcher is developing a wearable mini-EEG system that will record the interruptions to brain function. As technology advances, the ability to track concussions is improving.

There are some with hope for a radical cure to injured brains but those with the most understanding of the brain's capabilities to heal are not holding their breath. The direction is heading toward prevention of concussions in sports and early detection so that therapies that stop the cascade of damage can be started. The auto accident insurance industry is fighting to deny concussion as causing long term symptoms but the personal injury attorneys are learning how to win.

Thanks for the great posts Mark and mhr4!

I'm still trying to read through and understand them. Ironically, my injury makes it so difficult to understand my injury. I wish I could take you guys with me to my next neuro appointment. That would sure wipe the smug smile off that SOB's face.

Cheers

Bob,


Regarding therapy, yes - the sooner the better. And, if you are interested in getting yourself better, the main thing to do is not to dwell on the negative. So, don't focus on the fact that you've had multiple concussions and this could lead to dementia. Instead, focus on the therapy you are doing and that the therapy is going to work to get you better. Attitude is everything my friend.

There is a big difference between dwelling on the negative and accepting the reality of the symptoms of PCS. AD and other dementias are more likely in the future but do not have any control over today.

Instead, I have recognized my current symptoms and have worked to overcome them, whether by brain training or work-arounds.

Recently, I have learned that I can do certain brain training tasks that previously I could not do. I have historically used FreeCell as exercise. After my 2001 injury, I would fatigue quickly playing FreeCell.

Recently, I had an opportunity to play FreeCell on a PDA. I had minimal problems with fatigue. In comparing it to FreeCell on my computer, I realized that the fatigue was caused by the larger screen and the need to do much more visual scanning. The PDA was all in one small visual field of view.

I hope to find other exercises that I can do with the smaller visual field of view. Maybe I can get more of my multi-step processing restored.

Of all of the posters on this forum, I am likely the one with the longest PCS history. I have been recovering from PCS for over 40 years. I recovered to very high levels from my previous injuries until the last one in 2001. It has been a stubborn injury. The headaches are frequent. The confusion is recurring. The memory skills refuse to recover. The multi-step processing has been problematic.

My most successful area of recovery is right here. My ability to organize my thoughts to post on forums like NT has been remarkable. My ability to research and cut and paste information from multiple screens has been improving greatly. This may be due to work-arounds or other accommodations but I don't care one way or the other.

I can put my thoughts together at length. Yes, I know I can be very long winded. You can read what you chose and ignore the rest. It is great exercise for my brain. With my environmental stimuli limitations, this is a large part of my social like. I struggle to talk on the phone due to auditory struggles. So, I try to keep my mind exercised by researching and posting.

As Hockey noted to Soccer14, the effort to post with proper grammar and spelling, etc. can be difficult. The editing offered by the computer allows one to correct their typing and organize their thoughts. This is a large part of the therapy of on-line posting.

The need to be tolerant of others critiques stretches the brain as it wants to attack in response. The need to respond with information and not personal attacks takes great effort for some. The need to sort between opinions and factual information often requires research and review. More exercise for the mind.

So, do I dwell on the future? No, but I also do not plan my life to paint myself into a corner. My wife and I are trying to simplify our lives. This will benefit us if my condition deteriorates. But it is also a benefit as it allows us freedom from the complications of life. With this freedom, we can do things without the burden of returning home to a complex life and household.

There are magazines dedicated to living "The Simpler Life." Most people will benefit from simplifying their lives, whether they have a PCS condition or not.

Well, I have gone on too long. I think I will rest up to be ready for the excitement of the Canada-USA Olympic Gold Medal Men's Hockey game. We owe the Canadians a good fight. They beat us for the Women's Gold Medal.

The Olympics have been playing havoc with my blood pressure. Up and down, Up and down. Downhill and Super G, speed skating, bobsled and luge, and now hockey. My brain will enjoy the rest tomorrow after the Olympics are over.

Mark, I'm a typically long poster too and always have been, I enjoy reading your posts regardless of their length.

Even though I probably wont like the answer, I am interested as to what this cascade of damage is and what therapies stop it starting? If there's something I could have done when I got concussed then I'll be rather eff'd off