Recurrent concussions may be
linked to depression, North Carolina study finds
by Lauran Neergaard, Canadian Press and AP, May 5, 2003
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Retired football players who suffered three or four concussions
have twice the risk of later developing clinical depression - a
risk that rises with even more injuries, new research says.
It's the latest finding that suggests what many people consider
merely a bang really can have long-term repercussions. Now
scientists are beginning intensive imaging studies to pin down
just what happens inside the brain when someone suffers a
It's not a concern only for professional athletes. Concussions,
a mild brain injury, can be caused by any hard blow or jolt to
the head - from whiplash during a car accident to a tumble onto
a sidewalk. An estimated 1.1 million Americans suffer a
concussion each year.
But athletes, both professional and amateur, are more likely
than the average person to suffer repeated concussions.
That's a particular problem because concussions can be hard to
diagnose - and if you get banged around again before you've
fully healed and you can suffer potentially deadly brain
swelling. Still, specialists say athletes often beg to get back
in the game, swearing they're fine.
"I always say, 'You can ice your ankle but you can't ice your
brain,' " says Dr. Julian Bailes of West Virginia University's
School of Medicine. "You don't send a player who's still
symptomatic back to play."
Most people fully recover from a concussion. But a fraction
suffer lingering, sometimes severe, problems with memory and
other functions - and doctors wonder if sufferers of bad or
repeated concussions are more prone to neurologic disease later
As a first step in studying that question, Bailes and colleagues
from the University of North Carolina's Center for the Study of
Retired Athletes analyzed data from almost 2,500 retired
National Football League players.
Bailes found no link between concussions and later Alzheimer's
disease or strokes, two common worries.
But 263 of the retired players suffered depression. Having three
or four concussions meant twice the risk of depression as
never-concussed players - and five or more concussions meant a
nearly threefold risk.
The study, presented last week at an American Association of
Neurological Surgeons meeting, supports earlier research that
linked concussions suffered by Second World War soldiers to
depression decades later.
For better proof, University of Pittsburgh neuropsychologist
Mark Lovell now is tracking how NFL and National Hockey League
players fare in the years after a concussion.
More intriguing, he's using advanced MRI scanners to image the
brains of high school athletes in a study that will rescan up to
250 of them who go on to suffer a concussion - providing
before-and-after shots that could finally show just what the
injury does to delicate brain tissue.
Scientists already know a concussion somehow throws crucial
brain-chemical reactions out of whack, but they're not sure for
how long - key to deciding when the patient is healed - or if
that imbalance could cause a chain reaction leading to later
problems like depression.
For now, Lovell and other specialists want athletes and their
coaches and relatives to start taking concussions more
"If you get hit and have a headache, don't do the macho routine
- you need tell somebody," Lovell says.
Look hard for symptoms - they're not always obvious in an
adrenaline-pumped athlete. Loss of consciousness, from a few
seconds to a half-hour, is the best-known symptom but doesn't
always occur. Other symptoms include confusion, persistent
headache, cognitive problems, fatigue and changes in mood,
vision or hearing.
Particularly crucial is short-term memory: How long before you
were hit can you remember? The longer the period of amnesia, the
worse the concussion.
Watch for changes in behaviour, signs that signal pain the
Coaches have long thought that if obvious symptoms disappear
within 15 minutes, it's safe to put a player back in the game.
But last winter, Lovell discovered that teenage athletes with
the mildest of concussions often have subtle memory and other
symptoms days later - refuting that advice.
Rest is the only way to heal, and Lovell's research suggests
that takes about a week.
How many concussions is too many? Each one suffered seems to
render someone more vulnerable to another, but "there's no magic
number that we know at this point in time where you can say,
'OK, you've now had that final one concussion too many,"' Lovell
Concussions can have varied symptoms that last for days or
weeks, but that don't always arise immediately.
Doctors suspect a concussion if, after a blow to the head,
someone loses consciousness, can't remember the time around the
injury, or is confused or disoriented.
Other symptoms include persistent headaches; trouble
concentrating or making decisions; slowness in thinking, acting,
speaking or reading; getting lost or easily confused; fatigue;
blurred vision; changes in mood or sense of taste or smell.
The government offers the following tips for healing:
-Get plenty of rest.
-Avoid activities that could lead to another head injury, such
as sports, until your doctor clears them.
-Ask your doctor when it's safe to drive a car, ride a bike or
operate heavy machinery, because your reaction time may be
impaired after a concussion.
To avoid a concussion:
-Always wear a seat belt and buckle your child into an
appropriate safety seat.
-Wear a helmet whenever riding a bike, motorcycle, snowmobile or
-Wear a helmet during such sports as football, hockey, boxing,
horseback riding, skiing; and when in-line skating or
-Make sure your child's playground has a shock-absorbing surface
such as mulch or sand.
-Take steps to avoid falls, such as installing stair rails and
nonslip bath mats and using stair gates when young children are