Category Archives: Brain Science

Concussion and Sports

By now most of you have heard, seen, read, or experienced personally or in the family the head injury we clinically refer to as concussion. A concussion is generally defined as an injury to the brain that can result in temporary loss of normal brain function. Such functions can include orientation, alertness, judgment, information processing, processing speed, attention and memory. Concussions can, but do not need to involve a loss of consciousness.

Some estimates are that more than 300,000 sports-related concussions occur annually in the United States, and that there is a 19% per year of play likelihood of sustaining a concussion. High school sports yield about 60,000 concussions each year and among college players 34% have had one concussion and 20% multiple concussions. Suffering one concussion increases the risk for that person to incur a second concussion and this is particularly true for football.

Estimates are that between four and twenty percent of college and high school football players will sustain a brain injury over the course of the season. Nearly 60% of college soccer players reported symptoms of a concussion at least once during the season. Concussion rates are comparable for soccer and football. Concussions also occur in non-sport activities such as automobile, biking, sledding, and falls around the home.

Implications for Health

There is no good reason to strike your head and brain. That is a simple, yet important statement for any person at any age. A concussion not only leads to a higher risk for another concussion, it also correlates with depression, impulsivity, and even dementia later in life. We are bombarded now with reports of football players suffering dementia from sustained head injuries clinically referred to as chronic traumatic encephalopathy (CTE).

On a practical level, if your brain is damaged your ability to conduct basic daily activities such as driving, school work, sports, employment, and relationships may be limited. Our life as we had known it will likely be changed and the more severe the brain injury or concussion, the more limited we will be. This is devastating at any age, but it is particularly unfortunate for young persons who may not have even entered the work force yet.

Practical Ideas to Consider:

I am the father of three boys and I was raised and live in Pittsburgh Pennsylvania where football is second only to God! I want to provide you this context because the following ideas are not only difficult for me to express, they will be difficult for many to process. However, I work as a neuropsychologist and after 20 or more years of witnessing the consequences of brain injury I cannot be quiet:

  1. Communities should agree (not be legislated) to remove all tackle football for any child below the 11th grade. It is one thing to have ongoing discussions about the NFL and concussion, it is something completely different for our support of 6 and 7 year-olds dressing up with helmets and being instructed to “hit hard.” I refer to this as “organized stupidity.”
  2. All elementary schools should agree to provide curriculum on the basics of the human brain, how to keep it healthy, and what is not good for the brain.
  3. For those children who wish to play football prior to the 11th grade, flag football should be used.
  4. For those in the 11th grade who wish to play HS football, all schools should seek training and consultation of proper methods of play from college and professional coaches.
  5. All players in all sports, beginning at early ages, should undergo baseline assessments for brain integrity (Impact Test). This will provide important data on that child if a head injury occurs. All players should also be informed of proper lifestyle to help boost the health of their brain (see www.paulnussbaum.com).
  6. For those players who do play tackle football in the 11th grade and later, advanced equipment should be used and severe penalties should be extended to those who strike the head.
  7. For all sports, proper headgear should be used. I encourage all soccer, baseball, hockey, biking, basketball, etc. athletes to use some form of protective headgear or headband prior to setting foot on the field. The same is probably true of gymnastics, cheerleaders, and dancers.

It is my opinion that we are a great nation that should be more enlightened than our behavior suggests at times. I am not a proponent of legislating behavior change. We still have our rights and anyone has the right to be stupid! However, I think communities across the world and within school districts can have reasonable discussions that foster policies intended to protect our brains, particularly our young brains!

Stress Damaging to the Brain

Following up on my previous blog on the brain and the importance of keeping peace and harmony in the brain is a new study that indicates stress can cause damage to the brain.

Living a stressful life has been found to atrophy the cortex of the brain, the critical part that processes information consciously. Stress also can cause damage in areas of the brain the regulate emotion.

A lead researcher with Yale University observed 100 healthy participants using MRI scans while they answered questions about potentially traumatic life events, including the loss of loved one, job or home. The authors found a direct relationship between the experience of stressful life events and structural changes in the brain. This supports other research on chronic stress and structural changes and functional changes, particularly memory function in the brain.

Overall, the growing body of research on the impact of stress on the body and brain demands we all take time to care for ourselves and create periods of the day that are stress free.

Latest on Omega-3 Supplements

You may have read or heard about the recent study and news that Omega-3 supplements have no significant effect on reducing cardiovascular or cerebrovascular disease. Findings were published in the September 12 issue of the Journal of the American Medical Association.

A meta-analysis pooled from 20 randomized studies including more than 68,000 patients concluded that supplementation did not reduce the risks of all-cause mortality, cardiac death, sudden death, myocardial infarction or stroke.  The authors opined that the findings do not justify the use of Omega-3s as a structured intervention in everyday clinical practice or guidelines supporting daily Omega-3 polyunsaturated fatty acid administration.

Authors and clinicians suggest that even though supplements may not reduce the risk of cardiovascular disease, there is evidence they help reduce triglyceride cholesterol levels. Clinicians also indicate it is important we maintain a plant-based diet with Omega-3 rich fatty fish as part of a heart-healthy Mediterranean-like dietary strategy that hold benefits most likely beyond individual supplements.

It is important to differentiate disease prevention from health promotion. Because something does not prevent a disease does not mean it is not healthy. Omega-3s in the form of food consumption remains health promoting. Even supplements continue to help with unhealthy cholesterol reduction. We should engage in health promoting behaviors including diet, exercise, and stress reduction even if such behaviors do not prevent disease.

Caregiver Guilt

Over 20 years of clinical practice has taught me that caregivers experience a full range of emotions in their new role. We really do not have a manual or guide on how “how to be a great caregiver” growing up so the role of caregiver is often learned as we go. This can be difficult and challenging for many of us.

One of the primary emotions experienced by most caregivers is a sense of guilt. Guilt probably stems from the feeling that “I should be doing more and I should be able to take care of mom or dad in my home.” The emotion is typically confronted by the reality that a caregiver may also have a full time job, several kids, a family, and no room at home to provide such care.

Simultaneously, and particularly in the case of parents, the caregiver realizes that the parent cared for him or her and deserves the same in return. These really represent the core issues and thoughts the breed guilt. The feeling of guilt is universal and quite normal. It reflects love and compassion for a family member. It can also cause the caregiver many sleepless nights, depression, anger, etc.

In my practice, I try to provide the caregiver a chance to talk about what he or she is experiencing. I always let the caregiver know how normal guilt is and that the most important decision for care of an older person is safety. So often, a parent may be in need of 24-7 supervision, increased structure, socialization opportunities, and clinical attention. Most children cannot meet these needs, particularly on a 24-7 basis.

Time is helpful to the caregiver guilt, as children will see that most settings provide excellent and compassionate care within a safe environment. It is important for the caregiver to find time for him or herself and to not let guilt drive their decisions such as how often to visit. I will make recommendations to caregivers to not visit so often when I believe the behavior is causing more problems.

A decision to place a loved one such as a parent into assisted living or long-term care is very difficult. All caregivers can know that guilt is a primary and normal emotion with such decisions. Safety needs to be the most important factor in the decision-making process and time will help to heal the feelings of guilt. Caregivers need to create their own time for respite and to monitor their emotional health throughout.

Words Sculpt the Brain

Neuroscience has underscored the importance of neural plasticity and this has unleashed an entire new way of thinking about the human brain. Indeed, we now know more about the brain than ever in our civilization, and most of the knowledge has been accrued in the past twenty years.

Plasticity enables a brain to be shaped by environmental input and it presumes a constantly reorganizing and malleable system. The brain is constantly being shaped, some for the positive and some for the negative. The good news is we have plenty of opportunity to make good decisions regarding how we want our brains to be shaped.

My brain health lifestyle ® promotes five major components to shaping the brain. These include physical activity, mental stimulation, nutrition, socialization, and spirituality. I have promoted an enriched environment filled with novel and complex stimuli as one that can shape the brain for the health.

I believe another major source of shaping or sculpting our brains is language. The spoken language and words themselves. Words are processed by the brain and interpreted for meaning. Such processing creates or leads to thought, emotion, and movement. I have written and spoken about the long-term effects words can have on a human brain and human being.

Consider for a moment some of the most important and wise statements or pieces of advice you have been given or you have read in your life. The very words made a lasting impression, perhaps emotional or cognitive, and literally sculpted your brain in a positive way. This is all neurophysiological and structural in nature, but it results in a behavioral or functional outcome. You might also recall an insult or a negative piece of feedback that affected you in a negative manner. The sculpting here is no less significant and carries with it the same potential for long-term effects.

Grandmother was correct and wise when she instructed to “not open our mouths unless we had something good to say”!

The messages we deliver in the form of words can carry a significant and long lasting effect. We can start and stop wars, start and stop relationships, help others succeed in life, and make others feel good about themselves.

Words, a pretty cool medicine indeed!

Lifestyle and Brain Health

There was a conference held in Washington DC recently that dealt with prevention of dementia. This was an important event, as our society tends to approach health quite reactively. Indeed, the first Alzheimer’s Association International Conference on the Prevention of Dementia was held in mid April and lifestyle was highlighted as an important factor in both the etiology and potential protection against dementia.

As my work over the past decade or more has been focused on a proactive and comprehensive brain health lifestyle ® to build brain resiliency, it is easy to understand how pleased I am to see such conferences and discussion. I have been working to promote a comprehensive lifestyle approach that includes nutrition, socialization, mental stimulation, physical activity, and spirituality to build brain health across the lifespan (see www.paulnussbaum.com).

I was pleased to serve as guest editor of Generations, the official journal of the American Society on Aging (www.asaging.org) that published a special issue on the latest clinical research on brain health and lifestyle (Generations, 35, 2011). The information was then presented at the recent Annual Conference of the American Society of Aging-Brain Health Forum. Interestingly, the event was also held in Washington DC. Perhaps the one-two punch on brain health and lifestyle will generate some interest in the legislative world where it can help to prioritize a national proactive and lifelong effort for brain health.

A brain health lifestyle ® needs to begin in the womb and to be prioritized across the entire lifespan. Delaying or withstanding the effects of the neuropathological markers of the disease can have an enormous benefit for both quality of life and the economics of Alzheimer’s disease. There is nothing wrong with ongoing study for an intervention that will halt or cure the disease. However, it is simply foolish to ignore the robust literature on the relationship between lifestyle and brain resiliency. It is the resiliency of the human brain that is at present perhaps our best approach to confront and combat potential dementia.

Most important, the proactive brain health lifestyle ® (see Nussbaum-Save Your Brain at Amazon.com) needs to be started at the earliest of ages, prioritized in our lives, and understood from a deeply personal level.

Love and the Brain

A recent study published in the Proceedings of the National Academy of Sciences found a strong relationship between maternal support and nurturing in early childhood and the size of the hippocampus by school age. This is particularly interesting since so much recent study has focused on the power of the environment in shaping the structure and the function of the brain.

Children who obtain loving and nurturing care from their parents and particularly their mother (per this study) demonstrate larger hippocampal volume years later. The hippocampus is a structure in our brains critical for new learning and for processing stressful input. Chronic stress has been shown to negatively impact the structure and function of the hippocampus. This is why persons with chronic anxiety have memory problems.

On the positive side, a larger hippocampus not only helps us cope more effectively with daily stress, it also relates to reduced risk of mental illness and even to reduced risk of neurodegenerative diseases such as Alzheimer’s disease. Once again, early life interventions, in this case understanding the importance of loving our children, can have lifelong health benefits.

We need to continue to appreciate and respect the enormous import that factors such as attitude, positive spirit, faith, and love have on our health and wellbeing. These things do not come in a pill or liquid, but they represent the best medicine we have and we should all prescribe ourselves a daily dose.