TBI May Be as Complex as Cancer
Breast cancer and pancreatic cancer are both cancers, but are treated differently. The same may be true for different "kinds" of TBI.
I think what we're beginning to do with the findings from the football players who have died is that TBI is much more complex than anybody anticipated, and there are really, really two aspects of TBI. There's TBI as an injury, which is the immediate part of the--of when the person first gets hit and then they recover from that. And then there's TBI as a disease. And TBI as a disease--we're talking about the long-term consequences of TBI. And--you know--we don't know how many people have chronic traumatic encephalopathy. That's what the folks would--they found in the football players. There's no way to diagnose it right now in people while you're alive. So the only way you can pick it up is upon death. There's been one study now that was released on a new kind of neuroimaging approach that they used on five people. So it's far from standard of care. But even if you can diagnose it, you don't know how to treat it. And one of the things that we see is that oftentimes a TBI is masked by other things. So we know, for example, there is some overlap in some people between TBI and Alzheimer's disease. And the folks in my group did a--looked at some of the folks in our Alzheimer's brain bank who had a brain injury and really found that they were misdiagnosed with Alzheimer's when they really had a TBI. A certain proportion of these folks had CTE--not all of them. Okay, so we're really talking about TBI can be several different things. It can be--it can result in a dementia like Alzheimer's or another form of dementia. In some people it can be CTE. In some people, they stay the same. They don't decline. Each one of these entities--ways of looking at a TBI has different implications in terms of treatment. If somebody--if you had a diagnostic for CTE, for example, and you had different diagnostics for Alzheimer's, you wouldn't be treating somebody with a CTE with a drug that you would use for Alzheimer's, because they're two different-- one is tau and one is beta-amyloid. And so I think what we're evolving into is looking at TBI almost like we're looking at cancer. Cancer is a disease, and we can talk about cancer, but you have breast cancer, you have lung cancer, you have esophageal cancer, you have pancreatic cancer. Each one of these types of cancers leads to a different path of intervention. I think we're now seeing that TBI may be as complex as cancer, and there may be different types of TBI that depend upon, essentially, to some extent your genetic load. It may be dependent upon the severity of how you were hit, okay, the number of times you were hit, your educational background, and the like. But we're still basically in the very early stages of trying to figure this out.
Posted on BrainLine March 15, 2011.
Wayne Gordon, PhD, ABPP/Cn, is the Jack Nash Professor of Rehabilitation Medicine and associate director of the Department of Rehabilitation Medicine at the Mount Sinai School of Medicine. He is a neuropsychologist and the director of the Mount Sinai Brain Injury Research Center.
Produced by Noel Gunther, Ashley Gilleland, Victoria Tilney McDonough, and Brian King.