Repeated Concussions: Concerns About Future Cognitive Decline

Multiple concussions: Fear of future dementia?

Hello doctor, I have experienced five mild concussions within the past two years, the most recent one occurring in mid-November.
However, since my third concussion in March, I have been experiencing ongoing issues with attention, judgment, and memory.
A CT scan showed no abnormalities, so the physician believes it may be a psychological issue.
I would like to know if my risk of developing dementia in the future (such as early-onset dementia or CTE) is high.
The doctors have not provided me with an answer, so should I be concerned? Additionally, does having multiple concussions lower the threshold for future concussions? For instance, I experienced a headache for three days just from bumping into a bus handle.

Liu, 20~29 year old female. Ask Date: 2022/01/21

Dr. Jiang Junyi reply Neurology

Dear Mr.
Liu,
You mentioned that "the third concussion started at the end of March, with ongoing issues related to attention, judgment, and memory, and the CT scan showed no problems, so the physician believes it is a psychological issue..." Dementia is usually caused by multiple factors, but it is crucial to avoid brain injuries.

1.
Clinically, we will inquire about the patient's medical history and the course of the illness: when symptoms began, what symptoms are present, the impact on daily life and work, whether there is any medication use, alcohol abuse, or exposure to toxic substances, and conduct a detailed physical and neurological examination.

2.
A cognitive assessment will be performed to objectively evaluate the patient's mental state.

3.
Neurological and laboratory tests will be conducted: arranging for a CT or MRI of the brain to check for any brain lesions, and performing blood tests to assess general biochemical values, levels of vitamin B12 and folate, thyroid function, etc.

Certain "cognitive impairments" can be caused by specific treatable conditions, which may have the potential for recovery.
Examples include:
1.
Nutritional deficiencies: such as lack of vitamin B12 and folate.

2.
Intracranial lesions: such as normal pressure hydrocephalus, brain tumors, or brain trauma.

3.
Metabolic disorders: such as hypothyroidism or electrolyte imbalances.

4.
Central nervous system infections: such as syphilis or HIV.

If you have related concerns, I recommend discussing examinations and treatments with a neurologist.

Wishing you good health, peace, and joy.
Dr.
Jiang Junyi
Department of Neurology
Taoyuan Hospital

Reply Date: 2022/01/21

More Info

Repeated concussions are a significant concern in both sports and everyday life, particularly due to their potential long-term effects on cognitive function. You mentioned experiencing five mild concussions over the past two years, with the most recent one occurring in mid-November. Since your third concussion in March, you've been facing ongoing issues with attention, judgment, and memory, despite CT scans showing no immediate structural damage. This situation raises important questions about the risks of cognitive decline, including conditions like early-onset dementia and Chronic Traumatic Encephalopathy (CTE).

Firstly, it's essential to understand that repeated concussions can indeed increase the risk of long-term cognitive issues. Research has shown that individuals who suffer multiple concussions may experience cumulative effects that can lead to cognitive decline over time. CTE, a progressive neurodegenerative disease linked to repeated head trauma, is characterized by symptoms such as memory loss, confusion, impaired judgment, and eventually progressive dementia. While CTE is often associated with athletes in contact sports, it can also affect individuals who have experienced multiple concussions in non-sporting contexts.

Regarding your specific concerns about the likelihood of developing early-onset dementia or CTE, it's important to note that while there is an association between repeated concussions and cognitive decline, not everyone who experiences multiple concussions will develop these conditions. Factors such as genetics, age, overall health, and the severity of each concussion play a crucial role in determining individual risk. However, your ongoing cognitive symptoms, such as attention and memory issues, should not be overlooked. They may indicate that your brain is struggling to recover fully from the repeated trauma.

As for your question about whether multiple concussions can lower the threshold for future concussions, the answer is yes. Research suggests that individuals who have suffered multiple concussions may experience heightened sensitivity to subsequent head injuries. This phenomenon is sometimes referred to as "second impact syndrome," where a second concussion occurs before the brain has fully healed from the first, potentially leading to severe consequences. Your experience of prolonged headaches after minor impacts, such as bumping into a bus handle, could be indicative of this increased sensitivity.

Given your situation, it is crucial to take proactive steps to protect your brain health. Here are some recommendations:
1. Seek Comprehensive Evaluation: Consult with a neurologist or a specialist in sports medicine who can provide a thorough evaluation of your cognitive symptoms. They may recommend neuropsychological testing to assess your cognitive function more comprehensively.

2. Rest and Recovery: Allow your brain adequate time to heal after each concussion. This includes physical rest and cognitive rest, which means limiting activities that require intense concentration or mental effort.

3. Monitor Symptoms: Keep a detailed record of your symptoms, including any changes in cognitive function, mood, or behavior. This information can be valuable for your healthcare provider in assessing your condition.

4. Avoid Further Trauma: Be cautious about activities that could lead to additional head injuries. Consider avoiding contact sports or high-risk activities until you have fully recovered and received medical clearance.

5. Educate Yourself: Learn more about the signs and symptoms of cognitive decline and CTE. Early recognition of changes in your cognitive health can lead to timely intervention.

6. Support System: Engage with a support system, whether through friends, family, or support groups, to help you cope with the emotional and psychological aspects of dealing with repeated concussions.

In conclusion, while there is a potential risk for future cognitive decline following repeated concussions, individual outcomes can vary widely. It is essential to take your symptoms seriously and seek appropriate medical advice. By doing so, you can better understand your situation and take steps to protect your cognitive health moving forward.

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That's not the case; you're overthinking it!