1. Personality

2. Frontal Lobe Damage “Pseudopsychotic”
Two new classification of frontal lobe damage
Early diagnosis results in better patient outcomes.
“Pseudodepressed”
Characterized by apathy, lack of drive, inability to plan ahead, and limited insight.
“Pseudopsychotic”
Decreased social awareness, hyperactivity, and sexually disinhibited humor.

3. Personality Disorders (PD)
A 30 year follow up study of TBI patients found a sharp increase in major depression, alcohol abuse or dependence, panic disorder, specific phobia, and psychotic disorders.
Results show 55% of TBI patients without prior personality disorder diagnosis were later diagnosed with at least one disorder
US national average 9.1%

4. Personality Disorders
Paranoid personality disorder
Avoidant personality disorder
Dependent personality disorder
Obsessive compulsive disorder
Borderline personality disorder
Narcissistic personality disorder

5. Personality change
Testimonies from patient family’s as well as researchers who studied patients for extended periods of time report patients with traumatic brain injuries exhibit:
Uncontrolled emotional outburst
Impaired judgement
Decision making abilities
Lack of organizational skills

6. Criticism Criticism facing these findings include:
Subjective information
Researcher interpretation
Validity of measurements
Measures only overall change not degree
Unable to assess patients prior to TBI

7. Facial Emotion Recognition Deficit
51 patients with TBI’s versus 33 patients without
Patients were shown randomized face showing emotions such as
Surprise
Joy
Anger
Disgust
The FEEST test recorded patients accuracy as well as time taken to answer

9. Results Results show decreased scores in facial emotional recognition
Possible cause to perceived personality change due to inability to read social interaction appropriately

10. Effect on Cognition
Now, for my section, I will be discussing two studies done to determine if Traumatic brain injuries had a long lasting effect on one’s cognitive function.

11. Cognition The mental process of acquiring and understanding knowledge
Do head injuries impact cognition over a prolonged period of time( >1 year)?
For the purpose of these studies; cognition will be defined as the mental process of acquiring and understanding knowledge. The question we tried to answer for this portion of our research is: Do head injuries impact cognition or cognitive function over a prolonged period of time (more than one year) after the time of injury?

12. PCS and TBI’s Effect on Cognition Long-term effects of mild traumatic brain injury on cognitive performance Phillip J. Dean & Annette Sterr
Four groups
TBI + PCS
TBI + No PCS
Control + PCS
Control + No PCS
Cognitive Function Tests
NBACK (Working Memory)
PVSAT (Processing Speed)
Significant impairment in the TBI groups on both tests
The first study we looked as was conducted by Phillip J Dean and Annette Sterr, titled “long term effects of mild traumatic brain injury on cognitive performance. This study’s purpose was to determine the long term effect of TBIs on cognitive function. This study compared the following four groups: Those suffering a TBI with Post Concussion Symptoms, those with a TBI and no PCS, an uninjured control group with symptoms of PCS and an uninjured control with no PCS. They tested all groups using two tests; the NBACK for working memory which involves memorizing the position of a different number of items “N” on a grid. For example a 1-back involves memorizing the position of the item one turn back, 2-back involves memorizing the position of the item two turns back, so on. The other test used was the PVSAT (Paced Visual Series Addition Task) which measured processing speed. The PVSAT involves showing subjects a series of numbers, one at a time, and asking them to add the number they are looking at with the number shown before. Their study, as shown in the graph, demonstrated that patients with TBI, as seen in the black, performed significantly worse on both tests than did the uninjured control group.

13. Association of Age and Lapsed Time Impact of age on long-term cognitive function after traumatic brain injury Dawn Senathi-Raja, Jennie Ponsford, Michael Schönberger
TBI group compared to an matched, uninjured control group.
5-22 years following a TBI
Tested: processing speed, working memory, verbal and visual memory, attention, and executive functioning.
Poorer Performance by all subjects suffering a TBI
Determined: After recovery from a TBI, poorer cognitive functioning is associated with:
Older age at time of injury
Elapsed time since injury.
Tested using:
Wechler Test of Adult Reading
Digital Symbol Coding Task
Symbol Digital Modalities Test
Trail Making Test
Rey Auditory Verbal Learning Test
People and Names Test
Doors Test
Hayling Sentence Completion Test
Brixton Spatial Anticipitation Test
Controlled Oral Word Association
Porteus Maze Test
Sustained Attention to Response Task
The second study pertaining to cognition to be discussed was conducted by Dawn Senathi-Raja, Jennie Ponsford, and Michael Schönberg, Titled “Impact of age on long term cognitive function after traumatic brain injury”. This study measured the impact of age in relation to cognitive function after 5-22 years following a TBI. The groups used were the injured TBI suffering group 5-22 years post injury, and an uninjured control group matched to their TBI counterpart on age, gender, education, and estimated IQ. They were tested with a large variety of tests, as shown in the box, measuring different aspects of cognitive function such as processing speed, working memory, verbal and visual memory, attention, and executive functioning. Their data proved not only that patients suffering a TBI demonstrated poorer cognitive performance but they also determined that after recovery from a TBI, poorer cognitive functioning is associated with older age at time of injury and elapsed time since injury.

14. Effect on Academic Performance

15. Exploring the Study Skills and Accommodations Used by College Student Survivors of Traumatic Brain Injury

16. Criteria Sustained injuries between the ages of 14–17
Sustained injuries between 4-10 years ago
Graduated from public high schools despite the seriousness of their injuries.
No history of neurological problems other than those associated with TBI
Period of coma extending 1 week or greater

17. Lasting deficits in cognitive processes:
Executive functioning
Impulse control, Emotional control, flexible thinking, self monitoring, planning, prioritizing, task initiation, organization skills
Memory
Attention
Concentration

18. Academically Relevant Issues
Unpredictable periods of improvement
Day-to-day Variability
Medical Complications
Pharmacological side-effects
Concomitant Physical Sensory and/or motor deficits

20. Cerebrovascular Accident

21. Effects on Cerebrovascular Accident
Stroke is the second leading cause of death worldwide and the leading cause of acquired disability in adults in most regions.
About 20% of strokes occur in adults under age 65.

22. Stroke Risk and Outcome
Two nationwide studies were conducted to show the correlation between patients with traumatic brain injuries and an increased risk of having a stoke.

23. Stroke Risk Factors Cardiac disease Smoking Hypertension Alcohol
Diabetes
Psychosocial stress
Age
Depression

24. Occurrence
Men had higher risks of TBI and stroke than women due to greater exposure to dangerous activities, unhealthy lifestyles, and coexisting medical conditions.
In contrast, better outcomes in women after TBI or stroke might be due to female hormones or supplemental estrogen therapy.

25. Prevention
In order to reduce the risk of stroke in brain injured patients, rehabilitation should include stroke prevention strategies like increasing physical activities and regular checkups to monitor recovery.

26. Effects of Repetitive Head Injury in Athletes

27. Chronic Traumatic Encephalopathy (CTE) and Repetitive Head Injury
The effects of repetitive head injuries have been recognized since the late 1920’s
Precipitates a condition known as CTE
Leads to cognitive, physical, and psychiatric impairment
Evidenced by chemical and structural changes in the brain
In the 1920’s, the effects of repetitive head injuries was recognized as a syndrome coined “punch drunk” or dementia pugilistica because of it’s association with the sport of boxing
While its existence was first noted as a risk of the sport of boxing, dementia pugilistica has since been recognized as a consequence of other impact sports such as: football, hockey, wrestling, and soccer
We now know the condition precipitated by repetitive head injury as a condition known as chronic traumatic encephalopathy, or CTE
CTE leads to cognitive, physical and psychiatric impairment
And it is evidenced by chemical and structural changes in the brain

28. Manifestations Paranoia Depression Social withdrawal
Aggressive behavior
Poor judgement
Agitation
Altered gait
Parkinsonism
Dementia
Poor memory
Suicidal behavior
Manifestations of CTE include, but are not limited to:
Paranoia
Depression
Social withdrawal
Aggressive behavior
Poor judgement
Agitation
Altered gait
Parkinsonism
Dementia
Poor memory and
Suicidal behavior
With depression being the most common manifestation

29. Cognitive Impairment Occurring later in the course of CTE Impaired:
Orientation
Language
Attention
Processing speed
As mentioned before, CTE leads to cognitive impairments as wells
These changes have been recognized as later effects of the condition and
Lead to impairments in:
Orientation
Language
Attention
Processing speed

30. Structural and Chemical Changes
β-amyloid deposits
τ-positive neurofibrillary tangles
Changes similar to that of Alzheimer’s Disease
Lower brain weight
Frontal and temporal atrophy
Thinning of the corpus callosum
A 1973 examination of 15 former boxers’ brains revealed some of the structural changes we are more familiar with in CTE
Since then, 14 of the 15 brains previously examined were reviewed along with an additional 6
Of these brains, 19 of them had shown beta-amyloid deposits and tau protein positive neurofibrillary tangles similar to those found in Alzheimer’s Disease
2 of the brains contained neurofibrillary tangles that were identical to those found in Alzheimer’s Disease
These changes are ones that are consistently found in people who have been found to have CTE
Other changes that occur with CTE include:
Lower brain weight
Frontal and temporal atrophy and
Thinning of the corpus callosum

31. Study of Professional Athletes
Study of 6 retired Canadian Football League players
Study of deceased professional American football players
Average age of onset of 42.8
Onset on average 8 years after retirement
In 2013 a study of 6 retired Canadian Football League players revealed 3 of the 6 fell under diagnosis for CTE
The remaining 3 were diagnosed Alzheimer’s, ALS, and Parkinson’s
12 deceased professional American football players that had died between 2008 and 2010 were selected for autopsy Boston University
All 12 showed signs consistent with CTE diagnosis
Even if all of the remaining 321 players that died during this time were negative for CTE, these findings would still reveal a 3.7% rate of occurrence
Overall, the age of onset for the condition is 42.8 and it arises 8 years after the athlete has left the sport;
In some cases, signs of CTE are noticeable at the time of retirement

32. Conclusion
Patients with mTBI and post-concussion syndrome demonstrated working memory and processing speed impairment
Survivors of severe traumatic brain injuries report lasting deficits in cognitive processes such as executive function, memory, attention and concentration
After reevaluating patients with traumatic brain injuries, there have been significant personality changes.
Research into repetitive mTBIs has revealed chronic traumatic encephalopathy as a long term consequence
Patients who experienced a TBI had double the risk of developing a stroke compared to non-brain injured patients

33. References
Dean, P. J., & Sterr, A. “Long-term effects of mild traumatic brain injury on cognitive performance”. Frontiers in Human Neuroscience Front. Hum. Neurosci.,7. February Web. 29 Mar. 2016
Edwards, J. C., & Bodle, J. D. (2014). Causes and consequences of sports concussion. Journal of Law, Medicine, and Ethics, 42(2), Retrieved March 21, 2016.
Fowler Marc, McCabe Paul C. “Traumatic Brain Injury and Personality Change” Pediatric School Psychology National Association of School Psychologists, May Web. 25 Mar
Gardner, A., Iverson, G. L., & McCrory, P. (2013). Chronic Traumatic Encephalopathy: A Systemic Review. British Journal of Sports Medicine, 48, Retrieved March 21, 2016.
Gavett, B. E., Stern, R. A., & McKee, A. C. (2011). Chronic traumatic enchephalopathy: A potential late effect of sport-related concussive and subconcussive head trauma. Clinics in Sports Medicine, 30(1), Retrieved March 21, 2016.
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Liao, C., Chou, Y., Yeh, C., Hu, C., Chiu, W., & Chen, T. (2014). Stroke Risk and Outcomes in Patients With Traumatic Brain Injury: 2 Nationwide Studies. Mayo Clinic Proceedings, 89(2), Web. Retrieved March 28, 2016.
Senathi-Raja, D., Ponsford, J., & Schönberger, M. (2010). Impact of age on long-term cognitive function after traumatic brain injury. Neuropsychology, 24(3). May Web. 30 Mar. 2016
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