(31)头部损伤-Head Injury-公开课-关爱惟士
(31)头部损伤-Head Injury

课程视频:http://player.youku.com/embed/XMjY3ODM4NzM5Ng



Associate Professor Mathew Summers


The relationship between a head injury and dementia is that people who sustain significant brain injuries in early adulthood, do show a slight increase in the risk for dementia in late adulthood. That link is because head injury results in pathological changes in the brain, both at the microscopic level in terms of changes to your neural connections throughout different parts of the brain, but also at the macroscopic level where we see large infarcts and areas of dead tissue.

头部损伤和认知症之间的关系是,在成年早期维持显著的脑损伤的人,确实在成年后期显示患认知症的风险轻微增加。那种联系是因为头部损伤导致大脑的病理变化,还有微观层面上,大脑不同部分的神经连接的变化,而且在宏观水平上,我们看到大的梗死和死亡组织区域。



The evidence again for the relationship between head injury and dementia is retrospective, not prospective, and there are ethical reasons why we can’t do a prospective randomised control trial and deliberately give a group of people a head injury and then see what happens to them. The only studies we can really do in humans, are looking at people who have sustained a head injury, and see whether or not they develop dementia. The difficulty we have is that if we look at the epidemiological evidence for head injuries, people at highest risks for a head injury are male, educated less than year 12, under the age of 25 at the time of injury, have low socioeconomic status to start with, and then subsequent to the head injury, will have educational and socioeconomic disadvantage. Those factors alone may account for why there is an increased risk of dementia in that cohort, because it’s difficult to compare that group of people then with a wider population, where we have 50% female and the education standards are different.

头部损伤和认知症之间的关系的证据是回顾性的,而不是前瞻性的,有道德的原因,这就是为什么我们不能做前瞻性随机对照试验,故意给一群人头部损伤,然后看看他们发生了什么。我们在人类中唯一可以做的研究,是看看头部受伤的人,看他们是否发展成认知症。我们遇到的困难是,如果我们看头部损伤的流行病学证据,头部受伤高风险患痴呆的人是这样的男性,教育程度低于12年,受伤时年龄在25岁以下,从社会经济地位低时开始,然后头部损伤,他们将会有教育和社会经济方面的劣势。这些因素本身可能解释为什么在那群人中患认知症风险增加,因为很难把那群人和更宽泛的人口比较,那里我们有50%的女性,并且教育程度不同。


There is a new group of traumatic brain injuries that we are exploring in our research, that’s starting to appear in the research literature, and that’s related to sports related concussions, and particularly the risk of repetitive concussive injuries in contact sports. For instance, the sort of things we’re seeing out of the US relate to the NFL, the American Football League, where there are lots of concussive head injuries, which do not involve loss of consciousness. We’re seeing similar sorts of studies of AFL football players, rugby league players and rugby union players, as well as soccer players, in Australia. We were looking at the impact of those repetitive concussions. We have established evidence between boxing and dementia pugilistica, which is a form of dementia that arises from repetitive high impact concussive head injuries, but that’s specific to boxing. So the interest amongst competitive contact sports is, do we have an increased risk for seeing those sorts of outcomes in professional sports people who have repetitive injuries? There is some indication that there’s a risk. There are descriptions of a condition called CTE which involves pathological changes which have been detected in retired professional NFL players from the US. There are issues between sports, in terms of level and force of contact, that have to be worked out in terms of how they contribute. There are issues in terms of magnitude of concussion. There are issues, particularly in relation to sport, in terms of the age at which these concussions start. Most professional sports players commence their sport as children, and continue to play all the way through amateur and junior leagues. Do the concussions that happen that early on, carry more impact than the concussions that happen later on? So we don’t have the evidence yet, but there is sufficient concern at this stage that most sporting codes that involve contact sports have modified concussion rules, and we have very clear information and concussion rules particularly for junior sports. Rugby union was probably the first sport worldwide that brought in mandatory concussion reporting rules and taking players out of sport, particularly at junior levels, worldwide, and that is starting to influence every other professional code. Whether someone should be concerned about increased dementia risk from concussion, is difficult to be definitive about. There is possibly a link between the number of repeated concussions and the severity of those concussions, and dementia. That being said, the evidence isn’t firm yet, but it would most likely be dose dependent. That is, the sporting code rules would indicate that two concussions, of any form, within a season, should sideline a player for the rest of that season until medically cleared to resume playing, and that means cognitive testing to make sure that the brain functions are back to normal. So if we extend that risk, we need to monitor repeat concussions, and if a player starts to experience more than two concussions in a season, every season, they should probably reconsider their choice of sport and the potential for risks to future brain functions.

在我们的研究中,我们探索了一组开始出现在文献中的新的创伤性脑损伤,这种脑损伤与运动造成的脑震荡有关,特别是在身体接触的运动项目中,重复性脑震荡损伤引起的风险。例如,我们从美国看到的与NFL,美式橄榄球联赛有关的各种事情,就有大量的震荡性头部损伤,而不是昏迷。在澳大利亚,我们也正在看到类似的,如对AFL足球运动员,橄榄球联赛球员和橄榄球联盟球员以及足球运动员的研究。我们正在研究这些重复性脑震荡的影响。我们已经在拳击和拳击运动员认知症之间建立了证据,这种痴呆的形式是由重复性的、高度撞击性脑震荡头部损伤引起,但这是拳击特有的。因此,这就是竞争接触性运动的趣味,从看到这些种类,在遭受重复性伤害的专业运动人士的输出结果,我们是否有增加患认知症的风险呢?有一些迹象表明存在风险。有一种称为CTE症状的描述,这涉及到来自美国的退休职业NFL运动员中检测到的病理变化。有这样一些问题,我们必须解决运动、运动水平和接触力如何对脑震荡有贡献。还有些问题在脑震荡的度量方面。还有问题,特别是在体育方面,这些脑震荡的开始年龄。大多数职业体育运动员从孩子时开始他们的运动,并继续一路玩到业余和初级联赛。早期发生的脑震荡比以后发生的脑震荡有更多的影响吗?我们没有证据,但要在这个阶段有足够的关注,就是大多数涉及有身体接触运动的体育法规已经修改了冲撞规则,我们有非常清楚的信息和冲撞规则,特别是对于初级运动。橄榄球联盟可能是全球首个引入强制性震荡报告规则并使球员脱离运动的运动,特别是在世界范围内的初级运动,并开始影响了其他专业运动的规则。是否有人应该关注脑震荡引起的认知症风险增加,难以明确。重复脑震荡的次数和脑震荡的严重性以及痴呆之间可能存在联系。话虽如此,证据还不够坚实,但很可能是剂量依赖性的。也就是说,体育规则章程将指示,一个赛季内的任何形式的两个脑震荡,应该强迫球员退出该赛季的剩余时间,直到医学上被允许恢复参赛,那意味着必须认知测试以确保大脑功能恢复正常。因此,如果我们扩展这种风险,我们需要监控反复的脑震荡,如果一个球员在一个赛季开始经历两次以上的脑震荡,每个赛季,他们都应该重新考虑他们对运动的选择以及未来对大脑功能的潜在风险。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


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