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Brain injury

COVID-19 ‘increases risk of dementia and stroke’

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Contracting COVID-19 increases the risk of developing neurological conditions including depression, dementia and stroke, new research has revealed. 

One in three survivors of the deadly virus – 34 per cent – were diagnosed with a neurological or psychiatric condition within six months of being infected.

And for those who were admitted to hospital or intensive care, the risk became even higher, University of Oxford researchers found, at 39 per cent.  

This rose to 46 per cent in those who needed intensive care, and 62 per cent among people who had encephalopathy while battling COVID-19.

For 13 per cent of people, it was their first recorded neurological or psychiatric diagnosis. 

The study, the largest of its kind to date and published in The Lancet, analysed the TriNetX electronic 2020 health records of more than 230,000 COVID-19 patients, mostly from the US.

In addition to the most common effects in those with the virus – anxiety and mood disorders – other neurological consequences included brain haemorrhage, stroke, dementia and psychosis.

The authors of the study concluded that “substantial effects on health and social care systems are likely to occur” and that further “urgent” research needs to be carried out to establish how such effects happen and what can be done to treat them. 

The research team found that anxiety and mood disorders were likely to be due to the stress of having COVID-19 and its effects, while stroke and dementia were more likely to be due to the biological impacts of the virus and the body’s reaction to it. 

The study was conducted by researchers looking at the occurrence of 14 neurological and mental health disorders among 236,379 patients over the age of ten who were infected with COVID-19 on or after January 20, 2020, and who were still alive on December 13 that year.

This group was compared with 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with any respiratory tract infection, including influenza.

Mood, anxiety or psychotic disorders affected 24 per cent of all patients, which rose to 25 per cent in those admitted to hospital, 28 per cent in people who were in intensive care and 36 per cent in people who experienced delirium.

Strokes affected two per cent of all COVID-19 patients, rising to seven per cent of those admitted to ICU and nine per cent of those with encephalopathy.

Dementia was diagnosed in 0.7 per cent of all COVID-19 patients, but five of people who had experienced delirium as a result of the virus.

Brain injury

‘I’m sorry for handling the steering wheel with buttered fingers’

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As he continues to come to terms with the loss of his ‘ex life’ and learns to celebrate the 21st birthday of his new self, The Brain Damaged Baron reflects on the comfort blanket of support from those close to him, while struggling with the loss of vanishing friends

 

Let’s get straight down to business.  The salient truth is that one day, the life I once knew came to an end. Yep, gone, cheerio, toodle pip.

It is an ex-life. It has ceased to be, I trotted off this mortal coil in order to push up some buttercups. Is it buttercups? I forget. 

It was so very difficult, sometimes impossible, to comprehend that all I knew had gone. That sentiment only increased over the years and there have been 21 of them. Twenty-one long years.  My new life has matured and is now old enough…

To vote – when it remembers to.

To drive – it can’t, partial blindness caused by the brain injury would make driving an absolute lottery.  That and the complete lack of spatial awareness. After all, I can’t walk down the street without colliding with lampposts. I wouldn’t be safe in a bubble wrapped bumper car. I’m not sure the roads of the UK are ready for me just yet.

To drink alcohol – it can’t, epilepsy denied that pleasure. Due to medication, I feel half-drunk most of the time anyway. Without alcohol, I have the memory of a goldfish with Alzheimer’s disease. I hardly need the odd libation to wipe what recall I do have. 

To have sex – if I can stay awake long enough. I’ll say no more. It was all I could do to prevent myself typing ‘stay up’ long enough. Ooh-er, Mrs!

And it’s now old enough to know what the hell happened to me.  And is still happening right up to this very day.

That’s the nature of a bang on the bonce; confusion.  

Massive disorder in my mind, incomprehension shadows me like the gloomiest raincloud preparing to unleash a deluge of perplexity. I know it’s there, it’s always there. The monkey on my back, the albatross overhead, the angry weasel with a chip on its shoulder.   learnt to live with it. 

That and the ability to invent nonsensical idioms. It’s a gift.

However.

Back in the day, long before I became 21 again, it began.  The curtains were closed, slammed shut. Well, to be fair, they were curtains, not so much ‘slammed’, but more ‘flopped’.  They needed opening, I had to let the day begin.  And commence it did, as the flaccid curtains were swept aside and the hard graft started.

While I was hurting, while I was struggling, while I was learning, there were other people around. There still are, every day. It’s just a question of tenses really.  

Watching, witnessing, feeling my pain. Either on the side-lines or directly involved, family, friends, all observing the effects. Mostly it was no spectator sport, it was grim viewing, if I am honest. And still they remained, standing by with a collective arm outstretched.  

Twenty-one years later and it’s still there. A comfort blanket, a safety net cushioning the unavoidable falls.

It’s a whole new world out there, and that world has a habit of biting back. Sometimes it is just a nip, although occasionally, it’s like a bite from a hungry shark. And those nibbles come thick and fast. Each bite eroded away my former self and ate away, no pun intended, at the life that had sadly departed.  All the while…

Watching, witnessing, feeling my pain…

There are so many bites that they all seem to merge into one. Remembering can be exhausting beyond belief. I had never thought it possible to get so drained, so shattered simply from attempting to recall what the day is.  

Another aspect of my life that my previous self had taken for granted. There was never any reason not to. I was a 25-year-old man and it didn’t seem a lot to ask to remember where I kept my keys. It was never a conundrum.  

However, after the injury, I could then forget where I kept my pants and socks, let alone my keys. Not when I was wearing them, obviously; my pants and socks that is, not my keys.  

And with the exertion of something as basic to a human being as ‘thought’ came the inevitable headaches. The first to strike shook me to my very core. It smarted, just a tad.  They continue to this day, bless ‘em. 

Almost a year after the old brain took its battering and continued to fight the good fight, epilepsy was thrust into my life. The unwanted gate crasher causing havoc with every appearance. A lightning bolt from the deepest blue. Body spasms, unconsciousness, confusion, memory lapses, post seizure headaches that make the usual head pains seem like old friends.  Well, it keeps me on my toes.  And still…

Watching, witnessing, still feeling my pain. The outstretched arm remained, absorbing the anger and feeling my frustration. 

Fatigue and apathy soon entered the fray. More undesirable visitors cluttering an already overloaded brain. They pushed aside my old friends ‘eagerness’ and ‘concentration’ as ‘alertness’ looked on with all the subtlety of a slightly annoyed bricklayer wielding a sledgehammer. Oh, he had anger issues too.

The passage of time was a cruel mistress. Particularly when my addled brain was struggling to establish some form of normality… whatever that may be.  

My life in its entirety had altered beyond recognition. Epilepsy could now strike without warning at any given moment, throwing the day into chaos. Fatigue that plagued almost every aspect of my life began to throw up barricades.  

It was hard to live with what I had become.  To live in the present and not rely on the past.

And still they watched, witnessed, felt my pain. And for some, it was too much, too difficult, too much like hard work. 

Relationships ended and friendships broke down. Ultimately, people vanished. They had their reasons, I was never told what they were, but I’m sure they had them. Occasionally I had the courtesy of an invented tissue of lies that possibly salved their own conscience, but only served to batter my own into submission.

Relationships with everyone in my life, friends, new acquaintances, and even the odd member of my family, seem to be based on the flip of a coin. 

Should a ‘Head’ land on terra firma and whatever my brain throws into the mix, they’ll hang around. Should a ‘Tail’ drop gracefully to the ground and they’ll turn that tail and run for the hills.  And that’s how it’s been since the day I landed on my cranium with one hell of a thud.  But wait a moment here…

I like to think I’m not a stupid man, I pride myself on it in fact. I’m 46-years-old now, time is marching on relentlessly like a runaway train with only one destination.  

I’m married to my best friend, a couple of children have their place in my life and I’m still learning more about my own limitations and abilities. Only one thing has remained constant throughout the journey that became my second shot at this rollercoaster we call ‘Life’. That damn scar on my brain still throws its weight around whenever it fancies a bit of a giggle. And thus…

I still forget things with frightening regularity.

I can’t control my emotions like I should.

Background noise irritates me to the point of exasperation.

I still invent idioms like a ferocious aardvark with a knuckleduster.

I may have a seizure with varying degrees of severity at any given moment.

Fatigue is a pest that simply won’t leave me be. And sleep is my panacea.

I can’t socialise like I once could.

I can’t drink, I can’t drive.

I am no longer the ‘me’ I once was. And do you know what? I no longer care. I wouldn’t change one God damned thing.

I throw out these statements with gay abandon, almost on a whim.  The fact remains that while I was coming to terms with the throwaway facts, those people close to me WERE watching, they WERE witnessing and they WERE feeling my pain.  

For instance, let’s start at the very beginning. I was in a coma in hospital. Essentially, I was asleep, just for a smidgeon longer than usual. I always was a lazy sod. While I slept, my family and friends sat at my hospital bedside wondering whether I would live or die. I had it easy, I really did. I still do.

The first epileptic seizure and every single one since sees my good self disappear into another world for however long, while whoever is there can only watch, wait, and worry.  Again, I repeat, I have it easy.

I have a wife I adore. The lady who came along and turned out to be the missing piece in my jigsaw. Who knew? The rock to my roll, the milk on my cornflakes. Much like my friends and family who were there long before that missing piece arrived, she tolerates the moods and the headaches.  She lives with the forgetfulness, the now thankfully muted anger, the annoyances, etc. They’re all part of just another day.

Twenty years of watching and worry. Good grief, I’m so sorry for putting you all through this journey, none of you asked to be passengers, you really didn’t. You still don’t, you never so much as complain. I certainly didn’t want to be the driver and I’m sorry for handling the steering wheel with buttered fingers…

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Brain injury

Sleep problems ‘can be worse with mild TBI’

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Sleep disorders are more prevalent among people with mild traumatic brain injuries (TBI) in comparison to those with more a severe diagnosis, new research has revealed. 

In the study, the links between TBI and sleep problems were strengthened further, with people with TBI shown to be up to 50 per cent more likely to develop insomnia, sleep apnea and other sleep disorders than people who have not been injured. 

And in a significant outcome, the association with sleep disorders was stronger amongst those with mild TBI than in the case of serious injury. 

The research also showed that the risk for sleep disorders increased for up to 14 years after a brain injury – showing the need for the impact of TBI to be assessed in the long-term, said the research team from the University of California. 

“Clinicians should ask TBI patients about their sleep and they should follow that up,” says study investigator Yue Leng, assistant professor in the university’s Department of Psychiatry and Behavioral Sciences.

Data was analysed from 98,709 Veterans Health Administration patients diagnosed with TBI, alongside an age-matched group of the same number of veterans who had not received such a diagnosis. The mean age of the participants was 49 years at baseline, and 11.7 per cent were women. Of the TBI cases, 49.6 per cent were mild.

Researchers assessed a number of sleep disorders, including insomnia, hypersomnia disorders, narcolepsy, sleep-related breathing disorders, and sleep-related movement disorders.

During a follow-up period that averaged five years but ranged as high as 14 years, 23.4 per cent of veterans with TBI and 15.8 per cent of those without TBI developed a sleep disorder.

After adjusting for age, sex, race, education and income, those who had suffered a TBI were 50 per cent more likely to develop any sleep disorder compared to those who had not had a TBI. 

The association with sleep disorders was also found to be stronger for mild TBI than for moderate to severe TBI which, say the research time, might be due to differences in the brain injury mechanism.

While the study was conducted with veterans, the research team expected to find an increase in probability of sleep problems in those with PTSD. 

“But actually we found the association was pretty similar in those with, and without, PTSD, so that was contrary to our hypothesis,” says Leng.

The researchers could not examine the trajectory of sleep problems, so it could not be concluded whether sleep problems worsen or get better over time, she adds.

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Brain injury

Women ‘more likely to have long-term issues after concussion’

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Women may be at increased risk of long-term physical and mental issues after a concussion, a new study has revealed. 

In analysis of 2,000 people who sustained a head injury, women were found to be more likely than men to still have some symptoms a year later. 

These included memory and concentration problems, alongside headaches, dizziness or fatigue. 

Women between the ages of 35 and 49 typically had worse symptoms than both younger and older women, the research found. 

The study revealed that in other traumatic injuries, men and women’s recovery times were similar – the main area of disparity was in brain injuries.

While this research cannot answer the question as to why this happens, says lead researcher Professor Harvey Levin, from Baylor College of Medicine in Houston – it is possible, he says, that chronic inflammation in the brain tissue or hormonal influences play a role.

The brain has receptors for oestrogen, and previous research has indicated that women who sustain concussion at certain times in the menstrual cycle tend to have a slower recovery.

It also builds on previous research which has also pointed to sex differences in concussion recovery. 

Writing an accompanying piece to the study, which was published in JAMA Network Open, Martina Anto-Ocrah, an assistant professor of emergency medicine and neurology at the University of Rochester Medical Center, says it strengthens the case that women’s slower recovery is related to concussion. 

“We expect most patients to recover within weeks,” Anto-Ocrah says, adding that about 90 per cent have largely recovered within three months.

But in the study, women did have higher rates of depression and anxiety diagnoses before the concussion, compared to men. And those are risk factors for prolonged concussion symptoms, Anto-Ocrah adds.

However, the researchers accounted for depression and anxiety, and those diagnoses did not seem to explain women’s more persistent symptoms.

Some women, Anto-Ocrah says, encounter scepticism when they tell their doctor they are still having concussion symptoms many months after the injury.

“This is additional proof that it’s not all in your head,” she adds.

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