Press Release from UCSF -- Football Scuffles, Auto Injuries May Raise Risk for Parkinson's

Football Scuffles, Auto Injuries May Raise Risk for Parkinson’s

Concussion Linked to 56 Percent Increase in Neurological Disease, UCSF Study Shows

By Suzanne Leigh on April 18, 2018

A rear-ender in which the driver’s head slams against the steering wheel or a helmet-to-helmet tussle with an opponent on the football field may increase one’s risk for Parkinson’s disease if concussion results, say researchers from the UCSF Weill Institute for Neurosciences and the San Francisco Veterans Affairs Medical Center.

In their study, which publishes April 18, 2018, in the online issue of Neurology, the researchers looked at the prevalence of Parkinson’s among close to one-third of a million veterans, comparing its incidence in those who had experienced a traumatic brain injury – such as concussion – with those who had not. They found that veterans who had had concussion faced a 56 percent increased risk for Parkinson’s.

Concussion was defined as loss of consciousness for up to 30 minutes, altered consciousness or amnesia for up to 24 hours.

Results Relevant to More Than Vets

“While the participants had all served in the active military, many if not most of the traumatic brain injuries had been acquired during civilian life,” said senior author and principal investigator Kristine Yaffe, MD, of the UCSF departments of neurology, psychiatry, medicine, and epidemiology and biostatistics. “As such, we believe it has important implications for the general population.”

The mechanism in which concussion leads to Parkinson’s is not fully understood, but recent studies have pointed to abnormal brain deposits of a protein called alpha-synuclein in traumatic brain injuries. This protein is a hallmark of Parkinson’s.

Previous research has demonstrated a strong link between Parkinson’s disease and moderate-to-severe traumatic brain injury, but this is the first large-scale, nationwide study to show its association with concussion, said first author Raquel Gardner, MD, of the UCSF Department of Neurology.

For the study, researchers identified 325,870 veterans from three U.S. Veterans Health Administration medical databases. Half of the participants had been diagnosed with concussion or the more serious moderate-to-severe traumatic brain injury and half had not. The participants, who ranged in age from 31 to 65, were followed for an average of 4.6 years.

A total of 1,462 of the participants were diagnosed with Parkinson’s, with an average time to diagnosis of 4.6 years. Some 949 of the participants with traumatic brain injury, or 0.58 percent, developed Parkinson’s, compared to 513 of the participants with no traumatic brain injury, or 0.31 percent.

In total, 360 out of 76,297 with concussion, or 0.47 percent, developed the disease and 543 out of 72,592 with the more serious moderate-to-severe traumatic brain injury, or 0.75 percent, developed the disease.

More Serious Brain Injuries Linked to Higher Risk

After researchers adjusted for age, sex, race, education and other health conditions such as diabetes and high blood pressure, they found that those with concussion had a 56 percent increased risk of Parkinson’s. As expected, the risk was higher among veterans with the more serious moderate-to-severe traumatic brain injury (83 percent).

Researchers also found that those with any form of traumatic brain injury were diagnosed with Parkinson’s an average of two years earlier than those without traumatic brain injury.

“This study highlights the importance of concussion prevention, long-term follow-up of those with concussion, and the need for future studies to investigate if there are other risk factors for Parkinson’s disease that can be modified after someone has a concussion,” said Gardner. “There is increasing recognition that concussion may have long-lasting neurobehavioral consequences, including heightened risk for several psychiatric and neurodegenerative diseases.”

Military at Risk for Unique Cause of Concussion

Among servicemen and women, concussion may result from exposure to explosives in combat areas. In the general population, it most commonly occurs from falls in older people and motor vehicle accidents and contact sports in younger people.

Parkinson’s affects more than 1 million people in North America, most typically after age 60, according to the National Institutes of Health. It is a progressive disorder of the nervous system that primarily impacts balance and movement.

The study was supported by the U.S. Army Medical Research and Material Command and the U.S. Department of Veterans Affairs as part of the Chronic Effects of Neurotrauma Consortium (CENC), the National Institute of Neurological Disorders and Stroke, the National Institute on Aging and the American Federation for Aging Research.

The study’s co-authors are Amy Byers, PhD, MPH; Deborah Barnes, PhD, MPH; Yixia Li, MPH; and John Boscardin, PhD, all of UCSF and the San Francisco Veterans Affairs Medical Center.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.

Link to Press Release on UCSF website: https://www.ucsf.edu/news/2018/04/410246/football-scuffles-auto-injuries-may-raise-risk-parkinsons

If you have any questions or concerns regarding Parkinson's Disease, please call the Parkinson's Foundation at 1-800-473-4636 or reach out to our center at 1-415-502-1672.

New from the Parkinson's Foundation -- Stopping the Spiral Toward Demoralization in Parkinson's Disease

Stopping the Spiral Toward Demoralization in Parkinson’s Disease

People with chronic diseases such as Parkinson’s disease (PD) are at risk of spiraling into a demoralized state. Common symptoms include feeling helpless, hopeless, a sense of failure and incapacitated to respond to stressful situations. Doctors frequently fail to identify or address this issue. There is sparse research and a rare interest in screening for demoralization. In this month’s What’s Hot in PD? column we will address demoralization in Parkinson’s disease and suggest strategies to identify and address this problem.

Brian Koo, MD, and colleagues in the April edition of Neurology set out to determine the prevalence and associated features of demoralization. The researchers studied 96 people with Parkinson’s disease and compared them to 86 people without Parkinson’s.

Demoralization was measured by the Diagnostic Criteria for Psychosomatic Research, the Demoralization Questionnaire or the Kissane Demoralization Scale score. Study participants were counted as demoralized if any of the three scores were positive. Eighteen percent of people with Parkinson’s were demoralized as compared to eight percent of those without PD.

Depression was associated with demoralization, although interestingly there were participants who were demoralized but not depressed and those who were depressed but not demoralized. Younger unmarried participants with worse motor scores on the Unified Parkinson’s Disease Rating Scale (UPDRS)examination were at particular risk for demoralization (Koo, 2018).

The bottom line for people living with PD and care-partners is that demoralization is present in about one in five people with Parkinson’s. This symptom should not be confused with depression although it may co-occur with depression.

These tips that may be helpful for those suspicious of demoralization:

1. Younger unmarried people with PD with a high burden of parkinsonian motor features have a higher risk of demoralization.
2. Getting a referral for a licensed clinical social worker or counseling psychologist can be helpful.
3. Cognitive behavioral therapy may be useful, but more research is needed on this technique.
4. Do not assume that depression is the cause of demoralization.
5. Treatment of depression and/or apathy (if present) can help.
6. Getting a referral to a psychiatrist may be useful in select cases.
7. Doctors and members of the healthcare team who are positive can help.

Selected References

Koo BB, Chow CA, Shah DR, Khan FH, Steinberg B, Derlein D, Nalamada K, Para KS, Kakade VM, Patel AS, de Figueiredo JM, Louis ED. Demoralization in Parkinson disease. Neurology. 2018 Apr 4. pii: 10.1212/WNL.0000000000005425. doi:10.1212/WNL.0000000000005425. [Epub ahead of print] PubMed PMID: 29618626.

For more from the Parkinson's Foundation, visit www.parkinson.org. 

If you have any questions or concerns regarding Parkinson's Disease, please call the Parkinson's Foundation at 1-800-473-4636 or reach out to our center at 1-415-502-1672.