tag:theconversation.com,2011:/africa/topics/brain-damage-980/articlesBrain damage – The Conversation2024-03-14T17:19:15Ztag:theconversation.com,2011:article/2253892024-03-14T17:19:15Z2024-03-14T17:19:15ZMike Tyson is getting back in the ring at 58 – what could go wrong?<p>If at 58, I were to agree to a boxing match with a person half my age, much alarm would be caused. My daughters would burst into tears, my partner would have strong words, and my students would have final confirmation that I had lost the plot. I, however, am not “Iron Mike” Tyson.</p>
<p>On <a href="https://talksport.com/sport/1783383/mike-tyson-new-training-footage-fans-jake-paul-fight/">July 20</a>, the former heavyweight boxing world champion is due to step into the ring at the AT&T Stadium in Arlington, Texas, to fight YouTuber-turned-boxer Jake Paul. Tyson will be 58, Paul will be 27.</p>
<p>Let’s take a look at what will be going on biologically for Iron Mike.</p>
<p>Receiving repeated blows to the body can tire a boxer out, and a well-aimed shovel hook to the liver can cause a “technical knockout”, but the head is the main target. Boxers are always looking for the knockout blow – and that only happens if you hit the head.</p>
<p>However, the head takes many forceful blows before a knockout is achieved – if it is achieved at all. Many boxers “go the distance” – in other words, manage to fight till the end, which can be anywhere from four to 12 rounds, each lasting three minutes. So what are the potential effects of all this head trauma?</p>
<p>The immediate effects may be minimal; the boxer may simply recover. But on some occasions, the effects may be devastating: a <a href="https://www.nhs.uk/conditions/subdural-haematoma/">subdural haematoma</a> can occur. In this condition, shearing forces cause tearing of <a href="https://pubmed.ncbi.nlm.nih.gov/25052244/">bridging veins</a> between the brain and blood vessels within the brain coverings, or meninges. </p>
<p>Bleeding from these torn veins causes a collection of blood that presses on the brain. This causes confusion, loss of consciousness, neurological disability and, in some cases, death.</p>
<p>In older people, the brain tends to lose volume. This lengthens the bridging veins and makes them more vulnerable to rupture. Alcoholism is known to accelerate brain shrinkage, and it appears that Tyson has this as a <a href="https://www.essence.com/news/mike-tyson-im-verge-dying-alcoholism/">past risk factor</a>.</p>
<p>I recall a patient, a boxer who had previously sustained a <a href="https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/neurosurgery/subdural-haematoma--final-march-2021.pdf?rev=c5e687418d7947f38186d63cac47b012&sc_lang=en">subdural haematoma</a> and had physical disability and terrible depression. These were devastating permanent effects.</p>
<p>Shearing forces on the brain cause injury to neurons (brain cells). Nerve fibres can be torn and this can lead to effects that are either subtle or quite significant. This so-called <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury#:%7E:text=Diffuse%20axonal%20injury%20is%20the,different%20parts%20of%20the%20brain.">“diffuse axonal injury”</a> is cumulative over time and may lead to early loss of cognitive function. This is known as dementia pugilistica, or <a href="https://www.ncbi.nlm.nih.gov/books/NBK470535/">chronic traumatic encephalopathy</a> (CTE). </p>
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Read more:
<a href="https://theconversation.com/sport-induced-traumatic-brain-injury-families-reveal-the-hell-of-living-with-the-condition-172828">Sport-induced traumatic brain injury: families reveal the 'hell' of living with the condition</a>
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<p>Repeated injuries lead to the accumulation of abnormal tau proteins in the brain. As a result, brain cells are lost and the brain shrinks. The patient experiences changes in behaviour, mood and the ability to think.</p>
<p>In some instances, a condition resembling Parkinson’s disease may result from loss of neurons in a part of the brain called the substantia nigra. <a href="https://www.theguardian.com/sport/2016/jun/04/muhammad-ali-parkinsons-greatest-battle">Muhammad Ali </a> may have been afflicted with this, but it was <a href="https://mbi.ufl.edu/2022/10/24/neurologists-who-treated-muhammad-ali-provide-evidence-for-primary-parkinsons-diagnosis/">never confirmed</a>.</p>
<h2>Heart problems</h2>
<p>Middle age sees an increase in the likelihood of cardiac events such as arrhythmia (irregular heartbeat), angina (reduced blood flow to heart muscles), and myocardial infarction (heart attack). Keeping fit protects against cardiovascular disease, and Tyson’s exercise regime will benefit him greatly. However, the temptation to overdo it in the gym is always there. </p>
<p>Extreme exercise can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538475/">lead to cardiac fibrosis</a> (scarring of the heart muscles), which over time may lead to heart failure or, sometimes, <a href="https://health.clevelandclinic.org/can-too-much-extreme-exercise-damage-your-heart">sudden death</a>. </p>
<p>Coronary atherosclerosis (narrowed heart arteries) is common in middle age, even in seemingly healthy people. However, it can lead to <a href="https://www.sciencedirect.com/science/article/pii/S0735109714071770">sudden death during exercise</a>. Although regular exercise reduces this risk, a <a href="https://www.cureus.com/articles/55486-cocaine-and-cardiotoxicity-a-literature-review#!/">cocaine habit elevates it</a> considerably – and Tyson has been known to have <a href="https://www.dailymail.co.uk/sport/boxing/article-9171725/Mike-Tyson-reveals-giving-cocaine-alcohol-changed-life.html">used the drug</a> in the past.</p>
<p>A blow to the chest can also prove troublesome. <a href="https://theconversation.com/a-blow-to-the-heart-can-kill-you-or-bring-you-back-to-life-224197">Commotio cordis</a> is a condition in which the heart muscle is damaged by such a blow. This can lead to an irregular heartbeat, reduced ability of the heart muscles to contract, and death. Quite uncommon, but coronary artery disease might make things worse.</p>
<h2>Age doesn’t have to be a barrier</h2>
<p>So far, I have concentrated on Iron Mike, but what of his opponent, Jake Paul? He is a much younger man and may well be free of cardiac disease and brain atrophy, which may protect him, to an extent. However, he has less boxing experience and is a late entrant to boxing. </p>
<p>There are plenty of examples of <a href="https://boxingnewsonline.net/10-boxers-who-competed-into-their-50s-and-60s/">boxers in their 50s and 60s</a> still fighting well and defeating younger competitors. If Tyson retains his speed, power and ability to outwit Paul, then Tyson may prevail. </p>
<p>Finally, let us remember that exercise at all ages is good for us, and there is good evidence that boxing in moderation has <a href="https://health.clevelandclinic.org/benefits-of-boxing">many health benefits</a>.</p><img src="https://counter.theconversation.com/content/225389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Hughes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A look at the physiology of the older pugilist.Stephen Hughes, Senior Lecturer in Medicine, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2223022024-02-21T13:13:43Z2024-02-21T13:13:43Z80% of premature baby deaths happen in poorer countries. Five simple measures that can help save them<p>Worldwide in 2020 a baby died every <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">40 seconds</a> because of complications of prematurity. Preterm birth is the <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">leading cause of death</a> among children under 5 years old. </p>
<p>The burden of preterm birth is <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">heavier in in low- and middle-income countries</a>, where around 80% occur. The countries with the highest recorded preterm rates in Africa are Malawi, South Africa, Ethiopia, the Democratic Republic of Congo and Botswana. In Ethiopia <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(23)00878-4.pdf">12.9%</a> of babies were born preterm in 2020. In Nigeria the figure was <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(23)00878-4.pdf">9.9%</a>.</p>
<p>Preterm birth occurs when a baby is born before 37 weeks’ gestation. Preterm babies are more at <a href="https://pubmed.ncbi.nlm.nih.gov/18207020/">risk</a> of severe neurological problems, like cerebral palsy, poor lung function and long-term problems with their guts. But around 95% of babies born preterm are born <a href="https://sasog.co.za/wp-content/uploads/2023/05/Born-Too-Soon-2023.pdf">after 28 weeks</a>. They often survive with relatively less complex medical interventions. </p>
<p>Given the scale of the problem, the preterm birth committee of the <a href="https://www.figo.org/">International Federation of Gynaecology and Obstetrics</a> selected five key interventions known to save lives. </p>
<p>We co-authored a recent <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">paper</a> in which we discussed the five measures. There are many other interventions that may improve outcomes at the time of labour and after preterm birth. But the five selected are clinically effective and relatively inexpensive options that can be practised in most settings.</p>
<h2>Five interventions</h2>
<p>The five interventions are:</p>
<p>1.) Giving a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">course of steroids</a> before the baby is born. This triggers changes in the baby’s lungs, allowing them to expand, and so makes breathing easier. Additionally, it reduces the risk of brain bleeds, bowel complications and death. </p>
<p>A study run by the World Health Organization in low- and middle-income countries estimated <a href="https://www.emro.who.int/child-adolescent-health/newborn-health/prematurity.html">370,000 babies</a> could be saved each year if steroids were administered. </p>
<p>The drug is on the WHO <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.03">List of Essential Medications</a>. It is relatively easy to administer and carries a low risk of causing the mother any problems. It is also heat stable and does not require refrigeration, which is very important for environments where electricity is in short supply. </p>
<p>2.) Mothers can be given <a href="https://www.ncbi.nlm.nih.gov/books/NBK554553/">magnesium sulphate</a> soon before delivery. This is known to <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004661.pub3/full">stabilise cell membranes</a> in the baby. This protects neurons and therefore reduces brain damage. Magnesium sulphate given to a mother in preterm labour can be <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004661.pub3/full">lifesaving</a>.</p>
<p>This drug is also on the WHO <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.03">List of Essential Medications</a> and appropriate for low income environments.</p>
<p>3.) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641757/">Delayed cord clamping</a> for at least a minute postnatally at delivery. </p>
<p>When a baby is born their umbilical cord is clamped and then cut. However, a delay of around a minute before clamping is associated with a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15269">reduction in neonatal death</a>. It also reduces the need for medications to support blood pressure in the baby – something that cannot be offered outside highly specialist medical facilities. </p>
<p>4.) Encouraging breast feeding within one hour of delivery.</p>
<p>Breastfeeding is particularly beneficial for premature babies, reducing the risks of serious complications of prematurity like severe infection or a serious bowel condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK513357/">necrotising enterocolitis</a> that often requires surgery as a lifesaving measure. </p>
<p>5.) Strongly encouraging immediate “kangaroo care”. </p>
<p><a href="https://www.who.int/publications/i/item/9241590351">Kangaroo care</a> involves a baby being placed skin-to-skin on the chest of its mother or another family member for extended periods of time – at least eight hours a day, but for as long as possible. </p>
<p>Premature babies are very prone to getting very cold. Kangaroo care <a href="https://pubmed.ncbi.nlm.nih.gov/34038632">reduces the risk</a> of death. This has been found to be the case even if there aren’t other options to stabilise the baby. </p>
<p>Kangaroo care also reduces the <a href="https://pubmed.ncbi.nlm.nih.gov/37277198/">risk of infection</a> and improves rates of breastfeeding. </p>
<p>Beyond the benefits for the baby, both kangaroo care and breastfeeding play an important part in involving parents in the care of their infant, and in reducing rates of <a href="https://pubmed.ncbi.nlm.nih.gov/37265678/">maternal postnatal depression</a>. </p>
<p>The risk of postnatal depression is known to be higher following a preterm birth. </p>
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Read more:
<a href="https://theconversation.com/every-2-seconds-in-the-world-a-baby-is-born-prematurely-report-identifies-biggest-challenges-for-their-survival-207034">Every 2 seconds in the world a baby is born prematurely – report identifies biggest challenges for their survival</a>
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<h2>Looking to the future</h2>
<p>All these interventions have a track record of being effective in low- and middle-income settings. But there has been no coordinated effort to make them better known worldwide. </p>
<p>Using multimedia and other training methods, the <a href="https://www.figo.org/news/new-ijgo-publication-effective-and-simple-interventions-improve-outcomes-preterm-infants">FIGO PremPrep-5 initiative</a> provides initial training to national obstetrics and gynaecology societies so that they can pass on the skills to other professionals.</p>
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<figcaption><span class="caption">Five simple ways to prevent preterm deaths.</span></figcaption>
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Read more:
<a href="https://theconversation.com/the-number-of-premature-baby-deaths-is-still-too-high-what-can-be-done-about-it-67534">The number of premature baby deaths is still too high. What can be done about it</a>
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<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Preterm babies born after 28 weeks can often survive with relatively simple medical care. Here is how.Andrew Shennan, Professor of Obstetrics at King’s College London and chair of the FIGO Preterm Birth Committee (2012-23)., King's College LondonMegan Hall, Clinical Research Fellow, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006032023-03-01T12:31:35Z2023-03-01T12:31:35ZAmerican man developed an Irish accent after getting prostate cancer – foreign accent syndrome explained<figure><img src="https://images.theconversation.com/files/512626/original/file-20230228-24-wakqx8.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C5825%2C3755&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-talking-alphabet-letters-coming-out-769827094">pathdoc/Shutterstock</a></span></figcaption></figure><p>An American man <a href="https://casereports.bmj.com/content/16/1/e251655">developed an Irish accent</a> following treatment for metastatic prostate cancer. The man was in his 50s and had never been to Ireland. </p>
<p>The accent was described as “uncontrolled”, meaning the man couldn’t stop talking with an Irish brogue, even if he tried. He continued speaking this way until his death.</p>
<p>This is the first time a person has developed “foreign accent syndrome” linked to a prostate cancer diagnosis. And it is <a href="https://casereports.bmj.com/content/16/1/e251655">only the third case</a> of foreign accent syndrome linked to cancer – the others were breast cancer and brain cancer.</p>
<p>Foreign accent syndrome usually happens as a <a href="https://pn.bmj.com/content/16/5/409">result of brain damage</a>, such as from a stroke. Stroke can cause different types of speech and language disorders, but foreign accent syndrome is one of the more unusual ones. </p>
<p>Other causes of the syndrome are changes to the structure of the brain, such as cancer tumours, encephalitis (brain swelling), multiple sclerosis and neurodegenerative disorders such as dementia.</p>
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<figcaption><span class="caption">Woman on This Morning, ITV, with foreign accent syndrome.</span></figcaption>
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<p>The condition was first described by <a href="https://en.wikipedia.org/wiki/Pierre_Marie">Pierre Marie</a>, a French neurologist, in 1907. Marie described the case of a man who originally spoke French with a Parisian accent, but after a stroke, he started speaking with a regional French accent from the area of Strasbourg in France. </p>
<p>To date, around 200 cases of foreign accent syndrome have been reported in clinical studies, making it quite a rare speech disorder. Perhaps the best-known case is when <a href="https://www.nme.com/news/music/george-michael-14-1264722">George Michael briefly spoke with a West Country accent</a> when he came out of a coma following a bout of pneumonia in 2011. The singer is from North London.</p>
<p>The condition can be distressing for patients because they lose an important personality characteristic that is expressed by their accent. The impact of this illness was reported in 1947 by the Norwegian neurologist Monrad-Krohn: he <a href="https://doi.org/10.1093/brain/70.4.405">described a Norwegian lady</a> who had suffered a serious head injury in a bombing raid during the second world war. As a result of this damage, she spoke Norwegian with a German foreign accent, and this was quite problematic in postwar Norway.</p>
<p>She was often refused service in shops because people thought she was German. Being identified as a foreigner all the time and being questioned about it can be very distressing. The effect may be so serious that some patients apply unusual methods to find peace of mind. We have heard of a lady with the syndrome saying that she enjoyed staying in hotels because it is very natural to hear a foreign accent in a hotel environment, so it goes unnoticed.</p>
<h2>Psychological causes</h2>
<p>Apart from damage to the central nervous system, foreign accent syndrome can also be caused by psychological factors such as extreme stress. We have identified “<a href="https://www.frontiersin.org/articles/10.3389/fnhum.2016.00168/full">psychogenic foreign accent syndrome</a>” as a separate type of foreign accent syndrome. In 2005, researchers were contacted by a native Dutch speaker who had a heavy and persistent French accent after suffering intense stress as a result of almost being hit by a car. Detailed <a href="https://doi.org/10.1155/2005/989602">neurological investigations</a> did not reveal any brain abnormalities, but psychological tests identified important psychological issues. She only fully returned to her original Dutch accent after ten years.</p>
<p>Another version of this condition is “mixed foreign accent syndrome”. These patients first develop a foreign accent because of brain damage and then try to change their word use to create a more convincing “foreign” personality. This was noticed by researchers at the <a href="https://doi.org/10.1080/02699200400026900">University of Central Florida</a> who saw an American patient who developed a British accent following a stroke and who started using British English words like lift (instead of elevator) and mum (instead of mom). </p>
<p>The patient explained that it was easier for her to allow people to believe that she was from England, rather than trying to explain that her accent was the result of a stroke. Although she insisted that her use of “Briticisms” was not under her conscious control.</p>
<p>Full recovery from the accent change is difficult and often requires intensive speech therapy for a long time. But there have been cases of fairly quick recovery.</p><img src="https://counter.theconversation.com/content/200603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Johan Verhoeven received funding from the Leverhulme Foundation. </span></em></p><p class="fine-print"><em><span>Stefanie Keulen received funding from Research Council of the Vrije Universiteit Brussel (2013-2017) and the Research Foundation Flanders (2017-2021).</span></em></p>There have only been around 200 reported cases of foreign accent syndrome since it was first reported in 1907.Johan Verhoeven, Professor of Experimental Phonetics, City, University of LondonStefanie Keulen, Assistant Professor/Research Leader, Vrije Universiteit BrusselLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892722022-09-14T18:19:47Z2022-09-14T18:19:47ZStroke: young people can have them too – here’s how to know if you’re at risk and what to look out for<p>American rapper Kid Cudi shared recently that he suffered a stroke in 2016 at age 32, while in rehab for his mental health.</p>
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<p>His stroke resulted in problems with speech and movement. Even after several months of rehabilitation, he still struggled with some aspects of memory – losing out on an acting role because of it. </p>
<p>Model Hailey Bieber also spoke out earlier this year about the “mini-stroke” she experienced. She was only 25. The stroke was caused by a blood clot on the brain. Her first symptoms were numbness and tingling on one side of the body, drooping of one side of the face and difficulty forming words. </p>
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
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<p>Most of us think of stroke as a condition that only affects older people. But while it’s more common in old age, <a href="https://pubmed.ncbi.nlm.nih.gov/28395017">around 10% of all strokes</a> happen in people under the age of 45 – and the figure is rising.</p>
<p>Here’s what you need to know about why strokes happen, who’s most at risk, and what kind of symptoms you need to look out for.</p>
<h2>Types of stroke</h2>
<p>Stroke happens when there’s an <a href="https://jnnp.bmj.com/content/91/4/411">interruption of blood supply and oxygen</a> to the brain, which is caused by an obstruction, injury or haemorrhage. A number of factors may increase your risk of experiencing one.</p>
<p>For example, certain congenital factors may increase your risk. In Hailey Bieber’s case, her stroke was caused by a congenital hole in her heart which allowed a blood clot to escape into her bloodstream and travel to the brain. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795593">Other factors</a> that may increase stroke risk include heavy drug and alcohol use and head trauma – which is why wearing head protection during certain sports is so important.</p>
<p>Although we don’t currently have data showing exactly how common strokes are in people aged between 20 and 40, we do know what types of stroke this age group is most likely to have. </p>
<p>For example, one report claims that half of all strokes in people between the ages of 15-44 are <a href="https://pubmed.ncbi.nlm.nih.gov/23108720/">ischemic strokes</a>. This occurs when a blood clot or other substance (such as cholesterol) causes a blockage to the brain’s blood supply. These can occur as a transient ischemic stroke, which is similar to what Hailey Bieber had. This is essentially the same as a stroke, except the symptoms last for a much shorter time because the blockage is temporary. </p>
<p>Bleeding in the brain (also know as an intracerebral haemorrhage) is the <a href="https://pubmed.ncbi.nlm.nih.gov/12468771/">second most common cause</a> of strokes in young people. This happens when the brain’s arteries and veins rupture, usually due to a head injury, high blood pressure or a blockage (such as an aneurysm or embolism). This type of stroke is serious and can be fatal in some cases. </p>
<p>The third type of stroke, called a subarachnoid hemorrhage, is caused by bleeding on the surface of the brain. Blood becomes trapped beneath the brain’s protective subarachnoid layer, causing swelling which compresses the brain against the skull – leading to additional brain damage. Again, it’s very serious and may be fatal. However, this type of stroke is <a href="https://www.ncbi.nlm.nih.gov/books/NBK518975/">less common</a> than the other two types in young people. </p>
<h2>What to look out for</h2>
<p>Importantly, stroke symptoms aren’t any different for young people compared to older people. But since most people don’t expect to have a stroke in their 20s or 30s, they don’t recognise the symptoms or may downplay them if they do occur. Similarly, medical staff don’t expect young people to have a stroke, which may lead to misdiagnosis or <a href="https://pubmed.ncbi.nlm.nih.gov/20719534/">not being treated quickly enough</a>. </p>
<p>This could have a detrimental effect on recovery, especially since it’s vital that stroke is treated quickly to halt bleeding or treat the blood clot. Rapid response and treatment can also make the difference in whether or not a person recovers, which is why knowing the symptoms of a stroke can be so important. </p>
<p>Stroke symptoms typically affect one side of the body, and may cause odd sensations, such as tingling or numbness of the face, arm or leg. Confusion, dizziness, loss of balance, drooping of one side of the face and trouble speaking are also common.</p>
<p>The symptoms and <a href="https://www.stroke.org/en/about-stroke/effects-of-stroke">effects of the stroke</a> depend entirely on <a href="https://www.flintrehab.com/areas-of-the-brain-affected-by-stroke/">which brain regions</a> have been deprived of oxygen. Again, this is the same in young people as it is in older people. </p>
<p>So if the stroke affects a part of the brain necessary for speech, then speech may be impaired or lost. If the stroke affects motor areas of the brain then body weakness or paralysis may be more likely (depending on the stroke’s severity). If it affects the brainstem, total paralysis, coma, or death are possible.</p>
<p>The outcome of a stroke in young people can be complicated. While young brains are <a href="https://pubmed.ncbi.nlm.nih.gov/22238419">better able to repair themselves</a> after trauma, the brain isn’t fully developed until 28. So in some ways it <a href="https://psycnet.apa.org/record/2016-21173-001">may actually be more vulnerable</a> than an older brain to damage. </p>
<p>Stroke at a young age could also seriously delay or hamper development as well as many other aspects of life, such as independence, employment, or relationships. This is why it’s so important to know the signs of a stroke and get treatment immediately. </p>
<p>If you suspect you or someone else is having a stroke, do not hesitate to contact emergency services. Time is critical for stroke treatment and the longer the stroke goes untreated the worse the prognosis. </p>
<p>The good news is that medical treatment of stroke has advanced and immediate treatment can result in a positive outcome and good recovery. Importantly, never ignore symptoms of stroke.</p><img src="https://counter.theconversation.com/content/189272/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynne A Barker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kid Cudi and Hailey Bieber are among the growing proportion of stroke victims who are under 45.Lynne A Barker, Associate Professor in Cognitive Neuroscience, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847402022-07-21T12:25:29Z2022-07-21T12:25:29ZSilent, subtle and unseen: How seizures happen and why they’re hard to diagnose<figure><img src="https://images.theconversation.com/files/470665/original/file-20220623-64215-3tfegq.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5104%2C3380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Approximately 10% of people will experience at least one seizure during their lifetime.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/brain-and-brain-waves-in-epilepsy-royalty-free-illustration/973895626?adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>The dramatic and incapacitating nature of seizures is reflected in the word itself, which derives from the Greek “to take hold” – like an invisible force suddenly grasping someone and controlling their body. This sense of an unknown force has driven many superstitions and misrepresentations of seizures throughout history.</p>
<p>Over the past century, the public’s understanding of seizures has been gleaned mostly from depictions in movies and television, which are often as disturbing as they are inaccurate. While these dramatic representations intensify visual storytelling, they frequently perpetuate stigma and <a href="https://doi.org/10.1111/j.1528-1157.1999.tb00836.x">understate the complexity of seizures</a>. </p>
<p>The truth is, seizures are far more varied than what you see in popular culture. Instead, they are often subtle, silent and unseen.</p>
<p><a href="https://som.ucdenver.edu/Profiles/Faculty/iframeProfile/30305">As a neurologist</a> who focuses on the comprehensive care of people who experience seizures, I subspecialize in the treatment of those with epilepsy. That includes identifying and improving gaps in epilepsy care. Research shows there are many.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PG12JfJJW9U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Epilepsy is a complex condition, but it is also treatable.</span></figcaption>
</figure>
<h2>Why seizures occur</h2>
<p>A seizure is caused by sudden uncontrolled <a href="https://www.cureepilepsy.org/for-patients/understanding/basics/what-is-seizure/?">electrical activity from a group of neurons</a>. This hyperactivity overwhelms the brain’s normal tendency to suppress such abnormal activity on both a cellular and network level. </p>
<p>Not all seizures are indicative of epilepsy. An otherwise normal brain may experience seizures during alcohol withdrawal. Seizure-like events may also occur with an acute decrease in blood flow, which can cause fainting. </p>
<p>Seizures associated with epilepsy, on the other hand, are <a href="https://www.epilepsydiagnosis.org/">unprovoked and often very difficult to predict</a>. A broad spectrum of underlying abnormalities can all lead to the development of epileptic seizures, including brain tumors, infections, strokes, traumatic brain injury, autoimmune conditions, developmental abnormalities and genetic predispositions.</p>
<h2>Seizures are not uncommon</h2>
<p>Approximately 1 in 10 people <a href="https://doi.org/10.1212/WNL.40.8.1163">will experience a seizure</a> during their lifetime. But only those with a risk of recurrent unprovoked seizures are <a href="https://doi.org/10.1111/epi.13670">considered to have epilepsy</a>, which represents about <a href="https://doi.org/10.1111/J.1528-1157.1993.TB02586.X">1 in 26 people</a></p>
<p>Because of the wide variety of symptoms, substantial <a href="https://doi.org/10.1007/s11910-021-01161-8">delays to diagnosis and treatment</a> can happen. When unrecognized and untreated, seizures worsen over time and lead to <a href="https://doi.org/10.1016/j.yebeh.2015.10.020">decreased quality of life</a>, <a href="https://doi.org/10.1111/epi.16707">cognitive impairments</a>, <a href="https://doi.org/10.1111/j.1528-1157.1995.tb01660.x">injuries, including motor vehicle accidents</a>, and <a href="https://doi.org/10.1093/brain/awt117">sometimes death</a>. </p>
<p>The irony is, much of the suffering is unnecessary. Most people with epilepsy <a href="https://doi.org/10.1111/j.1528-1167.2009.02481.x">can be seizure-free</a> through the use of an inexpensive medication.</p>
<h2>Focal seizures</h2>
<p>Regardless of the cause, <a href="https://doi.org/10.1111/j.1528-1167.2009.02481.x">focal seizures</a> are the most common type found in adults. This seizure type arises from hyperactivation of a confined brain region. For instance, a seizure arising from the left motor cortex of the brain may result in shaking of the right arm. A seizure arising from the visual cortex may cause a person to see flashes of light or other strange visual phenomena. </p>
<p>The most common brain region for focal seizures to arise is one of the temporal lobes, of which there are two – one on either side of the brain. These lobes serve many functions and are involved in vocal, auditory and visual processing, as well as emotions and memory. This is why seizures arising from these areas can lead to a variety of unusual symptoms.</p>
<p>Frequently, focal temporal lobe seizures are relatively subtle, particularly to witnesses. Sometimes they are comprised of purely unusual internal sensations such as sudden intense fear, a sudden sense of déjà vu or possibly a strong odor. Until a seizure spreads to involve more areas of the brain, it may not cause loss of consciousness or convulsions.</p>
<p>Because untreated seizures become more frequent and severe over time, it is not uncommon for epilepsy to begin with these relatively subtle focal seizures, then worsen as the seizures begin to involve more brain tissue, and eventually progress to convulsions.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/W_uXaXwVQ4c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">People affected by epilepsy discuss the myths surrounding the condition.</span></figcaption>
</figure>
<h2>Delays in diagnosis</h2>
<p>A patient of mine described having strange symptoms for over a decade – symptoms he had not discussed before with me or anyone else. He described recurrent, sudden-onset euphoric sensations, which progressed to an inability to speak for one to two minutes. A bystander would think he was just staring into space. Over the years, these sensations increased in frequency. They eventually became more severe and led to loss of consciousness. </p>
<p>After the patient began an anti-seizure medication regimen, the sensations went away, and he reported improvements in both memory and cognition. Fortunately, he did not experience physical injury, or worse, before his evaluation. But many people are not so lucky.</p>
<p>Recent studies have confirmed that <a href="https://doi.org/10.1002/epi4.12443">delays in diagnosis are common</a> among people who have epilepsy. Undoubtedly, this is because the early subtle and unusual symptoms are not well recognized by patients, families or medical professionals. </p>
<h2>A revealing study</h2>
<p><a href="http://www.humanepilepsyproject.org/">The Human Epilepsy Project</a> is a large, multinational prospective study that followed nearly 500 people with newly treated focal epilepsy for five years. I was among the researchers who analyzed the study’s data, and we found a striking diagnostic delay among many participants. Many of them experienced seizures for <a href="https://doi.org/10.1111/epi.16707">several months or even several years before diagnosis</a>. </p>
<p>From those first seizures to the diagnosis, half the participants experienced injuries; 5% had car accidents attributable to seizures. Extrapolating this data to the general population suggests that every year in the U.S., over 1,800 motor vehicle accidents are due to <a href="https://doi.org/10.1111/epi.16707">undiagnosed subtle focal seizures</a>. With a timely diagnosis, these accidents are potentially preventable.</p>
<p>However, even those evaluated for seizures don’t always receive the correct diagnosis or treatment. Nearly two-thirds of those participating in the Human Epilepsy Project sought an initial seizure evaluation in an emergency department. About 90% were there only after their first convulsive seizure – that is, after the seizure spread and now involved the full brain. </p>
<p>But leading up to that first convulsive seizure, nearly half of participants had been experiencing nonmotor focal seizures, which went largely unrecognized. For that reason, many people who <a href="https://doi.org/10.1111/acem.14114">could have been diagnosed with epilepsy</a> and started on treatment were not. </p>
<p>As it stands now, about 200,000 U.S. adults <a href="https://doi.org/10.1111/j.1528-1167.2008.01443.x">seek evaluation at a hospital’s emergency department</a> for a first lifetime seizure every year. Often, they are diagnosed with epilepsy at that time or shortly thereafter. Poor recognition of subtle seizures bears significant consequences for individuals, communities and the health care system. Improving our understanding of the diverse ways seizures arise and affect lives will help us close the gap and lessen the consequences.</p><img src="https://counter.theconversation.com/content/184740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacob Pellinen receives funding in the form of grants from the University of Colorado Department of Neurology, NIH/NCATS Colorado CTSA Grant Number UL1 TR002535, and from the American Epilepsy Society.</span></em></p>Because some seizures are relatively subtle, they can go unrecognized, leading to a delay in diagnosis.Jacob Pellinen, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1804992022-04-04T20:43:37Z2022-04-04T20:43:37ZBruce Willis’s aphasia diagnosis draws attention to a common language disorder<figure><img src="https://images.theconversation.com/files/456211/original/file-20220404-13-kc2qvo.jpg?ixlib=rb-1.1.0&rect=230%2C15%2C3052%2C2302&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aphasia is a language disorder that affects about 30 per cent of stroke patients.</span> <span class="attribution"><span class="source">(Denis Makarenko/Shutterstock.com)</span></span></figcaption></figure><p>Until the recent news that <a href="https://variety.com/2022/film/news/bruce-willis-retiring-acting-apashia-1235219017/">Bruce Willis</a> had been diagnosed with aphasia and was retiring from acting, many people were <a href="https://www.aphasia.org/2020-aphasia-awareness-survey/">unfamiliar with the condition</a>. Despite its low profile, aphasia is not uncommon. </p>
<p>Across <a href="https://www.sac-oac.ca/news-events/news/speech-hearing-month-2021-what-aphasia">Canada</a> and the <a href="https://www.aphasia.org/">United States</a>, it’s estimated that more than two million people are living with aphasia and its associated challenges in communication and in using and understanding language.</p>
<p><a href="https://www.aphasia.ca/">Aphasia</a> affects language abilities, including listening, speaking, reading and writing. Some common language symptoms that occur in individuals living with aphasia are:</p>
<ul>
<li><p>Difficulty coming up with the right word. An individual might use a related word (for example, they may say or write “daughter” when trying to find the word “niece”) or even use a made up word (for example, say or write “pitsy” when trying to find the word “niece”).</p></li>
<li><p>Making mistakes in grammar or syntax such as omitting word endings. Examples include leaving off the plural “s” or “ed” to indicate past tense, or putting words in the wrong order, such as: “The cat was his ran house out.”</p></li>
<li><p>Needing more time to process what is said to them and needing more time to formulate a response.</p></li>
<li><p>Difficulty understanding individual letters, speech sounds or words when listening or reading, even though prior to the onset of aphasia, these letters, sounds and words were automatically understood.</p></li>
</ul>
<p>For individuals with aphasia who use sign language, their ability to use and understand signs is also negatively affected. Some people with aphasia may also experience problems using and understanding nonverbal means of communication, such as gestures and facial expressions.</p>
<h2>Causes of aphasia</h2>
<figure class="align-center ">
<img alt="A silhouette of a head with a maze, and a red line going from through the maze from the braid to the mouth" src="https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456217/original/file-20220404-15-yuez6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aphasia affects language abilities including listening, speaking, reading and writing.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Aphasia is not a disease, but rather a consequence of damage to the language-dominant regions of the brain. This brain damage is typically caused by a stroke (<a href="https://www.heartandstroke.ca/stroke/what-is-stroke">interruption of blood flow to or within the brain</a>), or sometimes by a traumatic brain injury, a brain tumour or an infection, such as meningitis. Stroke is the <a href="https://doi.org/10.3109/17549507.2010.520090">most common cause</a>, with aphasia affecting approximately <a href="https://doi.org/10.1016/j.apmr.2016.03.006">30 per cent of stroke patients</a>. </p>
<p>Aphasia is also <a href="https://doi.org/10.1002/ana.410110607">a key component</a> of a progressive neurodegenerative disease called <a href="https://www.aphasia.org/aphasia-resources/primary-progressive-aphasia/">primary progressive aphasia</a>, a type of <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/frontotemporal-dementia">frontotemporal dementia</a>.</p>
<p>Because the parts of the brain that support language also support other cognitive abilities, individuals living with aphasia may experience some difficulties in <a href="https://doi.org/10.1044/1058-0360(2012/11-0067)">attention, memory and thinking skills</a> like problem solving or planning. People living with aphasia may be challenged in these other cognitive functions because we often use and understand language in concert with these other functions. For example, rehearsing out loud or using your inner mind’s voice to repeat silently the items you have been asked to pick up at the store.</p>
<p>There is great <a href="https://doi.org/10.1093/brain/awab377">variability in the language symptoms</a> experienced by individuals living with aphasia. For example, one individual may experience significant difficulties equally across all language modalities. Another person may experience difficulties primarily in their verbal output and few difficulties with understanding what is said, written or gestured. </p>
<p>Likewise, there is a spectrum of aphasia severity. Some people with aphasia may only be able to understand short, common words. Others may only experience comprehension difficulties when reading books or following complex podcasts that include, for example, technical jargon or complex stories. </p>
<p>Variability also is common among those living with aphasia who are bilingual or multilingual. One individual with aphasia might experience similar difficulties in all of their languages while another might struggle more in one versus another of their languages.</p>
<h2>Living with aphasia</h2>
<figure class="align-right ">
<img alt="A bald man in a black suit with other people behind him" src="https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=852&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=852&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=852&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1071&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1071&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456213/original/file-20220404-21-pldbem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1071&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Like Bruce Willis, who has retired from acting, many people with aphasia are unable to remain in their vocation of choice.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Frank Gunn)</span></span>
</figcaption>
</figure>
<p>Regardless of the breadth and severity of the language symptoms, aphasia is challenging for those living with the language disorder, as well as for their family and friends. Having aphasia can make it difficult to complete daily activities like reading prescription medication labels, booking an appointment or using a phone. </p>
<p>Like Willis, many individuals with aphasia will not be able to remain in their vocation of choice. Aphasia also can lead to negative consequences for social roles, relationships and activities. Consider how many components of parenting involve language (listening to your child’s day at school, reading with your child, reprimanding) and how essential communication is to maintaining close relationships with family and friends. </p>
<p>Most leisure activities similarly involve language, whether it is reading for pleasure, watching movies or travelling. Because of these daily struggles, many individuals with aphasia also experience <a href="https://doi.org/10.1186/s13063-016-1257-9">mental health issues such as depression</a>.</p>
<h2>Assessment and services for people with aphasia</h2>
<p>However, there is help and hope for those with aphasia. Decades of aphasia research indicate <a href="https://doi.org/10.1002/14651858.CD000425.pub4">there are many interventions</a> to improve individuals’ language abilities and help them compensate for their language impairments. An important first step for getting help is <a href="https://doi.org/10.1161/STR.0b013e3181e7512b">seeking an assessment from a speech-language pathologist</a>. </p>
<p>Given the various manifestations of aphasia, a comprehensive assessment is needed to determine its presence and an individual’s language and communication strengths and weaknesses. The assessment also will help the <a href="https://www.sac-oac.ca/">speech-language pathologist</a> identify <a href="https://www.heartandstroke.ca/services-and-resources/aphasia-services">interventions that can help individuals living with aphasia</a> and their family and friends achieve their language and communication goals.</p>
<p>In addition to assessment and intervention services, family and friends can <a href="https://www.sac-oac.ca/sac-resource-page-stroke-awareness">find other ways</a> to <a href="https://www.aphasia.ca/">support someone living with aphasia</a>. </p>
<p>By sharing his diagnosis of aphasia, Willis and his family are helping <a href="https://doi.org/10.1080/02687038.2019.1702847">increase awareness</a> of this complex and often debilitating language disorder. Increasing awareness among the public and health-care professionals is an important step in ensuring that individuals living with aphasia <a href="https://doi.org/10.1080/09638288.2020.1722264">can participate in their community and receive appropriate health-care services</a>.</p><img src="https://counter.theconversation.com/content/180499/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Across Canada and the United States, more than two million people are living with aphasia and its language and communication challenges.Laura Murray, Associate Dean of Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western UniversityJ.B. Orange, Professor and Acting Director, School of Communication Sciences and Disorders; Scientific Director, Canadian Centre for Activity and Aging, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648572021-08-10T20:14:19Z2021-08-10T20:14:19ZHow does COVID affect the brain? Two neuroscientists explain<figure><img src="https://images.theconversation.com/files/415148/original/file-20210809-18-obzaj9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4000%2C2670&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Scientists are becoming more and more concerned with the emergence of a syndrome termed “long COVID”, where a significant percentage of sufferers of COVID-19 experience long-lasting symptoms.</p>
<p>Studies suggest <a href="https://spiral.imperial.ac.uk/handle/10044/1/89844">symptoms remain</a> for approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225991/">5</a>-<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298139/">24%</a> of confirmed COVID cases, at least three to four months after infection.</p>
<p>The risk of long COVID is <a href="https://www.journalofinfection.com/article/S0163-4453(21)00009-8/fulltext">no longer</a> thought to be directly linked with either age or the initial severity of the COVID illness. So younger people, and people with initially mild COVID, can still develop long-COVID symptoms.</p>
<p>Some long-COVID <a href="https://doi.org/10.1007/s11910-021-01130-1">symptoms</a> begin quickly and persist, whereas others appear well after the initial infection has passed. </p>
<p>Symptoms include extreme fatigue and ongoing breathing complications.</p>
<p>What particularly concerns us as neuroscientists is that many long COVID sufferers report difficulties with attention and planning — known as “brain fog”.</p>
<p>So how does COVID affect the brain? Here’s what we know so far.</p>
<h2>How does the virus get to our brains?</h2>
<p>There’s evidence connecting respiratory viruses, including influenza, with brain dysfunction. In <a href="https://link.springer.com/content/pdf/10.1007/s00702-009-0295-9.pdf">records</a> of the <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12255">1918 Spanish flu pandemic</a>, reports abound of dementia, cognitive decline, and difficulties with movement and sleep.</p>
<p><a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30203-0/fulltext">Evidence</a> from the SARS outbreak in 2002 and the MERS outbreak in 2012 suggest these infections caused roughly 15-20% of recovered people to experience depression, anxiety, memory difficulties and fatigue.</p>
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<p>There’s no conclusive evidence the SARS-CoV-2 virus, which causes COVID, can penetrate the blood brain barrier, which usually protects the brain from large and dangerous blood-borne molecules entering from the bloodstream.</p>
<p>But there’s <a href="https://www.nature.com/articles/s41593-020-00758-5">data</a> suggesting it may “hitchhike” into the brain by way of nerves that connect our noses to our brains. </p>
<p>Researchers suspect this because in many infected adults, the genetic material of the virus was <a href="https://www.nature.com/articles/s41593-020-00758-5">found in the part of the nose</a> that initiates the process of smell — coinciding with the loss of smell experienced by people with COVID.</p>
<h2>How does COVID damage the brain?</h2>
<p>These nasal sensory cells connect to an area of the brain known as the “limbic system”, which is involved in emotion, learning and memory.</p>
<p>In a <a href="https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v2">UK-based study released as a pre-print online in June</a>, researchers compared brain images taken of people before and after exposure to COVID. They showed parts of the limbic system had decreased in size compared to people not infected. This could signal a future vulnerability to brain diseases and may play a role in the emergence of long-COVID symptoms. </p>
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<p>COVID could also indirectly affect the brain. The virus can <a href="https://journals.lww.com/jcat/Abstract/2021/07000/Neuroimaging_in_the_First_6_Weeks_of_the_COVID_19.14.aspx">damage blood vessels</a> and cause either bleeding or blockages resulting in the disruption of blood, oxygen, or <a href="https://academic.oup.com/brain/article/144/4/1263/6209743">nutrient supply to the brain</a>, particularly to areas responsible for problem solving.</p>
<p>The virus also activates the immune system, and in some people, this triggers the production of toxic molecules which can <a href="https://link.springer.com/article/10.1007%2Fs11910-021-01130-1">reduce brain function</a>.</p>
<p>Although research on this is still emerging, the effects of COVID on nerves that control gut function should also be considered. This may impact digestion and the health and composition of gut bacteria, which are <a href="https://pubmed.ncbi.nlm.nih.gov/25830558/">known to influence the function of the brain</a>.</p>
<p>The virus could also compromise the function of the pituitary gland. The pituitary gland, often known as the “master gland”, regulates hormone production. This includes cortisol, which governs our response to stress. When cortisol is deficient, this <a href="https://link.springer.com/article/10.1007%2Fs12020-020-02325-1">may contribute</a> to long-term fatigue.</p>
<p>This was a recognised phenomenon <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2005.02325.x">in patients who were diagnosed with SARS</a>, and in a disturbing parallel with COVID, people’s symptoms continued for up to one year after infection.</p>
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<p>Given the already <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30411-9/fulltext">significant contribution</a> of brain disorders to the global burden of disability, the potential impact of long COVID on public health is enormous.</p>
<p>There are major unanswered questions about long COVID which require investigating, including how the disease takes hold, what the risk factors might be and the range of outcomes, as well as the best way to treat it.</p>
<p>It’s crucial we begin to understand what causes the wide variation in symptoms. This could be many factors, including the viral strain, severity of the infection, the effect of pre-existing disease, age and vaccination status, or even the physical and psychological supports provided from the start of the disease.</p>
<p>While there are many questions about long COVID, there’s certainty about one thing: we need to continue doing everything we can to prevent escalating COVID cases, including getting vaccinated as soon as you’re eligible.</p>
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<p><em>The Florey Institute’s Sarah Handcock was also a co-author of this article.</em></p><img src="https://counter.theconversation.com/content/164857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Petrou is an equity holder and paid consultant of Praxis Precision Medicine, though the company is not currently doing any work that relates to COVID-19. He receives funding from the Australian Government's Medical Research Future Fund and Praxis Precision Medicines.
</span></em></p><p class="fine-print"><em><span>Trevor Kilpatrick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many long COVID sufferers are reporting having ‘brain fog’, where they can’t concentrate as well as they used to.Trevor Kilpatrick, Professor, Neurologist and Clinical Director, Florey Institute of Neuroscience and Mental HealthSteven Petrou, Professor and Director, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1582772021-05-04T12:15:56Z2021-05-04T12:15:56ZBiden’s infrastructure plan targets lead pipes that threaten public health across the US<figure><img src="https://images.theconversation.com/files/398397/original/file-20210503-13-1hswze.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C5422%2C3645&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lead pipe (left) seen through a hole in the kitchen ceiling in the home of Desmond Odom, in Newark, New Jersey.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/EPADrinkingWaterLead/f8f74d0050304533ac70263c5c50bad7/photo">AP Photo/Julio Cortez</a></span></figcaption></figure><p>President Joe Biden’s infrastructure plan includes a proposal to upgrade the U.S. drinking water distribution system by removing and replacing dangerous lead pipes. As a <a href="http://scholar.google.com/citations?user=MEp4948AAAAJ&hl=en">geochemist and environmental health researcher</a> who has studied the heartbreaking impacts of lead poisoning in children for decades, I am happy to see due attention paid to this silent killer, which <a href="https://doi.org/10.1029/2018GH000167">disproportionately affects poor communities of color</a>.</p>
<p>Biden’s proposal <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/">includes US$45 billion</a> to eliminate all lead pipes and service lines nationwide. The funding would go to <a href="https://www.epa.gov/dwsrf#:%7E:text=The%20Drinking%20Water%20State%20Revolving,to%20state%20safe%20water%20programs">programs</a> <a href="https://www.epa.gov/dwcapacity/water-infrastructure-improvements-nation-act-wiin-act-grant-programs">administered</a> by the U.S. Environmental Protection Agency. </p>
<p>This effort would affect an estimated <a href="https://www.greenbiz.com/article/american-jobs-plan-gives-water-infrastructure-much-needed-boost">6 million to 10 million homes</a>, along with <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/">400,000 schools and child care facilities</a>. I see it as one of the nation’s best chances to finally get the lead out of the nation’s drinking water, and its children.</p>
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<h2>Lead poisoning does permanent damage</h2>
<p>Lead poisoning is a major public health problem, because lead has permanent impacts on the brain, particularly in children. Young brains are <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">still actively forming</a> the amazing network of neurons that comprise their hardware. </p>
<p>Neurons are designed to use calcium, the most abundant mineral in the human body, as a transmitter to rapidly pass signals. Lead is able to penetrate the brain because lead molecules look a lot like calcium molecules. If lead is present in a child’s body, it can impair neuron development and cause permanent neural damage.</p>
<p>Children with lead poisoning have lower IQs, poor memory recall, high rates of attention deficit disorder and low impulse control. They tend to <a href="https://www.cdc.gov/nceh/lead/prevention/health-effects.htm">perform poorly at school</a>, which reduces their earning potential as adults. They also face increased risk of <a href="https://www.kidney.org/atoz/content/lead-exposure-and-kidney-function">kidney disease</a>, <a href="https://doi.org/10.1289/ehp.9785">stroke and hypertension</a> as they age. Research has found strong connections between lead poisoning and <a href="https://www.brookings.edu/blog/up-front/2017/06/01/new-evidence-that-lead-exposure-increases-crime/">incarceration for violent crimes</a>. </p>
<p>The prevalence of childhood lead poisoning has <a href="https://doi.org/10.1367/1539-4409(2003)003%3C0027:POLTIU%3E2.0.CO;2">declined significantly in the U.S.</a> over the past 50 years. That’s largely due to the elimination of leaded gasoline in the 1980s and the banning of most lead-based paints.</p>
<p>In the 1970s, nearly 90% of children in the U.S. ages 1 to 5 had blood lead levels <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5210a1.htm">above 10 micrograms per deciliter of blood</a>, which then was the “level of concern” under federal health guidelines. Today, according to Centers for Disease Control and Prevention officials, <a href="https://www.nytimes.com/2021/03/11/health/virus-lead-poisoning-children.html">roughly 2% of U.S. children</a> have elevated blood lead levels. </p>
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<p>This decline is a public health success story – but researchers estimate that <a href="https://www.aafp.org/afp/2019/0701/p24.html">about 500,000 U.S. children</a> still have elevated blood lead levels. In 2012 the CDC adopted a new blood lead “reference value” of <a href="https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm">5 micrograms per deciliter or above</a>, which identifies children in the highest 2.5% of those tested for lead in their blood. </p>
<p>Health experts widely agree that there is <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health">no known “safe” blood lead concentration</a>. And as long as lead water pipes remain in service, children and families are vulnerable.</p>
<h2>No maps of lead service lines</h2>
<p>Like many U.S. bridges, roads and ports, America’s water systems are old. Much of the drinking water infrastructure in older cities was <a href="https://www.circleofblue.org/2016/world/infographic-the-age-of-u-s-drinking-water-pipes-from-civil-war-era-to-today/">built before 1950</a>, before researchers started to grapple with the toxicity of lead. </p>
<p>Most American cities have countless miles of lead service lines buried beneath streets and sidewalks and feeding into people’s homes. Utilities don’t know where many of these aging lines are and don’t have enough data to map them. Replacing them will require significant analysis, modeling, data and some guesswork.</p>
<p>Old service lines have repeatedly caused lead poisoning outbreaks in places like Washington, D.C.; <a href="https://www.britannica.com/event/Flint-water-crisis">Flint, Michigan</a>; and <a href="https://www.njspotlight.com/2021/01/op-ed-lessons-from-newarks-aggressive-replacement-of-lead-service-lines/">Newark, New Jersey</a>. <a href="https://www.pnas.org/content/117/38/23211">The chemistry is a bit different</a> in each case. </p>
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<a href="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Workers at an excavation remove lead pipes from underground." src="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=696&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=696&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398412/original/file-20210503-23-1cvv9hr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=696&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Workers remove water service lines in Trenton, New Jersey, on Jan. 9, 2020. The city is replacing 37,000 lead pipes over five years.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/LeadWaterPipesNewJersey/3de7106d9ea547e89027f07a6e502a10/photo">AP Photo/Mike Catalini</a></span>
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<p>Lead service lines typically develop a protective “plaque” of minerals on their inside walls after a short time, which effectively separates the toxic lead pipe from the water flowing through it. This coating, which is called scale, remains stable if the chemistry of the water coursing through it doesn’t change. But if that chemistry is altered, disaster can ensue.</p>
<p>In 2002, Washington, D.C., shifted from chlorine to chloramine for treating its water supply. Chloramine is a more modern disinfectant that does not <a href="https://theconversation.com/can-drinking-water-be-delivered-without-disinfectants-like-chlorine-and-still-be-safe-55476">form dangerous reactive chlorinated byproducts</a> as chlorine can. </p>
<p>This rapidly corroded the protective plaque lining the city’s pipes, flushing highly absorbable lead into homes. <a href="https://www.washingtonpost.com/local/dcs-decade-old-problem-of-lead-in-water-gets-new-attention-during-flint-crisis/2016/03/17/79f8d476-ec64-11e5-b0fd-073d5930a7b7_story.html">Tens of thousands of children were exposed</a> over two years before the problem was adequately identified and fixed. </p>
<p>In Flint, state-appointed managers decided to save money during a fiscal crisis in 2014 by switching from Detroit water to water from the Flint River. Flint river water has completely different corrosivity than Detroit water, but officials <a href="https://doi.org/10.1021/acs.est.6b04034">did not require enough chemical analysis</a> to determine what additives should be used to maintain the pipe plaque. One egregious and ultimately toxic decision was to forgo the typical step of adding phosphate, which binds chemically with lead and prevents it from leaching out of pipes, in order to save <a href="https://www.scientificamerican.com/article/q-a-what-really-happened-to-the-water-in-flint-michigan/">about $100 per day</a>. </p>
<p>Corrosion chemistry is well controlled in many U.S. cities, but it is not a perfect science. And utilities don’t always have detection systems that adequately alert water suppliers to dangers at the tap. That’s why removing lead pipes is the only sure way to avoid the threat of more water crises. </p>
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<figcaption><span class="caption">Households can use some basic tests to identify water pipes that may be made of lead.</span></figcaption>
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<h2>Cities will need to innovate</h2>
<p>While $45 billion is a huge investment, in my view it probably isn’t enough to replace all lead pipes nationwide. Take Flint as an example. The estimated cost of replacing all of the city’s lead service lines is <a href="https://www.freep.com/story/news/local/michigan/flint-water-crisis/2016/05/27/flint-lead-lines-water-crisis/85032096/">about $50 million</a>. As a rough calculation, then, for $45 billion, the nation theoretically could remedy slightly fewer than 1,000 Flints. </p>
<p>But there are literally <a href="https://www.vox.com/policy-and-politics/2019/6/12/18661193/lead-pipes-paint-flint-michigan-usa-cost-fix">thousands of U.S. cities to fix</a>. Some are smaller than Flint and thus likely cheaper to remediate, but others are much larger. </p>
<p>[<em>The Conversation’s newsletter explains what’s going on with the coronavirus pandemic. <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=coronavirus-going-on">Subscribe now</a>.</em>]</p>
<p>My own city, Indianapolis, has a population of about 850,000. That’s roughly 10 times as big as Flint, which means 10 times as many households and water distribution end points. What’s more, officials have only a rough idea of where to find the city’s lead service lines. There are ways to <a href="https://www.wateronline.com/doc/statistical-modeling-in-support-of-lead-service-line-identification-inventory-and-replacement-0001">statistically model</a> the likelihood that a given portion of the water system has lead service lines, using information such as water main sizes, locations and construction dates, but they are imperfect. </p>
<p>Cities will need to get creative to make whatever funds they get go as far as possible. As one example, I am working with colleagues to develop a citizen science project that will provide thousands of tests for lead at taps around Indianapolis. This effort, a partnership with the University of Notre Dame funded by the U.S. Department of Housing and Urban Development, may augment modeling with real data on levels of lead in homes, and will increase public awareness of this issue. </p>
<p>Lead water pipes are ticking time bombs in cities across the U.S. Other important sources of lead exposure, such as <a href="https://doi.org/10.3390/ijerph13040358">soil and dust contamination</a>, also require urgent attention. But I believe fixing water systems is a critical step toward protecting children from the lifelong burdens of lead poisoning.</p><img src="https://counter.theconversation.com/content/158277/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel Filippelli does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Biden has proposed spending $45 billion to replace every lead water pipe and service line in the nation. A public health expert explains why he sees this as a worthwhile investment.Gabriel Filippelli, Professor of Earth Sciences and Director of the Center for Urban Health, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1464952020-10-15T13:44:03Z2020-10-15T13:44:03ZConcussion can accelerate ageing of the brain – research from the rugby pitch<figure><img src="https://images.theconversation.com/files/362455/original/file-20201008-18-1a5c086.jpg?ixlib=rb-1.1.0&rect=287%2C197%2C11658%2C5730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rugby-players-fight-ball-on-professional-1150451498">Shutterstock/Alex Kravtsov</a></span></figcaption></figure><p>The serious harm caused by concussion in sport first became apparent among the “<a href="https://link.springer.com/article/10.2165/00007256-200737060-00001#ref-CR1">punch-drunk</a>” boxers who suffered repetitive blows to the head over the course of their fighting careers. A related form of brain damage is known to affect a <a href="http://sites.bu.edu/mckeelab/files/2014/06/Chronic-traumatic-encephalopathy-neurodegeneration-following-repetitive-concussive-and-subconcussive-brain-trauma1.pdf">range of other sports and professions</a>, where repeated head injuries kill brain cells and gradually cause the brain to shrink.</p>
<p>By working closely with elite rugby union players, <a href="https://www.physoc.org/abstracts/elevated-systemic-oxidative-nitrosative-stress-and-cerebrovascular-function-in-professional-rugby-union-players-the-link-to-impaired-cognition/">our research</a> has now helped us to understand the impact of concussion on the brain as we get older. We have shown that brain function in a young player with a history of concussion is on a par with someone in their 60s. In simple terms, concussion seems to accelerate biological brain ageing by as much as three decades. </p>
<p>One important discovery was that concussed rugby union players have more “free radicals” – unstable, cell-damaging molecules – in their blood. They also have less nitric oxide, a beneficial molecule which allows more oxygen and glucose to get to the brain. As a result, blood vessels in the concussed brain react sluggishly to changes in blood flow, a condition known as “cerebrovascular impairment”.</p>
<p>Cerebrovascular impairment has been <a href="https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP276898">linked to cognitive dysfunction</a>, and can have a negative effect on the way a person thinks, concentrates, formulates ideas and remembers. It can also make them more vulnerable to <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.027448">dementia</a> in later life. In our analysis, these impairments were mostly seen in the regions of the brain where head contact is most frequently made during play. </p>
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<p>Both active and retired elite rugby union players were found to be cognitively impaired compared with people of a similar age and fitness, who had not been concussed or participated in contact sports. The effects also appeared to be related to a player’s position in the rugby team. They were particularly prevalent among forwards, who usually experience more tackles and collisions in a game compared to the backs.</p>
<h2>Game changer?</h2>
<p>Positive steps have been taken in the world of rugby as awareness has grown from the negative effects that concussion has on the brain. Indeed, we have come a long way since 2005, when a neuropathologist working in a Pittsburgh coroner’s office became the <a href="https://pubmed.ncbi.nlm.nih.gov/20201914/">first to identify</a> a form of neurodegeneration called “chronic traumatic encephalopathy” (CTE) in an American Footballer who had suffered repetitive brain injuries. </p>
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Read more:
<a href="https://theconversation.com/will-the-law-strike-a-knockout-blow-on-concussion-in-rugby-37863">Will the law strike a knockout blow on concussion in rugby?</a>
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<p>But the problem has not been solved. And the increasingly gladiatorial nature of the modern game, with <a href="https://bjsm.bmj.com/content/46/8/580">players whose physiques resemble</a> those of a bodybuilder, mean the risks could be worsening. So what can be done to reduce the potentially life-altering effects of concussion in rugby players? </p>
<p>One approach involves changing the rules of the game. While some adjustments have been proposed, such as <a href="https://www.rugbypass.com/news/super-controversial-waist-height-tackling-among-6-law-changes-endorsed/">waist height tackling</a> to reduce the number of head-to-head collisions, <a href="https://www.bbc.co.uk/sport/rugby-union/41398969">some argue</a> that the tackle should be banned altogether. Others, including ourselves, have focused on establishing effective molecular (blood, saliva, urine) and cerebrovascular (brain blood flow) assessments for pitchside detection of concussion to enable swifter treatment and recovery. </p>
<p>While these remain in development, there are methods that rugby players – and anyone else – can use to help our brains fight off the risk of dementia. These include high-intensity interval training (HIIT) and regular aerobic exercise. </p>
<p>This is because exercise helps maintain a healthy body weight and promotes the release of nitric oxide, which improves the way our blood vessels function and <a href="https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1113/JP275021?casa_token=dGGWYrRmI3YAAAAA:edWmY49H0sNQ78ts1QZJvOsN-TkkkqgM4hvGVpw7iKYynxrpW2g-_KerXIoQ9JonSBzJNPgKBwLKrg">contributes to better brain health</a>. </p>
<p>For now, though, concussion across all sports remains a prominent and potentially life-altering injury, with the true consequences often only noticed when it is too late. There are almost <a href="https://resources.world.rugby/worldrugby/document/2020/07/28/212ed9cf-cd61-4fa3-b9d4-9f0d5fb61116/P56-57-Participation-Map_v3.pdf">10 million rugby players</a> around the world, and professional players are more likely than not to <a href="https://bjsm.bmj.com/content/bjsports/early/2018/03/12/bjsports-2017-098417.full.pdf">sustain a concussion within 25 games</a>. </p>
<p>And while modern treatments and management protocols for concussion have improved with increased monitoring and neurological testing, the mechanisms which increase an athlete’s susceptibility to CTE and other neurological complications remain poorly understood. </p>
<p>Meanwhile, rugby union’s governing bodies have faced <a href="https://www.espn.co.uk/espn/story/_/id/16029747/rugby-nfl-concussion-issue-figured-out">criticism</a> for the lack of concussion management. But perhaps this should come as little surprise given that not very long ago, in the amateur era of the game, the traditional treatment for a knock to the head was a “magic sponge” doused in cold water.</p><img src="https://counter.theconversation.com/content/146495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damian Bailey receives funding from the Royal Society, Japan Society for the Promotion of Science and the JPR Williams Foundation Trust</span></em></p><p class="fine-print"><em><span>Chris Marley and Tom Owens do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Thankfully treatment has moved on from the cold sponge of the amateur era. But brain damage continues to be a serious risk in many sports.Tom Owens, PhD Candidate, University of South WalesChris Marley, Senior Lecturer in Exercise Physiology, University of South WalesDamian Bailey, Professor of Physiology and Biochemistry, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1457262020-09-11T12:09:12Z2020-09-11T12:09:12ZAlcohol and your brain: study finds even moderate drinking is damaging<figure><img src="https://images.theconversation.com/files/357457/original/file-20200910-24-btinrr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even drinking fewer than 14 units of alcohol a week was damaging.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/group-of-people-drinking-beer-and-having-fun-3009773/">ELEVATE/ Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>It’s a well-known fact that drinking too much alcohol can have a serious impact on your health, including damaging your liver. But how much is too much? For conditions such as liver cirrhosis, that’s usually more than <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.22010">21 units of alcohol a week</a> – around two bottles of wine a week or one and a half pints of beer a day. The UK’s Chief Medical Officer recommends that adults don’t drink more than <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf">14 units of alcohol</a> a week to keep the risk of health problems low. </p>
<p>However, the liver isn’t the only organ that can be damaged by drinking – the brain can be damaged, too. Drinking over the current UK low-risk guidelines is associated with an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957093/pdf/ndt-16-87.pdf">increased risk of dementia</a>. And a <a href="https://www.nature.com/articles/s41598-020-70910-5">recent study</a>, published in Scientific Reports, found that even moderate drinking is associated with decreased brain volume.</p>
<p>The researchers in this latest study looked at 300 people between the ages of 39 and 45 to understand the effects of drinking on the brain. Most people in the study reported that they drank at what was considered moderate or low-risk levels (an average of less than 14 units of alcohol a week). Even at this level, there was a reduction in the amount of total brain tissue seen on brain scans. This held true for men and women when other risk factors, such as smoking, were considered. Their brains were compared against a <a href="http://brain-development.org/brain-atlases/adult-brain-atlases/">reference model</a> of average brain volume.</p>
<p>Although the study didn’t look at the physiological impact of brain tissue loss, any significant loss of brain tissue will reduce the brain’s ability to function at an optimal level. Though the adult brain <a href="https://www.sciencedirect.com/science/article/abs/pii/S0197458006001539">shrinks slowly with age</a>, the earlier the loss starts, brain shrinkage is likely to be accelerated by other medical conditions, such as <a href="https://n.neurology.org/content/77/5/461.short">high blood pressure and diabetes</a>, that may arise in late middle age and later life. This is important, as we now know that some of the early signs of brain damage from alcohol can be <a href="https://link.springer.com/article/10.1186/alzrt157">partially reversed after abstinence</a>. Which has been seen as early at six weeks after total abstinence – <a href="https://link.springer.com/article/10.1007/s00213-005-2267-6">more in the frontal lobes of the brain</a>, which play an important role in regulating behaviour and our thinking. </p>
<figure class="align-center ">
<img alt="Four people toasting their beer glasses." src="https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357461/original/file-20200910-18-1t99wbd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Moderate drinking levels are associated with increased dementia risk.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/_8KV86shhPo">Giovanna Gomes/ Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>These findings are similar to those of an earlier study which found that drinking between seven and 14 units of alcohol a week was associated with a <a href="https://www.bmj.com/content/357/bmj.j2353.full">smaller brain size</a>. This level of drinking was also associated with poorer performance on skills that involved recalling memorised words on demand.</p>
<h2>Frontal lobe damage</h2>
<p>When we study the effects of alcohol on the brain, we naturally focus on dementia. This inevitably means looking for memory changes. After all, a diagnosis of dementia relies on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898682/pdf/DialoguesClinNeurosci-15-445.pdf">memory loss</a>. But we now know that the brain’s <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/addressing-alcoholrelated-dementia-should-involve-better-detection-not-watchful-waiting/781C9017D415494F2F76B590B612F228/core-reader">frontal lobes</a> are actually damaged by alcohol at an earlier stage than those parts of the brain associated with memory. The frontal lobes control our personality, behaviour and ability to think flexibly. These skills are <a href="https://www.tandfonline.com/doi/abs/10.1080/13825585.2016.1277970">not assessed</a> by tests commonly used to diagnose dementia. </p>
<p>But drinking in a way that the general population believe to be sensible and moderate might be slowly damaging our brains. Given this, we need to be better at <a href="https://drinkwiseagewell.org.uk/how-can-we-improve-assessment-treatment-and-recovery-for-alcohol-related-dementia/">detecting damage at an earlier stage</a>. Luckily, a <a href="https://www.hindawi.com/journals/jad/2016/1539096/">eight item test</a> can now detect cognitive impairment early on, and is used routinely by specialists in mental health services to detect brain damage from alcohol in its early stages. <a href="https://jamanetwork.com/journals/jamaneurology/article-abstract/786118">Other tests</a> of frontal lobe function can also be performed in hospitals or general practices.</p>
<h2>Older drinkers</h2>
<p>The discovery that alcohol has the potential to damage our brains at levels at which we might find surprising and in ways that are not usually detected, has major implications for our society. For example, baby boomers (people now aged between 55 and 74) have shown the sharpest rise in <a href="https://theconversation.com/having-lived-hedonistic-lives-the-baby-boomers-are-drinking-themselves-into-an-early-grave-64016">harm from alcohol</a> compared with other generations and previous generations of the same age. They are also at higher risk of dementia than younger age groups. </p>
<p>If we are to tackle the problem, we need to change both attitudes to drinking and in how we deliver healthcare. Changing drinking behaviour in older people needs to be accompanied by picking up the early signs of brain damage for all those who drink alcohol. </p>
<p>Progress has been made in asking older people about their alcohol use within both <a href="https://www.nice.org.uk/guidance/qs188/resources/coexisting-severe-mental-illness-and-substance-misuse-pdf-75545728091845">public health</a> and <a href="https://www.england.nhs.uk/wp-content/uploads/2019/09/community-mental-health-framework-for-adults-and-older-adults.pdf">mental health</a> policy. But this not yet happened for the detection of brain damage in people who drink alcohol. Giving equal importance to both our brain and our liver can help us stay in better health. As a society, we have the potential to take care of both these vital organs.</p>
<p>Cutting down the amount we drink or giving it up altogether can reduce our risk of brain damage. But this can only happen if we also maintain a lifestyle that includes a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext">healthy diet and exercise</a>.</p><img src="https://counter.theconversation.com/content/145726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Rao does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Drinking at “safe” levels was shown to reduce the amount of a person’s total brain tissue.Tony Rao, Visiting Lecturer in Old Age Psychiatry, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1332092020-03-16T14:38:57Z2020-03-16T14:38:57ZSevere brain injuries: technology can tell what patients are thinking – here’s what to consider before using it<figure><img src="https://images.theconversation.com/files/320789/original/file-20200316-27648-1ge9oro.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5097%2C2874&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">fNIRS can be done at a patient's bedside. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/computer-screen-showing-mri-ct-image-1197120001">Gorodenkoff/ Shutterstock</a></span></figcaption></figure><p>When a person sustains a severe brain injury that leaves them unable to communicate, decisions about their treatment must be made for them. In some cases, these decisions can mean the difference between life and death. But <a href="https://www.frontiersin.org/articles/10.3389/fnins.2020.00105/full">new research</a> may have found a new way of communicating with patients who might otherwise have been unable to. </p>
<p>Researchers asked volunteers with normal brain function to imagine playing a game of tennis, which activates a specific area of the brain used for <a href="https://www.sciencedirect.com/topics/neuroscience/supplementary-motor-area">planning complex movements</a>. Researchers were able to see the brain activity using <a href="https://www.ncbi.nlm.nih.gov/pubmed/17366276">functional near-infrared spectroscopy</a> (fNIRS), which is a headset that, when placed on a patient’s head, uses beams of light to detect which <a href="https://www.ncbi.nlm.nih.gov/pubmed/17366276">areas of the brain are active</a>. </p>
<p>Volunteers were then told to imagine playing tennis to answer “yes” or to stay relaxed to answer “no”. If researchers saw activity in the brain’s <a href="https://www.sciencedirect.com/topics/neuroscience/supplementary-motor-area">supplementary motor area</a>, they knew the person was responding “yes”. This breakthrough could potentially give patients with severe brain damage the ability to communicate with doctors and family members – and could potentially transform how treatment decisions are made. </p>
<p>For example, if families can’t communicate with their loved one, they may feel pressure to make treatment decisions quickly to avoid leaving them “trapped” in a severely disabled state. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185074/">Research has shown</a> that 50% of families who withdraw treatment do so within the first 72 hours of patient admission to hospital. This means that some patients who could have made a good recovery die. Communication could allow patients to convey what treatment they want early on.</p>
<p>This new research is a significant step forward from <a href="https://www.nature.com/articles/nrn3608">foundational neuroimaging studies</a> developed over the last decade. In these early studies, severely brain-injured patients thought to be unconscious were placed in a functional magnetic resonance imaging scanner (fMRI), and asked to imagine playing tennis, or navigating their homes. By imagining these specific scenarios, patients could show they were conscious. <a href="https://jnnp.bmj.com/content/87/5/485.long">Several studies</a> have shown almost 15% of patients thought to be in a persistent vegetative state – defined by a complete lack of awareness of the self or environment – are actually conscious, based on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073717/">brain activity shown during scans</a>.</p>
<p>However, many severely brain injured patients <a href="https://academic.oup.com/brain/article/139/1/292/2468793">cannot be scanned using fMRI</a>, leaving them no way to communicate. By adapting the tennis task to fNIRS, researchers can safely and easily scan patients at the bedside, potentially meaning a greater number of patients could communicate with researchers at a time when important treatment decisions are being made.</p>
<h2>Important questions</h2>
<p>Though this method could ultimately allow patients to choose their own treatment, there are at least two conditions that must be met before fNIRS can be ethically applied in this way.</p>
<p>First, researchers need to ensure they’re interpreting a patient’s brain responses correctly. In the study, the researchers were correctly able to identify in volunteers without brain injury 79% of “yes” responses and 71% of “no” responses. But if we plan to administer treatment (or not) based on a patient’s response, how sure do we need to be that a patient has responded “yes” rather than “no”?</p>
<p>One approach is to think about the consequences of getting things wrong. If we ask a patient whether they prefer to watch hockey over football, 79% accuracy is probably enough, because the consequences of a mistake are minor. If we ask a patient if they’re depressed, 79% accuracy might also be acceptable, because the consequences of ignoring a depressed patient are potentially worse than offering treatment to someone who isn’t depressed. But if we’re asking a patient if they want to continue with life-sustaining treatment, we need to be very sure about their response.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320792/original/file-20200316-27643-o4of13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A brain injury might change our ability to make decisions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/puzzle-head-brain-concept-human-face-269726339">ESB Professional/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Second, we need to be sure that the patient has the capacity to make the decision we’re asking them to make. We usually assume that otherwise healthy adults can make their own medical decisions. But a patient with dementia might have to demonstrate their ability to a doctor by showing they understand the decision and its consequences, and can communicate this understanding. But severe brain injuries can cause cognitive deficits – giving us reason to be sceptical of a patient’s decision-making ability, especially complex decisions about <a href="https://www.tandfonline.com/doi/abs/10.1080/21507740.2013.821189">life-sustaining treatment</a>.</p>
<p>Of course, a patient could have the capacity to decide to end their life. Patients have the <a href="https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/do-i-have-the-right-to-refuse-treatment/">right to refuse treatment</a>, even if this is likely to result in their death. For example, a patient with terminal cancer may refuse chemotherapy. <a href="http://www.bbc.co.uk/ethics/euthanasia/overview/introduction.shtml">In some countries</a>, patients can be actively assisted by physicians in ending their own lives.</p>
<p>But asking a severely brain-injured patient to decide about life-sustaining treatment is different. In the cancer case, the patient’s diagnosis may be sudden, but death from cancer may not be imminent – giving them time to think about what treatment is best for them. In the assisted dying case, the patient’s death is imminent, but not sudden. They will have had time to reflect on their decision. But a severe brain injury is sudden, and death will be imminent without treatment.</p>
<p>It’s difficult to imagine a patient being able to understand and appreciate the consequences of a life-or-death decision given these circumstances. They may be in severe pain or distress, which may impair their ability to weigh their present suffering against the potential for recovery in the future. Research also suggests that people <a href="https://www.ncbi.nlm.nih.gov/pubmed/10390038">tend to overestimate</a> how much worse off their lives would be with a severe disability. A patient that initially views a life of severe disability as worse than death may <a href="https://bmjopen.bmj.com/content/1/1/e000039">see things differently</a> once they adjust to their circumstances.</p>
<p>However, using fNIRS to communicate with patients could still be incredibly useful for assessing a patient’s experiences, allowing them to report on symptoms, and <a href="https://link.springer.com/article/10.1007%2Fs10677-017-9836-8">express wishes or preferences</a>. Even without the ability to make decisions, people can still have values, desires and preferences which affect their quality of life, and we don’t need to presume decision-making capacity to take these preferences and wishes seriously.</p><img src="https://counter.theconversation.com/content/133209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mackenzie Graham receives funding from the Wellcome Trust. </span></em></p>By imagining a unique scenario to answer “yes” or “no” questions, this research could potentially be used to communicate with locked-in patients.Mackenzie Graham, Research Fellow of Philosophy, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1238202019-10-04T13:28:39Z2019-10-04T13:28:39ZHow routine sparring can cause short-term impairment to boxers’ brains<figure><img src="https://images.theconversation.com/files/295591/original/file-20191004-118209-1g0l0ef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-boxers-fighting-ring-34651705">Shutterstock</a></span></figcaption></figure><p>Thrilling the masses for millennia, boxing has evolved down the centuries – rules have changed, equipment improved, training enhanced. However, one key aspect has essentially stayed the same: incapacitating the opponent before they incapacitate you. </p>
<p>Boxers are mostly exposed to <a href="https://concussionfoundation.org/CTE-resources/subconcussive-impacts">subconcussive head impacts</a>, that is, impacts that do not result in visible symptoms of concussion, much like heading the ball in football. But for many years, debate has raged around the safety of boxing, often focusing on the heavy blows inflicted during competitive fights. But we decided to look at these subconcussive impacts inflicted during training – or <a href="https://www.expertboxing.com/boxing-sparring-for-beginners">sparring</a> – sessions.</p>
<p>Boxing, football and rugby are of particular interest to our work because athletes are routinely exposed to repetitive subconcussive head impacts, both in training and competition. We have <a href="https://www.ebiomedicine.com/article/S2352-3964(16)30490-X/fulltext">previously shown</a> that a single soccer heading drill affects how the brain “talks” to the muscles. </p>
<p>Sparring sessions – where boxers trade light blows in protective headgear – are well suited for research because they often form part of an athlete’s training regime, and are fairly easy to replicate in a controlled laboratory environment, which is really important if you want to understand cause and effect.</p>
<p>Our latest <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2019.00294/full">research</a> is one of the first studies to show that routine impact in sport – often thought to be fairly harmless – results in measurable changes in the brain.</p>
<h2>Boxing and brain function</h2>
<p>By the late 1920s scientists suspected that repetitive head impacts were associated with damage to the brain. Research from 1928 describes “punch drunk” syndrome, where boxers appeared to stagger around as if under the influence of alcohol. Scientists noted that the first symptoms of this “dementia pugilistica” – or what we now refer to as <a href="https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/">Chronic Traumatic Encephalopathy</a> (CTE), was an impairment in brain-to-muscle communication.</p>
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</figure>
<p>CTE is a neurodegenerative disease with <a href="https://www.nhs.uk/conditions/alzheimers-disease/">Alzheimer’s</a>-like symptoms, characterised by structural, behavioural and cognitive changes in the brain. Since the 1920s, knowledge of this disease has expanded, but this does not necessarily mean it is fully understood. </p>
<p>For example, it is now believed that CTE can be caused by a combination of <a href="https://www.nhs.uk/conditions/minor-head-injury/">concussive</a> and subconcussive injuries (rather than only concussive ones). Yet, not all athletes exposed to concussion/subconcussion develop CTE, meaning that other factors – such as genetics or the environment – have to play a role.</p>
<h2>Short term changes in the brain</h2>
<p>We recruited 20 boxers and <a href="https://punchermedia.com/what-is-muay-thai/">Muay Thai</a> athletes, plus 20 healthy individuals who would not receive any blows to the head. All participants completed tests before and after a 3x3 minute sparring session for boxers and Muay Thai athletes, or a 3x3 minute mock-sparring session where participants only hit pads with boxing gloves.</p>
<p>The tests completed ranged from measures of how well the brain communicates commands to the muscles (done by zapping the brain with a magnetic stimulator and seeing what happens in the muscle), to tasks designed to test participants’ memory. </p>
<p>We found that, much like heading a ball in football, the results of those engaged in the sparring session demonstrated increased inhibitory mechanisms within the central nervous system. The human body needs a balance of excitatory and inhibitory mechanisms to function properly. If we pretend the brain is a busy junction with a traffic light, green (excitation) allows information to flow from one part of the body to the other; red (inhibition) ensures that this information moves in a safe and controlled manner. </p>
<p>One hour after sparring, participants showed impaired brain-to-muscle communications and decreased memory performance. Because normal brain chemistry was (temporarily) disrupted by these subconcussive impacts during the session, the information going from the brain to the muscles slowed down, affecting how they worked, and it was more difficult for participants to remember things. After 24 hours, these effects returned to normal.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295595/original/file-20191004-118234-14f3lha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There has always been debate surrounding the safety of boxing, often focusing on the heavy blows inflicted during big competitive fights with the likes of famous boxers like Muhammad Ali.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/manila-philippines-september-1975-muhammad-ali-724182109">Shutterstock</a></span>
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</figure>
<h2>What do these results mean?</h2>
<p>Increased inhibition in the brain is also seen following a concussion and in this case is thought to be a protective mechanism, slowing down the brain’s processes to prevent further injury and help recovery. Problems may arise if this safeguarding response is activated without any actual injury (such as following subconcussive head impacts), as it could create a toxic environment and ultimately damage brain cells.</p>
<p>Also, if communication between brain and muscles is not occurring as it should, individuals may be at greater risk of muscular injury because muscles are not being properly controlled by the brain. We already know that athletes returning to play after a concussion are <a href="https://bjsm.bmj.com/content/50/15/926">more likely</a> to sustain an injury. </p>
<p>Ultimately, our studies are the first steps in lifting the veil on what goes on the brain after routine impact in sport. We show that sparring (as we did with heading a ball) results in acute and temporary changes to brain performance. This may be an indication of circuit dysfunction, an important mechanism in understanding the link between brain impact, brain health and disease. We need to better understand how circuit dysfunction affects the brain when there is repeated exposure to subconcussive impacts over the course of a sporting career.</p><img src="https://counter.theconversation.com/content/123820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angus Hunter received funding from the National Institute for Health Research. </span></em></p><p class="fine-print"><em><span>Magdalena Ietswaart received funding from the National Institute for Health Research and the Chief Scientist Office of the Scottish Government Health Directorates. Magdalena is a member of the SINAPSE collaboration (<a href="http://www.sinapse.ac.uk">www.sinapse.ac.uk</a>), a pooling initiative funded by the Scottish Funding Council and the Chief Scientific Office of the Scottish Executive.</span></em></p><p class="fine-print"><em><span>Thomas Di Virgilio does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research reveals that routine sparring can have immediate effects on the brain, putting athletes at greater risk of injury when brain-muscle communication is impaired.Thomas Di Virgilio, Lecturer, University of StirlingAngus Hunter, Reader in Exercise Physiology, University of StirlingMagdalena Ietswaart, Cognitive Neuroscientist and Associate Professor, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1009232018-08-10T12:35:24Z2018-08-10T12:35:24ZFrontal lobe paradox: where people have brain damage but don’t know it<figure><img src="https://images.theconversation.com/files/230897/original/file-20180807-191038-rxccp2.jpg?ixlib=rb-1.1.0&rect=16%2C285%2C5491%2C3353&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/665595454?src=7uq6SluPBoRtVuWaYjIySw-1-21&size=huge_jpg">vectorfusionart/Shutterstock</a></span></figcaption></figure><p>Humans have big brains and our frontal lobes, just behind the forehead, are particularly huge. Injuries to this part of the brain often happen after blows to the head or a stroke. Paradoxically, some people with frontal lobe injuries can seem unaffected – until they’ve been carefully evaluated.</p>
<p>The frontal lobes are sometimes described as the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18269902">executives</a> of the brain, or conductors of the orchestra. Among other things, they control and organise our thinking and decision-making processes. You rely on your frontal lobes when you do things like make plans, switch from one activity to another, or resist temptation.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19847072">Some people</a> with frontal lobe injuries seem completely normal in short one-to-one conversations, but they actually have great difficulty with everyday tasks, such as cooking, organising their paperwork or remembering to take medication. This is called the <a href="https://bit.ly/2O7bVcC">frontal lobe paradox</a> because, even though these people seem unimpaired when assessed, they have significant difficulties in everyday life. </p>
<p>Without specialist expertise in acquired brain injuries, it can be almost impossible to spot frontal lobe paradox because, in many cases, people will still be able to speak normally and seem remarkably unimpaired. They may be unaware of their difficulties and deny that they need any help or support.</p>
<h2>Insight issues</h2>
<p>People affected by the condition are not lying when they say they don’t need help or support. Instead, they may lack knowledge of their own condition because areas of the frontal lobes that are responsible for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318765/">self-monitoring</a> and developing insight have been affected by their brain damage.</p>
<p>A second reason for the frontal lobe paradox is that the skills needed for an assessment interview are different from those needed in everyday life. The structure and routine of an environment, such as a rehabilitation ward, can, in effect, play the role of someone’s frontal lobes. This can mask the difficulties people experience in less structured, open-ended environments. For this reason, a person’s level of ability needs to be assessed in a situation that resembles everyday life. A seemingly simple task, such as going shopping, can reveal <a href="https://www.ncbi.nlm.nih.gov/pubmed/2043945">difficulties</a> in people who appear unimpaired on standard tests of memory and attention, and have normal intelligence.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/230912/original/file-20180807-191019-12r7bob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with frontal lobe paradox may need help with things like cooking.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/495506845?src=QhaNvFvCO_PxQcvlBzcnAg-1-6&size=medium_jpg">Rawpixel.com/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Lack of specialist training</h2>
<p>Neuroscientists and doctors have known about the frontal lobe paradox for at least 50 years, but it is not always understood by non-specialists. This situation can lead to people not receiving help they desperately need. </p>
<p>For example, in England and Wales, social workers and care managers are usually responsible for deciding whether a person has the capacity (<a href="https://www.nhs.uk/conditions/social-care-and-support/mental-capacity/">under the Mental Capacity Act 2005</a>) to decline support or care. These are hardworking professionals who are motivated to act in the best interests of those under their care, but many receive little or no specialist training in brain injury. </p>
<p>These professionals tend to base their decision about a person’s mental capacity on a short face-to-face interview. This is exactly the situation that can lead to people with frontal lobe damage being denied the care that they need. </p>
<p>The assessment provides the support needed for a person to sound competent and able, but only for the duration of the assessment. In one example, a woman persuaded a series of professionals that she could safely live alone after a significant brain injury. In reality, she could not make meals for herself or remember to take her lifesaving medication. Sadly, she died at home shortly afterwards.</p>
<h2>Support needed</h2>
<p>We don’t know exactly how common the condition is, but the frontal lobe paradox is probably found in a much higher number of people than you might first imagine. As well as those who have suffered blows to the head and strokes, it can affect people with certain infections, some forms of dementia and even poorly controlled diabetes. </p>
<p>It is <a href="https://www.bps.org.uk/news-and-policy/neuropsychologists-make-recommendations-amendments-mental-capacity-act-parliament">vital</a> that social workers and care managers are trained on brain injury to protect the interests of people with frontal lobe injuries. People with these injuries are in particular need of support, but they are often the least likely to receive it.</p><img src="https://counter.theconversation.com/content/100923/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with damaged frontal lobes often need help with daily life. The problem is, they think they’re fine.Sam Gilbert, Associate Professor, Institute of Cognitive Neuroscience, UCLMelanie George, Consultant Clinical Neuropsychologist, Canterbury Christ Church UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/879862017-11-22T23:54:54Z2017-11-22T23:54:54ZGrey Cup haunted by brain injury risk — but doesn’t have to be<p>When the Toronto Argonauts and Calgary Stampeders square off in Ottawa for the 105th Grey Cup on Sunday, it will be under dark clouds — not necessarily of weather, but rather the risk of concussions and their devastating long-term effect on players’ brains.</p>
<p>A growing body of evidence — including groundbreaking research examining the brains of living former Canadian Football League football players — suggests that the way the sport is played and the subsequent health of athletes are grave and connected problems.</p>
<p>We have long been suspicious about what football injuries were doing to the brains of some players, but even we were shocked when we brought 22 former CFL players into <a href="http://www.humanities.mcmaster.ca/%7Elmblab/">our lab at McMaster University</a> and studied their brain activity and structure. </p>
<p>Some former players showed readings similar to those one would find in a coma patient. It was astounding to us that the most deeply affected men were still standing, let alone able to carry on everyday conversations. </p>
<p>We discovered this in a two-year research project — <a href="https://www.thespec.com/hamilton-topics/7521250-collision-course/">Collision Course</a> — conducted in collaboration with Hamilton Spectator reporter Steve Buist, comparing former players to other people in a control group.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=247&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=247&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=247&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=311&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=311&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=311&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The brain of a normal control subject, left, shows significant difference compared to the brain of a former CFL player.</span>
<span class="attribution"><span class="source">(Handout)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Brain shrinkage, memory problems</h2>
<p>The results and the stories of those players were stark, and often sad.</p>
<p>On average, the retired athletes, ranging from 44 to 66 years old, had lost 20 per cent of the mass of the cerebral cortex. This controls movement and cognitive functions including attention, speech and memory. </p>
<p>Of the 22 former players, 16 reported memory problems, compared to just two of the 20 healthy control subjects.</p>
<p>Brain images from some retired players in their 40s looked like images from men twice their age. </p>
<p>It’s not news that concussions from fast-moving, hard-hitting contact sports such as football and hockey have been coming under closer scrutiny. Before our project, there already had been plenty of evidence — most of it derived after athletes’ deaths — that <a href="https://thewalrus.ca/inside-the-controversial-concussion-lab-that-could-save-football/">head injuries from football had significantly damaged the brain structure of veteran players</a>. </p>
<p>Our goal was to take a comprehensive and non-invasive look at the brains of living former players, so we used the tools at our disposal, including magnetic resonance imaging (MRI) and electroencephalography (EEG). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=296&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=296&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=296&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Left and right images of the cerebral cortex show in blue areas where retired CFL players had significant thinning compared to people in the control group. Lighter areas represent more significant thinning. About two-thirds of the area was thinner in athletes.</span>
<span class="attribution"><span class="source">(Handout)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We measured the physical structures of our subjects’ brains, and gauged the neurophysiological activity going on in those same brains. These are two very different methods — revealing physical brain structures and activity — yet the results were grimly consistent.</p>
<p>The damage was not universal, to be sure. There was one player who showed no damage on either test, for example. But on balance, it was clear there is a strong and disturbing correlation between football and permanent brain injury.
Brain EEG shows <a href="https://www.thespec.com/news-story/7525066-collision-course-a-spectator-report-on-the-science-of-hard-head-knocks/">a difference in automatic attention that does not involve conscious awareness</a>, and also difference in voluntary attention that is usually controlled by awareness.</p>
<h2>Sports, science and risk</h2>
<p>As Canada approaches the Grey Cup on Sunday, one might expect researchers who have seen what we have to be marching outside the game with placards, calling for a stop to the carnage.</p>
<p>Far from it. Both of us will be watching — and enjoying — the action.
Football and hockey are simply great sports, packed with action and surprises, making them tremendously entertaining. Between the two of us, we have played years of both sports — one of us on the field, the other on the ice.</p>
<p>But unlike some, we won’t be cheering on Grey Cup Sunday when players get dumped on their heads, or when they get slammed to the ground and their helmets bounce off the turf. When we watch a game, we can see when a head-injured player is having a seizure after a tough hit, or when a player has lost consciousness even before hitting the turf. </p>
<p>Still, collisions are part of football and hockey, and that’s not going to change, nor should it. <a href="https://theconversation.com/how-to-avoid-recognize-and-treat-concussion-in-sports-83204">Players nowadays are more aware of the risks</a>, and that those risks increase with the number of years they play and the blows they take.</p>
<p>But those risks can certainly be diminished, if there is a will among sports leagues, owners, players and fans to adopt some small changes that can make football and hockey much more sustainable. </p>
<h2>Technology to protect players’ heads</h2>
<p>Improved rules to end hockey fighting, to better protect quarterbacks in the pocket, and to crack down much harder on illegal, high-risk blows in both sports, together with much stricter enforcement, would make football and hockey safer.</p>
<p>More cautious protocols around possible head injuries would go a long way to reducing repetitive concussion damage that echoes through decades. Today, we do more to protect players’ knees than their heads, and that has to change.</p>
<p>One way to go at it might be to use objective, evidence-based standards for blows to the head. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LPhNbs20p7k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Technology to detect a potential brain injury is used by Liberty Christian High School in Dallas-Fort Worth, Texas.</span></figcaption>
</figure>
<p><a href="http://www.cnn.com/2014/06/09/tech/innovation/smart-football-helmet-concussions/index.html">Technology exists today</a> that can slip easily into a <a href="https://www.sbnation.com/college-football/2017/5/12/15629572/texas-longhorns-helmet-technology-riddell-insite-monitor-hits">helmet to measure the force and torque of a blow to the head</a> and transmit it to coaches and medical staff on the sidelines. It could be made mandatory for someone who gets hit too hard to be pulled out of play for examination, regardless of the apparent symptoms.</p>
<h2>Surviving the game</h2>
<p>It’s clear that even without tougher rules, some players are ready for changes that will protect them from debilitating brain injuries. It’s already hard enough for a player to survive in a game where any play could be his last.</p>
<p>We understand that dialling back the extreme blows that lead to head injuries might make games slightly less exciting. On the other hand, they might also make them more exciting, as strategy and agility would become more important and integral to winning.</p>
<p>Owners may worry about losing money if the game is perceived as softer — but they will definitely lose money if <a href="http://ottawacitizen.com/sports/local-sports/legal-battle-over-cfl-players-benefits-moving-upfield-inch-by-inch">badly injured players sue</a> them for not taking better care of their brains and win.</p>
<p><a href="https://www.fastcodesign.com/1671752/why-nfl-helmets-will-never-be-concussion-proof">There will always be injuries, and there will always be risk</a>. Players accept that.
Surely, we don’t need to see their heads pounded so badly that their already short careers in professional sports leave them permanently and catastrophically injured.</p><img src="https://counter.theconversation.com/content/87986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Connolly conducted the EEG/ERP research using equipment purchased with funds from the Canada Foundation for Innovation. He is also the CSO of a pre-revenue start-up called VoxNeuro, Inc. that is involved in neurocognitive assessment. His work in the CFL research did not involve VoxNeuro, however. The CFL research described in this article received support from The Hamilton Spectator. </span></em></p><p class="fine-print"><em><span>Michael Noseworthy receives funding from: Natural Sciences and Engineering Research Council (NSERC) of Canada. MRI scanning was done using equipment purchased with funds provided through the Canada Foundation for Innovation (CFI). The CFL work described received support from the Hamilton Spectator.</span></em></p>Concussions in football and other contact sports correlate with severe, long-term brain damage — but science shows it doesn’t have to be that way.John F. Connolly, Professor and Senator Wm. McMaster Chair; Director, ARiEAL Research Centre; and co-director of Language, Memory & Brain Laboratories, McMaster UniversityMichael D. Noseworthy, Professor, Electrical and Computer Engineering, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/790362017-06-13T20:21:51Z2017-06-13T20:21:51ZResearch Check: can even moderate drinking cause brain damage?<figure><img src="https://images.theconversation.com/files/173522/original/file-20170613-10220-6kbdn3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3234%2C1525&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Heavy alcohol consumption over ten years or more can cause significant brain function problems. But what about casual drinking? </span> <span class="attribution"><a class="source" href="https://unsplash.com/search/beer?photo=aS7puomg6Oc">Robert Mathews/Unsplash</a></span></figcaption></figure><p>Research <a href="https://www.theguardian.com/society/2017/jun/06/even-moderate-drinking-can-damage-the-brain-claim-researchers">reported last week</a> found “even moderate drinking” could “damage the brain”. Considering 78% of Australians over 14 years old <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">drink alcohol</a>, this is understandably concerning information.</p>
<p>News reports were reasonably accurate in their interpretation of the study. With measured headlines using words such as “may damage the brain” and “linked with”, these reported that the observational study found an association between moderate drinking and brain damage, not a causation.</p>
<p><a href="http://www.afr.com/lifestyle/health/mens-health/the-silent-damage-from-drinking-moderately-down-the-decades-20170605-gwl2ge">The Financial Review</a> ran the headline:</p>
<blockquote>
<p>The silent damage from drinking moderately down the decades</p>
</blockquote>
<p>and <a href="http://www.cbsnews.com/news/even-moderate-drinking-could-harm-the-brain/">CBS News said</a>:</p>
<blockquote>
<p>Even moderate drinking could harm the brain.</p>
</blockquote>
<p>Others, such as the <a href="http://www.deccanchronicle.com/lifestyle/health-and-wellbeing/070617/moderate-drinking-leads-to-changes-in-brain-structure.html">Deccan Chronicle</a>, were more hyperbolic, hinting at causation:</p>
<blockquote>
<p>Moderate drinking leads to severe brain damage.</p>
</blockquote>
<p>We know about 17% of <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">Australians drink at levels</a> considered to put them at risk of long-term harm such as diabetes, liver disease and cognitive problems.</p>
<p>And it’s well established heavy drinking over ten years or more can cause significant cognitive difficulties. These include disorders such as <a href="http://www.alz.org/dementia/wernicke-korsakoff-syndrome-symptoms.asp">Korsakoff’s Syndrome</a> and <a href="https://en.wikipedia.org/wiki/Wernicke%27s_encephalopathy">Wernicke’s Encephalopathy</a>, where memory and other essential thinking functions, as well as motor co-ordination, are severely and permanently damaged.</p>
<p>But what about those of us who have two to three drinks a night? </p>
<p>First, this is an observational study that followed people over time, showing an association between their alcohol intake and certain cognitive functions. Observational studies cannot prove that one (alcohol) caused the other (impaired brain function).</p>
<p>And while alcohol can potentially affect multiple parts of the brain, the researchers found significant impact in only one part of the brain. And that did not appear to correlate with poorer brain functioning overall.</p>
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<hr>
<h2>How was the study conducted?</h2>
<p>Researchers from the University of Oxford and University College London conducted the study, which was published in the well-regarded journal <a href="http://www.bmj.com/content/357/bmj.j2353">The BMJ</a>. It followed 550 men and women for 30 years who were not alcohol-dependent. </p>
<p>Participants were categorised into four groups based on how much alcohol they drank per week. The “abstinent” group drank less than one standard drink a week, and the “light” between one and seven drinks. “Moderate” drinkers had between seven and 14 drinks a week for women, and between seven and 21 drinks for men. Men who had 21 or more drinks per week, and women who drank 14 or more, were classified as “unsafe” drinkers.</p>
<p>The participants had brain scans once (at the 30-year point) and neuropsychological testing five times over the 30 years.</p>
<iframe src="https://datawrapper.dwcdn.net/I51xI/1/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="415"></iframe>
<h2>What did it find?</h2>
<p>The main difference between the drinking groups was a smaller <a href="http://psycheducation.org/brain-tours/memory-learning-and-emotion-the-hippocampus/">hippocampus</a> – the area of the brain important for learning, memory and spatial awareness – in people who drank more.</p>
<p>Compared to “abstainers”, people who drank an average 30 or more drinks a week over the 30 years were more likely to have a smaller hippocampus. But even those drinking between 14 and 21 drinks a week had, on average, a smaller hippocampus.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=660&fit=crop&dpr=1 754w, https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=660&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/173525/original/file-20170613-603-122a2ez.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=660&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How should we interpret the results?</h2>
<p>There are a few reasons to be cautious about these results. The study looked at brain function (how well the brain works, measured by <a href="https://www.mentalhelp.net/articles/neuropsychological-tests/">neuropsychological tests</a>) over time. But researchers measured brain structure (the physical make-up of the brain) with a <a href="https://medlineplus.gov/ency/article/007341.htm">brain scan</a> only at the end of the study. </p>
<p>Although the hippocampus was smaller in the heavier drinking groups, alcohol consumption did not seem to affect the function of the brain. There was no alcohol-related decline in measures of memory and <a href="https://en.wikipedia.org/wiki/Executive_functions">executive functions</a> (such as planning, problem solving and impulse control). These are usually the cognitive domains most sensitive to effects of alcohol and most likely to show the negative impact of hippocampal shrinkage. </p>
<p>Not having scanned the brains of participants at the beginning of the study means researchers did not know the original size of their hippocampi. They visually assessed the size of brains from the scans and compared them to expected brain size, using an established scale for that purpose. Around 65% of people who drank 14 to 21 drinks a week showed a smaller hippocampus, but even 35% of the abstainers had “hippocampal atrophy”.</p>
<p>The study used many measures of brain functioning (visual and verbal memory, executive function and working memory), but it found alcohol-related decline in only one function – <a href="http://www.open.edu/openlearn/body-mind/psychology/verbal-fluency">verbal fluency</a> (the ease with which we can retrieve words). And none of the groups were particularly impaired overall compared to people in the general population of the same age and education level.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/173535/original/file-20170613-32456-1nlvmdu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researchers scanned participants’ brains only once, at the end of the study.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What else should we take into account?</h2>
<p>In a study with a moderate number of people like this, it can be harder to assess brain differences because it is difficult to properly take into account other important factors such as age, gender, mental health problems and other drug use.</p>
<p>It seems logical that something like alcohol, which has a strong short-term impact on the brain, might have longer-term effects, and this study adds to the growing evidence that alcohol can impact brain structure. But we are still some way off knowing how much moderate alcohol consumption affects the brain and whether that translates to a functional impairment.</p>
<p>Alcohol is implicated in a number of physical and mental health problems and should be used occasionally and within recommended limits. Studies that have reported <a href="http://www.abc.net.au/news/2016-03-22/studies-linking-alcohol-to-health-benefits-flawed-researchers/7264040">health benefits of moderate drinking</a> in the past have now been shown to be methodologically flawed.</p>
<p>The Australian National Health and Medical Research Council <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">guidelines on alcohol consumption</a> recommend that adults (both men and women) should drink a maximum of two standard drinks a day to maintain long-term health and no more than four drinks on one occasion to prevent short-term harm. <strong>– Nicole Lee and Rob Hester</strong></p>
<hr>
<h2>Peer Review</h2>
<p>I agree with the observations made in this Research Check. There are several other factors to consider when interpreting this study.</p>
<p>Firstly, the researchers found a decline in verbal fluency, as well as atrophy of the hippocampus in participants. But (as Figure 7 in the study shows) there is no pathway between hippocampal volume and verbal fluency decline. Verbal fluency is <a href="https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/role-of-frontal-versus-temporal-cortex-in-verbal-fluency-as-revealed-by-voxelbased-lesion-symptom-mapping/86562C8AF93BFCC9626A481CC90ECBCE">usually associated</a> with an area of the brain called the frontal lobe, while the <a href="http://science.sciencemag.org/content/253/5026/1380.long">hippocampus is associated with memory</a>. </p>
<p>Apart from differences in verbal fluency, the researchers found no other differences between groups on tests associated with the hippocampus, such as those for learning and memory. In the absence of changes to other executive and memory tests, it is uncertain what the clinical and functional significance of a reduction in verbal fluency means. </p>
<p>Further, it’s unknown how the participants spaced out their alcohol intake. There is <a href="http://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2015.24.7.401?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">new evidence</a> showing moderate drinking in a “binge” fashion could be dangerous to cognitive ability. The researchers did not distinguish between those who drank two standard drinks per day throughout the week and those who saved their 14 drinks for a single session on the weekend. This could also be mediating their results.</p>
<p>There is also <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2001.tb02174.x/abstract;jsessionid=141D8935B51895E920C433E8AF4F65C4.f03t02">evidence that abstinence</a> from alcohol can <a href="http://psycnet.apa.org/journals/neu/14/2/178/">improve brain structure</a> and cognitive performance, even <a href="https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awl303">after a few months</a>. So don’t be too alarmed when reading these results. – <strong>Travis Wearne</strong></p>
<hr>
<p><em>This article has been amended to say that the NHMRC guidelines recommend adults drink no more than four drinks on one occasion.</em></p><img src="https://counter.theconversation.com/content/79036/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p><p class="fine-print"><em><span>Rob Hester receives funding from the Australian Research Council and National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Travis Wearne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows an association between moderate drinking and long-term brain impairment. But there are a few reasons to be cautious about these findings.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityRob Hester, Professor, Melbourne School of Psychological Sciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/755462017-06-06T03:20:28Z2017-06-06T03:20:28ZExplainer: what is traumatic brain injury?<figure><img src="https://images.theconversation.com/files/172358/original/file-20170606-16856-gqwp6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with traumatic brain injuries, say after a car accident or an assault, can have behavioural problems long after their physical injuries have healed.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=syyx_gDuQnNZId7IeIgaYg-1-3">from www.shutterstock.com</a></span></figcaption></figure><p>Adam was fortunate to survive a major car accident three years ago. He was in hospital for several months but had no ongoing physical injuries. He looked like he made a full recovery. But he was argumentative, childish, vulgar and his family said he “was not the same person”. Adam had a severe traumatic brain injury. </p>
<h2>What is traumatic brain injury?</h2>
<p>A <a href="http://www.sciencedirect.com/science/article/pii/S0003999310006507">traumatic brain injury</a> is when the brain is damaged by an external mechanical force, like the type you may have in a car accident, if you fall, play sport or if you are assaulted.</p>
<p>These injuries are usually in the news when <a href="https://www.thechronicle.com.au/news/toowoomba-man-liam-cullen-is-suing-queensland-rugb/2960018/">sports players</a> have a <a href="http://www.abc.net.au/news/2017-03-20/nrl-players-brains-more-damaged-than-non-players:-study/8369226">concussion</a>; or in relation to drug and alcohol fuelled assaults where a blow to the head results in a damaging, <a href="http://www.smh.com.au/nsw/killer-punch-fall-caused-thomas-brain-damage-20120715-224q9.html">sometimes fatal</a>, <a href="http://www.dailytelegraph.com.au/news/nsw/newcastle-surfer-suffers-fractured-skull-in-coward-punch-attack/news-story/3576f0a5b3d1c8751ec78347fc210a4f">fall to the ground</a> (<a href="https://en.wikipedia.org/wiki/Sucker_punch">the coward’s punch or king hit</a>).</p>
<p>Mostly, it’s young adults, particularly men, who are affected. But many elderly people may get a traumatic brain injury when they fall.</p>
<p>Australia has a growing population of survivors of traumatic brain injury. This is due to the young age of most victims and decreased death rates <a href="https://www.psychology.org.au/publications/inpsych/2012/april/ponsford">due to better treatment</a>. Traumatic brain injury is expected to be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/18162698">major cause of disability by 2020</a>.</p>
<h2>How does it affect people?</h2>
<p>Few traumatic brain injuries are the same and the outcomes of two similar injuries can be different in different people. Injuries can affect the way people think, feel, behave and relate to everyday situations.</p>
<p>People with moderate to severe injuries can have problems communicating, paying attention, processing thoughts quickly, learning, remembering, planning, problem-solving, meeting goals, and thinking abstractly or flexibly.</p>
<p>Damage to the part of the brain called the <a href="https://www.researchgate.net/profile/Catherine_Gow2/publication/232210406_Frontal_Dysfunction_After_Traumatic_Brain_Injury/links/57ea9c6908aed3a3e08aaeb6.pdf">frontal lobes</a> affects people’s ability to regulate their thoughts, emotions and behaviour. It can cause people to be impulsive, irritable, aggressive, have reduced drive, be apathetic, to have excessive emotions or a flattened mood. </p>
<p>Difficulties understanding the emotions and intentions of others (known as <a href="https://en.wikipedia.org/wiki/Social_cognition">social cognition</a>) may cause reduced empathy and socially inappropriate behaviour. Reduced self-awareness can also result in lack of insight into their abilities and the changes others perceive.</p>
<p>Traumatic brain injury can change an individual’s personality to the point where they “may no longer be the same person” that they were before. Given that many of these difficulties can occur without physical problems, they fall under the umbrella of an “<a href="http://www.changedlivesnewjourneys.com/hidden-disability-after-brain-injury/">invisible disability</a>”.</p>
<h2>How does traumatic brain injury affect the brain?</h2>
<p>Injuries can be due to the immediate effect of the impact (known as primary injuries) or ones that follow these (secondary complications).</p>
<p>Primary injuries include: <a href="https://en.wikipedia.org/wiki/Cerebral_laceration">lacerations</a>, when the brain tissue is cut or torn; <a href="https://en.wikipedia.org/wiki/Cerebral_contusion">contusions</a>, when the brain is bruised; rupturing of blood vessels; and <a href="https://en.wikipedia.org/wiki/Diffuse_axonal_injury">axonal injury</a>, where neurons are stretched and torn.</p>
<p>These can occur where the object hits the head (a <a href="https://en.wikipedia.org/wiki/Focal_and_diffuse_brain_injury">focal injury</a>) or throughout the brain (<a href="https://en.wikipedia.org/wiki/Focal_and_diffuse_brain_injury">diffuse injury</a>). Parts of the brain known as the frontal and temporal lobes are most susceptible to both of these types of injuries. This is because of their large size and as they are close to the hard and uneven surfaces of the skull that can cause damage.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168349/original/file-20170508-20725-56q10b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The frontal and temporal lobes of the brain, shown here, are particularly susceptible to injury.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/102046603?src=Fe-S7aDefYB73SjZdXDbug-1-0&size=huge_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Secondary complications include brain <a href="http://www.webmd.com/brain/brain-lesions-causes-symptomstreatments#1">lesions</a> (damaged brain tissue); <a href="https://en.wikipedia.org/wiki/Edema">brain swelling</a>, increased <a href="https://en.wikipedia.org/wiki/Intracranial_pressure">intracranial pressure</a> (pressure inside the skull), <a href="https://en.wikipedia.org/wiki/Brain_herniation">herniation</a> (movement of brain tissue), <a href="https://en.wikipedia.org/wiki/Ischemia">tissue death</a>, <a href="https://en.wikipedia.org/wiki/Hypoxia_(medical)">hypoxia</a> (oxygen deprivation) and infection. </p>
<p>How long someone loses consciousness initially and how long they’re confused for (known as post-traumatic amnesia) are used to <a href="http://emedicine.medscape.com/article/326643-overview">classify</a> traumatic brain injury as mild, moderate or severe. Most (<a href="http://online.liebertpub.com/doi/abs/10.1089/089771501750357609">about 80%</a>) hospitalisations are for mild injuries.</p>
<h2>How is it managed?</h2>
<p>People with a traumatic brain injury can be treated while staying in hospital (as an in-patient) or after they’re discharged into the community (as an out-patient).</p>
<p>In-patient rehabilitation focuses on immediate medical and functional issues, with a range of health professionals involved, like physiotherapists, speech pathologists, neuropsychologists (psychologists who specialise in assessing, diagnosing and treating disorders of the brain) and occupational therapists. Typically, a personalised rehabilitation plan is drawn up to help the patient to move back into the community. </p>
<p>Out-patient rehabilitation focuses more on the <a href="https://www.ncbi.nlm.nih.gov/pubmed/20134333">context of daily living</a>. Here, there is a shift to helping patients establish life roles and successfully complete everyday tasks, like making meals, showering and travelling. </p>
<h2>What are the challenges ahead?</h2>
<p>Recovery from a traumatic brain injury varies from person to person. Some people can easily resume their lives while others can struggle <a href="http://journals.lww.com/jnnonline/Abstract/2005/02000/The_Meaning_of_Living_with_Traumatic_Brain_Injury.7.aspx">adjusting</a> to their limitations, new lifestyle and new self. Some can have trouble living independently, fulfilling life goals and finding a meaningful place in society. </p>
<p>Behavioural and emotional difficulties are significant barriers to <a href="http://journals.sagepub.com/doi/pdf/10.1177/026921559601000215">long-term recovery</a>. These challenges may not become obvious until the person is in the community, discharged from rehabilitation services and completely dependent on their carers and/or <a href="http://www.tandfonline.com/doi/full/10.3109/02699052.2015.1005134">families</a>. </p>
<p>Behavioural and personality issues also make traumatic brain injury difficult <a href="http://online.liebertpub.com/doi/pdf/10.1089/neu.2013.2997">to manage</a>, placing burden on carers and result in difficulties finding and keeping a job.</p>
<p>Family members and friends can pull away, leading to further <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1315633/">social isolation</a> and loneliness, making survivors more susceptible to <a href="https://www.ncbi.nlm.nih.gov/pubmed/10533556">mental health problems</a> and institutionalisation. Sadly, these problems <a href="http://journal.frontiersin.org/article/10.3389/fnhum.2013.00031/full">worsen</a> as years pass, despite improvements made during early recovery.</p>
<hr>
<p><em>If you or someone you know is a survivor of traumatic brain injury, contact <a href="http://www.braininjuryaustralia.org.au/">Brain Injury Australia</a>, <a href="http://synapse.org.au/">Synapse</a> or the <a href="http://moving-ahead.com.au/">Centre for Research Excellence in Brain Recovery</a> for more information and support.</em></p><img src="https://counter.theconversation.com/content/75546/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Survivors of traumatic brain injuries might have behavioural issues or have problems holding down a job for years after a blow to the head or a bad fall.Travis Wearne, Postdoctoral Research Fellow, UNSW SydneyEmily Trimmer, Postdoctoral Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/783862017-05-26T02:41:26Z2017-05-26T02:41:26ZCodswallop: how to stop boxing deaths and brain injury with a simple rule<figure><img src="https://images.theconversation.com/files/171071/original/file-20170525-23232-fywpqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If hitting below the belt, not the head, was the aim, then brain damage from boxing would disappear overnight.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/544977346?src=rFryrWFdcHig3OGjqdz6Wg-2-20&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>The <a href="http://www.abc.net.au/news/2017-05-19/david-browne-inquest-boxing-inspector-speaks-at-coronial-inquest/8542760">coronial inquest</a> in Sydney into the death by subdural haematoma (brain bleed) of 28-year-old boxer Davey Browne has yet again seen the same <a href="http://www.smh.com.au/sport/boxing/boxing-referee-not-trained-to-identify-serious-head-injury-davey-browne-inquest-20170524-gwbwdy.html">predictable response</a> about how we might prevent such outcomes in the future.</p>
<p>Solutions proposed by boxing officials, administrators and pundits are framed about when exactly a fight should be stopped, more even matching of boxers, greater latitude for trainers to throw in the towel and limiting pre-bout weight loss.</p>
<p>These solutions are as meaningful as if the Titanic’s owners had removed splinters from the liner’s handrails to reduce death and injury.</p>
<p>By 2015 there have been reportedly <a href="http://www.newyorker.com/news/sporting-scene/an-obsessive-chronicle-of-deaths-in-the-ring">2036 known boxing matches</a> where a competitor had died.</p>
<h2>What’s the point of boxing?</h2>
<p>In boxing, the main objective is to hit your opponent as directly and as hard as you can in the head, rendering them unconscious. The punch that knocks a boxer down so fast they can’t stand up within 10 seconds is what the crowds are baying for. It’s what pulls the crowds in and sees massive ticket prices for ringside seats in the hope of the glorious climax of a man being knocked out.</p>
<p>According to an <a href="http://www.medicaldaily.com/out-cold-what-happens-brain-when-we-get-knocked-out-331470">article</a> on what happens when boxers are knocked unconscious, a professional boxer’s punch can generate speeds of about 40-50 kilometres per hour.</p>
<p>The article continues, quoting research published in the journal <a href="http://www.neurology.org/content/70/10/771">Neurology</a>:</p>
<blockquote>
<p>A neurochemical reaction begins in the brain cells that cause cell death. The more cells that die, the fewer brain tissue you have … It may explain why people who suffer from head injuries are never quite the same afterward. </p>
</blockquote>
<h2>How common is this?</h2>
<p>We don’t have much <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034695/">good quality data</a> about how commonly boxers suffer brain injury and later impairment. The few studies available don’t separate amateur and professional boxing. Professional boxing matches can last 12 rounds, while amateur matches last three. Amateurs also wear headgear, while professionals don’t.</p>
<p><a href="http://jamanetwork.com/journals/jama/article-abstract/417443">This study</a> of 30 professional boxers found the following range of impairment (from none to severe): 11 boxers were had normal brain function, with no signs of impairment, 12 had mild deficits, four were moderately impaired and three had signs of severe impairment. Boxers who had 12 or more professional bouts had significantly higher levels of brain injury.</p>
<h2>An obvious solution</h2>
<p>Fouls in boxing consist of hitting below the belt, holding, tripping, kicking, head butting, wrestling, biting, spitting on, or pushing your opponent.</p>
<p>If we reversed the rules on fouls to make a punch to the head a foul and a punch below the belt (aimed at the <a href="http://lingomash.com/slang-meanings/15660/slang-meaning-of-cods">cods</a> or testicles), a scoring shot, the brain injury problem would be resolved. Boxing might consider a change of name to “codswalloping”.</p>
<p>Every boy and man who has playing a body-contact sport has experienced the instantly sickening feeling being hit, kneed or bumped in their “<a href="http://www.cockneyrhymingslang.co.uk/slang/alternatives/210">orchestra stalls</a>”.</p>
<p>For those who have never had the experience, <a href="http://www.womenshealthmag.com/sex-and-love/getting-hit-in-the-balls">here</a> are five men’s eloquent accounts of the unforgettable, deeply imprinted sensation.</p>
<p>A blow to the head can cause concussion, brain injury and occasionally death. But a blow to the groin, while instantly and nauseatingly painful, may occasionally cause minor trauma that needs surgical correction, and infertility. Yet, it is extremely unlikely to cause major trauma or death.</p>
<p><a href="http://laws.worldrugby.org/?law=10&language=EN">Rugby union</a> and <a href="https://playnrl.com/referee/laws-of-the-game/">league</a> have long banned tackling around the head and head locking, and in <a href="http://www.afl.com.au/afl-hq/laws-of-the-game">AFL</a>, any contact with opponents’ heads is instantly penalised. Crowds get this. Yet in boxing, the crowd bays for the maximum risk of damage.</p>
<p>The spectacle of grown men trying to thump each other in the crotch would also have boundless comedic appeal. Evasive stepping and hip swivelling would emerge in those most adept at defensive codswalloping. Codswalloping with the Stars would be an instant TV viewing magnet.</p>
<p>The <a href="http://www.abc.net.au/news/2015-09-04/ama-calls-for-ban-on-boxing-at-olympics-commonwealth-games/6751424">Australian</a>, <a href="http://news.bbc.co.uk/2/hi/uk_news/87267.stm">British</a> and <a href="https://www.wma.net/policies-post/wma-statement-on-boxing/">World</a> medical associations have often called for boxing to be banned. Let’s get serious with boxing reform.</p>
<hr>
<p><em>This is Simon Chapman’s 100th article for The Conversation. His articles have been read more than 2.6 million times.</em></p><img src="https://counter.theconversation.com/content/78386/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>When he was about 12, Simon Chapman earned a few pounds in coins thrown into the ring as spectators watched him fight a friend at Jimmy Sharman's boxing tent at the Bathurst show in a preliminary, warm-up bout.</span></em></p>Forget tinkering with the rules of boxing. It’s time for a wholesale change. Let’s make hits to the groin the aim of the game and ban hits to the head.Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725792017-02-14T01:46:38Z2017-02-14T01:46:38ZBasil Hetzel: Australian medical pioneer, and my friend<figure><img src="https://images.theconversation.com/files/156520/original/image-20170213-23354-vi0kk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Basil Hetzel's research supported the use of iodised salt as an easy way to ensure adequate dietary iodine intake. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/416788978?src=Y195lp0xsGMrng6sXlCJOQ-1-51&size=huge_jpg">from www.shutterstock.com </a></span></figcaption></figure><p>The <a href="https://en.wikipedia.org/wiki/Basil_Hetzel">Hon Dr Basil Hetzel AC</a> died on February 4th 2017, after a truly transformative 70-year career in medicine, research and public health advocacy. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156517/original/image-20170213-23337-1t73aq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian medical pioneer Basil Hetzel in 2012.</span>
<span class="attribution"><a class="source" href="http://www.newspix.com.au">Tricia Watkinson/Newspix</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Described as an <a href="https://csiropedia.csiro.au/hetzel-basil-stuart/">Australian medical pioneer</a>, he identified the most common cause of preventable brain damage: dietary deficiency in the mineral iodine. </p>
<p>Not only that, he progressed his scientific and clinical findings to create effective public health policy to prevent brain damage, cretinism (stunted intellectual and physical development) and goitre (enlargement of the thyroid gland) due to iodine deficiency across the world. He is the reason many of us now ingest iodised salt as a preventative health behaviour. </p>
<p>I met Basil in 2006, when the University of South Australia was establishing a formal research leadership development program. I had the idea of recruiting several patrons to the program.</p>
<p>Knowing of Basil’s work and, indeed, his longstanding <a href="http://www.unisa.edu.au/Media-Centre/Releases/2017-Media-Releases/UniSA-mourns-the-loss-of-national-treasure---Dr-Basil-Hetzel/#.WKD1ObZ95By">formal and informal ties to the university</a>, I wrote and invited him to be a patron. </p>
<p>And so, Basil rang me out of the blue and we discussed what role he might play. Admittedly that wasn’t as yet too well defined in my head, but we talked about ambassadorial, mentoring and presenting roles.</p>
<blockquote>
<p>Well dear, I’m happy to do it if you still want me, </p>
</blockquote>
<p>he said at the end of the call. </p>
<p>And, with that, he became an inaugural patron of the University of South Australia’s research leadership program, and quite possibly the only person I will allow to call me “dear”.</p>
<p>He was a terrific patron. Over four-plus years, he would call me periodically with observations and smart ideas about things we could do. He was instrumental, for instance, in helping design robust sessions that focused researchers on grand challenges in research. </p>
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<a href="https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=534&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=534&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=534&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=671&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=671&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156521/original/image-20170213-23350-1vo0v1h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=671&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pat Buckley with Basil Hetzel on the occasion of his 2012 scientific presentation.</span>
<span class="attribution"><span class="source">Pat Buckley</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>He routinely came along to contribute to and hear from the researchers in the cohort. He sought every opportunity to find out how they were going and what more he could do to help. </p>
<p>And he welcomed researchers into his home to mentor them and talk about all things research. </p>
<p>A few years on and as then Director of the <a href="http://www.unisa.edu.au/Research/Sansom-Institute-for-Health-Research/">Sansom Institute for Health Research</a>, I was honoured to host what I understand was Basil’s final scientific seminar. Stately and savvy, he commanded a large and mixed audience. The work was brilliant, travelling as it did from scientific discovery through to clinical trials and world uptake. The course of that work is shown in the timeline below. </p>
<blockquote>
<p>He’s awesome!</p>
</blockquote>
<p>was the unsolicited response when I asked a couple of young PhD students the following day what they thought of the seminar. </p>
<p>I met Basil in the later chapters of his work and life, and he was no less impressive for it. </p>
<p>I admired his scientific achievements – who couldn’t – and respected his humility and acknowledgement of the contribution of others when he spoke of it. </p>
<p>I enjoyed the edge of steel he would occasionally inject into the most genial of conversations, and I loved his humanity. </p>
<p>He changed the world, he was indeed awesome and he was my friend.</p>
<hr>
<h2>Pathway from discovery to public health impact</h2>
<h3>Starting in the 1960s, Basil Hetzel identified iodine deficiency as a preventable cause of intellectual impairment and other disorders, and initiated an effective global public health program that is still in place today.</h3>
<p><em>To navigate, click your mouse on the right and left pointers to move forwards and back.</em></p>
<iframe src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1eTPBffMPhGbDlOXM2L3RCYxsQHYT8-DLOTFukYFkjGc&font=Default&lang=en&initial_zoom=2&height=650" width="100%" height="650" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen="" frameborder="0"></iframe>
<hr>
<p><em>Content included in the timeline was provided by <a href="http://people.unisa.edu.au/howard.morris">Howard Morris</a>, and the structure originally prepared by Basil himself following his participation in discussion about a program of research in Nutritional Physiology at the University of Adelaide.</em> </p>
<p><em>Howard notes that Basil emphasised the necessity for fundamental physiology research to generate programs for the translation of knowledge to improve the human condition. This was what he termed the “Big Picture”. He prioritised communicating to the next generation of medical researchers, always willing to spend his time and energy exploring various avenues by which he could communicate his message of the Big Picture.</em></p>
<p><em>Basil published a summary of his work preventing iodine deficiency in a <a href="https://academic.oup.com/ije/article/41/3/595/836596/Commentary-From-iodine-deficiency-in-Papua-New">2012 commentary</a>.</em></p><img src="https://counter.theconversation.com/content/72579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pat Buckley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Public health pioneer Basil Hetzel died on February 4 2017. Among other career highlights, he identified the most common cause of preventable brain damage: dietary iodine deficiency.Pat Buckley, Dean of Graduate Studies , University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674682016-10-24T09:19:46Z2016-10-24T09:19:46ZHow we discovered that heading a football causes impairment of brain function<figure><img src="https://images.theconversation.com/files/142776/original/image-20161023-15969-syoa2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cristiano Ronaldo heading a football.</span> <span class="attribution"><span class="source">Alejandro Ramos/wikipedia</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Heading a football may look effortless but many scientists have suspected it might actually harm the player’s brain. There could be real consequences – we know that brain injury is linked to an <a href="http://www.annualreviews.org/doi/full/10.1146/annurev-pathol-012615-044116?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">increased risk of dementia</a>, for example. However, it has proven surprisingly difficult to find out the true impact of football heading, partly because mild brain injury is notoriously difficult to detect.</p>
<p>Now <a href="http://www.ebiomedicine.com/article/S2352-3964(16)30490-X/fulltext">our new research</a>, published in EBioMedicine, suggests that just a single session of heading practice results in temporary impairment in memory and a disruption of the normal balance of chemicals in the brain. We must now investigate whether these effects remain temporary after repeated football heading exposure and what the long-term consequences on brain health are.</p>
<p>Much of what we know about the brain is based on research on the mature brain, but the human brain is not fully developed until our early twenties. The frontal lobes are especially late to mature. This part of the brain, which absorbs the impact of the ball, is home to uniquely human qualities such as impulse control and conscious planning. In the teenage years brain chemicals are in a state of flux and the brain is very sensitive in lots of ways. A massive <a href="https://www.youtube.com/watch?v=6zVS8HIPUng">process of reorganisation of connections</a> takes place before the brain calms down in its mature state. </p>
<h2>The experiment</h2>
<p>A typical football practice drill involves many repetitions heading the ball. So what happens to the brain when these head impacts are repeated over and over again – particularly when done from a young age? </p>
<p>To find out, we used a sensitive research technique from our basic neuroscience lab to conduct our study. Transcranial magnetic stimulation uses a coil held over a person’s head to generate a brief magnetic pulse stimulating a small area of the brain. This, together with electrodes placed over the muscle, can be used to measure neural signals from the brain to the muscle.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qkNbYHu_STU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>From this we can work out the level of “inhibitory chemicals” in the brain. These can interrupt or block certain brain activity and potentially make muscles more difficult to control, for example. In particular we look at the <a href="http://thebrain.mcgill.ca/flash/d/d_04/d_04_m/d_04_m_peu/d_04_m_peu.html">brain signalling chemical called GABA</a>, which is the most powerful inhibitor in the brain’s motor system. If there is more inhibition in the brain it means that the normal brain chemistry is changed after hitting the ball with the head.</p>
<p>We asked a group of football players to head a ball 20 times, fired from a ball machine to simulate the pace and power of a corner kick. Before and after the heading sessions, we tested players’ brain inhibition measured using transcranial magnetic stimulation, and players’ cognitive function such as memory. We monitored these same levels again the next day, the day after that, and two weeks after the heading session in the lab. </p>
<p>We found that football heading resulted in immediate and measurable changes in brain function. Increased inhibition in the brain was detected after just a single session of heading. Memory test performance was also reduced by between 41 and 67%. </p>
<p>The good news is that these changes in brain function were transient, with effects normalising within 24 hours. The bad news is that we do not know whether there is an accumulative effect when this biochemical disruption is repeated over and over again through weekly heading practice drills, or what the long-term consequences of heading on brain health are. This is why further research is needed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142775/original/image-20161023-15941-170t84b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heading a football seems to release the inhibitory brain chemical GABA.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Now that we know that heading a football changes the biochemistry of the brain, at least temporary, we would like to visualise the effects of heading by using a brain scanner. In a brain scanner we can see how micro-damage to brain structure and brain connections relates to changes in the biochemistry of the brain. This would give us a much better idea of what goes on in the brain as a result of heading the ball. Therefore the research we have done is just a first step on the journey of finding out what is the true impact of football heading.</p>
<h2>Should we let kids play football?</h2>
<p>So what does this mean for players of the beautiful game? If there is more inhibition in the brain immediately after heading the ball, this could affect control of the muscles which may impair performance and expose the player to greater injury risk – something that has <a href="http://bjsm.bmj.com/content/early/2015/12/01/bjsports-2015-094982.abstract">previously been reported</a> in people who have had a concussion. </p>
<p>It is also important to realise that there are no known safe levels of football heading. One header is unlikely to give you brain damage, but how many headers do? At what levels of exposure do we enter the grey zone?</p>
<p>It is perhaps a bit like alcohol, there are <a href="http://www.medscape.com/viewarticle/824237">no known safe limits for alcohol</a> consumption. Disrupting the brain chemistry during brain development until late adolescence may warrant extra caution. Hopefully, further research can shed some more light on long-term health implications.</p><img src="https://counter.theconversation.com/content/67468/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Ietswaart receives funding from The National Institute of Health Research (NIHR) Brain Injury Healthcare Technology Cooperative.</span></em></p><p class="fine-print"><em><span>Angus Hunter receives funding from `sportscotland institute of sport</span></em></p><p class="fine-print"><em><span>Thomas Di Virgilio receives funding from NIHR (National Institute for Health Research).</span></em></p>A single session of football heading can temporarily impair memory. So what does that mean for children with developing brains?Magdalena Ietswaart, Cognitive Neuroscientist and Associate Professor, University of StirlingAngus Hunter, Reader in Exercise Physiology, University of StirlingThomas Di Virgilio, PhD student in Psychology, Health and Exercise Sciences, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/368872015-08-18T04:59:45Z2015-08-18T04:59:45ZYoga may be the missing link to stroke survivors’ rehabilitation<figure><img src="https://images.theconversation.com/files/90082/original/image-20150729-30886-15k81tj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The physical and mental health benefits associated with moving, being active and mindful are not just limited to yoga.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-119211757/stock-photo-group-doing-stretching-exercises-in-back-training-class-in-a-fitness-center.html?src=zX73Kid8TihDZEHqcHsUxA-1-1">Robert Kneschke/Shutterstock</a></span></figcaption></figure><p><a href="http://strokefoundation.com.au/">One in six</a> Australians will have a stroke in their lifetime. That’s about 51,000 strokes per year, or one every ten minutes. <a href="http://www.ncbi.nlm.nih.gov/pubmed/24449944">Worldwide</a>, stroke is the second most common cause of premature death, after heart disease, and is the leading cause of disability among adults. </p>
<p>During a stroke, the blood supply to the brain is interrupted by a blocked or ruptured blood vessel. Cells in the brain are deprived of oxygen and nutrients, causing them to die. Damage is localised to the area of brain where the blood supply was interrupted. But in cases where the blood vessel has ruptured, bleeding increases pressure in the brain region, causing greater damage.</p>
<p>Symptoms of stroke include drooping of the face or mouth, loss of feeling and movement in the arms, and a loss of ability to speak clearly and or understand what others are saying. Only a doctor can diagnose a stroke but contact emergency services immediately if it’s suspected. The longer a stroke is untreated, the higher the likelihood of long-term brain damage. </p>
<p>Strokes may cause long-term difficulties with attention, decision-making, memory, speech, understanding others, movement and balance. While these difficulties are typically targeted in <a href="http://www.ncbi.nlm.nih.gov/pubmed/25475247">rehabilitation and long-term stroke management approaches</a>, other less obvious consequences of stroke, such as poorer emotional well-being, may not be appropriately addressed.</p>
<p>Evidence-based lifestyle interventions such as <a href="http://www.hindawi.com/journals/ecam/2013/357108/">yoga</a> have a role to play in addressing unmet psychological, social and spiritual needs after a stroke.</p>
<h2>Emotional well-being</h2>
<p>Peoples’ lives change <a href="http://www.ncbi.nlm.nih.gov/pubmed/21510816">markedly</a> after a stroke. Along with poorer health, survivors often have reduced independence and must rely on others for basic needs. This changes the dynamics of their family environment, social interactions, lifestyle and ability to work.</p>
<p>While some stroke survivors are able to adapt to these changes, a significant proportion have trouble coping. Not surprisingly, stroke survivors <a href="http://www.ncbi.nlm.nih.gov/pubmed/15879342">commonly experience</a> poorer emotional well-being, depression and anxiety. </p>
<p>Not only can depression make daily challenges harder to cope with, and affect <a href="http://www.ncbi.nlm.nih.gov/pubmed/18019607">movement and balance</a>, research shows those with post-stroke depression are <a href="http://www.ncbi.nlm.nih.gov/pubmed/15169698">likely</a> to have poorer physical health outcomes and are more likely to die prematurely.</p>
<h2>How yoga can help after a stroke</h2>
<p><a href="https://www.yogaaustralia.org.au/what-is-yoga">Yoga is a system</a> of self-development that has evolved over many thousands of years since its inception in ancient contemplative societies in southern Asia. </p>
<p>Yoga aims to integrate mind and body. This is appropriate for survivors, as strokes have consequences for both physical and mental function. Yoga’s holistic approach <a href="http://www.ncbi.nlm.nih.gov/pubmed/16283496">views health</a> as relating to one’s mental, physical and social potential, not merely the absence of disease. </p>
<p><a href="http://www.tandfonline.com/doi/abs/10.1080/21641846.2014.957042?journalCode=rftg20#preview">Fatigue and low exercise tolerance</a> often make it difficult for stroke survivors to participate in standard modes of exercise. But yoga can be individualised and adapted to suit most individuals despite their movement abilities. In fact, yoga can be more accessible to those seeking to keep active after stroke than other forms of exercise. </p>
<p>With this level of accessibility, yoga can <a href="http://www.ncbi.nlm.nih.gov/pubmed/22836351">increase confidence</a> and promote participation in other forms of physical activity and daily activities. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/22836351">study from the Unites States</a>, for instance, found eight weeks of yoga improved stroke survivors’ balance and reduced their fear of falling.</p>
<h2>Meditation and mindfulness</h2>
<p>Beyond movement and physical activity, yoga involves contemplative practices such as <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834522/">meditation</a>. This means paying attention to breathing and body sensations while moving or keeping still. </p>
<p>Regular meditation has been shown to promote <a href="http://www.ncbi.nlm.nih.gov/pubmed/7042457">mindfulness</a>, a skill for purposefully maintaining attention in the present moment in an open and accepting way. Mindfuless training has been associated with a number of benefits, including improved emotional well-being and cognitive function. </p>
<p>However, the current level of evidence is far from conclusive and the mechanisms underlying these benefits are yet to be clearly delineated. <a href="http://www.cmu.edu/news/stories/archives/2015/february/mindfulness-training-and-health.html">Some commentators</a> have proposed that mindfulness techniques engage the brain in particular ways that strengthen parts of the brain responsible for attention, decision making, working memory, and emotional regulation. </p>
<p>Regardless, feeling in control and able to cope provides a sense of self-mastery, leading to <a href="http://www.ncbi.nlm.nih.gov/pubmed/24985393">better stress management</a> and emotional well-being. Yoga can help us develop the skills necessary to remain in control of our physical and mental reactions when we face challenging situations. </p>
<h2>Starting out</h2>
<p>Before starting yoga, stroke survivors should consult with their health professional. Overall, yoga is considered to be <a href="https://nccih.nih.gov/research/blog/safeyoga">safe</a>. But styles and teachers vary, so not all yoga classes are appropriate for stroke survivors. </p>
<p>Stroke survivors should ensure their potential teacher is adequately trained and experienced to support their special needs. This includes knowing which yoga practices are suitable and how others can be adapted. The National Stroke Foundation’s <a href="http://www.strokefoundation.com.au/blog/?tag=yoga-and-stroke">StrokeLine</a> – 1800 STROKE (787 653) – has a directory of yoga teachers who can meet the special needs of stroke survivors. </p>
<p>Some yoga teachers might provide group classes aimed at supporting those with special needs or, alternatively, provide one-on-one instruction. Which of these is better depends on personal preference, financial factors and the level of personal support needed to participate.</p>
<p>It’s important to note, however, that yoga is not a replacement for conventional health care, or a reason to postpone seeing a health professional. It can be an important addition to standard therapies. </p>
<p>The physical and mental health benefits associated with <a href="http://www.ncbi.nlm.nih.gov/pubmed/16639173">moving</a>, being active and mindful are not limited to yoga. Any activity that emphasises use and integration of one’s body and mind, such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/25591053">Tai Chi</a> or even <a href="http://www.ncbi.nlm.nih.gov/pubmed/16639173">walking</a>, may improve stroke survivors’ emotional well-being.</p><img src="https://counter.theconversation.com/content/36887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maarten Immink has received research funding from the National Stroke Foundation. He is a yoga and meditation teacher.</span></em></p>One in six Australians will have a stroke in their lifetime. That’s about 51,000 strokes per year, or one every ten minutes.Maarten Immink, Senior Lecturer, Human Movement, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/438112015-07-14T11:30:18Z2015-07-14T11:30:18ZAlexia: what happens when a brain injury makes you forget how to read<figure><img src="https://images.theconversation.com/files/88216/original/image-20150713-11798-6utyao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients with alexia – or acquired dyslexia – can recognise letters but not words. </span> <span class="attribution"><span class="source">Letters via B Calkins/www.shutterstock.com</span></span></figcaption></figure><p>Once we have successfully learned how to read, it continues to be easy for most of us. But for some people it can be an immense challenge. In developmental dyslexia, the process of learning to read is disrupted, while in alexia – or acquired dyslexia – brain damage can affect reading ability in previously literate adults. </p>
<p>Patients with pure alexia lose the ability to read fluently following injury to areas in the rear part of the left hemisphere of their brain. The curious thing is that they can still walk, talk, think, and even write like they did before their injury. They just can’t read. Not even what they have written themselves. </p>
<p>Some patients lose the ability to recognise letters and words completely, but more commonly, patients with pure alexia can recognise single letters and will spell their way through words to identify them. As a result, some researchers prefer the term “letter-by-letter reading” to pure alexia. </p>
<p>Pure alexia as a syndrome was <a href="http://www.sciencedirect.com/science/article/pii/S0093934X8371059X">first described</a> more than 120 years ago, but researchers still disagree on the cause of the reading problems. They agree that a lesion in the brain causes the problems, but they <a href="http://www.tandfonline.com/doi/full/10.1080/02643294.2014.924226#abstract">can’t agree</a> on which cognitive mechanisms may be responsible, or even how the disorder should be defined.</p>
<h2>Not a language problem</h2>
<p>Evidence from functional brain imaging has led to the idea of a brain area that is specialised in recognising words and letters, called the “visual word form area”. It is this area that is <a href="http://www.unicog.org/publications/cohen_lblreading_neuropsychologia_2004.pdf">commonly damaged</a> in pure alexia. However, the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223525/">role of this area</a> in the way we read is highly debated and there is disagreement about whether it is reading-specific, or important for all sorts of visual recognition, such as looking at images or even faces. The same questions are discussed regarding pure alexia: whether the disorder is specific to reading or a more general deficit in somebody’s visual processing ability. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88334/original/image-20150714-21711-109yjpc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The image shows the lesions of four patients with pure alexia. The colours represent the number of patients with lesions in different areas. The visual word form area is marked by the red crosshairs.</span>
<span class="attribution"><a class="source" href="http://cercor.oxfordjournals.org/content/19/12/2880.long">Randi Starrfelt, Cerebal Cortex</a></span>
</figcaption>
</figure>
<p>In most, if not all cases of pure alexia, other visual perceptual functions such as recognition of numbers or objects <a href="http://www.ncbi.nlm.nih.gov/pubmed/19366870">are affected</a>, while other language functions, like speech comprehension and production – as well as writing – may be intact. </p>
<p>So it makes sense to look at pure alexia as a visual disorder; if it was a language problem, we would at least expect writing to also be affected, and it’s not. It is also clear, however, that the deficit in pure alexia patients primarily affects recognition of complex visual stimuli. This is because patients with this disorder <a href="http://www.ncbi.nlm.nih.gov/pubmed/23774289">may perform normally </a> in perceiving simple patterns. </p>
<p>Pure alexic patients have difficulty recognising <a href="http://tdlc.ucsd.edu/SV2012/Pubs/StarrfeltBehrmann_Neuropsychologia2011.pdf">numbers</a> as well as letters, and also <a href="http://www.ncbi.nlm.nih.gov/pubmed/19366870">show problems</a> in perceiving more than a few letters or numbers at the same time. So it seems that patterns must be either visually complex, or need to be linked with meaning – such as words – for pure alexic patients to be impaired. On this basis, we have suggested that the core problem for pure alexic patients, is that they see “too little too late” to be able to read fluently. </p>
<p>As you read the words in this article, you need to perceive and integrate multiple letters at a time to access the meaning of the words and the text. Very few other visual tasks demand the same speed and span of apprehension for successful recognition, which is why patients with pure alexia rarely complain of any problems other than in reading.</p>
<h2>When letters come easier than words</h2>
<p>For normal readers, integrating letters into words is a very simple task that we perform automatically and effortlessly. It may actually be more difficult to focus on a single letter within a word than the word itself. </p>
<p>This is also known as the “word superiority effect” – that <a href="http://www.ncbi.nlm.nih.gov/pubmed/24027510">people are better</a> at identifying words than single letters, even though words consist of letters that must be processed for the word to be recognised. This effect probably arises because of two things: first, normal readers can process letters in parallel by identifying multiple letters at a time and second, our knowledge of word meaning and word spelling helps us to identify the word. </p>
<p>The word superiority effect is not present in pure alexic patients: they actually <a href="http://www.ncbi.nlm.nih.gov/pubmed/24801564">perform better</a> recognising single letters than with words. For instance, when they are asked to recognise something that is presented to them for a very short time they would recognise the letters, rather than the word itself. Perhaps it’s no wonder that many of them resort to letter-by-letter reading.</p>
<p>In evolutionary terms, reading is a very recent skill which takes time and instruction to learn. If a dedicated brain area is responsible for visual recognition of words then this function of the brain must have been created in each of us as we learn, rather than through evolutionary mechanisms and development. </p>
<p>But although the “visual word form area” may be specialised for reading, and this specialisation is created through learning to read, the area itself is not new – the brain hasn’t grown in any way. That is one of the intriguing things about the brain: even if all we learn is stored in there, the brain doesn’t grow much bigger when we learn. Instead, it seems to be reorganised, so that new skills may relocate or at least slightly displace older skills. </p>
<p>This has been referred <a href="https://books.google.co.uk/books/about/Reading_in_the_Brain.html?id=NlYsTqta7SYC&hl=en">to as “neuronal recycling”</a> by the French neuroscientist Stanislas Dehaene, the man who also coined the term “the visual word form area”. It seems that the visual word form area, in addition to being crucial for visual word recognition, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17239621">continues to contribute</a> to our recognition of other visual stimuli such as images of objects. Exploring this relationship between reading and other cognitive skills is a new avenue in research on reading and the brain where there is still much to learn.</p><img src="https://counter.theconversation.com/content/43811/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Randi Starrfelt receives funding from The Danish Council for Independent Research (Sapere Aude).</span></em></p>Lesions on a particular region of the brain can cause ‘acquired dyslexia’.Randi Starrfelt, Associate Professor, Department of Psychology, University of CopenhagenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/323172014-09-30T18:38:55Z2014-09-30T18:38:55ZBrain injury in sport is an unfolding tragedy – we’re only now starting to count the cost<figure><img src="https://images.theconversation.com/files/60436/original/svnff4zj-1412089660.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C798%2C502&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Try and run but you can't hide.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/blacksportsphotos/8013427088/sizes/l/in/photolist-dd7UG1-cjHNPU-cg2L1J-dd7Tvi-ayMcF5-dd7TEA-bzbSrE-cg2UvQ-c2NvEJ-cbGoLu-c2MTAE-bv8A8U-bN6vFD-ctnePq-awEVtD-cbGnW1-cbGkHU-buA7x9-c2MX2y-bJ3eJV-cg2Efs-cjHDnU-buA8Zm-buA2MU-bUkbZK-cjHQ5N-bzbS3f-dd7SL5-cg2TRY-awHx1w-ctncJG-cg2PBC-ayJWNM-cg2Lu3-bPwRHa-dd7SZS-dd7V5m-cbGj6E-bN6tBT-bJ3zp8/">BlackSportsPhotos by Schwarz Johann</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Ah, football. The great American pastime.</p>
<p>The freshly cut grass and crisply-painted yard lines. The sound of helmets clashing in an epic stack of large men vying for a single ball. Stands packed high with thousands upon thousands of crazed, prideful, body-painted fanatics. Dementia, confusion, and depression.</p>
<p>Wait, what? That last bit may not be present on game day, but for many football players, it’s brewing all along – with every clash, tackle, and fall.</p>
<p>Cases of chronic traumatic encephalopathy, or CTE, are only now beginning to unfold with post-mortem diagnoses and early symptoms of memory loss, depression, confusion, and aggression being reported by former NFL players.</p>
<p>With the recent cases of <a href="http://woodtv.com/2014/09/29/family-teen-told-to-play-football-after-concussion/">high schooler Morgan Manlick</a> and <a href="http://www.cbssports.com/collegefootball/eye-on-college-football/24729076/did-brady-hoke-send-shane-morris-into-the-game-with-a-concussion">Michigan quarterback Shane Morris</a> being sent back into the game after suffering obvious concussions, fans and players alike find themselves questioning the legal, ethical, and health ramifications of football coaches’ decisions.</p>
<p>And it’s not just in American football. In the UK, questions are now also being raised in the game of rugby after notable cases, including <a href="http://www.theguardian.com/sport/2013/dec/13/death-of-a-schoolboy-ben-robinson-concussion-rugby-union">14-year-old Ben Robinson</a> who died after being allowed to return to the field while concussed. </p>
<p>Boxers, wrestlers, ice hockey, soccer, and rugby players tend to be more prone to head traumas than athletes of other sports. But despite athletes getting the most attention, others are also at risk; combat militants, domestic abuse victims, and even those with a history of seizures are all ticking time bombs for CTE.</p>
<h2>What is CTE?</h2>
<p>Brain damage is more than a short-term problem. Brett Favre, former Green Bay Packers quarterback, <a href="http://espn.go.com/nfl/story/_/id/9872646/brett-favre-return-sources-saying-rams-reached-out">announced last October</a> that he couldn’t remember his daughter playing youth soccer one summer.</p>
<p>“For the first time in 44 years,” he said, “that put a little fear in me.”</p>
<p>Favre, though perhaps the most well-known, is not the first to “come out” with CTE symptoms.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=804&fit=crop&dpr=1 600w, https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=804&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=804&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1010&fit=crop&dpr=1 754w, https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1010&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/60437/original/jnntnghm-1412090691.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1010&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Brain slice.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mythago/2886087688/sizes/o/in/photolist-5p2Xjy-8BziEm-3z1ZA-4MwMCt-jDhpK-8YVKFB-HouxX-oeVbEq-oub94C-g8iPVj-4MFAHb-5N63kr-4qVZDd-7xDw8c-8YabQ4-4q1N3X-fNjS9U-7aZN6-hbRkR3-aBJnrJ-5Nai9Q-5Naikq-6DBoxJ-7FsrEs-adjQtZ-5Xwjjj-5Xs5fK-7FowZH-7FsrKo-dEu4jt-5UvtGG-7xC8qc-5K28tP-fgZhPs-buVh7i-kuqtwi-4wsKdL-fA9mkz-dotbm-pJWKq-cHVLJN-jXrDrc-4rfoY7-7faC8b-8kz8io-6b6PVH-ovQ4Vp-hkmM-3KcgE-6NyMvF-bwu91X/">Myrddrr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Like a number of neuro-degenerative diseases, such as Alzheimer’s, CTE can only be conclusively ruled after examining brain tissue once someone has died. As of last December, 34 former NFLers <a href="http://abcnews.go.com/Health/cte-degenerative-brain-disease-found-34-pro-football/story?id=17869457">have been diagnosed post-mortem</a> with CTE.</p>
<p>“Encephalopathy” is defined as any disease of the brain. Its prefixes – “chronic” and “traumatic” – are aptly named. CTE is a result of months to years to decades of repetitive impacts on the brain and its resulting damage to axons, the portion of the neuron at which impulses are conducted to communicate with other neurons. And at a rate of nearly <a href="http://www.ncbi.nlm.nih.gov/pubmed/14683544">one concussion every two games</a>, it’s likely that the average player will suffer several concussions during their career.</p>
<p>Symptoms of CTE range from changes in mood (apathy, anxiety, suicidal urges) to behaviour (aggression) to cognition (memory loss) to, in some cases, difficulty with balance and gait.</p>
<h2>The CTE brain</h2>
<p>In February 2011, former Bears, Giants and Cardinals safety Dave Duerson, aged 50, sent a text message to his family requesting that his brain be used for research at Boston University School of Medicine, location of the largest CTE brain bank in the world.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=493&fit=crop&dpr=1 600w, https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=493&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=493&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=620&fit=crop&dpr=1 754w, https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=620&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/60429/original/c8qdcp9h-1412089065.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=620&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Made a mark: Dave Duerson.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/6954526394/sizes/l/in/photolist-bAxLpu/">Thomas Hawk</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>He promptly held a gun to his chest and <a href="http://www.mensjournal.com/magazine/dave-duerson-the-ferocious-life-and-tragic-death-of-a-super-bowl-star-20121002">shot himself dead</a>.</p>
<p>Robert Stern, co-director of the research group, and his colleagues uncovered elevated levels of tau protein in Duerson’s brain, clumped especially around its deep wrinkles, called sulci. Although tau protein is critical for stability of a nutrient transport system in healthy brains, tangles of tau protein (as seen in Alzheimer’s) are thought to <a href="http://www.alz.org/braintour/tangles.asp">disrupt this system</a>, resulting in cell death.</p>
<p>At least nine active or retired NFL players have <a href="http://www.latimes.com/sports/sportsnow/la-sp-sn-lawsuit-concussions-suicide-paul-oliver-20140924-story.html">killed themselves in the past four years</a>. And <a href="http://sports.espn.go.com/ncf/news/story?id=5569329">the suicide</a> of 21-year-old University of Pennsylvania football player Owen Thomas in 2010 was a startling reminder that more than just the old veterans are affected by this kind of trauma.</p>
<p>In the two years since it was set up in 2008, the brain bank at Boston University had possession of more than 250 current and former athletes’ brains and a <a href="http://fifthdown.blogs.nytimes.com/2010/04/20/n-f-l-donates-1-million-for-brain-studies/">no-strings-attached $1m grant</a> from the NFL. And before that there was the Brain Injury Research Institute in Pennsylvania, co-founded by forensic pathologist Bennet Omalu. Omalu was the first to characterise CTE in the brains of five former NFLers who committed suicide. He was surprised to find Alzheimer’s and dementia-like brain damage in these relatively young men.</p>
<p>The typical brain afflicted with CTE has reduced brain volume, particularly in the frontal and temporal lobes. This reduction is associated with enlarged ventricles or fluid-filled brain cavities. </p>
<p>Reduced blood flow and, eventually, shrinkage of several key brain regions, including the amygdala (emotion) and hippocampus (memory formation) likely explains the physical and personality changes associated with the disease.</p>
<p>A view under the microscope reveals pathologies that greatly resemble Alzheimer’s: neuron loss, neuro-fibrillary tangles formed from deposits of tau protein and the accumulation of <a href="https://theconversation.com/the-best-way-to-halt-dementia-is-to-put-our-heads-together-31329">another protein</a> called beta-amyloid.</p>
<p>In rodent models, traumatic brain injury has been followed by neuro-degeneration for as long as <a href="http://www.ncbi.nlm.nih.gov/pubmed/9383090/">a year after impact</a>. The pathology, or cause, between point A (trauma) to point B (dementia) is not well-understood beyond these observations, unfortunately.</p>
<h2>The future of football</h2>
<p>Favre, now 44, was tackled over 525 times during his career. In <a href="http://www.today.com/news/brett-favre-nfl-concussions-toll-has-got-be-pretty-high-2D11603374">an interview for TODAY</a>, he told Matt Lauer: “In some respects I’m almost glad I don’t have a son because of the pressures he would face. I would be real leery of him playing.”</p>
<p>Some youth organisations have begun implementing flag football as an <a href="http://ideas.time.com/2012/11/06/why-kids-under-14-should-not-play-tackle-football/">alternative to tackle football</a> for kids, a critical time for the developing brain. But this proposal is unlikely to catch on. Not with the obsession, reverence, and hero worship for the Great American Sport.</p>
<p>In July, judge Anita Brody accepted a revised settlement agreement submitted by the NFL after class action was brought by 5,000 players and their families. The original settlement offered by the NFL was <a href="http://www.behindthesteelcurtain.com/steelers-2014-preview-preseason-news-updates-roster-depth-chart-salary-cap/2014/7/24/5925353/nfl-concussion-lawsuit-results-status-update-money-2014">rejected in January</a> because US$675m wasn’t thought enough to cover it. Alongside this unfolding tragedy, the NFL is now beginning to face a bill that continues to grow.</p>
<p>Helmets can only do so much. The rules of the sport are unlikely to change. And money can’t reverse the damage and tragedy resulting from CTE. All of this begs the question: what, if anything, can the NFL do to prevent this harm in the first place?</p><img src="https://counter.theconversation.com/content/32317/count.gif" alt="The Conversation" width="1" height="1" />
Ah, football. The great American pastime. The freshly cut grass and crisply-painted yard lines. The sound of helmets clashing in an epic stack of large men vying for a single ball. Stands packed high with…Jordan Gaines Lewis, Neuroscience Doctoral Candidate, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/320112014-09-29T09:02:34Z2014-09-29T09:02:34ZHow understanding athletes’ aim could help rehabilitate patients with brain damage<figure><img src="https://images.theconversation.com/files/59934/original/mdprdktn-1411570041.jpg?ixlib=rb-1.1.0&rect=49%2C47%2C928%2C677&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Calculating the shot.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/omtebekijken/6365058119/sizes/l/in/photolist-aGsA2n-4D2ccY-d4AnxG-d4ArdU-481SZh-5v6aRR-4vP7xp-d4C7dW-cPmdMY-nTrrAJ-d4BNmN-d4C9XS-d4AvoS-d9bhaU-8woX5q-5jgkpT-oaVLsX-4vP7gH-n6rRDK-bexGG-bexGj-ei9yip-exbD8u-6fzNJB-ecstHN-9pVTzv-f1MUH7-f1xDuX-f1xD56-f1xDTz-f1xC4B-f1MUpC-f1MUAE-f1MVUm-f1MUEW-f1MVHN-f1xCM4-f1MVh3-f1xCe6-f1xCac-f1xCSi-f1xDcK-f1MVe7-5jNz5H-dnwMAh-dnwNBb-8xdThm-mUfj6x-f7tdoP-5JABTX-ayCMwL/">Jeroan Bosman</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>How do we take aim at things? For example, how are athletes able to accurately throw a javelin, throw a boxing punch or put a ball into the 18th hole?</p>
<p>Many sports involve aiming and rapidly delivering an object, like a ball, that goes out of control once it’s released. In these situations, people must take aim based on initial visual information. They happens in two ways, either relative to themselves (something called egocentric direction) or relative to a visual landmark (allocentric direction).</p>
<p>Egocentric direction is an automatic process. It involves calculating an object’s direction relative to your eyes and keeping track of your eye position when launching the object. Allocentric direction involves seeing and remembering an object relative to some familiar and stable object, like the goalie relative to the goalpost.</p>
<p>In real world conditions, both of these mechanisms are combined in the brain. And ultimately the brain must convert both into egocentric commands to send signals to tell muscles to contract and carry out the action.</p>
<p>There are many examples of this in sports. To score a point, a soccer or football forward on a breakaway must use allocentric information, like where he sees the goal keeper relative to the goal, and the ball relative to his foot. But he must also use egocentric information, like his sense of goal location relative to his eye, and his foot relative to his body. The brain then combines all this information to trigger a kick that sends the ball toward the open part of the goal.</p>
<h2>Which parts of the brain?</h2>
<p>The egocentric mechanisms that visually guide action are fairly well known by neuroscientists, but relatively little is known about allocentric ones. </p>
<p>It is believed that more dorsal (upper) parts of the visual brain are involved in transforming egocentric vision into muscle commands, while more ventral (lower) parts of the visual brain are allocentric. This thinking is mainly based on studies with brain-damaged patients or ones that involve visual perception. But the specific brain areas that are involved in remembering allocentric visual locations to guide manual actions, like reaching toward an object, haven’t been investigated.</p>
<p>We aimed to do this in a recent study, published <a href="http://www.jneurosci.org/content/34/37/12515.short">in the Journal of Neuroscience</a>. We monitored brain activity in participants using functional magnetic resonance imaging (fMRI) while they glimpsed a briefly presented target, then remembered its location for several seconds, either relative to themselves (egocentric) or to a visual landmark (allocentric), until finally they were cued to aim a reach in the dark.</p>
<p>The results showed that partially overlapping but different brain areas were used for both types of visual processing. In particular, when participants were instructed to remember egocentric target locations, a part of the cerebral cortex at the back of the brain, called the superior occipital gyrus, encoded their visual direction. In contrast, the allocentric task caused activity in areas called the inferior occipital gyrus and inferior temporal cortex, to the lower and near the sides of the brain. In both types of task, other areas in parietal and frontal cortex, near the top and front of the brain, coded direction during the final reach response.</p>
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<img alt="" src="https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=607&fit=crop&dpr=1 754w, https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=607&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/60299/original/2t795mnr-1411992251.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=607&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<h2>Real-world applications</h2>
<p>These are scientifically novel results with clear implications. Besides helping to explain what is going on in the brain in demanding situations like sports, there are clinical applications. If the egocentric brain areas are damaged by a stroke, for example, the allocentric areas may still be able to influence action. In these patients, rehabilitation therapies designed to enhance the use of allocentric cues could reinforce recovery and continued function.</p>
<p>Likewise, egocentric function requires constant fine-tuning (through practice) of the brain’s internal sense of vision, eye position, and other body parts. This ability likely degrades in neuro-degenerative disorders and even during normal ageing, so strategies that build on allocentric mechanisms may be helpful for these people too.</p>
<p>So we know what areas of the brain are used when taking aim and how we might use it to help people with certain conditions. But what remains a mystery is how the allocentric parts of the visual system are able to influence parts of the brain that control actions like reaching. In other words, what is going on in the brain at the moment the athlete decides to take a shot at the net? To figure out this puzzle, we plan to go back to the lab to do more experiments.</p><img src="https://counter.theconversation.com/content/32011/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Douglas Crawford receives funding from the Canadian Institutes for Health Research, the National Sciences and Engineering Council of Canada (NSERC), and the Canada Research Chair Program. He is affiliated with the Canadian Action and Perception Network, the NSERC Brain in Action Program, and the Centre for Vision Research, Neuroscience Graduate Diploma Program and Departments of Psychology, Biology, and Kinesiology and Health Sciences at York University, Toronto, Ontario, Canada .</span></em></p><p class="fine-print"><em><span>Ying Chen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How do we take aim at things? For example, how are athletes able to accurately throw a javelin, throw a boxing punch or put a ball into the 18th hole? Many sports involve aiming and rapidly delivering…John Douglas Crawford, Distinguished Research Professor and Canada Research Chair, York University, CanadaYing Chen, PhD candidate in Kinesiology and Health Sciences, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/296282014-07-25T04:34:06Z2014-07-25T04:34:06ZWhat sign language teaches us about the brain<figure><img src="https://images.theconversation.com/files/54812/original/qsgvw596-1406210949.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The power is yours.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wycliffesa/8264639470">wycliffesa</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The world’s leading humanoid robot, ASIMO, has recently <a href="http://au.ibtimes.com/articles/559720/20140721/asimo-humanoid-robot-sign-language-japan.htm">learnt sign language</a>. The news of this breakthrough came just as I completed Level 1 of British Sign Language (I dare say it took me longer to master signing than it did the robot!). As a neuroscientist, the experience of learning to sign made me think about how the brain perceives this means of communicating. </p>
<p>For instance, during my training, I found that mnemonics greatly simplified my learning process. To sign the colour blue you use the fingers of your right hand to rub the back of your left hand, my simple mnemonic for this sign being that the veins on the back of our hand appear blue. I was therefore forming an association between the word blue (English), the sign for blue (BSL), and the visual aid that links the two. However, the two languages differ markedly in that one relies on sounds and the other on visual signs. </p>
<p>Do our brains process these languages differently? It seems that for the most part, they don’t. And it turns out that brain studies of sign language users have helped bust a few myths. </p>
<p>As neuroscience took off, it became fashionable to identify specific regions of the brain that were thought to be responsible for certain skills. However, we now know that this oversimplification paints only half a picture. Nowhere else is this clearer than in the case of how human brains perceive language, whether spoken or sign language.</p>
<p>The evidence for this comes from two kinds of studies: lesion analyses, which examine the functional consequences of damage to brain regions involved in language, and neuroimaging, which explores how these regions are engaged in processing language.</p>
<h2>Lesions teach new lessons</h2>
<p>Early theories of language processing pointed to two regions in the left hemisphere of the brain that were thought to be chiefly responsible for producing and understanding spoken language – <a href="http://en.wikipedia.org/wiki/Broca's_area">Broca’s area</a> and <a href="http://en.wikipedia.org/wiki/Wernicke's_area">Wernicke’s area</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54807/original/qjjp8vpv-1406208146.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Damage to Broca’s area, which is located near the part of the motor cortex that controls the mouth and lips, usually gives rise to difficulties in the production of speech. But this doesn’t adversely affect one’s ability to communicate, or understand conversation. So a hearing person with a lesion in Broca’s area – which can form, say, after a stroke – may not be able to form fluid sentences, but he or she could use single words, short phrases, and possibly nod or shake their head to gesture their responses.</p>
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<p>The comprehension of speech, on the other hand, is largely believed to be processed within Wernicke’s area, which is located near the auditory cortex – the part of the brain that receives signals from the ears. Hearing people with damage to Wernicke’s area are usually fluent in producing speech, but may make up words (for example: “cataloop” for “caterpillar” shown in the video below) and speak in long sentences that have no meaning.</p>
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<p>If Broca’s area is involved solely in the production of speech, and Wernicke’s area in understanding speech sounds, then we might expect that visual languages like sign language remain unaffected when these areas are damaged. But, surprisingly, they do not.</p>
<p><a href="http://www.nature.com/nature/journal/v381/n6584/abs/381699a0.html">One of the seminal studies in this field </a> was by award-winning husband and wife team <a href="http://lcn.salk.edu/team_ek.html">Edward Klima</a> and <a href="http://www.salk.edu/faculty/bellugi.html">Ursula Bellugi</a> at the Salk Institute. They found that deaf signers who had lesions in left hemisphere “speech centres” like Broca’s and Wernicke’s areas produced significantly more sign errors on naming, repetition and sentence-comprehension tasks than signers with damaged right hemispheres. </p>
<p>The right hemisphere of the brain is more involved in visual and spatial functions than the left hemisphere, and this is <a href="http://www.sciencedirect.com/science/article/pii/S1364661398012510?np=y">not to say</a> that the right hemisphere is not at all involved in producing and comprehending sign language. However, these findings verify that despite the differences in modality, signed and spoken languages are similarly affected by damage to the left hemisphere of the brain. </p>
<h2>Images speak out too</h2>
<p>Functional neuroimaging, which can show images of active regions in the brain, has agreed with lesion studies. Despite the fundamental differences in input or output modes for signed and spoken languages, there are common patterns of brain activation when deaf and hearing people process language.</p>
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<img alt="" src="https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54810/original/jxgj52hs-1406210419.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>For instance, Broca’s area is <a href="http://brain.oxfordjournals.org/content/124/10/2028.full">also activated when producing signs</a> and Wernicke’s area is <a href="http://www.pnas.org/content/97/25/13961.full">activated during the perception of sign language</a>. </p>
<p>Most importantly, these lesion and neuroimaging studies helped clarify two facts. First, that language is not simply limited to hearing and speech, and sign languages are complex linguistic systems processed much like spoken languages. Second, it also cemented our growing reservations of the oversimplified theories of language perception. Their involvement in processing sign language meant that we could no longer think of Broca’s and Wernicke’s areas exclusively as centres for producing speech and hearing sound, but rather as higher-order language areas in the brain.</p>
<p>Contrary to the common misconception, there is no universal sign language. According to a recent estimate, there are <a href="http://www.ethnologue.com/subgroups/deaf-sign-language">138 variations of sign language</a> in the world today, with structured syntax, grammar, and even regional accents. It is unfortunate then that a significant proportion of the global deaf community is <a href="http://link.springer.com/article/10.1007%2Fs10993-012-9245-8">still battling for legal recognition</a> of these languages. </p>
<p>Sign language is sometimes misguidedly looked upon as a “disability” language and simply a visual means of communicating spoken language, when it fact its linguistic construction is almost entirely independent of spoken language. For instance, American and British Sign Language are mutually incomprehensible, even though the hearing people of Britain and America predominantly share the same spoken language.</p>
<p>Knowledge of how sign languages are processed in the brain has not only furthered our understanding of the brain itself, but has also played a part in quashing the <a href="http://assets.cambridge.org/97805218/16205/sample/9780521816205ws.pdf">once widely believed notion</a> that these signs were simply a loose collection of gestures strung together to communicate spoken language.</p><img src="https://counter.theconversation.com/content/29628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sana Suri blogs at <a href="http://neurobabble.co.uk">http://neurobabble.co.uk</a>. The use of "deaf" in this article refers to culturally deaf individuals, such as those who have attended deaf schools.</span></em></p>The world’s leading humanoid robot, ASIMO, has recently learnt sign language. The news of this breakthrough came just as I completed Level 1 of British Sign Language (I dare say it took me longer to master…Sana Suri, PhD student, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/268972014-06-04T04:31:33Z2014-06-04T04:31:33ZExplainer: how we understand people and why it’s important<figure><img src="https://images.theconversation.com/files/50165/original/kmqsrs94-1401841355.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">By mimicking each other, humans try to physically understand each others' emotions. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/modenadude/5152332543/sizes/l">Flickr: modenadude</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Social cognition is our <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.58.110405.085654">ability to understand other people</a>, and it enables us to predict their behaviour and share experiences. </p>
<p>It’s also critical to understanding the many nuances underpinning everyday speech, because people frequently mean something different to what they actually say. </p>
<p>“It’s hot in here”, for example, may be a statement of fact or a request to open a window. To understand the speaker, we need to guess the intention behind her remark. </p>
<p>Social cognition may represent a specialised set of abilities in the brain that are separate from those needed for non-social tasks, such as recognising a car is out of fuel. If so, it follows that social cognition may be vulnerable to brain disorders even when non-social abilities remain intact.</p>
<h2>Evolutionary imperatives</h2>
<p>Research is beginning to show this to be the case. </p>
<p>Many <a href="http://www.sciencedirect.com/science/article/pii/S0010945208700248">people with brain damage</a>, often to the frontal lobes of the brain, develop disproportionately poor social skills and interpersonal behaviour despite relatively good intellect. </p>
<p>Similarly, people with autism spectrum disorders seem to have <a href="http://link.springer.com/article/10.1007%2FBF02172093">inordinate difficulty</a> with social information.</p>
<p>From an evolutionary perspective, it makes sense that social cognition may have developed separately to non-social skills. </p>
<p>Humans are social animals relying on cooperation and competition within groups to survive. So the ability to recognise social cues and understand the meaning of social behaviour may be an evolutionary imperative, resulting in its development independently of non-social information processing skills.</p>
<h2>How it works</h2>
<p>Basically, social cognition involves you being able to identify the mental states of others – putting yourself in someone else’s shoes. This helps us understand their beliefs, feelings, experiences and intentions. We can empathise and think about things from another point of view. </p>
<p>It also allows us to move flexibly between our own perspective and another. Interestingly, social cognition relies on information that cannot be directly observed but must be inferred from incoming information and our knowledge of the social world. </p>
<p>And increasingly, evidence suggests social cognition involves simulation – mimicking others’ experiences as a way to understand them. A good example here is how we experience other people’s emotions.</p>
<p>When watching someone’s face we tend to mimic her facial expression, smiling when she does, frowning in agreement. Such mimicry <a href="http://onlinelibrary.wiley.com/doi/10.1111/1467-9450.00054/abstract">may not be obvious</a> to the casual observer, but minute muscle activation can be detected very shortly after being exposed to an emotional expression. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716019/">Even our eyes dilate</a> in tune to the ones we’re looking at.</p>
<h2>More mimicry</h2>
<p>Within the brain itself, <a href="http://www.nature.com/nrn/journal/v11/n4/full/nrn2805.html">“mirror” neuron systems</a> in the premotor cortex of the frontal lobe are activated when we observe the actions of others. It seems that we don’t just mirror thoughts, we also mirror actions! </p>
<p>When healthy adults are put in fMRI scanners, and asked to think about the mental state of someone similar to themselves, the <a href="http://www.mitpressjournals.org/doi/abs/10.1162/0898929055002418#.U41eMuaSzl0">same region of the prefrontal cortex</a> is activated as when they think about themselves. This too suggests that we understand others by reference to ourselves. </p>
<p>Facial mimicry can be <a href="http://www.tandfonline.com/doi/abs/10.1080/.U3m9vKN--70#.U41i0-aSzl0">impaired following brain injury</a> although the reasons are still highly exploratory. If simulation does explain social cognition, there needs to be some kind of control of the process so we’re able to differentiate between our own experiences and that of others, and move between these flexibly.</p>
<h2>Understanding the brain</h2>
<p>In <a href="http://psycnet.apa.org/psycinfo/2014-19542-001/">some recent work</a> in my laboratory, we’ve found poor flexibility and inhibition can interfere with social cognition. </p>
<p>We asked a group of adults who’d suffered severe brain injury to do a simple communication task: describe their “ideal” holiday resort. They were then asked to put themselves in the shoes of a different kind of holiday-maker, such as a family with young children. </p>
<p>Once they’d thought of their ideal resort, the speakers with brain injury couldn’t describe a holiday from someone else’s perspective. But they didn’t have this problem when simply asked about two other types of holiday-makers. The problem only emerged when self-thoughts were activated first. </p>
<p>Understanding social cognition and how it can be disrupted in different kinds of brain disorders holds great promise for better assessment and remediation of social difficulties. It also promises to unlock knowledge of how our brains are wired to enable us to function in a social world.</p><img src="https://counter.theconversation.com/content/26897/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Skye McDonald receives funding from the National Health and Medical Research Council and the Australian Research Council.</span></em></p>Social cognition is our ability to understand other people, and it enables us to predict their behaviour and share experiences. It’s also critical to understanding the many nuances underpinning everyday…Skye McDonald, Professor of Clinical Neuropsychology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.