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The Brain : Concussion
CHAPTER 7. TESTING FOR CONCUSSION damage to axons – the main shafts of neurons – caused by the shear forces associated with a knock to the head or whiplash movement. Professor Henrik Zetterberg, a neurochemist from the University of Gothenburg in Sweden, has been looking at indicators of axon damage that might meet the criteria of a marker for more subtle brain damage. He says that, so far, research has singled out two key candidates. The first, the protein tau, is already making a name for itself as a biological villain of other conditions such as Alzheimer’s disease. Research has shown that amateur boxers have higher levels of tau in the blood stream the week or so after a bout, even if they’re not knocked out. These levels then slowly return to normal around eight to 10 weeks after the impact, as long as the boxer doesn’t have any more head impacts during that time. Similarly, a study by Zetterberg and his colleagues, conducted among Swedish ice-hockey players, showed that tau levels were elevated in the blood after a concussion when compared to measurements taken at the start of the hockey season. They also found the levels of the protein S-100B increased following a concussion, although not nearly as much as tau increased. Research has also found a correlation between blood tau levels and the severity of a TBI, where levels were higher in patients with a poorer outcome following injury. These studies suggest the potential for tau to be used as a diagnostic indicator for concussion. Another promising biomarker candidate for concussion is neurofilament light protein. Like tau, this is also a marker of damage to axons. Levels seem to peak four to 10 days after Australia has a strong sporting culture. We love our sport: we watch our kids grow up playing it on the weekends, and our professional athletes are household names. The nature of contact sports means that head knocks are sometimes unavoidable. But changing the fundamental rules of these sports isn’t the only way to make them safer. Through research, we can improve the diagnosis and management of concussive episodes. Finding a suitable biomarker to test for concussion will enable rapid diagnosis and reduce the risk of repeated head injury. And imaging technology is helping us understand how concussion affects the brain. Longitudinal studies to track brain changes have never been undertaken before, and are the missing piece of the concussion puzzle. In the long-term, they are critical to understanding the lasting consequences of head injury, and will enable us to intervene early and prevent or reduce lasting damage. Through research, we can begin to tackle some of concussion’s unanswered questions. the injury, but unlike tau, neurofilament light protein levels are raised in the cerebrospinal fluid. This liquid cushions the brain and spine, and samples can only be taken in a sterile hospital setting. The challenge now for researchers is to refine the tests for these biomarkers and use them in combination with imaging techniques in order to better diagnose concussion and assess when it is safe to return to play. HELP QBI MAKE A DIFFERENCE.
Learning and Memory