Deep in this “methodology” paper is a case report of a nearly 90 y/o woman who seemed to retain most of her cognitive functions until the end of her life, despite a concussion with loss of consciousness in her mid-20’s (before seatbelts!), then in her 80’s (airbags by then), then several subsequent falls with head injury, and finally a subdural. The report includes serial cognitive testing and MRI imaging both pre and post-mortem + brain autopsy results. [Evidently recruited by the ACT group at GHC/KP/UW for their longitudinal study.]
There are remarkably few findings in the brain. There was mild atrophy, some evidence of old blood, “tauopathy” perhaps not as extensive as CTE brains, a few fibrillary tangles, some but not much amyloid beta, no Lewy bodies, no frontal temporal or major findings, in fact, the hippocampi were fairly intact. [I did do a year of pathology residency in the last century, and had the privilege of examining a few brains with Dr. G. Zu Rhein at Univ. WI-Madison, so I know some of the jargon.]
I wanna know this lady’s secret!! [she did exercise 15′ every day]
Anyway, she seemed to resist the patterns seen in others with head injuries. She had loss of consciousness with her first car accident, had an interval of sixty years until her next bad accident, and then there were nearly ten years from her airbag concussion to death. Maybe a remarkable exception to the “rule”, but nice to see that an individual can prevail somehow. Thanks, Ron
[image: CDC from their public domain Concussion video]
Multimodal Characterization of the Late Effects of Traumatic Brain Injury: A Methodological Overview of the Late Effects of Traumatic Brain Injury Project.
Abstract
Epidemiological studies suggest that a single moderate-to-severe traumatic brain injury (TBI) is associated with an increased risk of neurodegenerative disease, including Alzheimer’s disease (AD) and Parkinson’s disease (PD). Histopathological studies describe complex neurodegenerative pathologies in individuals exposed to single moderate-to-severe TBI or repetitive mild TBI, including chronic traumatic encephalopathy (CTE). However, the clinicopathological links between TBI and post-traumatic neurodegenerative diseases such as AD, PD, and CTE remain poorly understood. Here, we describe the methodology of the Late Effects of TBI (LETBI) study, whose goals are to characterize chronic post-traumatic neuropathology and to identify in vivo biomarkers of post-traumatic neurodegeneration. LETBI participants undergo extensive clinical evaluation using National Institutes of Health TBI Common Data Elements, proteomic and genomic analysis, structural and functional magnetic resonance imaging (MRI), and prospective consent for brain donation. Selected brain specimens undergo ultra-high resolution ex vivo MRI and histopathological evaluation including whole-mount analysis. Co-registration of ex vivo and in vivo MRI data enables identification of ex vivo lesions that were present during life. In vivo signatures of postmortem pathology are then correlated with cognitive and behavioral data to characterize the clinical phenotype(s) associated with pathological brain lesions. We illustrate the study methods and demonstrate proof of concept for this approach by reporting results from the first LETBI participant, who despite the presence of multiple in vivo and ex vivo pathoanatomic lesions had normal cognition and was functionally independent until her mid-80s. The LETBI project represents a multidisciplinary effort to characterize post-traumatic neuropathology and identify in vivo signatures of postmortem pathology in a prospective study.