Concussions May Increase The Risk Of PTSD : Shots - Health News Troops returning from Iraq and Afghanistan are far more likely to develop post-traumatic stress disorder if they have suffered a concussion. The reason may be a change in the brain's fear circuits.
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War Studies Suggest A Concussion Leaves The Brain Vulnerable To PTSD

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War Studies Suggest A Concussion Leaves The Brain Vulnerable To PTSD

War Studies Suggest A Concussion Leaves The Brain Vulnerable To PTSD

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DAVID GREENE, HOST:

And in Your Health this morning, we're learning about the link between concussions and post-traumatic stress disorder. For a while now, researchers have suspected that even a mild brain injury can make a person more vulnerable to PTSD. And the link became much clearer when scientists began studying troops returning from Iraq and Afghanistan. Here's NPR's Jon Hamilton.

JON HAMILTON, BYLINE: Scientists who study PTSD have been learning a lot from people like Charles Mayer. In 2010, Mayer was on patrol in an Army Humvee near Baghdad. Then a roadside bomb went off.

CHARLES MAYER: I was unconscious, you know, for several minutes. So I know the story from the people that, you know, that dragged me out, my buddies.

HAMILTON: The blast fractured a bone in Mayer's spine. It also affected his memory.

MAYER: But I didn't really realize the effects that it would cause, like, cognitively, so to speak.

HAMILTON: Mayer's thinking was impaired. That became painfully clear when he got out of the Army in 2012.

MAYER: Two weeks later, I started school. And a simple math equation, like 120 times seven, where I previously would do that in my head very easily, I all of a sudden couldn't do that.

HAMILTON: And Mayer had a bigger problem. His time in Iraq had left him with an uncontrollable fear of improvised explosive devices, or IEDs.

MAYER: When I would walk down the street, I would walk away from trash piles 'cause that's often how they would hide IEDs. I stayed away from large crowds.

HAMILTON: Eventually, Mayer went to the VA for help. An exam confirmed that he had PTSD. And Mayer says it was bad.

MAYER: I would get severe panic attacks - and to the point, you know, so severe where I would be - have to go to the hospital, you know, 'cause I would feel like I'm actually having a heart attack.

HAMILTON: The wars in Iraq and Afghanistan produced thousands of Charles Mayers. First they got a concussion. Then they got PTSD. And Dewleen Baker has seen many of these veterans. She's a psychiatrist at the University of California, San Diego, who also runs a PTSD clinic at the local VA Medical Center. Baker remembers a time early in the wars when she began seeing more and more returning troops with symptoms of both PTSD and brain injury.

DEWLEEN BAKER: We had people who were looking very miserable when they came back and reporting a blast injury and some difficulty thinking.

HAMILTON: Baker kept asking herself, was the PTSD just from the emotional trauma of combat, or did a concussion alter the brain in a way that amplified fear and anxiety?

BAKER: I could easily diagnose the PTSD. But I found it very, very difficult to tease apart the contribution of traumatic brain injury, what was going on with their cognition.

HAMILTON: So Baker and a team of researchers began studying more than 1,600 Marines from Camp Pendleton. The Marines had been assessed before deploying to Iraq or Afghanistan and then again three months after returning.

BAKER: At one point, we got this battalion that went to Helmand Province in Afghanistan. And literally 50 percent of them were complaining of blast exposures and symptoms, and I got concerned.

HAMILTON: Baker had reason to worry. The study found that Marines who experienced a traumatic brain injury, or TBI, were much more likely to develop post-traumatic stress disorder.

BAKER: TBI doubled the rate of PTSD in some cases.

HAMILTON: But why? There was no easy way to answer that question in people. But a team of scientists at the University of California, Los Angeles, had been studying rats. Michael Fanselow says the team focused on the amygdala, an area of the brain that processes information coming from the senses.

MICHAEL FANSELOW: The amygdala takes the sensory information and decides, should I learn to be afraid? Should I give a fear response? What should I do in this situation?

HAMILTON: Fanselow did an experiment. It compared healthy rats with rats that had experienced a traumatic brain injury. He says all of the rats received a type of behavioral conditioning known to induce fear.

FANSELOW: What happened in the animals that experienced a TBI is that this fear response that they learned during the situation was exaggerated. It was much greater than it normally would be.

HAMILTON: And Fanselow says the brain injury changed more than the rats' behavior. There were obvious changes in the amygdala.

FANSELOW: So it seemed like the amygdala was geared to really be able to strongly learn new fear information. And we think that that's the way TBI has of increasing your susceptibility to post-traumatic stress.

HAMILTON: Back at UC, San Diego, psychiatrist Dewleen Baker had come to a conclusion. If brain injuries really do change the brain's fear circuitry, there should be some way to detect that change in people. So she teamed up with Mingxiong Huang, a biomedical physicist in the radiology department. Huang had been using a technology that measures electrical activity in the brain. It's called magnetoencephalography, or MEG for short.

MINGXIONG HUANG: And you come in over here.

HAMILTON: OK.

Huang shows me the room where his team used MEG to scan the brains of 84 people. Some were service members. Some were civilians. But they'd all experienced a brain injury. Huang points to a chair beneath a helmet-like hood designed to detect brain signals. He says what the scans from this device revealed was intriguing. People with brain injuries often have too much activity in the amygdala and not enough in an area that moderate's emotional reactions. Huang says these people appear to have brains that are likely to overreact when something frightening happens.

HUANG: Just like when you're driving a car, there's a brake. And you have an engine, but you need a brake. But in the case of PTSD and driving a car, the brake's not fully functioning.

HAMILTON: Now Dewleen Baker is getting ready to expand her study of Marines. She wants to scan the brains of about 200 combat veterans, including some with both TBI and PTSD. Baker will have help on this project from Charles Mayer, the former soldier whose college career was interrupted by PTSD. After getting treatment, Mayer was able to finish his undergraduate degree.

MAYER: I actually graduated early (laughter), believe it or not.

HAMILTON: That was in December. Then Mayer started looking for a job. He wanted something that would let him study the problems that had affected his own brain.

MAYER: I looked up the psychiatrists that were doing research that I really cared about, and Dr. Baker was definitely up there.

HAMILTON: Baker hired him. Their research will focus on veterans, but the findings could also help identify civilians who suffered a brain injury that makes them vulnerable to PTSD. Jon Hamilton, NPR News.

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