Head Injury(TBI) Is Associated with More Severe Parkinson's Disease

We have to worry about Parkinsons because this: 

Parkinson’s Disease May Have Link to Stroke March 2017

I dislike their solution to reduce TBIs, almost impossible rather than figure out how to prevent Parkinsons, which would help stroke survivors also.

Head Injury(TBI) Is Associated with More Severe Parkinson's Disease

Patients with Parkinson's disease (PD) who have a history of head injuries may be likelier to have more severe motor and non-motor phenotypes of the disease, according to an abstract featured as part of the 2020 AAN Science Highlights.
Reviewing data from 267 individuals who participated in the Parkinson's Progression Markers Initiative (PPMI), Ethan Brown, MD, assistant professor of neurology at the University of California, San Francisco, and colleagues found those who experienced head injury before they were diagnosed with PD had higher non-motor symptom burden at enrollment.
Those with any head injury reported had a mean score of 7.73 on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) compared with a score of 6.19 among PD patients who did not have a history of head injury (p=0.035).

The researchers also noted that severe head injury among this group also trended to have worse scores —8.29 among those with severe head injury prior to a Parkinson's diagnosis—compared with 6.19 for those without a head injury report (p=0.051). Motor symptoms were higher among those with severe injury, with a score of 8.35 on the MDS-UPDRS-II assessment compared with a score of 6.42 among patients without a head injury history (p=0.042).
Dr. Brown added that in 110 patients followed for five years, participants reporting severe head injury before diagnosis had a decline in cognitive function on the Montreal Cognitive Assessment with a mean decline of 0.60 points compared with an increase of 0.76 among the patients without a head injury (p=0.048).
"Among people with Parkinson's disease, symptoms and disease progression vary tremendously," Dr. Brown told Neurology Today. "Understanding which patients are at risk of certain symptoms and disease courses could help clinicians counsel patients and families, increase screening for symptoms, and identify candidates or targets for clinical trials."
"For instance, detailed screening for cognitive impairment may be challenging in a busy clinic, but the presence of traumatic brain injury may encourage a clinician that it is worthwhile," he suggested.  "Earlier detection of cognitive impairment would expedite the appropriate treatment and support, which can be very meaningful for patients and families."
Dr. Brown noted that other studies have suggested that traumatic brain injury is a risk factor for developing Parkinson's disease as well as other neurodegenerative diseases. "The mechanisms of this relationship are unclear, though researchers have suggested that chronic inflammation may play a role," he said.
"Our study suggests that even after developing Parkinson's disease, the sequelae of traumatic brain injury may be playing a role and contributing to symptoms," he said. "This relationship indicates that similar mechanisms of cognitive impairment may be present across neurodegenerative diseases, and therapies being investigated to treat traumatic brain injury may have implications in Parkinson's disease."
"Our study further emphasizes how important efforts are to reduce the frequency of traumatic brain injuries in our population, before they occur," Dr. Brown said. "Of course, there are several limitations to our study, and more detailed analysis needs to be performed to better understand this relationship. In the future, a prospective study could better help us understand the association between traumatic brain injury and Parkinson's disease."
Commenting on the study, Samuel A. Frank, MD, FAAN, associate professor of neurology at Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, told Neurology Today: "The relationship between head injury and the risk of Parkinson's disease has been suspected for many years. However, this current study is novel in that it begins to parse out whether the phenotypes of Parkinson's disease may be related to previous head injury.
Dr. Frank was an investigator in the PPMI trial but has not been involved in the study since 2015. He also was not involved in the current analysis.
"The fact that they found an association between head injury and non-motor issues in Parkinson's disease may point to an increased risk of co-morbidities such as dementing disorders like chronic traumatic encephalopathy or Alzheimer's Disease," he said. "The differences in the scales were small, but due to large numbers of participants in these studies, they were able to identify statistically significant differences."
"Whether they will continue to diverge, and the clinical meaning will be determined with continued observation over time. One possible limitation that needs to be addressed are the definitions used for head injury. There are various methods of assessing and defining the presence and grade," he continued.
Disclosures: Dr. Brown has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with HiOscar, NEJM Knowledge Plus, and Rune Labs. Dr. Brown has received research support from Gateway Institute for Brain Research. Dr. Frank had no relevant disclosures.
Link Up for More Information
AAN Abstract 1261: Brown E, Goldman S, Meng C, Tanner C. Head injury and Parkinson's disease (PD) phenotype.