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BRAIN HEALTH
BRAIN HEALTH

Protecting Against Concussions, Brain Injury

and Early Dementia: Wear your helmet!

By Brandon Goff, DO; Cooper Allenbrand, OMS-IV; and Austin Smith, OMS-IV

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s physicians, one of our fears is the acute or gradual decline in ed TBIs account for as high as 15% of the attributable risk for dementia.
our cognitive abilities. When we buy disability insurance, this One acute manifestation of TBI is diffuse axonal injury (DAI), caused
Ais one of the issues we are paying for coverage but we hope by rotational trauma, which can lead to the accumulation of pathological
to never have to use. Whether physicians or not, one of our greatest proteins like tau and amyloid, commonly seen in Alzheimer’s disease and
assets is our brain health, and there are simple ways to ensure it is safe- chronic traumatic encephalopathy (CTE).2 Additional studies support
guarded. How many times do we see children and adults engaged in that TBI victims are also at greater risk for neurodegenerative disorders
high-risk activities without helmets? Frequently. Reinforcing helmet such as Alzheimer’s, amyotrophic lateral sclerosis (ALS), frontotemporal
wear among our family, friends and patients is crucial, whether it is dementia (FTD) and Parkinson’s disease. 3,5,19 Wear that helmet!
for recreational activities or in industrial settings. In our experience,
people are often not aware that even mild brain injuries can lead to an Psychiatric Disorders & Sleep Disturbance
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increased risk of cognitive decline and dementia. That fact can be an Neuropsychiatric symptoms such as depression, anxiety and apa-
effective starting point in a conversation to capture attention. Protect- thy are more likely to arise within 12 months post-TBI, with sleep dis-
ing our brains is essential for leading a fulfilling life and preventing the turbances in the acute phase predicting these issues.4 A meta-analysis
long-term effects of traumatic brain injuries (TBIs). As awareness of indicated that individuals with TBI double their risk for psychiatric
TBIs grows, understanding the importance of helmet use in preventing disorders, and another study with a large cohort found that 75.2% of
5,6
these injuries is even more evident. participants received a psychiatric diagnosis. Although anxiety rates
decreased over time, mood disorders and substance use remained stable,
The Impact of TBIs influenced by pre-injury diagnoses and accompanying limb injuries.
Traumatic brain injuries can result from a variety of common recre- Sleep is the time when our brain performs its clean-up duties.
ational activities, including cycling, skateboarding, skiing, snowboard- When the brain is injured, its self-regulatory processes are diminished.
ing and contact sports as well as in industrial settings. In fact, contact Research by Werner et al. on 138 warfighters with chronic mild TBI
sports such as football, basketball and soccer accounted for 45% of all showed that poorer sleep quality correlated with higher plasma neu-
sport-related TBI and concussion-related emergency room visits for rofilament levels, a TBI biomarker and impaired executive function.7
children 17 years and under. TBIs can range in severity from mild This highlights the long-term impact of TBIs on sleep and mental
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to moderate to severe. We all understand the potential of significant health. Wear that helmet!
repercussions in a catastrophic TBI (a continuum leading up to unre-
sponsive wakefulness syndrome or death) but the repercussions of a The Role of Helmets
mild or moderate TBI can be life-altering as well, impacting cognitive Helmets are crucial for reducing the risk of TBI during high-risk
function, emotional well-being and overall quality of life. Research activities. They absorb impact and protect the skull, significantly low-
shows that the brain’s functioning before an injury influences recov- ering the chance of injuries like subdural hematomas and skull frac-
ery, so taking good care of our brains before an accident is also import- tures, especially for cyclists. 8-10 The evolution and acceptance of bicycle
ant. Even mild TBIs can lead to many unfortunate sequelae, including helmets is an interesting story. From pith helmets in the 1880s to the
dementia, psychiatric disorders and sleep disturbance. 1,3,4 If patients helmets of today, helmet wear has become ubiquitous in cycling. The
understand that even the mild end of the continuum can radically same goes for skiing. In the 2000s, it was unusual to see helmets on the
change their life, helmets seem much more reasonable. ski mountains. Now the un-helmeted skier stands out to the observer
and, at many ski mountains, helmets are now mandatory. When advis-
Dementia ing on proper helmet selection, the Consumer Product Safety Com-
Neurocognitive decline and dementia are a significant concern follow- mission (CPSC) has an easy-to-understand e-brochure that is helpful
ing traumatic brain injuries (TBIs). A Swedish study found that individu- and user-friendly. 11
als with TBI had a markedly increased risk of dementia, even 30 years later, Promoting helmet use among patients, family and friends is essen-
with higher risks associated with multiple TBIs. A separate study estimat- tial. Encourage others to wear helmets, support initiatives that empha-
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22 SAN ANTONIO MEDICINE • June 2025