By Sean O’Malley
When Dr. Neil Vasdev looks back at how brain injury awareness has evolved over his lifetime, he just shakes his head.
“There wasn’t any when I was growing up,” says Dr. Vasdev, Director of the CAMH Brain Health Imaging Centre and the Azrieli Centre for Neuro-Radiochemistry. “We didn’t have bike helmets. We didn’t have ski helmets. When we played soccer we headed the ball over and over again. We practiced it.”
“We just didn’t take it seriously,” says Tim Fleiszer, Executive Director of the Concussion Legacy Foundation Canada (CLFC), about prevailing attitudes towards brain injury awareness when he began playing professional football in the Canadian Football League 20 years ago. “I remember playing in Hamilton as a rookie running down the field on the opening kickoff on Labour Day weekend and I got the worst concussion of my life. I called my dad after the game and we were both laughing about it.”
“We know now that the brain is much more fragile that we ever thought and the effects of brain injuries can be much worse and long-lasting than we ever imagined,” says Fleiszer.
The CLFC is dedicated to advancing the study, treatment and prevention of the effects of brain trauma in Canadian athletes and other at-risk groups, including the Canadian military. It has entered into a research collaboration with Vasdev’s team at CAMH with a special interest in the degenerative brain disease chronic traumatic encephalopathy (CTE) that is associated with repeated concussive and sub-concussive impacts on the brain.
Dr. Vasdev’s interest in brain injury sports science began a decade ago when he learned of ground-breaking research taking place on the donated brain tissue of retired NFL players. The findings shocked the sports world. Evidence of CTE was found in the brains of virtually every player studied, even though many of them exhibited no symptoms before they died, and had stopped playing decades earlier. It was finally understood how much long-term damage can be done to the brain due to repeated hits to the head in contact sports. Professional sports leagues around the world have introduced concussion protocols and other brain safety measures, and amateur sports organizations in the U.S. and Canada introduced minimum age restrictions for body-checking in hockey and heading the ball in soccer.
What makes CTE is particularly insidious is it can be years or even decades before any symptoms appear, and can only be definitively diagnosed after death.
Dr. Vasdev and his colleagues are exploring the progression of traumatic brain injuries through brain imaging in patients. The key to better understanding CTE is a brain protein called tau, which plays an essential role in the regulation of every healthy brain, and the brains of those with CTE, Alzheimer’s and other related neurodegenerative diseases that have a build-up of abnormally shaped tau protein.
How and why these abnormal tau proteins accumulate in the brain and facilitate the progression of these diseases remains a mystery, but Vasdev is optimistic that his ongoing development work with PET tracers at CAMH will help crack that code. The hope is that creating customized positron emission tomography (PET) tracers that can accurately diagnose these brain diseases will allow for much early diagnosis and treatment interventions.
No imaging technology currently exists to definitively confirm CTE in living or in vivo brains, which is one of the reasons Fleiszer is excited about the CLFC’s collaboration with Vasdev’s team at CAMH. “As a proud Canadian, I want to make sure that Canada has a seat at the table with all this work that is being done. Neil and his group quite frankly are unique in Canada. The work they are doing nobody else is doing—their research team is phenomenal. I think they will be the first in the world to find a way to diagnose CTE in-vivo. In our world that’s the ballgame. Because right now, you can’t treat a disease that you can’t diagnose.”
“There is a lot we can do with PET,” says Dr. Vasdev. “We’re very much at the infancy and just scratching the surface now. I think CAMH is really at the forefront in leading research on head injuries, including other mental health consequences related to head injuries like major depressive disorder, addictions and suicide.”
Partnering with the Canadian Military
In addition to collaborating with Concussion Legacy Foundation Canada on brain injury research, CAMH is also working with the Department of National Defence on a study into whether some military training exercises could be negatively impacting long-term brain health.
CAMH Scientist Dr. Isabelle Boileau is currently conducting a study that involves doing PET imaging on active soldiers who are taking part in explosives detonation training exercises to look for that indicators in their brains that they may be at risk for developing a neurodegenerative disease.
“We are looking for evidence of tau accumulation in the brain, which is common in people at high-risk for developing dementia,” says Boileau. “If we find evidence of tau in blast-exposed military personnel that may explain some of the neurological signs and symptoms we see in this population. The goal of this study is to see if training habits need to be shifted a bit to minimize the potential long-term neurological effects.
Dr. Boileau says she would like to do future research into whether sub-concussive brain impacts may also be associated with new or worsening cognition and other mental health concerns, including PTSD.
June is Brain Injury Awareness Month, and an opportunity to illuminate how CTE and related diseases can severely impact mental health. Dr. Vasdev adds, “The imaging work we’re doing with PET tracers could not only help those with CTE, but also those with Alzheimer’s and other similar conditions. We are on the verge of a whole new understanding of these conditions. I think about how little we knew about brain injuries only a generation ago, and can only imagine how our research now will help people 20 or 30 years from now.”