Traumatic Brain Injury

Many TBI’s involve injury to the frontal lobe of the brain, which is the primary part of the brain involved in acts of judgment, oversight, conscience, decision-making, and cause-to-effect reasoning. Alcohol is known to suppress frontal lobe function (as seen by reduced inhibitions), an effect also seen with a number of addictive substances including narcotics and benzodiazepines. TBI and alcohol abuse are being seen among combat veterans. The effects of these conditions manifest in:

• Increased risk of suicide
• Divorce
• Domestic violence
• DUI
• Legal problems
• Homelessness

If you as a veteran are facing a family law or criminal matter, the conduct that often leads to matrimonial or domestic violence issues may be the symptom of an underlying TBI and is a medical condition. Similarly, given the impairment in judgment, oversight, conscience, decision-making, and cause-to-effect reasoning resulting from TBI, particularly to the frontal lobe of the brain, a veteran should be thoroughly evaluated for TBI.

Other effects of TBI:

Depression is nearly always associated with significant frontal lobe dysfunction (Videbach P. PET measurements of brain glucose metabolism and blood flow in major depressive disorder; A critical review. Acta Psychiatr Scand 2000 Jan;101(1):11-20), and studies of brain metabolism and blood flow have shown a consistent decrease in frontal lobe blood flow which precedes (i.e. is a cause, not the effect of) symptoms of depression (Drevets W. Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression. Prog Brain Res 2000;126:413-431. and Steingard R, Renshaw P, et al. Structural abnormalities in brain magnetic resonance images of depressed children. J Am Acad Child Adolesc Psychiatry 1996 Mar;35(3):307-11).

Head injury is a well-documented cause of depression (Binder LM, Persisting symptoms after mild head injury: a review of post concussive syndrome. J Clin Exp Neuropsychology 1988;8:323, Evans RW. The post-concussion syndrome and the sequelae of mild head injury. Neurol Clin 1992;10:815). Trauma to the head resulting in one single concussion may sometimes begin a series of biochemical events in the brain which over time will result in degenerative nerve changes similar to those found in Alzheimer’s disease (Plassman BL, Harlik RJ, et al. Documented head injury in early adulthood and the risk of Alzheimer’s disease and other dementias. Neurol 2000 Oct; 55(8)1158-1166).