summary: In a comprehensive brain autopsy study, researchers found significant damage to blood vessels and white matter in women who experienced intimate partner violence. Unlike male contact athletes, no evidence of CTE was detected.
The study, which observed an increase in conditions such as cardiovascular disease, highlights the significant impact that intimate partner violence has on brain health. These facts highlight the need for specialized care for such survivors.
Important facts:
- Brain autopsies of women who faced intimate partner violence revealed significant vascular and white matter damage, but no signs of CTE.
- The study also found that these women had increased comorbidities such as cardiovascular and cerebrovascular disease.
- This study suggests that the effects of intimate partner violence on brain health are under-recognized and require broader medical understanding.
sauce: Mount Sinai Hospital
The largest brain autopsy study in women exposed to intimate partner violence reveals significant damage to blood vessels and white matter in the brain, but contact sports in men with repeated head trauma reveals significant damage to blood vessels and white matter in the brain There was no evidence of chronic traumatic encephalopathy (CTE), a neurodegenerative disease found among athletes.
This international collaboration, led by a team at the Mount Sinai Brain Injury Research Center and in collaboration with the New York City Office of the Chief Medical Examiner, is published in the current issue. acta neuropathologica.
Importantly, this study also revealed substantial medical comorbidities, including cardiovascular and cerebrovascular disease. This suggests the need to consider the broader pathology underlying brain damage associated with intimate partner violence and the medical and psychiatric comorbidities that contribute to brain health. life.
Despite how common intimate partner violence is (it affects one in three women at some point in their lives), surprisingly little is known about the neuropathology of intimate partner violence. Is not …
Long-term effects of traumatic brain injury include the risk of neurodegenerative diseases, and even in the popular press and scientific discussion, repeated head injuries in the context of intimate partner violence are There is an assumption that it is equivalent to head injuries sustained by men. Contact athletes.
“Our team has conducted research and clinical care for survivors of intimate partner violence for many years, and we now know that the neuropathology of brain injury may be much more complex than we assumed. We had strong suspicions,” said Dr. Kristen Dams O’Connor, director of the center. Mount Sinai Brain Injury Research Center and first author of the paper.
“Through our unique collaboration with the Office of the Chief Medical Examiner here in New York and with colleagues internationally, we were able to shed light on this group that has been largely missing from the medical literature.”
The collaboration between the Center for Brain Injury Research and the Office of the Chief Medical Examiner dates back to 2019, when the two organizations broke precedent with the common goal of identifying decedents with a history of traumatic brain injury who are included as late effects. Not strengthened academic cooperation. TBI (LETBI) Brain Donor Program.
The clinical research team will invite family members of the decedent to participate in interviews to learn more about the decedent’s health status, history of brain trauma, and any symptoms of clinical decline that the relative may have observed before death. Invited.
The post-mortem protocol for the LETBI study includes: ex vivo During image processing, the entire brain specimen is scanned at high resolution. This allows researchers to identify lesions that are invisible to the human eye and missed by standard brain dissection, allowing for unparalleled comprehensiveness of the examination.
A prospective case series documented intimate partner violence (age ranging from 20s to late 70s, median 30s) from women with complex medical histories, including past traumatic brain injury. Fourteen brains were collected over the course of a year. Non-fatal strangulation. cerebrovascular, neurological, and/or psychiatric disorders; and epilepsy.
At autopsy, all had old and/or recent traumatic brain injury stigmata (physical traces found in the brain that are characteristic of the condition). Some had significant vascular and white matter pathology.
Brain due to lacunae (small cystic cavities in the brain, usually caused by ischemic infarction; very rarely caused by small, deep cerebral hemorrhages) and/or chronic infarcts (localized areas of dead tissue caused by failure of blood supply) evidence of vascular disease).
Neuropathological changes of Alzheimer’s disease were present only in the oldest cases in the series (range 70-79 years), and neuropathological changes of CTE were not identified in any cases.
Findings from the first prospective case series included an archive of 70 intimate partner violence cases (ranging in age from late teens to late 80s, median age 30s) collected from multiple international organizations. It prompted a similar investigation of the expanded case series. In this archival series, the research team again found evidence of vascular and white matter pathology.
Only limited neurodegenerative proteinosis occurred in the oldest subjects, none of which met consensus criteria for CTE neuropathological changes.
“We were struck by the burden of comorbidity among the women in this series. Around half have epilepsy, and chronic conditions such as diabetes, hypertension, drug use and HIV are common. ,” said Dr. Dames-O’Connor.
“Our findings clearly demonstrate that we should cast a wider net when characterizing the neuropathology of intimate partner violence-related brain injury and posttraumatic neurodegeneration.”
“The impact of intimate partner violence is devastating at both the individual and societal levels, and it is more common than most people realize,” she added. “Our study suggests that it is an unmeasured and underrecognized cause of the decline in brain health that many survivors experience.”
Rebecca Folkers, M.D., a neuropathologist in the New York City Office of the Chief Medical Examiner, clinical professor of forensic medicine at New York University’s Grossman School of Medicine, and lead author of this paper, emphasizes: Although analyzed for medicolegal purposes and by clinical research collaborators such as the Mount Sinai Brain Injury Research Center, progress in the field of intimate partner violence will remain highly constrained.
“The only way to understand associated brain damage at a cellular level is through direct, systematic, intensive examination of the affected person’s brain. We are very grateful for this first opportunity. , we hope to expand on it while leveraging and sharing what we have learned.”
Researchers advise people who encounter someone with a history of intimate partner violence to be aware that the person may have neurological damage that affects brain health and function. are doing.
A study by researchers and clinicians at the Mount Sinai Brain Injury Research Center shows that people living with a brain injury may not benefit from standard interventions that are not tailored to address their disorder. We have consistently proven that there is.
You may need different considerations, reminders, or additional support to take advantage of available assistance.
“If someone with a brain injury misses an appointment, it may not be because they don’t appreciate the help or are indifferent to the services being provided. If they have a tantrum, it may be due to a traumatic It may be a manifestation of neurobehavioral dysregulation resulting from brain injury.
“If they remain in an abusive relationship, they may not have the cognitive and executive function skills or resources necessary to orchestrate a safe, successful and safe path forward,” Dames-O’Connor says. The doctor explained. “This is not something the survivors should be blamed for.”
The results of this case series represent an unprecedented advance in our understanding of brain injuries associated with intimate partner violence, and researchers believe they have a message of hope. Blood vessels that cause cognitive impairment or cognitive decline may be treatable in some cases.
Given the high burden of vascular brain injury, combined with the wide range of disease comorbidities observed in this cohort, some of the symptoms experienced by people living with intimate partner violence-related brain injury are treatable. , or may even be preventable.
Domestic violence often goes unreported, and victims may have difficulty accessing even basic medical care. Systematic screening for intimate partner violence could connect survivors to available resources and even save the life of the young woman in this study.
About this IPV and brain trauma research news
author: elizabeth dowling
sauce: Mount Sinai Hospital
contact: Elizabeth Dowling – Mount Sinai Hospital
image: Image credited to Neuroscience News
Original research: Open access.
“Neuropathology of intimate partner violenceWritten by Kristen Dams O’Connor and others. acta neuropathologica
abstract
Neuropathology of intimate partner violence
The effects of traumatic brain injury (TBI) on lifelong brain health include the risk of neurodegenerative diseases. Up to a third of women experience intimate partner violence (IPV) in their lifetime, often with traumatic brain injury, and a range of anatomical neuropathologies encountered in IPV. Surprisingly little is known about it.
We report a prospectively collected case series from a single institution, the New York City Office of the Chief Medical Examiner. This case was evaluated in collaboration with the Brain Injury Research Center at Mount Sinai using a multimodal protocol that included review of the clinical history and minor ex vivo imaging. subset, and comprehensive neuropathological evaluation with established consensus protocols.
Among women with documented IPV (age range 3 to 80 years, median 4 years), 6 had traumatic brain injury, 4 had non-fatal strangulation, 13 had cerebrovascular disease, neurological disease, Fourteen brains were collected over a two-year period from women with complex medical histories, including and/or psychiatric disorders. 7 epilepsy.
At autopsy, all had traumatic brain injury stigmata (old and/or recent). Furthermore, in white matter regions susceptible to diffuse axonal damage, perivascular and parenchymal iron deposits and microgliosis were seen in some subjects. Six patients had evidence of cerebrovascular disease (hiatus and/or chronic infarction).
Regarding the pathology of neurodegenerative diseases, neuropathological changes of Alzheimer’s disease were present in one case (in the 1980s), but neuropathological changes of chronic traumatic encephalopathy (CTE-NC) were not identified in any case. It was.
The findings from this first series subsequently prompted a similar investigation in an expanded case series of 70 archival IPV cases (age 2–90 years, median rank 4) collected from multiple international institutions. I did. Evidence of vascular and white matter pathology was also found in this secondary case series.
However, only limited neurodegenerative protein diseases occurred in the oldest subjects, none of which met consensus criteria for CTE-NC.
These observations from this descriptive exploratory study reinforce the need to consider the wide range of comorbidities and neuropathological substrates that contribute to brain health outcomes in the context of IPV, some of which may potentially It is possible that it can be corrected.
