Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. It's important to know the signs of one so you don't delay treatment. Dr Maheen Adamson shares her insight into this topic with us in today’s episode - learn more about how TBI affects men and women differently.
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After completing undergraduates degrees in Biology and Women's Studies at UC Irvine, Dr. Adamson completed a PhD in Neuroscience at the University of Southern California, followed by a Postdoctoral Fellowship in Psychiatry at the VAPAHCS & Stanford University School of Medicine. Dr. Adamson is a neuroscientist and neuroimaging expert, whose research interests include the neurological impact of traumatic brain injury, pain, and Alzheimer's disease. She's a leader in healthcare innovation, entrepreneurship, and translational neuroscience. A passionate advocate for healthcare gender equality and policy change committed to the development of novel therapeutic approaches such as brain stimulation and virtual reality.
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Instagram: @AdamsMausoof
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Website: https://med.stanford.edu/adamson-lab.html
Recent Publicatoin: https://med.stanford.edu/adamson-lab.html
Sources and articles mentioned in todays episode:
Memorbale Moments:
5:50 So that's why I think one of the most important things to realize is that a lot of people don't even go to the hospital when they fall or they get hit. They're like, “I'll be fine.” So that's one of the biggest things that gets misdiagnosed [around traumatic brain injuries].
8:50 There's a lot of changes that were actually made in sports as well as in the military. So we had to come up with TBI guidelines. We had to come up with specific ways of diagnosing these three different categories. So there's three, right? There’s mild, moderate, and severe.
10:10 All this really came about because of awareness, because we found out that this is something we have to pay attention to because [it's] leading into all these other problems. And they can appear six months after an injury. And some of the patients that I see, those symptoms have been there for 10 years.
14:27 What's different about it is that in symptoms, we would go ahead and look at data that we already have, and we will see all these differences, all these disparities between men and women in just symptom reporting. The women were reporting more cognitive problems. After brain injury, women were reporting more psychiatric problems.
15:36 Cortex can be a certain thickness and it's a variable that changes throughout life, but it's pretty stable in your adult stage. And usually the cortex of the brain is thicker in women than it is in men. That's just what the data shows. After brain injury, we compared cortical thickness between men and women after adjusting for age and, you know, skull size because men have bigger skulls, right? And so we were like, okay, are there any differences? It turns out that women who have brain injury somehow don't end up recuperating in terms of the mass of the cortex, as much as men. So men go back to their size, women don't.
18:37 I think it's mind blowing because we, you know, we have hormones, we bear our children. We have very different external stimuli that are coming to us. And somehow the treatments that are offered to men are supposed to be completely fine as-is for us. And they're not. I also just did another study in which I've found that the models that are created, machine learning models that are created for men do not fit the women. They fit, but not as well as they do for men.
19:17 We know for a fact that our bodies, our stomachs digest medicine, different from men. We, our brains respond differently to medication than men. Our skull is smaller. We have less blood in our body. Our neck is thinner, which is one of the reasons why, and we have what's called when you jerk your head back in a motor vehicle accident, it's called whiplash. One of the reasons that women report more vertical and more balance problems is because we have a thinner neck. And it moves back. So there's all these tiny differences that can actually get really accentuated later on in life, if they're not treated.
20:36 One of the base things really learned in the past 10, 15 years is asking somebody if you've had a TBI, that's not going to give you the answer. You have to really be interactive about it and assertive about it. In fact, a lot of academic centers have developed what's called TBI questionnaires, traumatic brain injury questionnaires, and this goes for a lot of different things, right? It can also go for depression. It can go for a lot of different things.
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Allison: Hello and welcome to the Dear, Mind You Matter Podcast. My name is Alison Walsh. I'm a long time mental health advocate and vice-president at advanced recovery systems. On each episode, I will be joined by my colleague and clinical expert, Dr. Angela. This show along with our mental health and wellness app, Nobu are just some of the ways we're working to provide you with actionable tips and tools to take really good care of yourself each and every day.
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Angela: After completing undergraduate degrees in Biology and Women's Studies at UC Irvine, Dr. Adamson completed a PhD in Neuroscience at the University of Southern California, followed by a Postdoctoral Fellowship in Psychiatry at the VAPAHCS & Stanford University School of Medicine. Dr. Adamson is a neuroscientist and neuroimaging expert, whose research interests include the neurological impact of traumatic brain injury, pain, and Alzheimer's disease. She's a leader in healthcare innovation, entrepreneurship, and translational neuroscience. A passionate advocate for healthcare gender equality and policy change committed to the development of novel therapeutic approaches such as brain stimulation and virtual reality.
Allison: Okay, well Maheen thank you so much for being on the show today. Would you mind introducing yourself to our audience?
Dr. Maheen Adamson: So my name is Maheen Adamson. I'm a neuroscientist. I have a PhD from the University of Southern California a very long time ago, and I did my postdoctoral fellowship in psychiatry at Stanford School of Medicine.
Again a very long time ago. So I'm currently a clinical associate professor at Stanford in the department of neurosurgery and also the director of research, every rehabilitation. I've been working with a traumatic brain injury, Alzheimer's disease, and cognitive aging for about 15 years. And under those three things that I just told you, I look particularly at a lot of depression, anxiety, the sleep problems, and the entire smorgasbord of mental illness. .
Angela: Awesome. Thank you. Maheen and I love that you try to date yourself so much with how long ago you've been doing this work. But no, so Maheen, I know you're, you're so big and, you know, traumatic brain injury research and a lot of that, that kind of work. And I've actually had the wonderful opportunity of working with you and a couple of different projects, but you know, many who are listening may not be familiar with.
You know, the types of traumatic brain injury, what it is, the prevalence. So I was really hoping you could just give us a quick overview because I know just in the work that we've done and even outside of that in my clinical practice, it's really something that flies under the radar. A lot of people aren't aware when it's, you know, something that is going misdiagnosed or, you know, not treated.
So can you give us a quick overview of the types of TBI and the prevalence?
Dr. Maheen Adamson: I think this is probably the best way to understand it is that we always think of brain injury. It's very large, it's a big phrase, right? Brain injury. It could be anything coming from, you know, you can even have people put in pediatric developmental problems.
Like, so you, you have problems when you were born. And then there's always developmental organic things that happen in the brain. Such as stroke. What I study is management injury thinking in terms of something that happens from the outside and external blow to the head, literally, that's what it was in the old days.
When we look at, you know, something to study is like the history of neuroscience, which is really exciting because you get to read about how the brain was thought about in the old days. And in the old days there was something called punch drunk syndrome. I don't know if you guys know what that is. Some boxers used to like to beat each other.
Like this, right? So if you hit somebody in them and you know, doing a sport you know, you hit somebody with a punch, you actually can move the brain inside. The skull is really tough, right? So, I mean, now all of us have fallen on our hands when we're young and we're still alive, nothing, you know, but the idea is that that fall can also be something that you get up and you're a little dazed or, you know, Maybe you forget a couple of things for the next few seconds, and then it all comes back.
So a lot of people don't even go to the hospital when something like this happens and they're like, oh, I'll be fine. Then, you know, a few days later you're like, you know, the lightest bothering me or I'm having a hard time hearing something. Or, you know, those are like mild symptoms that people have. Kind of, if it doesn't get taken care of in the first place, those mild symptoms can get me out.
So there's this mild, traumatic brain injury that can happen from a fall. You'd get halfling in sports concussion. It can also happen in sexual violence. Intimate violence can happen in car accidents, motor vehicle accidents. And one of the things that I studied, which is in the military, TBI is can happen when you are close to a blast.
So imagine you're, if you then hope that this never happens to any one of us, is that if you're close to a blast, then last causes a lot of debris, right? It can hit you physically, but it can also change. It can also travel to the air and also through ground and travel up your body and down your body.
Like the blast pressure can actually move your brain inside the skull. And the most amazing thing about traumatic brain injury is that it's like if it's blast injury or even a motor vehicle accident, and sometimes you don't know which side of the brain moves. It's very heterogeneous, it's a really awesome scientific problem.
You're kind of looking for a needle in a haystack because the brain can move anywhere. Right. And it's like in a jar. So that's why I think one of the most important things to realize is that a lot of people don't even go to the hospital when they fall or they get hit. They're like, I'll be fine. So that's one of the biggest things that gets misdiagnosed.
When it comes to sexual trauma, it gets misdiagnosed because it's not reported because women don't report it. And also what ends up happening is that when you were in the military and you wanted to just. Comeback. And not a lot of people want to see a doctor. It gets unreported like that. And then another thing is when you, I don't know if you know people like this.
I know a lot of people like this in my family, unless you're bleeding, they don't go to the doctor. So that's another way. And then the last thing I wanted to say is that if you're in, what's called an accident and you're bleeding and your arm is hurt, the doctor's going to pay attention to the arm.
Doctors are not going to ask about your head. And so a lot of the time what we call polytrauma patients, people who have trauma all over in different parts. The head doesn't even get checked. And then a few months later you look, oh, I have concussion symptoms. Oh, I have pain. I have sleep problems and oh my God, I have depression.
I've just been diagnosed. And how did that happen? Because a lot of the time we haven't taken care of it in the first place.
Allison: Right. So I imagine just based on what you said, there's a lot of times where this is missed or it's maybe even misdiagnosed especially for things like the mild to moderate TBI.
So how does this impact people when it's missed in the process?
Dr. Maheen Adamson: So about 10, 15 years ago, mild traumatic brain injury became a really big issue because there were a lot of soldiers coming back and they were in the military and they would come back and they would report that, you know, they've had not just one, but a few of these moderate, traumatic brain injuries and their symptoms are just getting exasperated.
Right. They would, they would just get. Sleep problems, they would have the advice of the psychiatric problems in that population was on the high, it's a human impact on the healthcare system, especially in the VA system or in the military healthcare system. And I'm sure you guys have heard about the sports with the football, you know, how in the football we have that huge thing about.
Somebody's been injured and how that was leading. There were a lot of connections made to chronic traumatic encephalopathy. And I don't want to get into that aspect of it, but there was, there's a lot of changes that were actually made in the. Sports as well as in the military. So we had to come up with TBI and guidelines.
We had to come up with specific ways of diagnosing these three different categories. So there's three, right to this mild, moderate, and severe, and notice I'm not bringing in the fact that it could be penetrating or non-penetrating. And one of the most things that were really talked about and there were huge you know, Congress has made the American Congress of rehab medicine.
Medicine was involved. Department of defense, VA, NIH. We all have the guidelines in which we have to figure out how to designate. Who's mild TBI, who's moderate and severe. I don't believe in those categories. I believe it's a continuum and there's a lot of other comorbidities that go under it. So guidelines were created in specific ways.
Understanding self-report as well as clinically guided understanding of what you're trying to put into floods, really studying the biomarkers for it. Then you study what kind of treatment will be offered. All this really came about because of awareness, because we found out that this is something we have to pay attention to because it could be it's, it's leading into all these other problems.
And they can appear six months after an injury. And some of the patients that I see those symptoms have been there for 10 years.
Angela: Right. Yeah. I mean, you bring up a really good point and I think where a lot of, you know, what you and I worked on together, intersected, which is, you know, as someone who I'm working with a lot of people with, with depression, mood disorders, things like that.
I started to see even long before we met. Way back in the day. Folks would come in and would have all of these symptoms and, you know, we would try different treatments. We would try, you know, certain standardized approaches that may work for someone who maybe has a different subtype of depression or something to that effect.
But we just couldn't quite figure out where the disconnect was with sort of the psychiatric and the medical side of things coming together and really getting behind that and the. Biomedical model neuroscience wasn't quite there yet. I think. And so it's tough. Right? And so we would, we would sort of get into this position where we would just be banging our heads against the wall for lack of a better term, to try to figure out what, how to help people that are in this position.
And so, then you're making all these referrals and you're just really not, not meeting their needs. So I think this is such an important topic that we're talking about. So I really appreciate you. Also bringing light to that continuum because there was no one that really seemed to fit into one category or into one box.
And then you're continuously trying to put them there and they just have, like you said, all of these varying levels of severity within each symptom to right? And so it just further would pathologize and frustrate them. Whereas if we take more of that, you know, a patient centered approach to really trying to individualize that for them, which I know is what you're working on as well.
It's so important. So one of the other things we wanted to talk about. Which you and I have also talked a lot about, is really looking at, what, what are we seeing in terms of TBI and sex differences? So what are you seeing and in terms of your research and treatment, what's, what's that looking like in the amazing field of neuroscience?
Dr. Maheen Adamson: Yeah. So that has been quite a, quite a really amazing journey for me. And as well as you, Angela, we published a wonderful review paper on something that I will bring up later. So I started looking at this. So this one, I was an undergrad. I actually ended up doing a bachelor's in women's studies.
So I've been, you know, I did that a long time ago and I was interested in, you know, how we could look at things, especially stem from a woman's perspective and going into the field and really understanding from the perspective of. As a woman leader in stem, how do you manage all that? And I'm lucky enough to work with some very amazing female mentors.
And I started looking at brain injury differences. So as you know, in the VA and in the military, there are not a lot of women. Because women have been increasing in all different fields for the past 10, 15 years. So the CEOs of companies have increased support in sports basketball and football, all the different sports have more, they have teams even, you know different teams that are in, I think there's a women cricket team and in Pakistan, where I'm from, so I think that's, the women are going into all these different fields where injury is more likely and the same goes for the military. So the rise of women in the military and in the veteran population, but it's still quite small. It's gone up from about five to about 12% in the past 10 years.
What's different about it is that in symptoms, we would go ahead and look at data that we already have, and we will see all these differences, all these disparities between men and women in just symptom reporting. The women were reporting more cognitive problems. After brain injury, women were reporting more psychiatric problems.
And the funny thing was even the women were more educated. They were not employed. They were more educated than men, but they were not employed. And this isn't our database, right? This is in our polytrauma brain injury database. So I was quite interested in this. And so it was sort of other people at Stanford and other places.
And they're like, well, symptomatology is something that we can talk about. Like the reporting is different. What's going on in the brain? And I ended up doing a study in which I looked at. Men and women, and they're basically the differences in the thickness of the brain. Now. We all know that the brain has a cortex, right?
Cortex can be a certain thickness and it's a variable that changes throughout life, but it's pretty stable in your adult stage. And usually the cortex of the brain is picker in women than it is in men. That's just what the data shows. After brain injury, be compared cortical techniques between men and women after adjusting for age and, you know, skull size because men have bigger skulls.
Right. And so we were like, okay, are there any differences where it turns out that women who have brain injury somehow don't end up recuperating in terms of the mass of the cortex, as much as men. So men go back to their size women don't. Now combine that with more cognitive problems, combine that with reporting of more psychiatric problems, combine that with not being able to work and having less employment.
That's you're basically creating this position of these factors that are bringing women down in a way. Right? So we had, we showed this and our papers were accepted and we just got another big out at the Stanford school of medicine, quarterly magazine. We have this article published on our research and I think those, some of those things are really important to point out because.
We have to tell health policy as well as people who are responsible for giving money to certain targeted populations for treatment. this puppet that women who are, who have suffered from brain injury or putting cognitive problems, maybe the ones who are on fast-track for dementia. Maybe the ones we're on FastTrack for even more problems.
So those are some of the things that we have looked at and Angela and I published a paper about a year ago in which we basically said, why don't we look at all these treatment studies that are doing your modulation or what's called brain stimulation, which is a non-invasive treatment for major depressive disorder.
Why don't we look at how. Many people write about these treatments. Talk about the difference between men and women and what was it? Angela out of 52 review papers. There were only seven that talked about.
Angela: Right. And I mean, that's even just, just mentioning that they even assessed it or that even could have been assessed.
Sometimes they did. Sometimes they didn't even have a sex data to compare, so they just lumped everyone together. So, yeah, that was, it was definitely very eye opening, I think for me as well, he was definitely onto that.
Dr. Maheen Adamson: Certainly, yeah, I mean, it's. I think it's mind blowing because we, you know, we have hormones, we met our children.
We have very different external stimuli that are coming to us. And somehow the treatments that are offered to men are supposed to be completely fine as is for us. And they're not because I also just did another study in which I've found that the models that are created. Machine learning models that are created for men do not fit the women they fit, but not as well as the do for, for, for men.
So I think we have to be, we know for a fact that our bodies, our stomachs digest medicine, different from that. We, our brains respond differently to medication than men. Our skull is smaller. We have less blood in our body. Our neck is tenor, which is one of the reasons why, and we have what's called when you jerk your head back in a motor, we laxative it's called whiplash.
One of the reasons that women report more vertical and more balance problems is because we have a pin or that. And it moves back. So there's all these tiny differences that can actually get Vinnie accentuated later on in life, if they're not treated.
Allison: Well, thank you for sharing all of that. And I'm sure there's some folks that are probably listening going wow this is eye opening and perhaps. I've been misdiagnosed or I've missed something along the way. And I need to get myself checked out or figure out what's going on. What should you do if you're listening right now? And you're thinking I might've suffered from this, what would be your recommendation?
Dr. Maheen Adamson: I think that everybody has their providers, or maybe they have their doctors. I would ask the questions first. Right? So one of the base things really learned in the past 10, 15 years. Asking somebody, if you've had a TBI, that's not going to give you the answer. Right. You have to really be. Interactive about it and assertive about it. In fact, a lot of academic centers have developed what's called TBI questionnaires, traumatic brain injury questionnaires, and this goes for a lot of different things, right.
It can also cause depression. It can go for a lot of different things, you kind of have to ask them, you should go talk to your, talk to your provider. I would go to a neurologist and if I would go to what's called a physical medicine rehab specialist.
So or even if you've been, if you're active and you've had a sports injury, I would go to sports medicine, but a lot of people don't know where to go because they don't know the symptoms.
There's if you go to what's called defense veterans and brain injury centers. They have huge guidelines on traumatic brain injury, but the symptoms are, you also can go to a lot of the rehabilitation centers. So once you were past the acute stage, you would be going to rehab centers and they have a lot of different guidelines on what a way to reach out to them. They have support groups, they have wonderful podcasts and they have lists of symptoms that you can look into.
What is also quite interesting is the rise of understanding the differences between women and men in brain injury. And there's a lot of literature out there on sexual trauma, or what's called intimate partner violence.
IPV. There is a group in different universities that are doing research on it. And there's also female brain injury groups that are also very good at giving out information on this.
Angela: Definitely. Yeah. I know when I worked in Washington state and again, sort of saw a lot of these issues. We were really trying to, like you said, I think in the medical community in general, but in psychiatry and psychology, we really started to see that we needed to start asking more questions because we would end up getting people who were seeking support for a lot of these symptoms that were a by product most likely of the, the TBI, maybe that someone experienced or you know, who, who knows exactly what the culprit is.
But either way we're treating them as kind of a primary person and they really need to be referred to and really get down to, you know, what, whatever else is going on, what other treatments would be available.
So we will also post additional resources that I know we found to be helpful in terms of non-profits and other organizations as well. But thank you so much for sharing those resources. I know they're heavily relied upon in the community, for sure. So Maheen and there's so much more we could talk about, but because we don't have all day. There's one question that we love to ask all of our guests and that is, you know, with where things are at with you and your life at this very moment.
What matters most to you right now?
Dr. Maheen Adamson: What matters most to me is I guess I can think about it a little bit. And I know that this is a question that a lot of people have been thinking about in the past two years because of the pandemic. Like what we thought about two years ago has completely changed and we've had a lot of people leave out their life and talk about things.
And I think my goal right now is to. Really provide treatment and also more mechanistic approaches to understanding why it is that we have disparities in the healthcare system. So I'm a neuroscientist, I come from a very logical, very scientific background. The kind of study that is very expensive.
So I do need an imaging and I do brain stimulation, which is an expensive technique. They cost a lot of money and I look at research studies.. The kind of work that we're doing in academia and in government is very restricted and we need to expand ourselves because we, it’s not agile enough and it doesn't create the impact that we want to create.
The impact we have in academia is big. Yes, we work for hospitals and our goals have been to publish grade papers and be on talks and things like that. The impact I'm looking for now is to actually go into translational medicine and move it into the community. So the work that I've been doing in terms of looking at sex differences in brain stimulation or sex differences in brain injury. The work that I've been doing is looking at the disparities that exist when you're trying to reach out to women of different occupations, different races, different ethnicities. How do you incorporate that in your research so that you can apply your research to a bigger end? So if my end is 15 it is like 150 people and it's mostly from Hollowell.
How was that research universally applicable? It's not.
So those are some of the things that I'm trying to work on right now, and I'm doing it. But from a standpoint of you doing it from data, so really trying to understand the idiosyncrasies of the data. And for that, it goes back to the question of doing what's called personalized medicine.
Personalized medicine has one issue though. And that's an issue that's very systemic in government and academia, mostly in government. If you're targeting an individual, you need to have access to that individual's information, which means you need to connect health records. Which means that you have to have identified data, not deidentified data.
You see the whole thing, everybody's like, oh, we want to do personalized medicine. Well, that's great. But you need to know the patient really well in order to do it. And if you are not an MD, you're a PhD and you're looking at it from data. That's something that we have to really work out. So those are some of the problems that we're facing.
And then another thing that I'm really interested in is trying to launch into an entrepreneurial phase. So that's why I'm moving from academia and government into launching our, you know, our own ideas into front station medicine. So. Thinking about how I could reach out to the community with my own company, with my own entrepreneurship that can reach out to and address needs that are there in terms of depression in older adults and people who've had traumatic brain injury.
So those are some of the things that.
Allison: I love it. And I think you've got some new fan girls. Well, I know Angela is already a fan girl cause she has been bragging about how cool and amazing and smart you are. So thank you for joining us on the podcast today. And I am now a new fan girl as well, but if we want, if those that are listening right now, want to find out more about you or follow what you're doing, the research that you're conducting, or just simply be able to connect and stay in touch.
What should they do? Where should they go?
Dr. Maheen Adamson: So I have a website that's very simple. If you type adamson lab at Stanford, it would show up. And there's an email on there that they can contact me. And I would love to hear from people. I am currently running three clinical trials. And I'm always looking for wonderful participants, either from this veteran community or from the regular civilian community.
I love giving talks about the work that I've done. And I also give talks about female entrepreneurship and how to launch in the medical field. Translational science, but from a very stem perspective, most of the people who do this at either business or have these still out here, I am a PhD driver.
Allison: I love it. Right? Know, own your niche. Right? So thank you. Maheen for being here and being with us on the show today, sharing what you're doing. It is fascinating and we appreciate it.
Dr. Maheen Adamson: Thank you very much. And this was, this was very, very nice. And I've been actually watching you guys on LinkedIn and you've got a really good message for people.
Angela: Thank you. We appreciate that. Thank you so much, Maheen.
Dr. Maheen Adamson: Thank you.
Angela: Thank you so much for listening to today's episode. If you're not already subscribed, we hope you join us regularly and please leave us a five-star review wherever you get your podcasts. We hope that this podcast is beneficial to you and your wellness journey.
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