ARI SHAPIRO, HOST:
Researchers know a lot about the traumatic brain injuries that occur in contact sports and combat, but they're just beginning to study injuries from another leading cause - domestic violence. NPR's Jon Hamilton reports on how assaults by a spouse or intimate partner can damage the brain - and a warning that this story contains graphic descriptions of physical violence.
JON HAMILTON, BYLINE: Domestic abuse takes many forms. Maria E. Garay-Serratos saw that up close during her childhood in Southern California.
MARIA E GARAY-SERRATOS: My mom was hit a lot. There was choking. There was a lot of shaking, objects thrown at her, shoved against the wall, thrown against appliances, dragged by her hair in the yard.
HAMILTON: Garay-Serratos was about 4 the first time she saw her mom assaulted. The abuser was her father. Friends and relatives knew but didn't intervene, and her mother never tried to leave. Garay-Serratos says she was still a child when she realized the violence was affecting her mother's brain.
GARAY-SERRATOS: My father was a very avid fan of boxing. And I remember seeing some of the symptoms that these boxers exhibited while they were in the ring. And I thought, oh, my God. That's my mom.
HAMILTON: Sluggish, confused, struggling to balance. But Garay-Serratos says domestic violence has no rules that limit the damage.
GARAY-SERRATOS: It is not like boxing. It's not like football, you know, where there's times out and referees. No, some of these episodes last for, like, hours.
HAMILTON: Today, Garay-Serratos is a Ph.D. social worker who knows that her experience is part of a much larger problem. About a third of women and some men say they've experienced severe physical violence by an intimate partner. Studies suggest most women in this group have sustained at least one traumatic brain injury, or TBI. The symptoms often resemble those seen in athletes or military personnel. But Kristen Dams-O'Connor, who directs the Brain Injury Research Center at Mount Sinai, says the underlying injuries in abused women may be different and potentially worse.
KRISTEN DAMS-O'CONNOR: We have repetitive head impacts. We have non-fatal strangulation. We have that shaking. These multiple etiologies of injuries that are overlaid upon each other - we thought to ourselves, how can this be the same pathology?
HAMILTON: Near-fatal strangulation, for example, can damage blood vessels and leave brain cells starved for oxygen. So Dams-O'Connor and a team of researchers studied brains from 14 women who died during a two-year period in New York City. All had a documented history of intimate partner violence. The median age at death was just 35. Dams-O'Connor says the team found evidence of brain damage in every woman.
DAMS-O'CONNOR: Their brains carried an enormous burden of injury that likely accumulated over the course of, in some cases, multiple violent relationships.
HAMILTON: Many also had experienced brain-related health problems, including stroke and psychiatric or substance use disorders. Dams-O'Connor says one notable finding was that half of the women had epilepsy.
DAMS-O'CONNOR: When you see rates of epilepsy as high as what we saw in this cohort, it does make you wonder, is it possible that traumatic brain injury history initiated the development of that seizure disorder?
HAMILTON: The team then reviewed older autopsies of 70 other women with similar histories. Their brains also showed scarring, bruising, signs of inflammation and damage to the connections between neurons. These changes have been found in athletes who have taken a lot of hits, but the women's brains were more likely to show signs of oxygen deprivation and changes to blood vessels. Dr. Rebecca Folkerth is with the office of the Chief Medical Examiner in New York City.
REBECCA FOLKERTH: They really don't seem to have that same pattern in their brain, and it suggests that while they are getting repetitive brain injuries, it's of a different sort.
HAMILTON: Folkerth says some of the changes could be detected only by examining samples of brain tissue after someone died. But she says other changes were apparent in brain scans that could be used on a living person.
FOLKERTH: We did pick up things that neuroradiologists doing diagnostic work in hospital settings are able to recognize.
HAMILTON: Which means it might be possible to identify a patient who's been abused but is afraid to speak up. Still, researchers are only beginning to understand how domestic violence can alter the brain. One open question is how often it leads to chronic traumatic encephalopathy, or CTE, a degenerative brain disease found in hundreds of former NFL players. CTE can look a lot like Alzheimer's but tends to affect different brain areas. Folkerth says her team expected to find that many women who'd experienced domestic violence also had CTE.
FOLKERTH: To our surprise, they didn't. And it led us to ask the question, well, what is causing their symptoms then? And how are these individuals different from the elite athletes?
HAMILTON: Unexpected findings like that show how much researchers still have to learn about brain trauma that occurs outside of sports or the military. Maria E. Garay-Serratos ran into that knowledge gap after her mother, who had spent more than 40 years in an abusive relationship, finally asked for help.
GARAY-SERRATOS: I went to my mom's home, and she was literally crawling on the floor. And to my surprise, she said, I think your dad wants to kill me. That was, like, the first time my mom had ever expressed any fear. So I just, like, grabbed her and said, you have to leave. I'm not going to take no for an answer.
HAMILTON: Garay-Serratos took her mother in. She was safe now, but her brain had deteriorated.
GARAY-SERRATOS: She seemed like a different person. Her gait was different. Her way of being was different - the way she was talking to me, her memory. The headaches seemed to be getting worse. It was just markedly different.
HAMILTON: So Garay-Serratos, who'd become a Ph.D. social worker, took her mother to doctor after doctor. They confirmed the problems with memory and thinking, but Garay-Serratos says they didn't connect these problems with her mother's history of abuse.
GARAY-SERRATOS: I already knew it was some kind of dementia or dementias. I couldn't get the neurologist to understand that she had a lot of trauma to the head.
HAMILTON: Garay-Serratos' mother died in 2015 no longer able to speak or recognize her own children. Her brain was examined by four experts over the next few years. Two saw signs of CTE. Two didn't. But the question of whether or not she had CTE may be academic. All the experts found evidence of traumatic brain injury and of Alzheimer's, which is much more common in people who've experienced repeated head trauma. Garay-Serratos says the most pointed assessment came from Dr. Ann McKee, who runs the CTE Center at Boston University and has examined the brains of hundreds of former athletes.
GARAY-SERRATOS: She's the one that said, you know what? Your mom had an immense amount of trauma to the head. She had the worst brain impacted by this that she had ever seen.
HAMILTON: McKee called the loss of brain cells incredible. She said the overall damage was more severe than she'd ever seen in an athlete. Jon Hamilton, NPR News.
SHAPIRO: And if you or someone you know is affected by domestic violence, you can contact the National Domestic Violence Hotline. Their website is thehotline.org.
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