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ObjectiveOur quest was to find an answer for “Why are some people able to recover 100% from a concussion/traumatic brain injury while others tend to have prolonged symptoms after their concussion/traumatic brain injury?”BackgroundThe prevalence of hyperhomocysteinemia in general is 5%–7% with increasing evidence showing higher prevalence of HHcy as age increases. The prevalence of vitamin D deficiency was 41.6% in the American population. The prevalence of vitamin B-12 deficiency is at least 40% in the patients of the Americas. With recent data, the prevalence of magnesium deficiency is around 10%–30% of the population. Hyperhomocysteinemia due MTHFR gene mutation B-12, B-6, magnesium, and folic acid deficiency is well established.Design/MethodsA retrospective study involving 45 patients was conducted in order to correlate the persistent symptoms concussion head injury/traumatic brain injury and their bio nutraceutical deficiency.ResultsThis data provides evidence that a patient's Homocysteine levels are significantly linearly related with their MoCA scores (t = −5.837, df = 34, p-value = 1.403e-06, [95% CI: −0.8406114 to −0.4936554]). In the mTBI group, for every 1 umol/L increase in Homocysteine levels, there is a 0.54217 decrease in MoCA scores. mTBI patients that had Homocysteine levels greater than 14 umol/L were 76% more likely to experience cognitive decline. The mean MoCA score of mTBI patients is significantly lower than the mean MoCA score of patients in the control group (t = −3.2898, df = 67, p-value = 0.0016, [95% CI: −6.710893 to −1.642642]). The mean Homocysteine levels of mTBI patients are significantly greater than the mean Homocysteine levels of patients in the control group (t = 2.2182, df = 85, p-value = 0.0292, [95% CI: 0.3039847 to 5.5603010]).ConclusionsmTBI patients should be routinely screened for serum homocysteine, vitamin D, B12, B6 and magnesium levels to know their risk for cognitive decline.

Background:The uniform standardized neuro-cognitive test is a challenge for the primary care physician due to time constraints, interpretation, and clinical use in the daily practice for dementia care.

Introduction: Neuroplasticity can only occur in an ideal body condition and establish a new synaptic connection with repeated stimulations in weak cognitive domains or circuits. Method: A Two-phase study was planned as a course of memory loss treatment in an outpatient clinic for a period of 3 years. 49 of 72 acquired brain injury and dementia patients completed X≥14 sessions of cognitive therapy intervention within the period of 2-4 months. Patients selected for intervention had mild severe memory loss on MoCA Score [(9-24)/30]. The first phase of intervention was the correction of nutraceutical status and sleep optimization. The second phase of the intervention was individualized cognitive therapy (CT) by trained cognitive therapists after the Digital Mobile Assessment of Cognitive test (DMAC) was given before and after an intervention. The domains included visual, auditory, delayed recall, attention, executive, number recall, disinhibition, language, and working memory.Results: Statistical analysis of n-49 with confidence interval 95%, series paired t-tests showed in the post-intervention group, on average, scores were higher as follows:Visual domain 4.89% to 13.74% (p < 0.001), Auditory domain 8.35% to 19.72% (p < 0.001), Delayed recall 21.34% to 33.95% (p < 0.001), Disinhibition Frontal domain 6.89% to 21.80% (p < 0.001), Attention domain 9.33%, 26.12% (p < 0.001 ), Executive domain 9.81%, 23.06% ( p < 0.001), Number domain 5.22% to 17.91% (p < 0.001), and Working memory 2.96%, 29.85% (p = 0.01).Discussion: Dr. Eric Kandel, Nobel Laureate, showed that damaged neurons can synapse after repeated neuron stimulation. Physical therapy is a standard of practice after acquired brain injury, but cognitive impairment evaluation is often ignored.The systematic approach to body optimization for learning and cognitive therapy can change the course of cognitive decline in dementia or acquired brain injury. Conclusion:The significant improvement in mild to severe dementia in short-term memory or patients' ability of memory retention improved 22% to 34% in the intervention group provides statistically significant evidence that a systematic approach to cognitive therapy can reverse the course of cognitive decline.