Glasgow researchers have uncovered the ‘substantial’ impacts of domestic abuse on brain health by looking at the autopsies of women part of this marginalised and highly vulnerable population with experience of intimate partner violence.

In an international collaboration led by the University of Glasgow and the Brain Injury Research Center of Mount Sinai, researchers examined the brains of more than 80 women with histories of domestic violence.

The study, published in Acta Neuropathologica, revealed substantial vascular and white matter pathology damage in the brain, which can lead to significant cognitive impairment, and balance and mobility issues.

Dr Willie Stewart, Glasgow’s research lead, says that despite the prevalence of domestic violence-associated traumatic brain injuries, the lifelong consequences have received “remarkably little attention”.

Dr Stewart previously spoke with healthandcare.scot about the importance of recognising the silent victims of brain injuries, highlighting the need for more research – and adds that this study begins to address the research gap.

He says the findings of this collaborative work “reinforces the need for more work” in this high priority issue.

The team also found that the domestic violence survivors suffered ‘substantial’ medical comorbidities including cardiovascular disease and cerebrovascular disease.

Researchers say these findings demonstrate the urgent need to consider the wider impacts of domestic violence-related brain injuries as well as the medical and psychiatric comorbidities that affect brain health.

Anxiety and depression are commonly experienced by survivors of domestic violence, conditions which have also been linked to cognitive decline.

Under-recognised and understudied

Dr Kristen Dams-O’Connor, Director of the Brain Injury Research Center of Mount Sinai and lead author on the paper, says the burden of comorbidities revealed in the new study is astounding:

“Because our team has been conducting research and clinical care with survivors of partner violence for years, we strongly suspected that the neuropathology of brain injury may be far more complex than assumed.

“Through our unique relationship with the Office of the Chief Medical Examiner here in New York and collaboration with international colleagues, we were able to shed light on this issue that has been nearly absent from the medical literature.

“We were astounded by the burden of comorbidity carried by the women in this series.

“Approximately half had epilepsy, and chronic diseases such as diabetes, hypertension, substance use, and HIV were common. The findings clearly indicate that we should be casting a much wider net when it comes to characterising the neuropathology of partner violence-related brain injury and post-traumatic neurodegeneration.”

She adds that the consequences of domestic abuse are “enormous” on both an individual and societal level – with this research suggesting that it frequently goes unrecorded.

As a result, Dr Dams-O’Conner says domestic violence is an under-recognised contributor to the brain health decline experienced by many survivors.

At the women’s brain health session during the Alzheimer’s Scotland conference earlier this year, attendees heard calls for more work to understand the higher prevalence of dementia among women.

Speaking for Brain Health Scotland, Anna Borthwick explained that the role of domestic abuse is a “major, often underrepresented” factor in brain health despite most of the estimated 20-30% of women reporting partner violence having suffered traumatic brain injuries.

Traumatic brain injuries

Another key finding of this study is that brain injury pathology experienced by domestic violence survivors is markedly different to that seen among contact sports athletes.

State-of-the-art imaging and pathology techniques have revealed that the examined women’s brains showed traumatic brain injuries, but no evidence of chronic traumatic encephalopathy – a degenerative condition that leads to dementia often associated with contact sports – was found.

While researchers say domestic violence survivors frequently report head injuries, the lifelong impacts of this on this group had not been known until this new study.

The research teams say the results represent an ‘unprecedented advancement’ in the understanding of domestic violence-related brain damage.

Moreover, researchers believe the work presents a message of hope as vascular contributors to cognitive impairment and decline may be more treatable.

The team adds that with increased societal awareness of these risks, screening and life-saving interventions could help treat the brain health consequences observed in domestic abuse survivors.

While this major study has shed some light on the brain health impacts of domestic violence, researchers say larger studies are needed to fully understand the potential links to dementia.

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