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Killops J, Sewry NA, Schwellnus M, Swanevelder S, Janse van Rensburg D, Jordaan E. Women, older age, faster cycling speed and increased wind speeds are independent risk factors for acute injury-related medical encounters during a 109 km mass community-based participation cycling event: a 3-year study in 102251 race starters—SAFER XII. Inj Prev 2020; 27:338-343. [DOI: 10.1136/injuryprev-2020-043874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Abstract
BackgroundThere are limited data on acute injury-related medical encounters (injuries) in endurance cycling events.ObjectiveTo determine the risk factors for injuries during a mass community-based endurance cycling event.DesignRetrospective, cross-sectional study.SettingCape Town Cycle Tour (109 km), South Africa.Participants102 251 race starters.MethodsAll injuries for 3 years were recorded by race medical doctors and nurses. Injuries were grouped into main anatomical area of injury, and a Poisson regression model was used to determine the risk factors associated with injuries.ResultsThe four injury risk factors associated with all injuries during an endurance cycling event were sex (women vs men, p<0.0001), older age (p=0.0005), faster cycling speed (p<0.0001) and higher average individualised Wind Speed (aiWindSpeed, p<0.0001). The only risk factor for serious/life-threatening injuries was women (p=0.0413). For specific main anatomical areas: head/neck (women), upper limb (women, older age, faster cyclists), trunk (women, higher aiWindSpeed), and lower limb (higher aiWindSpeed).ConclusionWomen, older age, faster cycling speed and higher aiWindSpeed were all risk factors for acute injuries during a mass community-based endurance cycling event. These risk factors should help inform race organisers and medical teams on race day to ensure the best medical care is given, and effective acute injury prevention programmes are disseminated.
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252
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Chendrasekhar A, Kuczabski B, Cohen D, Grageda M, Genovese-Scullin D, Patwari J, Harris L. Delayed Sequelae Related to Mild Traumatic Brain Injury in Children. Glob Pediatr Health 2020; 7:2333794X20947988. [PMID: 32923524 PMCID: PMC7448128 DOI: 10.1177/2333794x20947988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Delayed sequelae from mild traumatic brain injury (Glasgow Coma Score at admission >13, TBI) has been documented in case reports however larger studies of these effects are sparse. We undertook a telephone based survey to assess the long term sequelae of TBI. We tracked 100 pediatric TBI patients via our trauma registry for demographic data including age, injury severity, and mechanism of injury. Then we proceeded to contact these patient’s parents via telephone. We asked regarding residual symptoms and signs of concussive injury. Duration out from initial concussive injury ranged from 4 to 68 months. The parents of 66 boys and 34 girls were surveyed. The age of the patients at the time of mild TBI ranged from 1 to 14 years. The injury severity score ranged from 1 to 21. One being the most common Injury severity score. Thirty-three percent of patients had residual effects of concussion at the time of telephone survey. Fourteen percent had memory loss issues, 21% had anxiety/depression issues, 20% had learning disability issues, and 15% had sleep disturbance issues. Duration of time post concussive injury, mechanism, and age did not influence incidence of sequelae. Mild traumatic brain injury has significant long term sequelae. Better identifying characteristics are needed to characterize patients susceptible to long term residual effects of concussion.
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Affiliation(s)
- Akella Chendrasekhar
- Richmond University Medical Center, Staten Island, NY, USA.,SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Douglas Cohen
- Richmond University Medical Center, Staten Island, NY, USA
| | | | | | - Jakey Patwari
- Richmond University Medical Center, Staten Island, NY, USA
| | - Loren Harris
- Richmond University Medical Center, Staten Island, NY, USA.,SUNY Downstate Medical Center, Brooklyn, NY, USA
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253
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Puig J, Ellis MJ, Kornelsen J, Figley TD, Figley CR, Daunis-i-Estadella P, Mutch WAC, Essig M. Magnetic Resonance Imaging Biomarkers of Brain Connectivity in Predicting Outcome after Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2020; 37:1761-1776. [DOI: 10.1089/neu.2019.6623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Josep Puig
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Michael J. Ellis
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Department of Surgery and Pediatrics and Child Health, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Neurosurgery, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Pan Am Concussion Program, Winnipeg, Manitoba, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Teresa D. Figley
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
| | - Chase R. Figley
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pepus Daunis-i-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, Universitat de Girona, Girona, Spain
| | - W. Alan C. Mutch
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marco Essig
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
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254
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Turner M, Maddocks D, Hassan M, Anderson A, McCrory P. Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware). Br J Sports Med 2020; 55:bjsports-2020-102108. [PMID: 32788296 DOI: 10.1136/bjsports-2020-102108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 11/03/2022]
Abstract
While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a cause and effect relationship has not yet been demonstrated between CTE and concussions or between CTE and exposure to contact sports, as no prospective longitudinal studies have been performed to address that question. Studies of high-school sports exposure and long-term outcomes have not demonstrated consistent findings.Medical advice regarding return to play and the risk of acute and/or long-term consequences is therefore problematic. It is important that the individual's right to make their own choices regarding their health is respected. Team, coach, parental, peer or financial pressures should not influence this decision. The choice to return to play after a concussion or mild TBI injury is the athlete's decision once they have (1) recovered from their injury and have the legal capacity to make an informed decision; (2) been medically assessed and (3) been informed of any possible long-term risks in a language that they can understand.Given the current lack of certainty in relation to long-term outcomes from concussion, is it possible to provide a framework to inform players of current evidence, as part of a consent process, even if the information upon which the decision to return to sport is based remains uncertain and evolving?
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Affiliation(s)
- Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
| | - David Maddocks
- Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Paul McCrory
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
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255
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Gard A, Lehto N, Engström Å, Shahim P, Zetterberg H, Blennow K, Marklund N, Tegner Y. Quality of life of ice hockey players after retirement due to concussions. Concussion 2020; 5:CNC78. [PMID: 33005437 PMCID: PMC7506471 DOI: 10.2217/cnc-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Sports-related concussion (SRC) is increasingly recognized as a potential health problem in ice hockey. Quality of life (QoL) in players retiring due to SRC has not been thoroughly addressed. Materials & methods: QoL using the Sports Concussion Assessment Tool 5th Edition, Impact of Event Scale-Revised and Short Form Health Survey was measured in Swedish ice hockey players who retired due to persistence of postconcussion symptoms or fear of attaining additional SRC. Results: A total of 76 players were assessed, on average of 5 years after their most recent SRC. Overall, retired players had a high burden of postconcussion symptoms and reduced QoL. Conclusion: Retired concussed ice hockey players have a reduced QoL, particularly those retiring due to postconcussion symptoms. Symptom burden should be continuously evaluated and guide the decision to retire. Concussions sustained while playing ice hockey are increasingly recognized as a potential health problem. Long-term consequences for players retiring due to concussions have not been fully investigated. Therefore, we evaluated symptoms, quality of life and post-traumatic stress in former Swedish ice hockey players who retired due to postconcussion symptoms or to a fear of attaining additional concussions. We found that retired ice hockey players with a history of concussions had a low quality of life and high post-traumatic stress, particularly in players with a high symptom burden. We recommend that symptom burden should be continuously evaluated and guide the decision to retire.
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Affiliation(s)
- Anna Gard
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund 222 41, Sweden
| | - Niklas Lehto
- Department of Applied Physics, Luleå University of Technology, Luleå 971 87, Sweden
| | - Åsa Engström
- Department of Health Sciences, Luleå University of Technology, Luleå 971 87, Sweden
| | - Pashtun Shahim
- Clinical Neurochemistry Laboratory, Institute of Neuroscience & Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal 431 41, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience & Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal 431 41, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience & Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal 431 41, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund 222 41, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Luleå 971 87, Sweden
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256
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Pattinson CL, Meier TB, Guedes VA, Lai C, Devoto C, Haight T, Broglio SP, McAllister T, Giza C, Huber D, Harezlak J, Cameron K, McGinty G, Jackson J, Guskiewicz K, Mihalik J, Brooks A, Duma S, Rowson S, Nelson LD, Pasquina P, McCrea M, Gill JM. Plasma Biomarker Concentrations Associated With Return to Sport Following Sport-Related Concussion in Collegiate Athletes-A Concussion Assessment, Research, and Education (CARE) Consortium Study. JAMA Netw Open 2020; 3:e2013191. [PMID: 32852552 PMCID: PMC7453307 DOI: 10.1001/jamanetworkopen.2020.13191] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Identifying plasma biomarkers associated with the amount of time an athlete may need before they return to sport (RTS) following a sport-related concussion (SRC) is important because it may help to improve the health and safety of athletes. OBJECTIVE To examine whether plasma biomarkers can differentiate collegiate athletes who RTS in less than 14 days or 14 days or more following SRC. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective diagnostic study, conducted by the National Collegiate Athletics Association-Department of Defense Concussion Assessment, Research, and Education Consortium, included 127 male and female athletes who had sustained an SRC while enrolled at 6 Concussion Assessment, Research, and Education Consortium Advanced Research Core sites as well as 2 partial-Advanced Research Core military service academies. Data were collected between February 2015 and May 2018. Athletes with SRC completed clinical testing and blood collection at preseason (baseline), postinjury (0-21 hours), 24 to 48 hours postinjury, time of symptom resolution, and 7 days after unrestricted RTS. MAIN OUTCOMES AND MEASURES A total of 3 plasma biomarkers (ie, total tau protein, glial fibrillary acidic protein [GFAP], and neurofilament light chain protein [Nf-L]) were measured using an ultrasensitive single molecule array technology and were included in the final analysis. RTS was examined between athletes who took less than 14 days vs those who took 14 days or more to RTS following SRC. Linear mixed models were used to identify significant interactions between period by RTS group. Area under the receiver operating characteristic curve analyses were conducted to examine whether these plasma biomarkers could discriminate between RTS groups. RESULTS The 127 participants had a mean (SD) age of 18.9 (1.3) years, and 97 (76.4%) were men; 65 (51.2%) took less than 14 days to RTS, and 62 (48.8%) took 14 days or more to RTS. Linear mixed models identified significant associations for both mean (SE) plasma total tau (24-48 hours postinjury, <14 days RTS vs ≥14 days RTS: -0.65 [0.12] pg/mL vs -0.14 [0.14] pg/mL; P = .008) and GFAP (postinjury, 14 days RTS vs ≥14 days RTS: 4.72 [0.12] pg/mL vs 4.39 [0.11] pg/mL; P = .04). Total tau at the time of symptom resolution had acceptable discrimination power (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.63-0.86; P < .001). We also examined a combined plasma biomarker panel that incorporated Nf-L, GFAP, and total tau at each period to discriminate RTS groups. Although the analyses did reach significance at each time period when combined, results indicated that they were poor at distinguishing the groups (area under the receiver operating characteristic curve, <0.7). CONCLUSIONS AND RELEVANCE The findings of this study suggest that measures of total tau and GFAP may identify athletes who will require more time to RTS. However, further research is needed to improve our ability to determine recovery following an SRC.
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Affiliation(s)
- Cassandra L Pattinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
- Institute for Social Science Research, University of Queensland, Brisbane
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Thaddeus Haight
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Christopher Giza
- Department of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, University of California, Los Angeles
| | - Daniel Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | | | | | | | - Kevin Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Jason Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Alison Brooks
- Department of Orthopedics and Sports Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Stefan Duma
- Department of Biomedical Engineering, Virginia Tech, Blacksburg
| | - Steven Rowson
- Department of Biomedical Engineering, Virginia Tech, Blacksburg
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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257
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Cognitive Ageing in Top-Level Female Soccer Players Compared to a Normative Sample from the General Population: A Cross-sectional Study. J Int Neuropsychol Soc 2020; 26:645-653. [PMID: 32098636 DOI: 10.1017/s1355617720000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is an ongoing debate on the potential negative effect of contact sport participation on long-term neurocognitive performance due to inherent exposure to concussive and subconcussive head impacts. The aim of the present study was to investigate whether cognitive ageing is exacerbated in elite soccer players compared to the general population. METHOD Neurocognitive performance in 6 domains was compared between 240 elite soccer players and a normative sample from the general population (n = 585) using the computerised test battery CNS Vital Signs. We used two-way factorial ANOVA to analyse the interaction between age groups (15-19, 20-29, 30-39, 40-49 years) and study population (female soccer players vs. norm sample) in their effects on neurocognitive performance. RESULTS We found no significant interaction effect of age group and study population in five of six test domains. For processing speed, the effect of age was more pronounced in female soccer players (F = 16.89, p = .002). Further, there was a clear main effect of study population on neurocognitive performance with generally better scores in soccer players. CONCLUSIONS Elite female soccer players generally performed better than the norm sample on tests of cognitive function, and further, cognitive ageing effects were similar in elite soccer players and controls in all but one domain. A lifespan approach may facilitate insightful future research regarding questions related to long-term neurocognitive health in contact sport athletes.
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258
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Mills BD, Goubran M, Parivash SN, Dennis EL, Rezaii P, Akers C, Bian W, Mitchell LA, Boldt B, Douglas D, Sami S, Mouchawar N, Wilson EW, DiGiacomo P, Parekh M, Do H, Lopez J, Rosenberg J, Camarillo D, Grant G, Wintermark M, Zeineh M. Longitudinal alteration of cortical thickness and volume in high-impact sports. Neuroimage 2020; 217:116864. [DOI: 10.1016/j.neuroimage.2020.116864] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023] Open
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Knell G, Burkhart SO, Caze TJ, Polousky JD, Kohl HW, Messiah SE. Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis. Am J Sports Med 2020; 48:2534-2543. [PMID: 32692937 DOI: 10.1177/0363546520938776] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. PURPOSE To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. RESULTS A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. CONCLUSION Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses.
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Affiliation(s)
- Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Todd J Caze
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Peter O'Donnell Jr Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin, Texas, USA.,Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
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260
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Ledreux A, Pryhoda MK, Gorgens K, Shelburne K, Gilmore A, Linseman DA, Fleming H, Koza LA, Campbell J, Wolff A, Kelly JP, Margittai M, Davidson BS, Granholm AC. Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers. Front Neurosci 2020; 14:761. [PMID: 32848549 PMCID: PMC7406890 DOI: 10.3389/fnins.2020.00761] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) in athletes can cause persistent symptoms, known as post-concussion syndrome (PCS), and repeated injuries may increase the long-term risk for an athlete to develop neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), and Alzheimer's disease (AD). The Center for Disease Control estimates that up to 3.8 million sport-related mTBI are reported each year in the United States. Despite the magnitude of the phenomenon, there is a current lack of comprehensive prognostic indicators and research has shown that available monitoring tools are moderately sensitive to short-term concussion effects but less sensitive to long-term consequences. The overall aim of this review is to discuss novel, quantitative, and objective measurements that can predict long-term outcomes following repeated sports-related mTBIs. The specific objectives were (1) to provide an overview of the current clinical and biomechanical tools available to health practitioners to ensure recovery after mTBIs, (2) to synthesize potential biological mechanisms in animal models underlying the long-term adverse consequences of mTBIs, (3) to discuss the possible link between repeated mTBI and neurodegenerative diseases, and (4) to discuss the current knowledge about fluid biomarkers for mTBIs with a focus on novel exosomal biomarkers. The conclusions from this review are that current post-concussion clinical tests are not sufficiently sensitive to injury and do not accurately quantify post-concussion alterations associated with repeated mTBIs. In the current review, it is proposed that current practices should be amended to include a repeated symptom inventory, a cognitive assessment of executive function and impulse control, an instrumented assessment of balance, vestibulo-ocular assessments, and an improved panel of blood or exosome biomarkers.
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Affiliation(s)
- Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Moira K. Pryhoda
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Kim Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver, CO, United States
| | - Kevin Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Anah Gilmore
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Daniel A. Linseman
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Holly Fleming
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Lilia A. Koza
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Julie Campbell
- Pioneer Health and Performance, University of Denver, Denver, CO, United States
| | - Adam Wolff
- Denver Neurological Clinic, Denver, CO, United States
| | - James P. Kelly
- Marcus Institute for Brain Health, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Martin Margittai
- Department of Chemistry and Biochemistry, University of Denver, Denver, CO, United States
| | - Bradley S. Davidson
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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261
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O'Reilly M, Mahon S, Reid D, Hume P, Hardaker N, Theadom A. Knowledge, attitudes, and behavior toward concussion in adult cyclists. Brain Inj 2020; 34:1175-1182. [PMID: 32683900 DOI: 10.1080/02699052.2020.1793386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge. METHODS Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge. RESULTS The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, p < .001. CONCLUSIONS Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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Affiliation(s)
- Maureen O'Reilly
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Duncan Reid
- Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology , Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Natalie Hardaker
- Injury Prevention, Accident and Compensation Corporation , Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology , Auckland, New Zealand
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262
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Brett BL, Wilmoth K, Cummings P, Solomon GS, McCrea MA, Zuckerman SL. The Neuropathological and Clinical Diagnostic Criteria of Chronic Traumatic Encephalopathy: A Critical Examination in Relation to Other Neurodegenerative Diseases. J Alzheimers Dis 2020; 68:591-608. [PMID: 30856113 DOI: 10.3233/jad-181058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This work critically reviews chronic traumatic encephalopathy (CTE), with a specific focus on the single criterion necessary and sufficient for diagnosis. Herein, CTE is compared to other well-established neurodegenerative entities including Alzheimer's disease and dementia with Lewy bodies. Each neurodegenerative disorder is reviewed in five pertinent areas: 1) historical perspective, 2) guideline formation process, 3) clinical diagnostic criteria, 4) pathological diagnostic criteria, and 5) validation of previously described diagnostic criteria (e.g., sensitivity and specificity). These comparisons indicate that CTE is a disease in the earliest stages of formation and has yet to undergo rigorous development and refinement similar to other neurodegenerative diseases. Suggested future revisions to the diagnostic criterion of CTE include establishing a lower threshold for accumulation of pathology, as well as accounting for the presence of concomitant neuropathology and comorbid neurodegenerative disorders. Currently, while initial efforts have been attempted, agreed upon antemortem clinical criteria do not exist. As has been the scientific standard with similar neurodegenerative disorders, antemortem diagnostic guidelines should first be refined through subcommittees of neuroscientists from diverse institutional backgrounds with a subclassification of levels of diagnostic certainty (possible, probably, and definite). Validation studies should then assess the predictive value and accuracy of proposed antemortem diagnostic criteria in relation to potential pathological criteria.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristin Wilmoth
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter Cummings
- Department of Anatomy and Neurobiology, Boston University Medical Center, Boston, MA, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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263
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Waterworth V, Procyk A, Canetti E, Hing W, Gough S. The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes. Study design Systematic review. Methods A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk. Results Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p < 0.001. Conclusion Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.
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Affiliation(s)
- Victoria Waterworth
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Alexander Procyk
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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264
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Guedes VA, Devoto C, Leete J, Sass D, Acott JD, Mithani S, Gill JM. Extracellular Vesicle Proteins and MicroRNAs as Biomarkers for Traumatic Brain Injury. Front Neurol 2020; 11:663. [PMID: 32765398 PMCID: PMC7378746 DOI: 10.3389/fneur.2020.00663] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous condition, associated with diverse etiologies, clinical presentations and degrees of severity, and may result in chronic neurobehavioral sequelae. The field of TBI biomarkers is rapidly evolving to address the many facets of TBI pathology and improve its clinical management. Recent years have witnessed a marked increase in the number of publications and interest in the role of extracellular vesicles (EVs), which include exosomes, cell signaling, immune responses, and as biomarkers in a number of pathologies. Exosomes have a well-defined lipid bilayer with surface markers that reflect the cell of origin and an aqueous core that contains a variety of biological material including proteins (e.g., cytokines and growth factors) and nucleic acids (e.g., microRNAs). The presence of proteins associated with neurodegenerative changes such as amyloid-β, α-synuclein and phosphorylated tau in exosomes suggests a role in the initiation and propagation of neurological diseases. However, mechanisms of cell communication involving exosomes in the brain and their role in TBI pathology are poorly understood. Exosomes are promising TBI biomarkers as they can cross the blood-brain barrier and can be isolated from peripheral fluids, including serum, saliva, sweat, and urine. Exosomal content is protected from enzymatic degradation by exosome membranes and reflects the internal environment of their cell of origin, offering insights into tissue-specific pathological processes. Challenges in the clinical use of exosomal cargo as biomarkers include difficulty in isolating pure exosomes, variable yields of the isolation processes, quantification of vesicles, and lack of specificity of exosomal markers. Moreover, there is no consensus regarding nomenclature and characteristics of EV subtypes. In this review, we discuss current technical limitations and challenges of using exosomes and other EVs as blood-based biomarkers, highlighting their potential as diagnostic and prognostic tools in TBI.
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Affiliation(s)
- Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jacqueline Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Delia Sass
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jedidiah D Acott
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Sara Mithani
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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265
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Amitay N, Zlotnik Y, Coreanu T, Zeller L, Abu-Salameh I, Novack V, Ifergane G. Soccer heading and subclinical neuropsychiatric symptomatology in professional soccer players. Neurology 2020; 95:e1776-e1783. [DOI: 10.1212/wnl.0000000000010244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Abstract
ObjectivesTo evaluate the association between postconcussive symptomatology and heading in professional soccer players, overcoming the bias of self-reported exposure, we evaluated several clinical neuropsychiatric symptoms using questionnaires after a thorough objective follow-up of players’ heading exposure throughout an entire season.MethodsWe collected heading data for all Israeli Premier League players for an entire season using a web-based platform for performance analysis, which enabled us to quantify the exact number of headers per player. Players filled out questionnaires regarding postconcussion symptoms, depression, anxiety, and sleep disorders. We tested the association between the number of headers and each outcome using a negative binomial regression corrected for the hours played.ResultsA total of 159 players were included, of whom 79 were considered in the high heading exposure group (49%), defined as more than median number of headings (1.34 per game hour). Among players without any past head injury, those with higher heading exposure were less likely to have postconcussion symptoms compared with players with low heading exposure (relative risk [RR] per heading per hour 0.94, 95% confidence interval [CI] 0.912–0.963). Players with high heading exposure had fewer depression symptoms (RR 0.98, 95% CI 0.961–0.997), anxiety (RR 0.98, 95% CI 0.958–0.997), and sleep disorders (RR 0.98, 95% CI 0.961–0.996).ConclusionProfessional soccer players with high heading rate do not display higher postconcussive symptomatology severity. Symptoms among players with low heading exposure might be explained by low resilience, possibly associated with an inferior heading technique. Alternatively, it can reflect heading-avoidant behavior.
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Peltonen K, Launes J, Koskinen S, Vartiainen M, Pajunen S, Pertab J, Laitala T, Hokkanen L. On‐field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Kati Peltonen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jyrki Launes
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Matti Vartiainen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sara Pajunen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jon Pertab
- Neurosciences Institute Intermountain Medical Center Murray UT USA
| | - Tiina Laitala
- Institute of Biomedicine University of Turku Turku Finland
| | - Laura Hokkanen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
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267
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Eisele A, Hill-Strathy M, Michels L, Rauen K. Magnetic Resonance Spectroscopy following Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis on the Potential to Detect Posttraumatic Neurodegeneration. NEURODEGENER DIS 2020; 20:2-11. [PMID: 32610337 DOI: 10.1159/000508098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/11/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is the most relevant external risk factor for dementia and a major global health burden. Mild TBI (mTBI) contributes to up to 90% of all TBIs, and the classification "mild" often misrepresents the patient's burden who suffer from neuropsychiatric long-term sequelae. Magnetic resonance spectroscopy (MRS) allows in vivo detection of compromised brain metabolism although it is not routinely used after TBI. OBJECTIVE Thus, we performed a systematic review and meta-analysis to elucidate if MRS has the potential to identify changes in brain metabolism in adult patients after a single mTBI with a negative routine brain scan (CCT and/or MRI scan) compared to aged- and sex-matched healthy controls (HC) during the acute or subacute postinjury phase (≤90 days after mTBI). METHODS A comprehensive literature search was conducted from the first edition of electronic databases until January 31, 2020. Group analyses were performed per metabolite using a random-effects model. RESULTS Four and 2 out of 5,417 articles met the inclusion criteria for the meta-analysis and systematic review, respectively. For the meta-analysis, 50 mTBI patients and 51 HC with a mean age of 31 and 30 years, respectively, were scanned using N-acetyl-aspartate (NAA), a marker for neuronal integrity. Glutamate (Glu), a marker for disturbed brain metabolism, choline (Cho), a marker for increased cell membrane turnover, and creatine (Cr) were used in 2 out of the 4 included articles. Regions of interests were the frontal lobe, the white matter around 1 cm above the lateral ventricles, or the whole brain. NAA was decreased in patients compared to HC with an effect size (ES) of -0.49 (95% CI -1.08 to 0.09), primarily measured in the frontal lobe. Glu was increased in the white matter in 22 mTBI patients compared to 22 HC (ES 0.79; 95% CI 0.17-1.41). Cho was decreased in 31 mTBI patients compared to 31 HC (ES -0.31; 95% CI -0.81 to 0.19). Cr was contradictory and, therefore, potentially not suitable as a reference marker after mTBI. CONCLUSIONS MRS pinpoints changes in posttraumatic brain metabolism that correlate with cognitive dysfunction and, thus, might possibly help to detect mTBI patients at risk for unfavorable outcome or posttraumatic neurodegeneration early.
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Affiliation(s)
- Amanda Eisele
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - MaryJane Hill-Strathy
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland, .,Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland,
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268
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Alosco ML, Tripodis Y, Baucom ZH, Mez J, Stein TD, Martin B, Haller O, Conneely S, McClean M, Nosheny R, Mackin S, McKee AC, Weiner MW, Stern RA. Late contributions of repetitive head impacts and TBI to depression symptoms and cognition. Neurology 2020; 95:e793-e804. [PMID: 32591472 DOI: 10.1212/wnl.0000000000010040] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition. METHODS This cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group. RESULTS A total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36-2.12), TBI without LOC (β, 0.43; 95% CI, 0.31-0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59-0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001-0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002-0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, -0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition. CONCLUSIONS RHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.
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Affiliation(s)
- Michael L Alosco
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA.
| | - Yorghos Tripodis
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Zachary H Baucom
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Jesse Mez
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Thor D Stein
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Brett Martin
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Olivia Haller
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Shannon Conneely
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Michael McClean
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Rachel Nosheny
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Scott Mackin
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Ann C McKee
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Michael W Weiner
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
| | - Robert A Stern
- From the Departments of Neurology (M.L.A., J.M., O.H., S.C., A.C.M., R.A.S.), Pathology & Laboratory Medicine (T.D.S., A.C.M.), Boston University Alzheimer's Disease Center and CTE Center (Y.T., B.M.), and Departments of Neurosurgery (R.A.S.) and Anatomy and Neurobiology (R.A.S.), Boston University School of Medicine; Department of Biostatistics (Y.T., Z.H.B.), Biostatistics and Epidemiology Data Analytics Center (B.M.), and Department of Environmental Health (M.M.), Boston University School of Public Health, MA; VA Boston Healthcare System (T.D.S., A.C.M.); Department of Veterans Affairs Medical Center (T.D.S., A.C.M.), Bedford, MA; Departments of Psychiatry (R.N., S.M., M.W.W.), Radiology (M.W.W.), Biomedical Imaging (M.W.W.), Medicine (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco; and Department of Veterans Affairs Medical Center (R.N., S.M., M.W.W.), Center for Imaging and Neurodegenerative Diseases, San Francisco, CA
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269
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Kent JB, Wood CL, Pugh K, Statuta SM, MacKnight JM. The medical observer in American football: a survey of use and efficacy. Brain Inj 2020; 34:1100-1105. [DOI: 10.1080/02699052.2020.1782473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jeremy B. Kent
- Department of Family Medicine, Team Physician, UVa Sports Medicine, University of Virginia Health System, Charlottesville, Virginia, Virginia, USA
| | - Colton L. Wood
- Primary Care Sports Medicine Fellow, Department of Family Medicine, University of North Carolina, Chapel Hill, North Caroline, USA
| | - Kelli Pugh
- Associate Athletics Director for Sports Medicine, University of Virginia, Charlottesville, Charlottesville, Virginia, USA
| | - Siobhan M. Statuta
- Family Medicine and Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John M. MacKnight
- Internal Medicine & Orthopaedic Surgery, Team Physician and Medical Director, UVA Sports Medicine, University of Virginia Health System
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270
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Guedes VA, Kenney K, Shahim P, Qu BX, Lai C, Devoto C, Walker WC, Nolen T, Diaz-Arrastia R, Gill JM. Exosomal neurofilament light: A prognostic biomarker for remote symptoms after mild traumatic brain injury? Neurology 2020; 94:e2412-e2423. [PMID: 32461282 PMCID: PMC7455370 DOI: 10.1212/wnl.0000000000009577] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To measure exosomal and plasma levels of candidate blood biomarkers in veterans with history of mild traumatic brain injury (mTBI) and test their relationship with chronic symptoms. METHODS Exosomal and plasma levels of neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor (VEGF) were measured using an ultrasensitive assay in a cohort of 195 veterans, enrolled in the Chronic Effects of Neurotrauma Consortium Longitudinal Study. We examined relationships between candidate biomarkers and symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression. Biomarker levels were compared among those with no traumatic brain injury (TBI) (controls), 1-2 mTBIs, and repetitive (3 or more) mTBIs. RESULTS Elevated exosomal and plasma levels of NfL were associated with repetitive mTBIs and with chronic PCS, PTSD, and depression symptoms. Plasma TNF-α levels correlated with PCS and PTSD symptoms. The total number of mTBIs correlated with exosomal and plasma NfL levels and plasma IL-6. Increased number of years since the most recent TBI correlated with higher exosomal NfL and lower plasma IL-6 levels, while increased number of years since first TBI correlated with higher levels of exosomal and plasma NfL, as well as plasma TNF-α and VEGF. CONCLUSION Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL, even years following these injuries, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. Our results suggest a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially repetitive.
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Affiliation(s)
- Vivian A Guedes
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Kimbra Kenney
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia.
| | - Pashtun Shahim
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Bao-Xi Qu
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Chen Lai
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Christina Devoto
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - William C Walker
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Tracy Nolen
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Jessica M Gill
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
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271
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Brooks BL, Virani S, Khetani A, Carlson H, Jadavji Z, Mauthner M, Low TA, Plourde V, MacMaster FP, Bray S, Harris AD, Lebel C, Lebel RM, Esser MJ, Yeates KO, Barlow KM. Functional magnetic resonance imaging study of working memory several years after pediatric concussion. Brain Inj 2020; 34:895-904. [PMID: 32396403 DOI: 10.1080/02699052.2020.1753240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PRIMARY OBJECTIVE The neurophysiological effects of pediatric concussion several years after injury remain inadequately characterized. The objective of this study was to determine if a history of concussion was associated with BOLD response differences during an n-back working memory task in youth. RESEARCH DESIGN Observational, cross-sectional. METHODS AND PROCEDURES Participants include 52 children and adolescents (M = 15.1 years, 95%CI = 14.4-15.8, range = 9-19) with past concussion (n = 33) or orthopedic injury (OI; n = 19). Mean time since injury was 2.5 years (95%CI = 2.0-3.0). Measures included postconcussion symptom ratings, neuropsychological testing, and blood-oxygen-dependent-level (BOLD) functional magnetic resonance imaging (fMRI) during an n-back working memory task. MAIN OUTCOMES AND RESULTS Groups did not differ on accuracy or speed during the three n-back conditions. They also did not differ in BOLD signal change for the 1- vs. 0-back or 2- vs. 0-back contrasts (controlling for task performance). CONCLUSIONS This study does not support group differences in BOLD response during an n-back working memory task in youth who are on average 2.5 years post-concussion. The findings are encouraging from the perspective of understanding recovery after pediatric concussion.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada
| | - Shane Virani
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Alberta, Canada.,Vi Riddell Pain and Rehabilitation Program, Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada
| | - Aneesh Khetani
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Helen Carlson
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Zeanna Jadavji
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Trevor A Low
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Vickie Plourde
- École de Psychologie, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Monton, New Brunswick, Canada; Faculty Saint-Jean, University of Alberta , Edmonton, AB, Canada
| | - Frank P MacMaster
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Psychiatry and Paediatrics, University of Calgary , Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute , Calgary, Alberta, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services , Edmonton, Alberta, Canada
| | - Signe Bray
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Ashley D Harris
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - R Marc Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Radiology and Biomedical Engineering, University of Calgary , Calgary, Alberta, Canada.,MR Applications and Workflow, GE Healthcare , Calgary, Alberta, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Karen M Barlow
- Departments of Paediatrics and Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada.,Faculty of Medicine, University of Queensland , Brisbane, Australia
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272
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Wright DK, Gardner AJ, Wojtowicz M, Iverson GL, O'Brien TJ, Shultz SR, Stanwell P. White Matter Abnormalities in Retired Professional Rugby League Players with a History of Concussion. J Neurotrauma 2020; 38:983-988. [PMID: 32245344 DOI: 10.1089/neu.2019.6886] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The topic of potential long-term neurological consequences from having multiple concussions during a career in collision sports is controversial. We sought to investigate white matter microstructure using diffusion tensor imaging (DTI) in retired professional Australian National Rugby League (NRL) players (n = 11) with a history of multiple self-reported concussions compared with age- and education-matched controls (n = 13) who have had no history of brain trauma. Diffusion-weighted images were acquired with a Siemens 3T scanner. All participants completed a clinical interview. There were no significant differences between groups on measures of depression, anxiety, stress, or post-concussion symptoms; however, NRL players scored significantly higher on the alcohol use disorder identification test (AUDIT). Voxelwise analyses of DTI measures were performed using tract-based spatial statistics (TBSS) with age and AUDIT scores included as covariates. TBSS revealed significantly reduced fractional anisotropy (FA), and increased radial diffusivity (RD), axial diffusivity (AD), and trace (TR) in white matter regions of recently retired NRL players compared with controls. FA was significantly reduced in the right superior longitudinal fasciculus and right corticospinal tract while TR, RD, and AD were increased in these regions, as well as the corpus callosum, forceps major, right uncinate fasciculus, and left corticospinal tract. In summary, DTI in a small cohort of recently retired professional NRL players with a history of multiple concussions showed differences in white matter microstructure compared with age- and education-matched controls with no history of brain trauma.
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Affiliation(s)
- David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Gardner
- Hunter New England Local Health District Sports Concussion Program, New Lambton Heights, New South Wales, Australia
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,MassGeneral Hospital for ChildrenTM Sport Concussion Program Foundation, and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
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273
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Li W, Chang C, Liang S, Bigler ED. Radiographic and neurobehavioral profile of sports-related concussion associated with scholastic wrestling: a case report. Neurocase 2020; 26:147-155. [PMID: 32412324 DOI: 10.1080/13554794.2020.1764977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sports-related concussions (SRCs) are typically characterized by transient neurologic deficits due to physiologic and metabolic brain injury. However, following an SRC, subsequent insults may lead to severe and permanent injury in the affected brain cells. We present the case of a 15-year-old female scholastic wrestler who developed acute encephalopathy, macroscopic white matter injury on imaging, and chronic behavioral changes from inadequate neuro-recovery after a documented SRC. We also compare her case with established SRC data, demonstrating that wrestling-related concussions and repetitive head impacts can produce similar degrees of diffuse neuroinflammation, myelinated axonopathy, blood-brain barrier disruption, and post-concussive symptoms.
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Affiliation(s)
- Wentao Li
- Department of Neurology, University of California Davis , Sacramento, USA
| | - Celia Chang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Shannon Liang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Erin D Bigler
- Department of Neurology, University of California Davis , Sacramento, USA.,Department of Psychology and Neuroscience, Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University , Provo, USA.,Department of Neurology and Department of Psychiatry, University of Utah , Salt Lake City, USA
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274
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Hellewell SC, Beaton CS, Welton T, Grieve SM. Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Front Neurol 2020; 11:350. [PMID: 32508733 PMCID: PMC7248359 DOI: 10.3389/fneur.2020.00350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. Methods: We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. Results: We included 47 cross-sectional studies (n = 25,103 mTBI and 29,982 control), 26 cohort studies (n = 70,119 mTBI, 262,034 control), four prospective observational studies (n = 1,058 mTBI and 733 control), two prospective longitudinal studies (n = 119 mTBI, 81 control), two case-control studies (n = 56 mTBI, 56 control), and one randomized controlled trial (n = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68–4.03, I2 = 96%). The OR for depression did not change when subjects were assessed at 6–12 months (OR 2.43, 1.45–4.07), years 1–2 (OR 4.12, 2.10–8.07); 2–10 (OR 3.28, 2.42–4.46), or 10+ (OR 3.42, 1.51–7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82–2.81; 25–35: OR 4.67, 3.06–7.14; >35: OR 2.69, 1.42–5.10) and different age at assessment (<40 years: OR 3.14, 2.48–3.99; >40 years: OR 4.57, 2.54–8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39–166.93) compared to male (OR 3.0, 2.33–3.86). mTBI etiology had no impact on depression. Conclusions: Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Caerwen S Beaton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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275
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Rosenblum DJ, Walton SR, Erdman NK, Broshek DK, Hart JM, Resch JE. If Not Now, When? An Absence of Neurocognitive and Postural Stability Deficits in Collegiate Athletes with One or More Concussions. J Neurotrauma 2020; 37:1211-1220. [PMID: 31910071 DOI: 10.1089/neu.2019.6813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A history of concussion has been associated with decreased neurocognitive function and postural control. The purpose of our study was to compare neurocognitive function and postural control in collegiate athletes with and without varying histories of concussion. Collegiate athletes were divided into groups based on 0 (n = 129), 1 (n = 91), 2 (n = 52), and 3+ (n = 34) prior concussions. Participants in each group were carefully matched by sport, sex, height, weight, and age. Athletes were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT™) and the Sensory Organization Test (SOT) as part of a standard of care pre-season assessment. Group ImPACT (Verbal and Visual Memory, Visual Motor Speed, and Reaction Time) and SOT (Equilibrium Score and Somatosensory, Visual, and Vestibular sensory ratios) outcome scores were compared using one-way analyses of variance (ANOVAs). Coefficients of variation (CVs) were also calculated for each outcome score and were compared using two-sample tests with 95% confidence intervals (CIs). Participants with and without a history of concussion were not significantly different for any ImPACT or SOT outcome score (p's > 0.10). Groups (0, 1, 2, and 3+ previous concussions) were not different from each other for any ImPACT or SOT outcome score (p's ≥ 0.11). Likewise, the CVs associated with each ImPACT and SOT outcome score did not vary significantly between outcome scores for any group comparison (p ≥ 0.09). Our findings suggest that a history of one or more concussions does not influence neurocognitive performance or postural stability in collegiate athletes at their pre-season baseline assessment.
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Affiliation(s)
- Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joeseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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276
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Gallo V, Motley K, Kemp SPT, Mian S, Patel T, James L, Pearce N, McElvenny D. Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review. J Neurol Neurosurg Psychiatry 2020; 91:455-468. [PMID: 32107272 PMCID: PMC7231435 DOI: 10.1136/jnnp-2019-321170] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/20/2019] [Accepted: 01/26/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Understanding whether concussion in sport is associated with worsening cognitive function in later life will likely have immediate repercussion on sports concussion prevention and management policy and sporting rules and regulations. This systematic review aims to summarise the evidence on the association between concussion sustained by professional/elite athletes and long-term cognitive impairment. METHODS Embase, PubMed and Web of Science were used to search for eligible studies. Studies including professional/elite athletes from any sport were considered. Three comparison groups were considered: internal comparison (concussed vs non-concussed athletes within the same sample); between-sport comparison (contact sport athletes vs non-contact sports ones); external comparison (athletes vs samples of the general population or population norms). RESULTS 14 studies were included (rugby, American football, ice hockey players, boxers and marital art fighters). The general quality of the evidence was poor. The overall evidence, weighted for type of comparison and study quality, points towards an association between sustaining a sport-related concussion and poorer cognitive function later in life in rugby, American football and boxing, although it is unclear to what extent this is clinically relevant. Data on ice hockey and martial arts were too sparse to allow conclusions to be drawn. CONCLUSION High-quality, appropriately designed and powered epidemiological studies are urgently needed to assess the association between sustaining a sport-related concussion and cognitive impairment later in life. Particular emphasis should be put on the clinical translational value of findings.
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Affiliation(s)
- Valentina Gallo
- Institute of Population Health Sciences, Queen Mary, University of London, London, UK .,School of Public Health, Imperial College London, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical, London, UK
| | - Kim Motley
- School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Simon P T Kemp
- Department of Medical Statistics, London School of Hygiene and Tropical, London, UK.,Rugby Football Union, Twickenham, London, UK
| | - Saba Mian
- Department of Medical Statistics, London School of Hygiene and Tropical, London, UK
| | - Tara Patel
- Institute of Population Health Sciences, Queen Mary, University of London, London, UK.,BSc in Biology, Imperial College London, London, UK
| | - Laura James
- Institute of Population Health Sciences, Queen Mary, University of London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical, London, UK
| | - Damien McElvenny
- Department of Medical Statistics, London School of Hygiene and Tropical, London, UK.,Institute for Occupational Medicine Edingburgh, Edingburgh, UK.,University of Manchester, Manchester, UK
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277
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Guell X, Arnold Anteraper S, Gardner AJ, Whitfield-Gabrieli S, Kay-Lambkin F, Iverson GL, Gabrieli J, Stanwell P. Functional Connectivity Changes in Retired Rugby League Players: A Data-Driven Functional Magnetic Resonance Imaging Study. J Neurotrauma 2020; 37:1788-1796. [PMID: 32183583 DOI: 10.1089/neu.2019.6782] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is considerable interest in the long-term brain health of retired contact and collision sport athletes; however, little is known about possible underlying changes in functional brain connectivity in this group. We evaluated whole-brain functional connectivity patterns using multi-voxel pattern analysis (MVPA) to determine whether alterations in functional connectivity distinguish retired professional athletes from a matched group of healthy community control subjects. Thirty-two retired athletes with a history of multiple self-reported sport-related concussions and 36 healthy community control subjects who were similar in age and education, completed functional magnetic resonance imaging. We identified brain regions with abnormal functional connectivity patterns using whole-brain MVPA as implemented in the Conn toolbox. First-level MVPA was performed using 64 principal component analysis (PCA) components. Second-level F test was performed using the first three MVPA components for retired athletes > controls group contrast. Post hoc seed-to-voxel analyses using the MVPA cluster results as seeds were performed to characterize functional connectivity abnormalities from brain regions identified by MVPA. MVPA revealed one cluster of abnormal functional connectivity located in cerebellar lobule V. This region of lobule V corresponded to the ventral attention network. Post hoc seed-to-voxel analysis using the cerebellar MVPA cluster as a seed revealed multiple areas of cerebral cortical hyper-connectivity and hypo-connectivity in retired athletes when compared with controls. This initial report suggests that cerebellar dysfunction might be present and clinically important in some retired athletes.
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Affiliation(s)
- Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Andrew J Gardner
- Hunter New England Local Health District Sport Concussion Program, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Peter Stanwell
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
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278
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Cookinham B, Swank C. Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players. Arch Clin Neuropsychol 2020; 35:257-264. [PMID: 30927353 DOI: 10.1093/arclin/acz012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 02/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if concussion history and career status is associated with neurocognitive performance in elite football players. METHODS The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 ± 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool - third edition (SCAT-3), in an outpatient therapy setting. RESULTS Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). CONCLUSIONS Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.
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Affiliation(s)
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
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279
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Abstract
Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.
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280
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Quan H, Koltai E, Suzuki K, Aguiar AS, Pinho R, Boldogh I, Berkes I, Radak Z. Exercise, redox system and neurodegenerative diseases. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165778. [PMID: 32222542 DOI: 10.1016/j.bbadis.2020.165778] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 12/12/2022]
Abstract
Regular exercise induces a wide range of redox system-associated molecular adaptive responses to the nervous system. The intermittent induction of reactive oxygen species (ROS) during acute exercise sessions and the related upregulation of antioxidant/repair and housekeeping systems are associated with improved physiological function. Exercise-induced proliferation and differentiation of neuronal stem cells are ROS dependent processes. The increased production of brain derived neurotrophic factor (BDNF) and the regulation by regular exercise are dependent upon redox sensitive pathways. ROS are causative and associative factors of neurodegenerative diseases and regular exercise provides significant neuroprotective effects against Alzheimer's disease, Parkinson's disease, and hypoxia/reperfusion related disorders. Regular exercise regulates redox homeostasis in the brain with complex multi-level molecular pathways.
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Affiliation(s)
- Helong Quan
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua City, Zhejiang, China
| | - Erika Koltai
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Aderbal S Aguiar
- Research Group on Biology of Exercise, Department of Health Sciences, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Ricardo Pinho
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Istvan Boldogh
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Istvan Berkes
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Zsolt Radak
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary; Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan.
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281
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Aggarwal SS, Ott SD, Padhye NS, Schulz PE. Sex, race, ADHD, and prior concussions as predictors of concussion recovery in adolescents. Brain Inj 2020; 34:809-817. [DOI: 10.1080/02699052.2020.1740942] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Seema S. Aggarwal
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Summer D. Ott
- Department of Orthopedics, McGovern Medical School of UTHealth, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nikhil S. Padhye
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul E. Schulz
- Department of Neurology, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas, USA
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282
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Cecchi NJ, Monroe DC, Phreaner JJ, Small SL, Hicks JW. Patterns of head impact exposure in men's and women's collegiate club water polo. J Sci Med Sport 2020; 23:927-931. [PMID: 32303477 DOI: 10.1016/j.jsams.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Recent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo. DESIGN Prospective cohort study. METHODS Head impact sensors (SIM-G, Triax Technologies) were worn by men's (n=16) and women's (n=15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts. RESULTS Men's players sustained 52 verified head impacts of magnitude 39.7±16.3g PLA and 5.2±3.2 krad/s2 PRA, and women's players sustained 43 verified head impacts of magnitude 33.7±12.6g PLA and 4.0±2.8krad/s2 PRA. Impacts sustained by men had greater PLA than those sustained by women (p=.045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent's torso or limb. CONCLUSIONS Our cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.
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Affiliation(s)
- Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
| | - Derek C Monroe
- Department of Neurology, University of California-Irvine, United States.
| | - Jenna J Phreaner
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
| | - Steven L Small
- Department of Neurology, University of California-Irvine, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California-Irvine, United States
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283
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Caccese JB, DeWolf RM, Kaminski TW, Broglio SP, McAllister TW, McCrea M, Buckley TA. Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study. Sports Med 2020; 49:477-487. [PMID: 30747378 DOI: 10.1007/s40279-019-01069-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes. OBJECTIVE The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes. METHODS We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history. RESULTS Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction. CONCLUSION Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Ryan M DeWolf
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA.
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA.
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284
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Lust CAC, Mountjoy M, Robinson LE, Oliver JM, Ma DWL. Sports-related concussions and subconcussive impacts in athletes: incidence, diagnosis, and the emerging role of EPA and DHA. Appl Physiol Nutr Metab 2020; 45:886-892. [PMID: 32119565 DOI: 10.1139/apnm-2019-0555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sports-related concussions (SRC) are traumatic brain injuries induced as the result of a biomechanical force to the body that temporarily impair neurological functions. Not all traumatic impacts reach the threshold necessary to produce concussive symptoms; however, the culmination of these events is known as a subconcussive impact (SCI). Athletes who have been diagnosed with a SRC or those who accumulate multiple SCI have exhibited structural damage to the brain, impairments to learning and memory, and an increase in depressive symptoms. This area is rapidly evolving, and current clinical definitions of injury, diagnosis, and treatment of SRC and SCI are reviewed. In tandem, there is also growing research examining the role of nutrition in brain injuries, focusing primarily on n-3 polyunsaturated fatty acids (PUFA). The potential role of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in reducing inflammation and promoting recovery following brain injury are also reviewed. Overall, advancements in the evaluation of SRC and SCI coupled with n-3 PUFA supplementation show promise in the management of brain injuries, leading to better long-term health outcomes for athletes. Novelty SRC have garnered widespread attention due to the growing body of reported prevalence in youth and professional sports. Current definitions and protocol(s) for diagnosing SRC and SCI have improved, but still require further evaluation. n-3, EPA and DHA, reduce inflammation and promote recovery following brain injuries in experimental models.
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Affiliation(s)
- Cody A C Lust
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Margo Mountjoy
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Lindsay E Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jonathan M Oliver
- Athletics, United States Military Academy, West Point, NY 10996, USA
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
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285
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Beaudouin F, Aus der Fünten K, Tröß T, Reinsberger C, Meyer T. Match Situations Leading to Head Injuries in Professional Male Football (Soccer)-A Video-Based Analysis Over 12 Years. Clin J Sport Med 2020; 30 Suppl 1:S47-S52. [PMID: 32132477 DOI: 10.1097/jsm.0000000000000572] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify risk situations promoting head injuries in professional male football (soccer) and to investigate the impact of a rule change in 2006 punishing elbow-head contacts. DESIGN Analysis of video sequences of head events leading to head injury. PARTICIPANTS Professional football players of the first male German Bundesliga. MAIN OUTCOME MEASURES Observational criteria of head impacts on video recordings (players' actions preceding head injuries, foul play-referee's decision and assessment of rater, ball possession, on-pitch medical treatment, and consequences of head impact). RESULTS Three hundred thirty-four head injuries were reported in kicker Sportmagazin corresponding to an incidence rate of 2.25 (95% confidence interval 2.01-2.51) per 1000 player match hours. The injured player predominantly jumped (60%), headed the ball (36%), or ran forwards (20%); the noninjured players mainly jumped (64%), headed the ball (27%), or raised the elbow to the head (23%). Free ball situations (2 players challenge for the ball) caused most of the head injuries (81%). The players' action "raising the elbow" during a head injury seemed to be lower after the rule change. CONCLUSIONS Jumping for the ball with the intention of heading is the predominant action associated with head injury risk. Head injuries occur most often when players challenge for the ball in a header duel. As head injuries bear the potential risk of long-term health sequelae, the identification of situational circumstances is essential to develop preventative means in the future.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Karen Aus der Fünten
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Tobias Tröß
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
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286
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Moore BA, Brock MS, Brager A, Collen J, LoPresti M, Mysliwiec V. Posttraumatic Stress Disorder, Traumatic Brain Injury, Sleep, and Performance in Military Personnel. Sleep Med Clin 2020; 15:87-100. [DOI: 10.1016/j.jsmc.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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287
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Kelman JC, Hodge C, Stanwell P, Mustafic N, Fraser CL. Retinal nerve fibre changes in sports-related repetitive traumatic brain injury. Clin Exp Ophthalmol 2020; 48:204-211. [PMID: 31691473 DOI: 10.1111/ceo.13673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is limited literature on the use of optical coherence tomography in the assessment of retinal nerve fibre layer (RNFL) thickness in sports-related repetitive mild traumatic brain injury. BACKGROUND To evaluate RNFL thickness in professional rugby league players. RNFL thinning may serve as a proxy for wider white matter degeneration. DESIGN Cross-sectional observational study. PARTICIPANTS Thirteen retired Australian professional rugby league players were recruited. METHODS Participants underwent binocular optical coherence tomography to measure RNFL thickness. Each participant underwent a complete ophthalmic assessment to exclude concurrent disease. MAIN OUTCOME MEASURES RNFL thickness of each eye were compared with a normative database. RESULTS Participants had played professional Rugby League for 18 years on average and reported sustaining 15 sports-related concussions throughout their career. The RNFL in participants was four micrometres thinner than that of matched normative data. Cohort average RNFL thickness was reduced in 12 out of 14 optical coherence testing parameters. These findings were statistically significant in the left inferonasal [P = .013] and left nasal [P = .006] sectors. There was no statistically significant relationship between RNFL thickness and other visual measures. CONCLUSIONS AND RELEVANCE This study is the first to demonstrate RNFL thinning in a cohort of retired Australian professional Rugby League players. RNFL changes have been shown to correlate with cerebral white matter loss and neurodegeneration. Optical coherence tomography may serve as a safe and economical means of screening for repetitive traumatic brain injury related neurodegeneration in contact sport athletes.
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Affiliation(s)
- Julian C Kelman
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Hodge
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Peter Stanwell
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nina Mustafic
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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288
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Barr WB. POINT/COUNTER-POINT-Links between traumatic brain injury and dementia remain poorly defined. Arch Clin Neuropsychol 2020; 35:128-132. [PMID: 32008038 DOI: 10.1093/arclin/acz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
There has been considerable public interest in the topic of traumatic brain injury (TBI) as a risk factor for development of late-life dementia. A review was performed on empirical studies examining the relationship between these two conditions. Although results from a number of studies clearly demonstrate that TBI is a positive risk factor for developing dementia, there are an equivalent number of studies that obtain inconclusive or negative findings. Inconsistencies across studies are often the result of methodological findings including the nature of the investigational design, choice of comparison groups, and criteria used to define cases. In many studies, the diagnosis of TBI is obtained retrospectively in a manner that is subject to bias. Accurate identification of dementia cases is often compromised by the use of inappropriately brief follow-up periods and variations in diagnostic methods. There remains no universally accepted neurobiological mechanism to explain the transition from acute TBI to the chronic effects of dementia. Studies of specialty populations, including athletes and military personnel are beset by secular and cohort effects, raising questions about the applicability of findings to the general population. No existing studies have been able to exclude the possible effects of confounding medical or lifestyle factors in facilitating the onset of dementia following TBI. Although the research findings suggest a general association between TBI and dementia, the specifics of the relationship remain poorly defined.
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Affiliation(s)
- William B Barr
- Departments of Neurology & Psychiatry, NYU School of Medicine, Ney York, NY, USA
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289
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Mantey DS, Omega-Njemnobi O, Barroso CS, Kelder SH. Self-reported history of concussions is associated with risk factors for suicide completion among high school students. J Affect Disord 2020; 263:684-691. [PMID: 31740108 DOI: 10.1016/j.jad.2019.11.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/16/2019] [Accepted: 11/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion. METHODS Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier. RESULTS Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02-1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02-1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31-1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68-3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models. LIMITATIONS Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health. CONCLUSION Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship.
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Affiliation(s)
- Dale S Mantey
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA.
| | - Onyinye Omega-Njemnobi
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA
| | - Cristina S Barroso
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, United States
| | - Steven H Kelder
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, Texas 78701, USA
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290
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291
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Yang C, Nag S, Xing G, Aggarwal NT, Schneider JA. A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology. Front Neurol 2020; 11:42. [PMID: 32117011 PMCID: PMC7028767 DOI: 10.3389/fneur.2020.00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) was recently recognized as a new tauopathy in which multifocal perivascular phosphorylated tau aggregates accumulate in neurons, astrocytes, and neurites at the depths of the cortical sulci. Traumatic brain injury (TBI) in early or mid-life is known to be associated with an increased risk of dementia in late life. This case report describes a 93-year-old former street boxer with a premortem diagnosis of severe dementia, who showed pathological evidence of the coexistence of Alzheimer's disease, CTE, dementia with Lewy bodies, and hippocampal sclerosis with TDP-43 pathology. These findings suggest that TBI may trigger a variety of misfolded proteins leading to dementia. Currently, clear clinical diagnostic criteria for CTE have not been established. Therefore, clinicians should be aware that TBI is a risk factor for dementia and that CTE can overlap with other neurodegenerative diseases.
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Affiliation(s)
- Chunhui Yang
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Sukriti Nag
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, United States
| | - Guoqiang Xing
- The Affiliated Hospital of the North Sichuan Medical College, Nanchong, China
| | - Neelum T Aggarwal
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Julie A Schneider
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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292
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Krukowski K, Nolan A, Frias ES, Grue K, Becker M, Ureta G, Delgado L, Bernales S, Sohal VS, Walter P, Rosi S. Integrated Stress Response Inhibitor Reverses Sex-Dependent Behavioral and Cell-Specific Deficits after Mild Repetitive Head Trauma. J Neurotrauma 2020; 37:1370-1380. [PMID: 31884883 DOI: 10.1089/neu.2019.6827] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mild repetitive traumatic brain injury (rTBI) induces chronic behavioral and cognitive alterations and increases the risk for dementia. Currently, there are no therapeutic strategies to prevent or mitigate chronic deficits associated with rTBI. Previously we developed an animal model of rTBI that recapitulates the cognitive and behavioral deficits observed in humans. We now report that rTBI results in an increase in risk-taking behavior in male but not female mice. This behavioral phenotype is associated with chronic activation of the integrated stress response and cell-specific synaptic alterations in the type A subtype of layer V pyramidal neurons in the medial prefrontal cortex. Strikingly, by briefly treating animals weeks after injury with ISRIB, a selective inhibitor of the integrated stress response (ISR), we (1) relieve ISR activation, (2) reverse the increased risk-taking behavioral phenotype and maintain this reversal, and (3) restore cell-specific synaptic function in the affected mice. Our results indicate that targeting the ISR even at late time points after injury can permanently reverse behavioral changes. As such, pharmacological inhibition of the ISR emerges as a promising avenue to combat rTBI-induced behavioral dysfunction.
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Affiliation(s)
- Karen Krukowski
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | - Amber Nolan
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA.,Department of Pathology, University of California, San Francisco, California, USA
| | - Elma S Frias
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA.,Department of Biomedical Sciences, University of California, San Francisco, California, USA
| | - Katherine Grue
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | - McKenna Becker
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | | | | | | | - Vikaas S Sohal
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Peter Walter
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA.,Howard Hughes Medical Institute, University of California, San Francisco, California, USA
| | - Susanna Rosi
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.,Department of Brain and Spinal Injury Center, University of California, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, California, USA.,Weill Institute for Neuroscience, University of California, San Francisco, California, USA.,Kavli Institute of Fundamental Neuroscience, University of California, San Francisco, California, USA
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293
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Gouttebarge V, Kerkhoffs GMMJ. Sports career-related concussion and mental health symptoms in former elite athletes. Neurochirurgie 2020; 67:280-282. [PMID: 32017942 DOI: 10.1016/j.neuchi.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/08/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In elite sports, concussion is common and recurrent, especially in high-speed contact or collision sports such as american and australian football, ice hockey and rugby. Mental health symptoms (e.g., anxiety, depression, sleep disturbance) are often reported by former elite athletes, with prevalence ranging from 16% for distress to 26% for anxiety/depression. This article focuses on the potential relationship between sports career-related concussion and mental health symptoms in former elite athletes. METHOD A narrative mini-review was based on the scientific literature. RESULTS Some literature based on cross-sectional data suggests that sports career-related concussion might lead in the long term to mental health symptoms in former elite athletes. Retired professional American football players reporting three or more previous concussions were found to be three times more likely to be diagnosed with depression than those with no history of concussion. Former professional athletes from football, ice hockey and rugby who reported a history of six or more concussions were approximately up to five times more likely to report mental health symptoms. CONCLUSIONS While longitudinal evidence about any causal relationship is lacking, the suggested relationship between sports career-related concussion and mental health symptoms in former elite athletes warrants the development of support measures for elite athletes transitioning out of sport, especially for those with a history of concussion.
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Affiliation(s)
- V Gouttebarge
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, 9, Meibergdreef, 1105 Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands; Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
| | - G M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, 9, Meibergdreef, 1105 Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
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294
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Cunningham J, Broglio SP, O'Grady M, Wilson F. History of Sport-Related Concussion and Long-Term Clinical Cognitive Health Outcomes in Retired Athletes: A Systematic Review. J Athl Train 2020; 55:132-158. [PMID: 31935139 DOI: 10.4085/1062-6050-297-18] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sport-related concussions (SRCs) are known to have short-term effects on cognitive processes, which can result in diverse clinical presentations. The long-term effects of SRC and repeated exposure to head impacts that do not result in SRC on specific cognitive health outcomes remain unclear. OBJECTIVES To synthesize and appraise the evidence base regarding cognitive health in living retired athletes with a history of head-impact exposure or SRC. DATA SOURCES A systematic search of the EMBASE, PsycINFO, MEDLINE/PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted from inception to April 2018 using common key words and medical subject headings related to 3 components: (1) the participant (eg, retired athlete), (2) the primary outcome measure (eg, cognitive test used), and (3) the secondary outcome measure (eg, history of sport concussion). STUDY SELECTION Cross-sectional studies of living retired male or female athletes in which at least 1 cognitive test was used as an outcome measure were included. Two reviewers independently screened studies. DATA EXTRACTION Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodologic quality was assessed independently by 2 reviewers using the Downs and Black tool. DATA SYNTHESIS The search yielded 46 cross-sectional observational studies that were included in a qualitative synthesis. Most included studies (80%, n = 37) were published in the 5 years before our review. A large proportion of these studies (n = 20) included retired American National Football League players. The other research investigated professional, university, high school, and amateur retired athletes participating in sports such as American and Australian football, boxing, field and ice hockey, rugby, and soccer. The total sample consisted of 13 975 participants: 7387 collision-sport athletes, 662 contact-sport athletes, 3346 noncontact-sport athletes, and 2580 participants classified as controls. Compared with control participants or normative data, retired athletes displayed worse performance in 17 of 31 studies (55%) of memory, 6 of 11 studies (55%) of executive function, and 4 of 6 studies (67%) of psychomotor function and increased subjective concerns about cognitive function in 11 of 14 studies (79%). The authors of 13 of 46 investigations (28%) reported a frequency-response relationship, with poorer cognitive outcomes in athletes who had greater levels of exposure to head impacts or concussions. However, these results must be interpreted in light of the lack of methodologic rigor and moderate quality assessment of the included studies. CONCLUSIONS Evidence of poorer cognitive health among retired athletes with a history of concussion and head-impact exposure is evolving. Our results suggest that a history of SRC may more greatly affect the cognitive domains of memory, executive function, and psychomotor function. Retired athletes appeared to have increased self-reported cognitive difficulties, but the paucity of high-quality, prospective studies limited the conclusions that could be drawn regarding a cause-and-effect relationship between concussion and long-term health outcomes. Future researchers should consider a range of cognitive health outcomes, as well as premorbid ability, in diverse samples of athletes with or without a history of concussion or head-impact exposure to delineate the long-term effects of sport participation on cognitive functioning.
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Affiliation(s)
- Joice Cunningham
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | | | - Megan O'Grady
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | - Fiona Wilson
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
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295
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Murofushi Y, Hosoyama K, Kubota K, Sato N, Takahashi Y, Takanashi JI. Cerebral white matter lacerations in children caused by repetitive head trauma. Brain Dev 2020; 42:83-87. [PMID: 31563417 DOI: 10.1016/j.braindev.2019.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
It has been known that infants less than 1 year develop cerebral white matter (WM) lacerations associated with head trauma, however, there has been no report of similar WM lesions over 1 year. We report three teenage boys (11, 12, and 18 years at final MRI studies) with acquired WM lacerations associated with recurrent head trauma who developed neurologic symptoms such as spastic paralysis, afebrile convulsions, and cognitive impairment. Two of them (patients 1 and 2) were given a diagnosis of autism spectrum disorder and had a history of repeated severe self-inflicted head trauma from preschool age. Patient 3, who practiced karate and boxing from preschool age, showed gradual declining intellectual ability. Brain MRI of the three patients revealed severe lacerations in the bilateral cerebral WM. Previous neuroimaging showed no WM lacerations at 4 and 5 years in patients 1 and 2, or mild WM lacerations at 17 years in patient 3, indicating the WM lacerations could have been acquired in childhood. It is suggested that repetition of head trauma in children can cause cerebral WM lacerations and brain dysfunction.
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Affiliation(s)
- Yuka Murofushi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Japan.
| | - Kimiko Hosoyama
- Chiba Association of Medical Service for Workers, Inage Clinic, Japan
| | - Kazuo Kubota
- Department of Pediatrics, The Graduate School of Medicine, Gifu University, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center of Neurology and Psychiatry, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Japan
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296
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Peters ME, Rahman S, Coughlin JM, Pomper MG, Sair HI. Characterizing the Link Between Glial Activation and Changed Functional Connectivity in National Football League Players Using Multimodal Neuroimaging. J Neuropsychiatry Clin Neurosci 2020; 32:191-195. [PMID: 31394988 PMCID: PMC7007820 DOI: 10.1176/appi.neuropsych.18110274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The primary objective of this preliminary study was to examine the impact of NFL play on interregional functional connectivity between two brain regions, the supramarginal gyrus (SMG) and the thalamus, identified as having higher binding of [11C]DPA-713 in NFL players. The authors' secondary objective was to examine the effect of years since play on the interregional connectivity. METHODS Resting-state functional MRI was used to examine functional brain changes between regions with evidence of past injury in active or recently retired NFL players (defined as ≤12 years since NFL play) and distantly retired players (defined as >12 years since NFL play). Age-comparable individuals without a history of concussion or participation in collegiate or professional collision sports were included as a control group. RESULTS Compared with healthy control subjects, NFL players showed a loss of anticorrelation between the left SMG and bilateral thalami (mean z score=-2.434, p=0.015). No difference was observed when examining right SMG connectivity. The pattern of connectivity in active and recently retired players mimicked the pattern observed in distantly retired players and older control subjects. CONCLUSIONS Further study of the clinical significance of this altered pattern of interregional connectivity in active and recently retired NFL players is needed.
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Affiliation(s)
| | - Saudur Rahman
- The Johns Hopkins University School of Medicine, Baltimore
| | | | | | - Haris I. Sair
- The Johns Hopkins University School of Medicine, Baltimore
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297
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Katzin S, Andiné P, Hofvander B, Billstedt E, Wallinius M. Exploring Traumatic Brain Injuries and Aggressive Antisocial Behaviors in Young Male Violent Offenders. Front Psychiatry 2020; 11:507196. [PMID: 33192641 PMCID: PMC7581682 DOI: 10.3389/fpsyt.2020.507196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is a major cause of disabilities and mortality worldwide, with higher prevalence in offender populations than in the general population. Previous research has strongly advocated increased awareness of TBI in offender populations. The aim of this study was to explore the prevalence and characteristics of TBI, and to investigate associations and interactions between TBI, aggressive antisocial behaviors, general intellectual functioning, and substance use disorders (SUD) in a well-characterized group of young violent offenders. Methods: The study investigated a cohort (n = 269) of 18 to 25-year-old male violent offenders in Sweden. Data on TBI (files + self-report), aggressive antisocial behaviors (Life History of Aggression), SUD (clinical interviews), and general intellectual functioning (General Ability Index, Wechsler Adult Intelligence Scales Third Edition) were collected between 2010 and 2012. Parametric (Student's t-test) and non-parametric (Mann-Whitney U-test, Spearman's rho, χ2, Kruskal Wallis test) inferential statistics were applied and effect sizes reported. Results: TBI, both with and without loss of consciousness, was common, with 77.5% of the offenders reporting having suffered at least one TBI during their lifetime. TBI was associated with an increased occurrence of aggressive antisocial behaviors and SUD, and offenders with both TBI and SUD evidenced the largest amount of aggressive antisocial behaviors. No clinically meaningful associations were found between TBI and general intelligence. Effect sizes were in the small to medium range. Conclusions: Our study confirms an increased prevalence of TBI among young violent offenders compared to the general population, as well as associations between TBI, aggressive antisocial behaviors, and SUD. However, it provides no information on the severity of the TBI, nor on the causality of the demonstrated associations. Nevertheless, TBI, and possible related deficits, need to be considered in the assessment and treatment of young violent offenders.
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Affiliation(s)
- Samuel Katzin
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Andiné
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Division of Forensic Psychiatry, Trelleborg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
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298
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McGuine TA, Pfaller A, Kliethermes S, Schwarz A, Hetzel S, Hammer E, Broglio S. The Effect of Sport-Related Concussion Injuries on Concussion Symptoms and Health-Related Quality of Life in Male and Female Adolescent Athletes: A Prospective Study. Am J Sports Med 2019; 47:3514-3520. [PMID: 31647876 DOI: 10.1177/0363546519880175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sport-related concussions (SRCs) are associated with short-term disablement, characterized as increased concussion symptoms and lower health-related quality of life (HRQoL). However, there are limited longitudinal data detailing how an SRC affects disablement beyond short-term injury recovery. PURPOSE To longitudinally assess the effect of SRCs on symptoms and HRQoL in high school athletes through the 12 months after injury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The 125 participants included high school athletes who sustained an SRC (female patients, 36%; mean ± SD age, 15.9 ± 1.1 years). The Post-concussion Symptom Scale (PCSS) from the Sport Concussion Assessment Tool-3 and the Pediatric Quality of Life Inventory 4.0 (PedsQL) were completed at enrollment and repeated at 24 to 72 hours (onset) and at 7 days (D7) after the SRC; on the date of return to play (RTP); and at 3, 6, and 12 months (M12) after the SRC. Scores at each time point were compared with the athletes' own baseline via linear mixed models for repeated measures, controlling for age, sex, and history of previous SRC and with patient as a random effect. RESULTS Relative to baseline, female patients reported higher PCSS symptom and severity scores at onset (P < .001) and D7 (P < .001), while scores were not higher (P > .05) for RTP through M12. As compared with baseline, male patients reported higher PCSS scores at onset (P < .001) and D7 (P = .003) and severity scores at onset (P < .001) and D7 (P = .016), while the symptom and severity scores were not higher (P > .05) at RTP through M12. Female participants reported lower PedsQL physical scores at onset (P = .006), while scores were not lower (P > .05) from D7 through M12. Female psychosocial scores were not lower (P > .05) at any time after the SRC, while the total PedsQL score was lower at onset (P = .05) but not from D7 through M12. Male physical scores were lower at onset (P < .001) and D7 (P = .001) but not lower (P > .05) from RTP through M12. Male psychosocial and PedsQL scores were unchanged (P > .05) from baseline at onset through M12. CONCLUSION After an SRC, high school athletes reported initial disablement (increased symptoms and lower HRQoL) through their RTP. However, after RTP, no similar disablement was detected through 12 months after injury.
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Affiliation(s)
- Timothy A McGuine
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Adam Pfaller
- Department of Family Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie Kliethermes
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Allison Schwarz
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin Hammer
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Steven Broglio
- NeuroTrauma Research Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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299
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Surfing-related head injuries presenting to United States emergency departments. J Orthop 2019; 19:184-188. [PMID: 32025130 DOI: 10.1016/j.jor.2019.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022] Open
Abstract
This study examined the incidence and trends of surfing-related and mild traumatic brain injuries that presented to United States emergency departments between 2001 and 2016. Subjects with surging-related head injuries were retrieved from the National Electronic Injury Surveillance System. A weighted total of 34,337 surfing-related head injuries were identified. The annual incidence of surfing-related head injuries insignificantly decreased from 2001 to 2016 (R2 = .119; p = .19). Most common injuries included lacerations (50.4%), blunt head injuries (25.7%), and mild traumatic brain injuries (16.1%). Mild traumatic brain injury incidence and annual percentage increased significantly during the study period (R2 = .251; p = .05 and R2 = .346; p = .02, respectively).
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300
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Abstract
A systematic approach is required for patients with a suspected concussion. Although standardized tools can aid in assessment, the diagnosis of concussion remains a clinical one. At the time of diagnosis, patients should be given both verbal and written review of the common symptoms of concussion, expected course of recovery, as well as strategies to manage symptoms. Most patients benefit from a brief period of rest, followed by a gradual reintroduction of activities, and a graduated return-to-sport protocol. Patients with prolonged recovery from a concussion may benefit from exercise, vestibular, and cognitive rehabilitation programs.
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Affiliation(s)
- Michael Robert Misch
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Neha P Raukar
- Department of Emergency Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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