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Terry DP, Grashow R, Iverson GL, Atkeson P, Rotem R, Eagle SR, Daneshvar DH, Zuckerman SL, Zafonte RD, Weisskopf MG, Baggish A. Age of First Exposure Does Not Relate to Post-Career Health in Former Professional American-Style Football Players. Sports Med 2024:10.1007/s40279-024-02062-9. [PMID: 38918303 DOI: 10.1007/s40279-024-02062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Prior studies examining small samples of symptomatic former professional football players suggest that earlier age of first exposure (AFE) to American football is associated with adverse later life health outcomes. This study examined a larger, more representative sample of former professional American football players to assess associations between AFE before age 12 (AFE < 12) and clinical outcomes compared with those who started at age 12 or older (AFE 12 +). METHODS Former professional American football players who completed a questionnaire were dichotomized into AFE < 12 and AFE 12 + . AFE groups were compared on outcomes including symptoms of depression and anxiety, perceived cognitive difficulties, neurobehavioral dysregulation, and self-reported health conditions (e.g., headaches, sleep apnea, hypertension, chronic pain, memory loss, dementia/Alzheimer's disease, and others). RESULTS Among 4189 former professional football players (aged 52 ± 14 years, 39% self-reported as Black), univariable associations with negligible effect sizes were seen with AFE < 12, depressive symptoms (p = 0.03; η2 = 0.001), and anxiety-related symptoms (p = 0.02; η2 = 0.001) only. Multivariable models adjusting for age, race, body mass index, playing position, number of professional seasons, and past concussion burden revealed no significant relationships between AFE < 12 and any outcome. Linear and non-linear models examining AFE as a continuous variable showed similar null results. CONCLUSIONS In a large cohort of former professional American-style football players, AFE was not independently associated with adverse later life outcomes. These findings are inconsistent with smaller studies of former professional football players. Studies examining AFE in professional football players may have limited utility and generalizability regarding policy implications for youth sports.
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Affiliation(s)
- Douglas P Terry
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, 1500 21st Ave South, Suite 4340, Village at Vanderbilt, Nashville, TN, 37212, USA.
| | - Rachel Grashow
- Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
- Sports Concussion Program, Mass General for Children, Boston, MA, USA
| | - Paula Atkeson
- Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA
| | - Ran Rotem
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Shawn R Eagle
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, 1500 21st Ave South, Suite 4340, Village at Vanderbilt, Nashville, TN, 37212, USA
| | - Ross D Zafonte
- Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA
| | - Marc G Weisskopf
- Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Aaron Baggish
- Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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Tan CO, Grashow R, Thorpe R, Miller KK, Nathan DM, Izzy S, Radmanesh F, Kim JH, Weisskopf MG, Taylor HA, Zafonte RD, Baggish AL. Concussion burden and later-life cardiovascular risk factors in former professional American-style football players. Ann Clin Transl Neurol 2024; 11:1604-1614. [PMID: 38808967 PMCID: PMC11187967 DOI: 10.1002/acn3.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Mid-life cardiovascular risk factors are associated with later cognitive decline. Whether repetitive head injury among professional athletes impacts cardiovascular risk is unknown. We investigated associations between concussion burden and postcareer hypertension, high cholesterol, and diabetes among former professional American-style football (ASF) players. METHODS In a cross-sectional study of 4080 professional ASF players conducted between January 2015 and March 2022, we used an mulitsymptom concussion symptom score (CSS) and the number of loss-of-consciousness (LOC) episodes as a single severe symptom to quantify football-related concussion exposure. Primary outcomes were hypertension, dyslipidemia, and diabetes, defined by current or recommended prescription medication use. RESULTS The prevalence of hypertension, high cholesterol, and diabetes among former players (52 ± 14 years of age) was 37%, 34%, and 9%. Concussion burden was significantly associated with hypertension (lowest vs. highest CSS quartile, odds ratio (OR) = 1.99; 95%CI: 1.33-2.98; p < 0.01) and high cholesterol (lowest vs. moderate CSS, OR = 1.46, 95%CI, 1.11-1.91; p < 0.01), but not diabetes. In fully adjusted models, the prevalence of multiple CVD was associated with CSS. These results were driven by younger former players (≤ 40 year of age) in which the odds of hypertension were over three times higher in those in the highest CSS quartile (OR = 3.29, 95%CI: 1.39-7.61; p = 0.01). Results were similar for LOC analyses. INTERPRETATION Prior concussion burden is associated with postcareer atherogenic cardiovascular risk profiles among former professional American football players.
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Affiliation(s)
- Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer ScienceUniversity of Twentethe Netherlands
| | - Rachel Grashow
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Roland Thorpe
- Program of Research on Men's Health, Hopkins Center for Health Disparities SolutionsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
| | - Karen K. Miller
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - David M. Nathan
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Diabetes Research CenterMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Farid Radmanesh
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Neurocritical Care, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Jonathan H. Kim
- Emory Clinical Cardiovascular Research InstituteEmory University School of MedicineAtlantaGeorgiaUSA
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Herman A. Taylor
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Research InstituteMorehouse School of MedicineAtlantaGeorgiaUSA
| | - Ross D. Zafonte
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyUniversity of LausanneLausanneSwitzerland
- Department of Sports ScienceUniversity of LausanneLausanneSwitzerland
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Ahmed Z, Chaudhary F, Fraix MP, Agrawal DK. Epidemiology, Pathophysiology, and Treatment Strategies of Concussions: A Comprehensive Review. FORTUNE JOURNAL OF HEALTH SCIENCES 2024; 7:197-215. [PMID: 38708028 PMCID: PMC11067689 DOI: 10.26502/fjhs.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A concussion is a particular manifestation of a traumatic brain injury, which is the leading cause of mortality and disabilities across the globe. The global prevalence of traumatic brain injury is estimated to be 939 instances per 100,000 individuals, with approximately 5.48 million people per year experiencing severe traumatic brain injury. Epidemiology varies amongst different countries by socioeconomic status with diverse clinical manifestations. Additionally, classifying concussions is an ambiguous process as clinical diagnoses are the only current classification method, and morbidity rates differ by demographic location as well as populations examined. In this article, we critically reviewed the pathophysiology of concussions, classification methods, treatment options available including both pharmacologic and nonpharmacologic intervention methods, etiologies as well as global etiologic differences associated with them, and clinical manifestations along with their associated morbidities. Furthermore, analysis of the current research regarding the incidence of concussion based traumatic brain injuries and future directions are discussed. Investigation on the efficacy of new therapeutic-related interventions such as exosome therapy and electromagnetic field stimulation are warranted to properly manage and treat concussion-induced traumatic brain injury.
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Affiliation(s)
- Zubair Ahmed
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Fihr Chaudhary
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Marcel P Fraix
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
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Grashow R, Eagle SR, Terry DP, DiGregorio H, Baggish AL, Weisskopf MG, Kontos A, Okonkwo DO, Zafonte R. Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome. Neurotrauma Rep 2024; 5:376-386. [PMID: 38655114 PMCID: PMC11035840 DOI: 10.1089/neur.2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Consensus criteria for traumatic encephalopathy syndrome (TES) specify that at least one core clinical feature of cognitive impairment (CI; e.g., difficulties with memory, executive function) or neurobehavioral dysregulation (ND; e.g., explosiveness, rage, and mood lability) be present and not fully accounted for by other health disorders. Associations between self-reported symptoms that mirror the core clinical features of TES-and how they may be related to concomitant medical conditions-remain unclear. The purpose of this study was to evaluate the association of medical conditions and football exposures with TES clinical features (CI+/-, ND+/-) in 1741 former professional American-style football (ASF) players (age, 57.7 ± 13.9 years; professional seasons, 6.6 ± 3.9 years). Demographics (age, race/ethnicity, current body mass index, age of first football exposure, use of performance-enhancing drugs, position played, and past concussion symptoms), self-reported medical conditions (anxiety, depression, attention-deficit hyperactivity disorder [ADHD], sleep apnea, headache, stroke, hypertension, heart disease, high cholesterol, erectile dysfunction, and low testosterone) were collected. Of 1741 participants, 7.4% were CI+ and/or ND+ (n = 129). Participants who were CI+ or ND+ were more likely to report one or more coexisting medical conditions than participants who did not report CI or ND (odds ratio [OR] = 2.04; 95% confidence interval: 1.25-3.47; p = 0.003). Separate general linear models for each medical condition that adjusted for demographics and football-related factors identified significant associations between ADHD, diabetes, erectile dysfunction, headaches, sleep apnea, anxiety, and low testosterone and CI+ and/or ND+ (ORs = 1.8-6.0). Chi-square automatic interaction detection (CHAID) multi-variable decision tree models that incorporated medical conditions and football exposures accurately differentiated former players meeting either CI or ND clinical criteria from those meeting none (accuracy = 91.2-96.6%). CHAID identified combinations of depression, headache, sleep apnea, ADHD, and upper quartiles of concussion symptom history as most predictive of CI+ and/or ND+ status. CI+ and/or ND+ players were more likely to report medical conditions known to cause cognitive symptoms. Concussion exposure and medical conditions significantly increased the likelihood that a former ASF player would demonstrate cognitive or neurobehavioral dysfunction. Clinicians engaged with this population should consider whether treatable coexisting condition(s) could account for some portion of the clinical picture associated with TES presentation.
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Affiliation(s)
- Rachel Grashow
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shawn R. Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Aaron L. Baggish
- Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Marc G. Weisskopf
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anthony Kontos
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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5
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Eagle SR, Grashow R, DiGregorio H, Terry DP, Baggish A, Weisskopf MG, Okonkwo DO, Zafonte R. Interaction of Medical Conditions and Football Exposures Associated with Premortem Chronic Traumatic Encephalopathy Diagnosis in Former Professional American Football Players. Sports Med 2023:10.1007/s40279-023-01942-w. [PMID: 37798551 DOI: 10.1007/s40279-023-01942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite being a postmortem diagnosis, former professional American-style football players report receiving chronic traumatic encephalopathy (CTE) diagnoses from medical care providers. However, many players also report other health conditions that manifest with cognitive and psychological symptoms. The purpose of this study was to identify how medical conditions, psychological disorders, and football exposure combinations are associated with former athletes reporting a premortem CTE diagnosis. METHODS This study was a cross-sectional cohort survey from 2015 to 2019 of 4033 former professional American-style football players. Demographics (age, race, domestic status, primary care recipient), football-related factors (position, years of professional play, burden of symptoms following head impacts, performance-enhancing drug use), and comorbidities (sleep apnea, psychological disorder status [depression and anxiety; either depression or anxiety; neither depression nor anxiety], diabetes mellitus, attention-deficit/hyperactivity disorder, hypertension, heart conditions, high cholesterol, stroke, cancer, low testosterone, chronic pain, current and maximum body mass index) were recorded. A Chi-square automatic interaction detection (CHAID) decision tree model identified interactive effects between demographics, health conditions, and football exposures on the CTE diagnosis. RESULTS Depression showed the strongest univariate association with premortem CTE diagnoses (odds ratio [OR] = 9.5, 95% confidence interval [CI] 6.0-15.3). CHAID differentiated participants with premortem CTE diagnoses with 98.2% accuracy and area under the curve = 0.81. Participants reporting both depression and anxiety were more likely to have a CTE diagnosis compared with participants who reported no psychological disorders (OR = 12.2; 95% CI 7.3-21.1) or one psychological disorder (OR = 4.5; 95% CI 1.9-13.0). Sleep apnea was also associated with a CTE diagnosis amongst those with both depression and anxiety (OR = 2.7; 95% CI 1.4-5.2). CONCLUSIONS Clinical phenotypes including psychological disorders and sleep apnea were strongly associated with an increased likelihood of having received a pre-mortem CTE diagnosis in former professional football players. Depression, anxiety, and sleep apnea produce cognitive symptoms, are treatable conditions, and should be distinguished from neurodegenerative disease.
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Affiliation(s)
- Shawn R Eagle
- University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, 15261, USA.
| | | | | | | | | | | | - David O Okonkwo
- University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, 15261, USA
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Edwards RR, Tan CO, Dairi I, Whittington AJ, Thomas JD, Campbell CM, Ross E, Taylor HA, Weisskopf M, Baggish AL, Zafonte R, Grashow R. Race differences in pain and pain-related risk factors among former professional American-style football players. Pain 2023; 164:2370-2379. [PMID: 37314441 PMCID: PMC10502895 DOI: 10.1097/j.pain.0000000000002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023]
Abstract
ABSTRACT The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.
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Affiliation(s)
- Robert R. Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Alicia J. Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Julius Dewayne Thomas
- Department of Clinical Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Claudia M. Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar Ross
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Marc Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
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7
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Strong RW, Grashow R, Roberts AL, Passell E, Scheuer L, Terry DP, Cohan S, Pascual-Leone A, Weisskopf MG, Zafonte RD, Germine LT. Association of Retrospectively Reported Concussion Symptoms with Objective Cognitive Performance in Former American-Style Football Players. Arch Clin Neuropsychol 2023; 38:875-890. [PMID: 36861317 DOI: 10.1093/arclin/acad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers. METHODS In total, 353 former professional football players (Mage = 54.3) completed both (1) an online cognitive test battery measuring objective cognitive performance and (2) a survey querying demographic information, current health conditions, and measures of past football exposure, including recollected concussion symptoms playing professional football, diagnosed concussions, years of professional play, and age of first football exposure. Testing occurred an average of 29 years after former players' final season of professional play. In addition, a comparison sample of 5,086 male participants (nonplayers) completed one or more cognitive tests. RESULTS Former players' cognitive performance was associated with retrospectively reported football concussion symptoms (rp = -0.19, 95% CI -0.09 to -0.29; p < 0.001), but not with diagnosed concussions, years of professional play, or age of first football exposure. This association could be due to differences in pre-concussion cognitive functioning, however, which could not be estimated based on available data. CONCLUSIONS Future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.
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Affiliation(s)
- Roger W Strong
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Douglas P Terry
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cohan
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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8
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Dhaynaut M, Grashow R, Normandin MD, Wu O, Marengi D, Terry DP, Sanchez JS, Weisskopf MG, Speizer FE, Taylor HA, Guehl NJ, Seshadri S, Beiser A, Daneshvar DH, Johnson K, Iverson GL, Zafonte R, El Fakhri G, Baggish AL. Tau Positron Emission Tomography and Neurocognitive Function Among Former Professional American-Style Football Players. J Neurotrauma 2023; 40:1614-1624. [PMID: 37282582 PMCID: PMC10458363 DOI: 10.1089/neu.2022.0454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
American-style football (ASF) players experience repetitive head impacts that may result in chronic traumatic encephalopathy neuropathological change (CTE-NC). At present, a definitive diagnosis of CTE-NC requires the identification of localized hyperphosphorylated Tau (p-Tau) after death via immunohistochemistry. Some studies suggest that positron emission tomography (PET) with the radiotracer [18F]-Flortaucipir (FTP) may be capable of detecting p-Tau and thus establishing a diagnosis of CTE-NC among living former ASF players. To assess associations between FTP, football exposure, and objective neuropsychological measures among former professional ASF players, we conducted a study that compared former professional ASF players with age-matched male control participants without repetitive head impact exposure. Former ASF players and male controls underwent structural magnetic resonance imaging and PET using FTP for p-Tau and [11C]-PiB for amyloid-β. Former players underwent neuropsychological testing. The ASF exposure was quantified as age at first exposure, professional career duration, concussion signs and symptoms burden, and total years of any football play. Neuropsychological testing included measures of memory, executive functioning, and depression symptom severity. P-Tau was quantified as FTP standardized uptake value ratios (SUVR) and [11C]-PiB by distribution volume ratios (DVR) using cerebellar grey matter as the reference region. There were no significant differences in [18F]-FTP uptake among former ASF players (n = 27, age = 50 ± 7 years) compared with control participants (n = 11, age = 55 ± 4 years), nor did any participant have significant amyloid-β burden. Among ASF participants, there were no associations between objective measures of neurocognitive functioning and [18F]-FTP uptake. There was a marginally significant difference, however, between [18F]-FTP uptake isolated to the entorhinal cortex among players in age-, position-, and race-adjusted models (p = 0.05) that may represent an area of future investigation. The absence of increased [18F]-FTP uptake in brain regions previously implicated in CTE among former professional ASF players compared with controls questions the utility of [18F]-FTP PET for clinical evaluation in this population.
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Affiliation(s)
- Maeva Dhaynaut
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc D. Normandin
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ona Wu
- Athinoula A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin S. Sanchez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E. Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachsetts, USA
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Nicolas J. Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UTHSA, San Antonio, Texas, USA
| | - Alexa Beiser
- NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics and Neurology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
| | - Keith Johnson
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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9
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McLoughlin RJ, Swanson RL. Hypopituitarism After Mild Traumatic Brain Injury: A Case Report. Cureus 2023; 15:e41282. [PMID: 37405126 PMCID: PMC10317077 DOI: 10.7759/cureus.41282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/06/2023] Open
Abstract
Hypopituitarism is characterized by an underactive pituitary gland and may result in growth hormone deficiency, hypothyroidism, testosterone deficiency, and/or adrenal insufficiency. Traumatic brain injury (TBI) exposure is a known risk factor for hypopituitarism. However, patients with hypopituitarism secondary to TBI exposure may go undiagnosed because the signs and symptoms of hypopituitarism can be subtle. This case report describes a 40-year-old male US military veteran who endorsed fatigue, sexual dysfunction, and weight gain several years after experiencing multiple mild TBIs during his military service. He ultimately underwent a full neuroendocrine workup that revealed low testosterone in addition to previously diagnosed hypothyroidism with a resolution of symptoms after starting testosterone therapy.
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Affiliation(s)
- Ryan J McLoughlin
- Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Randel L Swanson
- Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA
- Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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10
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Dairi I, Brown C, DiGregorio H, Wasfy M, Baggish A, Pitler L, Copen WA, Doyle M, Wu O, Zafonte R, Tenforde AS. A Case Report of Reversible Cognitive Decline in a Former Professional American-Style Football Player: Findings from the Football Players Health Study In-Person Assessments. Curr Sports Med Rep 2023; 22:154-157. [PMID: 37141607 DOI: 10.1249/jsr.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Heather DiGregorio
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | | | | | - Linda Pitler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - William A Copen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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11
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Abstract
OBJECTIVE Research points to exercise having a positive effect in fighting relapse and use of drugs of abuse. Through conducting this research, differences have been observed in the effects of exercise on drug abuse between sexes. Many of the studies found that exercise tends to cause a more profound effect in blocking drug relapse or reinstatement in males when compared with females. METHODS Our hypothesis is that these differences in response to drugs of abuse after an exercise regimen could in part be attributed to variations in testosterone levels between males and females. RESULTS Testosterone has been shown to have a modulatory impact on the dopaminergic activity in the brain, causing an effect on the brain's response to drugs of abuse. Exercise has demonstrated a causal effect on increasing testosterone levels in males, whereas drugs of abuse decrease testosterone levels in males. CONCLUSIONS Thus, exercise raising testosterone levels in males helps to decrease the dopaminergic response in the brain to drugs of abuse causing attenuation to drugs. To find sex-specific exercise treatments for drugs of abuse, it is important to continue researching exercise's efficacy against drugs of abuse.
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12
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Pain Acceptance Among Retired National Football League Athletes: Implications for Clinical Intervention. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2023; 17:27-40. [PMID: 36919031 PMCID: PMC10010661 DOI: 10.1123/jcsp.2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over 80% of National Football League (NFL) retirees experience daily pain. Pain acceptance is an important psychological construct implicated in the intensity of chronic pain, though these findings have not been extended to NFL retirees. Therefore, the current study examined the association between pain acceptance and pain intensity among former NFL athletes. NFL retirees (N = 90) recruited from 2018 to 2019 completed questionnaires that assessed pain, substance use, and NFL career information. Multiple linear regression examined the association between current pain acceptance and pain intensity while adjusting for other risk factors of pain. NFL retirees reported average scores of 33.31 (SD = 10.00), and 2.18 (SD = 2.40) on measures of pain acceptance and pain intensity, respectively. After covariate adjustment, greater pain acceptance (β = -0.538, p < .001) was associated with lower pain intensity. These findings can further inform the behavioral and mental health care of retired NFL athletes.
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13
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Anto-Ocrah M, Cafferky V, Lewis V. Pregnancy After Concussion: A Clarion Call for Attention? J Head Trauma Rehabil 2022; 37:E268-E279. [PMID: 34570027 DOI: 10.1097/htr.0000000000000723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emerging research shows that women who sustain a mild traumatic brain injury, also termed concussion, have a higher risk of menstrual irregularities and sexual dysfunctions. However, no research exists on how these reproductive disruptions affect women's subsequent pregnancies. The objective of this study was to evaluate pregnancy outcomes after concussion in a cohort of reproductive-aged women (aged 18-45 years), 24 months post-injury. We hypothesized that, compared with their extremity-injured peers in the same cohort, women with concussion will have lower incidence of pregnancies. SETTING Emergency department of a level 1 trauma center. PARTICIPANTS Women of reproductive age (aged 18-45 years) seeking care for concussion or extremity injury. DESIGN Longitudinal cohort study that used data collected at 3 distinct time points: t0, baseline: an original cohort of 245 women recruited in January to July 2017 for exposure assessment; t1, 6(+4) weeks post-injury: evaluation of self-reported postinjury menstrual and sexual changes for subgroup analyses-data collected in March to September 2017 ( n = 135); t2, 24 months post-injury: March 2020 chart review for documentation of pregnancies/pregnancy-related events ( N = 245). MAIN MEASURE Poisson regression estimates used to model the incidence rate (IR) of pregnancies, comparing concussion with extremity injury. RESULTS We reviewed the charts of 254 women from the t0 cohort. After excluding 9 patients who were either deceased or missing relevant data, we had the 245 (96.5%) charts of 102 concussed and 143 extremity-injured study participants. After adjusting for race and obstetric history, women with concussion had 80% lower incidence of pregnancies than their extremity-injured peers (adjusted [adj] IR = 0.20; 95% CI: 0.07-0.59; P = .003). When we excluded women who were using birth control, the IR of pregnancy for women with concussions was 76% lower than for those who had sustained extremity injuries (adj IR = 0.24; 95% CI: 0.07-0.81; P = .02). Pregnancy incidence remained consistently lower for concussed women in additional sensitivity analyses excluding assault/domestic violence victims and those with a prior/new concussion at t0 and t2. Subgroup analyses of the 135 women who had experienced menstrual and/or sexual dysfunctions at t1 showed 84% reduced incidence of pregnancy for women with concussions compared with those who had sustained an extremity injury (adj IR = 0.16; 95% CI: 0.04-0.73; P = .02). CONCLUSION AND RELEVANCE Our study potentially serves as a clarion call to understand the long-term reproductive effects of female concussions.
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Affiliation(s)
- Martina Anto-Ocrah
- Departments of Emergency Medicine (Dr Anto-Ocrah), Obstetrics and Gynecology (Drs Anto-Ocrah and Lewis), and Neurology (Dr Anto-Ocrah), School of Medicine and Dentistry, University of Rochester, Rochester, New York; and University of Rochester, Rochester, New York (Ms Cafferky)
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14
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Cortez B, Valdivia C, Keating D, Marengi D, Bates T, Brown C, Dairi I, Doyle M, Keske R, Connor A, Grashow R, Tenforde A, Wasfy MM, Weisskopf MG, Speizer F, Zafonte R, Baggish A. Multi-modality human phenotyping to examine subjective and objective health afflictions in former professional American-style football players: The In-Person Assessment (IPA) protocol. PLoS One 2022; 17:e0265737. [PMID: 35358242 PMCID: PMC8970522 DOI: 10.1371/journal.pone.0265737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation.
Objective
To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Methods
The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol.
Results
This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Conclusion
The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.
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Affiliation(s)
- Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dylan Keating
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dean Marengi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trevor Bates
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Berenson Allen Center and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Adam Tenforde
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Meagan M. Wasfy
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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15
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Singman E. From Provider to Advocate: The Complexities of Traumatic Brain Injury Prompt the Evolution of Provider Engagement. J Clin Med 2021; 10:jcm10122598. [PMID: 34204619 PMCID: PMC8231255 DOI: 10.3390/jcm10122598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for a team approach.
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Affiliation(s)
- Eric Singman
- Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
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16
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Izzy S, Tahir Z, Grashow R, Cote DJ, Jarrah AA, Dhand A, Taylor H, Whalen M, Nathan DM, Miller KK, Speizer F, Baggish A, Weisskopf MG, Zafonte R. Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities. J Neurotrauma 2021; 38:1834-1841. [PMID: 33451255 DOI: 10.1089/neu.2020.7484] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
While chronic neurological effects from concussion have been studied widely, little is known about possible links between concussion and long-term medical and behavioral comorbidities. We performed a retrospective cohort study of 9205 adult patients with concussion, matched to non-concussion controls from a hospital-based electronic medical registry. Patients with comorbidities before the index visit were excluded. Behavioral and medical comorbidities were defined by International Classification of Diseases, Ninth and Tenth Revision codes. Groups were followed for up to 10 years to identify comorbidity incidence after a concussion. Cox proportional hazards models were used to calculate associations between concussion and comorbidities after multi-variable adjustment. Patients with concussion were 57% male (median age: 31; interquartile range [IQR] = 23-48 years) at enrollment with a median follow-up time of 6.1 years (IQR = 4.2-9.1) and well-matched to healthy controls. Most (83%) concussions were evaluated in outpatient settings (5% inpatient). During follow-up, we found significantly higher risks of cardiovascular risks developing including hypertension (hazard ratio [HR] = 1.7, 95% confidence interval [CI]: 1.5-1.9), obesity (HR = 1.7, 95% CI: 1.3-2.0), and diabetes mellitus (HR = 1.8, 95% CI: 1.4-2.3) in the concussion group compared with controls. Similarly, psychiatric and neurological disorders such as depression (HR = 3.0, 95% CI: 2.6-3.5), psychosis (HR = 6.0, 95% CI: 4.2-8.6), stroke (HR = 2.1 95% CI: 1.5-2.9), and epilepsy (HR = 4.4, 95% CI: 3.2-5.9) were higher in the concussion group. Most comorbidities developed less than five years post-concussion. The risks for post-concussion comorbidities were also higher in patients under 40 years old compared with controls. Patients with concussion demonstrated an increased risk of development of medical and behavioral health comorbidities. Prospective studies are warranted to better describe the burden of long-term comorbidities in patients with concussion.
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Affiliation(s)
- Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Zabreen Tahir
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - David J Cote
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al Jarrah
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amar Dhand
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Herman Taylor
- The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Michael Whalen
- Department of Pediatrics, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Nathan
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Diabetes Center, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen K Miller
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Neuroendocrine Unit, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Speizer
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Aaron Baggish
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Internal Medicine, Cardiovascular Performance Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc G Weisskopf
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts, USA.,The Football Players Health Study at Harvard University, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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17
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Dhand A, McCafferty L, Grashow R, Corbin IM, Cohan S, Whittington AJ, Connor A, Baggish A, Weisskopf M, Zafonte R, Pascual-Leone A, Barabási AL. Social network structure and composition in former NFL football players. Sci Rep 2021; 11:1630. [PMID: 33526803 PMCID: PMC7851122 DOI: 10.1038/s41598-020-80091-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Social networks have broad effects on health and quality of life. Biopsychosocial factors may also modify the effects of brain trauma on clinical and pathological outcomes. However, social network characterization is missing in studies of contact sports athletes. Here, we characterized the personal social networks of former National Football League players compared to non-football US males. In 303 former football players and 269 US males, we found that network structure (e.g., network size) did not differ, but network composition (e.g., proportion of family versus friends) did differ. Football players had more men than women, and more friends than family in their networks compared to US males. Black players had more racially diverse networks than White players and US males. These results are unexpected because brain trauma and chronic illnesses typically cause diminished social relationships. We anticipate our study will inform more multi-dimensional study of, and treatment options for, contact sports athletes. For example, the strong allegiances of former athletes may be harnessed in the form of social network interventions after brain trauma. Because preserving health of contact sports athletes is a major goal, the study of social networks is critical to the design of future research and treatment trials.
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Affiliation(s)
- Amar Dhand
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA.
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
- Network Science Institute, Northeastern University, Boston, MA, USA.
| | - Liam McCafferty
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ian M Corbin
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Cohan
- Football Players Health Study at Harvard University, Boston, MA, USA
| | | | - Ann Connor
- Department of Neurology, Berenson-Allen Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Baggish
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA
- Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Weisskopf
- Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ross Zafonte
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA
- Football Players Health Study at Harvard University, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Albert-László Barabási
- Network Science Institute, Northeastern University, Boston, MA, USA
- Department of Physics, Northeastern University, Boston, MA, USA
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18
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Anto-Ocrah M, Oktapodas Feiler M, Pukall C, Pacos-Martinez A. Resilience and Sexuality After Concussion in Women. Sex Med 2021; 9:100297. [PMID: 33482610 PMCID: PMC7930863 DOI: 10.1016/j.esxm.2020.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Previous findings from our group show that in the acute (ie, 6–10 weeks) post-injury period, women with concussions have a 70% greater risk of sexual dysfunction than those with extremity injuries. There are currently limited treatment options for the clinical management of concussions. Resilience is a protective, modifiable psychological construct that has been shown to improve concussion-related sequelae. To date, however, no research has evaluated how resilience impacts sexuality outcomes after concussion in women. Aim Evaluate if resilience offers protection against negative sexuality outcomes in a cohort of reproductive, aged women with a concussion, seeking care in the Emergency Department of a Level-1 Trauma Center. We hypothesized that women with low resilience will be more likely to experience negative impacts on sexuality and that increasing levels of resilience will be associated with more positive sexuality outcomes. Methods Secondary data analyses. Measures Resilience was evaluated with the Resilience Scale (RS), and the Brain Injury Questionnaire for Sexuality (BIQS) was used for sexuality. Results Of the 299 participants recruited for the parent study, 80 with concussion had complete follow-up data and were included in these secondary analyses. Less than half (42.5%; n = 34) had low resilience (score≤130 on the RS), and the remaining 46 (57.5%) had high resilience (score>130 on the RS). In crude linear regression models, 1-unit increase in resilience was associated with a 4% increase in sexuality outcomes (β = 0.04, 95% CI:0.01, 0.05; P = .008). The effect estimate remained similar in post-concussion-symptom-adjusted models (β = 0.03, 95% CI:0.002, 0.06; P = .03). Mood-adjusted models showed a statistically significant interaction term (P < .0001). After stratifying by mood, findings showed that unit increases in resilience were associated with a 6% increase in sexuality outcomes for women in the high risk mood group (HADS score ≥11; PCS-adjusted β = 0.06, 95% CI:0.02, 0.11; P = .009). Conclusion Longitudinal studies are needed to evaluate how these improvements in resilience translate to patient recovery measures following concussion. Anto-Ocrah M, Oktapodas Feiler M, Pukall C, et al. Resilience and Sexuality After Concussion in Women. Sex Med 2021;9:100297.
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Affiliation(s)
- Martina Anto-Ocrah
- Department of Emergency Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY; Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY; Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY.
| | - Marina Oktapodas Feiler
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Caroline Pukall
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Amy Pacos-Martinez
- Department of Physical Medicine & Rehabilitation, School of Medicine and Dentistry, University of Rochester, Rochester, NY
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19
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Kazemi E, Zargooshi J, Kaboudi M, Heidari P, Kahrizi D, Mahaki B, Mohammadian Y, Khazaei H, Ahmed K. A genome-wide association study to identify candidate genes for erectile dysfunction. Brief Bioinform 2020; 22:6034052. [PMID: 33316063 DOI: 10.1093/bib/bbaa338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022] Open
Abstract
Erectile dysfunction (ED) can be caused by different diseases and controlled by several genetic networks. In this study, to identify the genes related to ED, the expression profiles of normal and ED samples were investigated by the Gene Expression Omnibus (GEO) database. Seventeen genes were identified as associated genes with ED. The protein and nucleic acid sequences of selected genes were retrieved from the UCSC database. Selected genes were diverse according to their physicochemical properties and functions. Category function revealed that selected genes are involved in pathways related to humans some diseases. Furthermore, based on protein interactions, genes associated with the insulin pathway had the greatest interaction with the studied genes. To identify the common cis-regulatory elements, the promoter site of the selected genes was retrieved from the UCSC database. The Gapped Local Alignment of Motifs tool was used for finding common conserved motifs into the promoter site of selected genes. Besides, INSR protein as an insulin receptor precursor showed a high potential site for posttranslation modifications, including phosphorylation and N-glycosylation. Also, in this study, two Guanine-Cytosine (GC)-rich regions were identified as conserved motifs in the upstream of studied genes which can be involved in regulating the expression of genes associated with ED. Also, the conserved binding site of miR-29-3p that is involved in various cancers was observed in the 3' untranslated region of genes associated with ED. Our study introduced new genes associated with ED, which can be good candidates for further analyzing related to human ED.
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Affiliation(s)
- Elham Kazemi
- Family Sexual Health at Fertility and Infertility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javaad Zargooshi
- Department of Sexual Medicine at the Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Marzieh Kaboudi
- Reproductive Health Department of the Kermanshah University of Medical Sciences
| | | | | | - Behzad Mahaki
- Department of Bio-Statistics and Epidemiology, School of Health, Kermanshah University of Medical Sciences
| | | | | | - Kawsar Ahmed
- Department of Information and Communication Technology (ICT) at the Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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20
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Giagio S, Salvioli S, Pillastrini P, Innocenti T. Sport and pelvic floor dysfunction in male and female athletes: A scoping review. Neurourol Urodyn 2020; 40:55-64. [PMID: 33137211 DOI: 10.1002/nau.24564] [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] [Received: 09/18/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/06/2022]
Abstract
AIMS The aims of the present scoping review were to systematically map and summarize findings to identify any study that reported epidemiological data on pelvic floor dysfunction (PFD) among male and female athletes. METHODS Six medical databases were searched up to March 2020. No language, study design, and publication type restrictions were applied. Additional studies were identified through gray literature and the reference lists of articles were screened. The results were presented numerically and thematically. RESULTS A total of 4358 records were identified with an initial search. A hundred studies met the criteria for inclusion. The number of studies published annually increased over the years. Cross-sectional studies (n = 62), urinary incontinence (n = 64), multiple sports (n = 58), and female athletes (n = 83) are the most investigated study design, condition, sport, and population, respectively. Only 12 studies explored PFD in the male population. Authors focused selectively on elite athletes in 21 studies. CONCLUSIONS This is the first scoping review to provide a comprehensive overview of the topic. The major gaps in the literature include studies focused on male participants, other PFD (e.g., anal incontinence, pelvic organ prolapse, and pelvic pain), with appropriate study design. This review may be useful to raise awareness of the issue among clinicians and stakeholders in sport and it may represent a starting point for future research.
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Affiliation(s)
- Silvia Giagio
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tiziano Innocenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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21
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Giordano KR, Rojas-Valencia LM, Bhargava V, Lifshitz J. Beyond Binary: Influence of Sex and Gender on Outcome after Traumatic Brain Injury. J Neurotrauma 2020; 37:2454-2459. [PMID: 32808570 DOI: 10.1089/neu.2020.7230] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Traumatic brain injury (TBI) affects millions of individuals each year and is a leading cause of death and disability worldwide. TBI is heterogeneous and outcome is influenced by a combination of factors that include injury location, severity, genetics, and environmental factors. More recently, sex as a biological variable has been incorporated into TBI research, although there is conflicting literature regarding clinical outcomes in males versus females after TBI. We review the current clinical literature investigating sex differences after TBI. We focus our discussion on differences within contemporary gender categories to suggest that binary categories of male and female are not sufficient to guide clinical decisions for neurotrauma. Some studies have considered physiological variables that influence sex such as hormone cycles and stages in males and females pre- and post-TBI. These data suggest that there are phasic differences within male populations and within female populations that influence an individual's outcome after TBI. Finally, we discuss the impact of gender identity and expression on outcome after TBI and highlight the lack of neurotrauma research that includes non-binary individuals. Social constructs regarding gender impact an individual's vulnerability to violence and consequent TBI, including the successful reintegration to society after TBI. We call for incorporation of gender beyond the binary in TBI education, research, and clinical care. Precision medicine necessarily must progress beyond the binary to treat individuals after TBI.
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Affiliation(s)
- Katherine R Giordano
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Luisa M Rojas-Valencia
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Vedanshi Bhargava
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA.,Phoenix VA Health Care System, Phoenix, Arizona, USA
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22
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Affiliation(s)
| | - Mandeep Ghuman
- Dignity Health Family Medicine Residency Program at Northridge Hospital, Los Angeles, California
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23
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Grashow R, Miller KK, Roberts AL. Uncertain Association Between Concussion and Hypogonadism-Reply. JAMA Neurol 2020; 77:774-775. [PMID: 32250389 DOI: 10.1001/jamaneurol.2020.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel Grashow
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Karen K Miller
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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Grashow R, Weisskopf MG, Baggish A, Speizer FE, Whittington AJ, Nadler L, Connor A, Keske R, Taylor H, Zafonte R, Pascual-Leone A. Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football. Ann Neurol 2020; 88:106-112. [PMID: 32281676 PMCID: PMC7383807 DOI: 10.1002/ana.25747] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. METHODS A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. RESULTS Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE. INTERPRETATION Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
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Affiliation(s)
- Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Lee Nadler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Dana Farber Cancer Institute, Boston, MA
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Herman Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School Boston, Boston, MA
| | - Alvaro Pascual-Leone
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA.,Center for Memory Health and Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA.,Institut Guttmann, Universitat Autónoma, Barcelona, Spain
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25
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Anto-Ocrah M, Tiffany K, Hasman L, van Wijngaarden E. Mild traumatic brain injury/concussion and female sexuality, a scoping review of the literature. Inj Epidemiol 2020; 7:7. [PMID: 32127044 PMCID: PMC7050144 DOI: 10.1186/s40621-020-0232-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background The American Congress of Rehabilitation Medicine (ACRM) in 2010 called for more head injury research on gender disparities to bridge the gender gap for the short-and long-term effects of TBI, including sexual and reproductive outcomes. In this paper, we review the state of the literature before and after the ACRM announcement, and evaluate how research teams have considered females and mildly injured TBI(mTBI)/concussion groups in post-TBI-related changes in sexual functioning. Methods The research question for this scoping review was “what is the state of the literature in the evaluation of post-TBI sexual changes for women, and individuals with mTBI?” Using the 2010 ACRM call for action as a line of demarcation, we compared our findings before and after the 2010 announcement. Results We identified 9 research studies that addressed sexual functioning changes in females and mTBI/concussion groups. Four of the nine were published before the 2010 ACRM announcement, and five were published after. The representation of female research participants increased steadily over the 28-year timespan. The proportion of individuals with mTBI included in the post-2010 era was higher than the earlier time period. Consistently, women with mTBI reported more adverse sexual outcomes compared to male cohorts, orthopaedic, and non-injured comparison groups. This observation persisted regardless of recruitment site (rehabilitation center/Emergency Department (ED)/Community) or time of outcome assessment (acute versus chronic). The findings also remained despite the heterogeneity of survey questionnaires used to evaluate sexual functioning outcomes. Excluding the most recent 2019 study, none of the research groups compared the findings by TBI severity, making it difficult to fully understand how concussion-related sexual changes compare to more severe forms of the head injury. The long term impacts of the sexual changes, such as infertility and relationship discord were also absent across all studies; even though most evaluated outcomes chronically (some as far out as 20 years post injury). Conclusion The number of publications in the era before the ACRM call for action and afterwards were almost identical. In order to tailor interventions for the appropriate groups of TBI patients, more neurosexuality research is needed to increase awareness of the importance of sexuality as a health outcome for individuals with neurodisabilities.
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Affiliation(s)
- Martina Anto-Ocrah
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. .,Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. .,Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | | | - Linda Hasman
- Miner Library, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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26
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Hackney AC. Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment? Front Endocrinol (Lausanne) 2020; 11:11. [PMID: 32082255 PMCID: PMC7005256 DOI: 10.3389/fendo.2020.00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
For decades researchers have reported men who engaged in intensive exercise training can develop low resting testosterone levels, alterations in their hypothalamic-pituitary-gonadal (HPG) axis, and display hypogonadism. Recently there is renewed interest in this topic since the International Olympic Committee (IOC) Medical Commission coined the term "Relative Energy Deficiency in Sports" (RED-S) as clinical terminology to address both the female-male occurrences of reproductive system health disruptions associated with exercise. This IOC Commission action attempted to move beyond the sex-specific terminology of the "Female Athlete Triad" (Triad) and heighten awareness/realization that some athletic men do have reproductive related physiologic disturbances such as lowered sex hormone levels, HPG regulatory axis alterations, and low bone mineral density similar to Triad women. There are elements in the development and symptomology of exercise-related male hypogonadism that mirror closely that of women experiencing the Triad/RED-S, but evidence also exists that dissimilarities exist between the sexes on this issue. Our research group postulates that the inconsistency and differences in the male findings in relation to women with Triad/RED-S are not just due to sex dimorphism, but that there are varying forms of exercise-related reproductive disruptions existing in athletic men resulting in them displaying a relative hypogonadism condition. Specifically, such conditions in men may derive acutely and be associated with low energy availability (Triad/RED-S) or excessive training load (overtraining) and appear transient in nature, and resolve with appropriate clinical interventions. However, manifestations of a more chronic based hypogonadism that persists on a more permanent basis (years) exist and is termed the "Exercise Hypogonadal Male Condition." This article presents an up-to-date overview of the various types of acute and chronic relative hypogonadism found in athletic, exercising men and proposes mechanistic models of how these various forms of exercise relative hypogonadism develop.
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Affiliation(s)
- Anthony C. Hackney
- Department of Exercise and Sport Science, Department of Nutrition, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
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