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Wallingford A, Junn C. Chronic Traumatic Encephalopathy. Phys Med Rehabil Clin N Am 2024; 35:607-618. [PMID: 38945654 DOI: 10.1016/j.pmr.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This article focuses on neuropathologic diagnostic criteria for chronic traumatic encephalopathy (CTE) and consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES). CTE as a tauopathy has a unique pattern for diagnosis and differs from other neurodegenerative diseases. We discuss the history, neuropathology, and mechanism of CTE as well as the preliminary reasearch diagnostic criteria for TES, which is the proposed clinical presentation of suspected CTE.
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Affiliation(s)
- Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Cherry Junn
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue Box 359740, Seattle, WA 98104, USA.
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2
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Bouvette V, Petit Y, De Beaumont L, Guay S, Vinet SA, Wagnac E. American Football On-Field Head Impact Kinematics: Influence of Acceleration Signal Characteristics on Peak Maximal Principal Strain. Ann Biomed Eng 2024; 52:2134-2150. [PMID: 38758459 DOI: 10.1007/s10439-024-03514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
Recorded head kinematics from head-impact measurement devices (HIMd) are pivotal for evaluating brain stress and strain through head finite element models (hFEM). The variability in kinematic recording windows across HIMd presents challenges as they yield inconsistent hFEM responses. Despite establishing an ideal recording window for maximum principal strain (MPS) in brain tissue, uncertainties persist about the impact characteristics influencing vulnerability when this window is shortened. This study aimed to scrutinize factors within impact kinematics affecting the reliability of different recording windows on whole-brain peak MPS using a validated hFEM. Utilizing 53 on-field head impacts recorded via an instrumented mouthguard during a Canadian varsity football game, 10 recording windows were investigated with varying pre- and post-impact-trigger durations. Tukey pair-wise comparisons revealed no statistically significant differences in MPS responses for the different recording windows. However, specific impacts showed marked variability up to 40%. It was found, through correlation analyses, that impacts with lower peak linear acceleration exhibited greater response variability across different pre-trigger durations. Signal shape, analyzed through spectral analysis, influenced the time required for MPS development, resulting in specific impacts requiring a prolonged post-trigger duration. This study adds to the existing consensus on standardizing HIMd acquisition time windows and sheds light on impact characteristics leading to peak MPS variation across different head impact kinematic recording windows. Considering impact characteristics in research assessments is crucial, as certain impacts, affected by recording duration, may lead to significant errors in peak MPS responses during cumulative longitudinal exposure assessments.
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Affiliation(s)
- Véronique Bouvette
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada.
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada.
- International Laboratory on Spine Imaging and Biomechanics, Montreal, Canada.
- International Laboratory on Spine Imaging and Biomechanics, Marseille, France.
| | - Y Petit
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
- International Laboratory on Spine Imaging and Biomechanics, Montreal, Canada
- International Laboratory on Spine Imaging and Biomechanics, Marseille, France
| | - L De Beaumont
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
- Department of Surgery, Université de Montréal, Montreal, Canada
| | - S Guay
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - S A Vinet
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - E Wagnac
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
- International Laboratory on Spine Imaging and Biomechanics, Montreal, Canada
- International Laboratory on Spine Imaging and Biomechanics, Marseille, France
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3
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Hack L, Singh B, Binkofski F, Helmich I. Repetitive Subconcussive Head Impacts in Sports and Their Impact on Brain Anatomy and Function: A Systematic Review. Int J Sports Med 2024. [PMID: 38857880 DOI: 10.1055/a-2342-3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Repetitive subconcussive head impacts occur regularly in sports. However, the exact relationship between their biomechanical properties and their consequences on brain structure and function has not been clarified yet. We therefore reviewed prospective cohort studies that objectively reported the biomechanical characteristics of repetitive subconcussive head impacts and their impact on brain anatomy and function. Only studies with a pre- to post-measurement design were included. Twenty-four studies met the inclusion criteria. Structural white matter alterations, such as reduced fractional anisotropy and an increase in mean diffusivity values, seem to be evident in athletes exposed to repetitive subconcussive head impacts exceeding 10 g. Such changes are observable after only one season of play. Furthermore, a dose-response relationship exists between white matter abnormalities and the total number of subconcussive head impacts. However, functional changes after repetitive subconcussive head impacts remain inconclusive. We therefore conclude that repetitive subconcussive head impacts induce structural changes, but thus far without overt functional changes.
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Affiliation(s)
- Lukas Hack
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Bhagyashree Singh
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
| | - Ferdinand Binkofski
- Clinical Cognitive Sciences, University Hospital RWTH Aachen, Aachen , Germany
| | - Ingo Helmich
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
- Department of Exercise and Sport Studies, Smith College, Northampton, United States
- Department of Neurology, Psychosomatic Medicine and Psychiatry, German Sport University Cologne, Koln, Germany
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4
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Culhane JE, Jackson CE, Tripodis Y, Nowinski CJ, Dams-O'Connor K, Pettway E, Uretsky M, Abdolmohammadi B, Nair E, Martin B, Palmisano J, Katz DI, Dwyer B, Daneshvar DH, Goldstein LE, Kowall NW, Cantu RC, Stern RA, Huber BR, Crary JF, Mez J, Stein TD, McKee AC, Alosco ML. Lack of Association of Informant-Reported Traumatic Brain Injury and Chronic Traumatic Encephalopathy. J Neurotrauma 2024; 41:1399-1408. [PMID: 38445389 DOI: 10.1089/neu.2023.0391] [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] [Indexed: 03/07/2024] Open
Abstract
Repetitive head impacts (RHIs) from football are associated with the neurodegenerative tauopathy chronic traumatic encephalopathy (CTE). It is unclear whether a history of traumatic brain injury (TBI) is sufficient to precipitate CTE neuropathology. We examined the association between TBI and CTE neuropathology in 580 deceased individuals exposed to RHIs from football. TBI history was assessed using a modified version of the Ohio State University TBI Identification Method Short Form administered to informants. There were 22 donors who had no TBI, 213 who had at least one TBI without loss of consciousness (LOC), 345 who had TBI with LOC, and, of those with a history of TBI with LOC, 36 who had at least one moderate-to-severe TBI (msTBI, LOC >30 min). CTE neuropathology was diagnosed in 405. There was no association between CTE neuropathology status or severity and TBI with LOC (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.64-1.41; OR = 1.22, 95% CI = 0.71-2.09) or msTBI (OR = 0.70, 95% CI = 0.33-1.50; OR = 1.01, 95% CI = 0.30-3.41). There were no associations with other neurodegenerative or cerebrovascular pathologies examined. TBI with LOC and msTBI were not associated with CTE neuropathology in this sample of brain donors exposed to RHIs from American football.
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Affiliation(s)
- Julia E Culhane
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Colleen E Jackson
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Concussion Legacy Foundation, Boston, Massachusetts, USA
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erika Pettway
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Evan Nair
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, Massachusetts, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Concussion Legacy Foundation, Boston, Massachusetts, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts, USA
| | - John F Crary
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pathology, Molecular, and Cell-Based Medicine, Nash Family Department of Neuroscience, Friedman Brain Institute, Mount Sinai, New York, New York, USA
- Department of Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Todd N. Medico-legal implications of dementia following concussion in rugby football. Med Leg J 2024; 92:91-95. [PMID: 38340786 DOI: 10.1177/00258172231184550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
There is litigation in respect of dementia in ex-rugby football players. The allegation is that these ex-players have suffered a traumatic encephalopathy syndrome causing dementia and other neurological problems. The syndrome is alleged to have been caused by repeated concussion during play. It is alleged that governing bodies of rugby should have been aware, and players should have been warned, of this risk. The dilemma, for both claimants and defendants, is that there is no agreed definition of the syndrome nor are there any diagnostic tests that confirm or refute this diagnosis. This paper reviews the literature of traumatic encephalopathy syndrome and when governing bodies were aware of the possibility of rugby concussion causing dementia. The legal principles are discussed and a framework for determining the probability of an ex-rugby player having the syndrome is proposed.
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Affiliation(s)
- Nicholas Todd
- Newcastle Nuffield Hospital, Newcastle upon Tyne, UK
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6
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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7
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Banks SJ, Yhang E, Tripodis Y, Su Y, Protas H, Adler CH, Balcer LJ, Bernick C, Mez JB, Palmisano J, Barr WB, Wethe JV, Dodick DW, Mcclean MD, Martin B, Hartlage K, Turner A, Turner RW, Malhotra A, Colman M, Pasternak O, Lin AP, Koerte IK, Bouix S, Cummings JL, Shenton ME, Reiman EM, Stern RA, Alosco ML. Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea. Neurol Clin Pract 2024; 14:e200263. [PMID: 38425491 PMCID: PMC10900387 DOI: 10.1212/cpj.0000000000200263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024]
Abstract
Background and Objectives Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players. Methods The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested. Results Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup. Discussion Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.
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Affiliation(s)
- Sarah J Banks
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eukyung Yhang
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yi Su
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Hillary Protas
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles H Adler
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Laura J Balcer
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles Bernick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jesse B Mez
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Joseph Palmisano
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - William B Barr
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jennifer V Wethe
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - David W Dodick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael D Mcclean
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Brett Martin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Kaitlin Hartlage
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Arlener Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert W Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Atul Malhotra
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael Colman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Ofer Pasternak
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Alexander P Lin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Inga K Koerte
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Sylvain Bouix
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey L Cummings
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Martha E Shenton
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eric M Reiman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert A Stern
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael L Alosco
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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8
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Butler ML, Pervaiz N, Ypsilantis P, Wang Y, Cammasola Breda J, Mazzilli S, Nicks R, Spurlock E, Hefti MM, Huber BR, Alvarez VE, Stein TD, Campbell JD, McKee AC, Cherry JD. Repetitive head impacts induce neuronal loss and neuroinflammation in young athletes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.26.586815. [PMID: 38585925 PMCID: PMC10996668 DOI: 10.1101/2024.03.26.586815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Repetitive head impacts (RHI) sustained from contact sports are the largest risk factor for chronic traumatic encephalopathy (CTE). Currently, CTE can only be diagnosed after death and the multicellular cascade of events that trigger initial hyperphosphorylated tau (p-tau) deposition remain unclear. Further, the symptoms endorsed by young individuals with early disease are not fully explained by the extent of p-tau deposition, severely hampering development of therapeutic interventions. Here, we show that RHI exposure associates with a multicellular response in young individuals (<51 years old) prior to the onset of CTE p-tau pathology that correlates with number of years of RHI exposure. Leveraging single nucleus RNA sequencing of tissue from 8 control, 9 RHI-exposed, and 11 low stage CTE individuals, we identify SPP1+ inflammatory microglia, angiogenic and inflamed endothelial cell profiles, reactive astrocytes, and altered synaptic gene expression in excitatory and inhibitory neurons in all individuals with exposure to RHI. Surprisingly, we also observe a significant loss of cortical sulcus layer 2/3 neurons in contact sport athletes compared to controls independent of p-tau pathology. These results provide robust evidence that multiple years of RHI exposure is sufficient to induce lasting cellular alterations that may underlie p-tau deposition and help explain the early clinical symptoms observed in young former contact sport athletes. Furthermore, these data identify specific cellular responses to repetitive head impacts that may direct future identification of diagnostic and therapeutic strategies for CTE.
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Affiliation(s)
- Morgane L.M.D. Butler
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Nida Pervaiz
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | - Yichen Wang
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Julia Cammasola Breda
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Sarah Mazzilli
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | | | - Marco M. Hefti
- Department of Pathology, University of Iowa Health Care, Iowa City IA, USA
| | - Bertrand R. Huber
- VA Boston Healthcare System, Jamaica Plain MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Victor E. Alvarez
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Joshua D. Campbell
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Jonathan D. Cherry
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
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9
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Conway Kleven B, Chien LC, Young DL, Cross CL, Labus B, Bernick C. Repetitive head impacts among professional fighters: a pilot study evaluating Traumatic Encephalopathy Syndrome and postural balance. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38418380 DOI: 10.1080/00913847.2024.2325331] [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: 11/06/2023] [Accepted: 02/27/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Clinical criteria for Traumatic Encephalopathy Syndrome (ccTES) were developed for research purposes to reflect the clinical symptoms of Chronic Traumatic Encephalopathy (CTE). The aims of this study were to 1) determine whether there was an association between the research diagnosis of TES and impaired postural balance among retired professional fighters, and 2) determine repetitive head impacts (RHI) exposure thresholds among both TES positive and TES negative groups in retired professional fighters when evaluating for balance impairment. METHODS This was a pilot study evaluating postural balance among participants of the Professional Athletes Brain Health Study (PABHS). Among the cohort, 57 retired professional fighters met the criteria for inclusion in this study. A generalized linear model with generalized estimating equations was used to compare various balance measures longitudinally between fighters with and without TES. RESULTS A significant association was observed between a TES diagnosis and worsening performance on double-leg balance assessments when stratifying by RHI exposure thresholds. Additionally, elevated exposure to RHI was significantly associated with increased odds of developing TES; The odds for TES diagnosis were 563% (95% CI = 113, 1963; p-value = 0.0011) greater among athletes with 32 or more professional fights compared to athletes with less than 32 fights when stratifying by balance measures. Likewise, the odds for TES diagnosis were 43% (95% CI = 10, 102; p-value = 0.0439) greater with worsening double leg stance balance in athletes exposed to 32 or more fights. CONCLUSION This pilot study provides preliminary evidence of a relationship between declining postural balance and a TES diagnosis among retired professional fighters with elevated RHI exposure. Further research exploring more complex assessments such as the Functional Gait Assessment may be of benefit to improve clinical understanding of the relationship between TES, RHI, and balance.
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Affiliation(s)
- Brooke Conway Kleven
- Sports Innovation Institute, University of Nevada, Las Vegas, Las Vegas, NV, USA
- School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Lung-Chang Chien
- School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Daniel L Young
- School of Integrated Health Sciences, Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Chad L Cross
- School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Brian Labus
- School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Charles Bernick
- Department of Neurology, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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10
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Bailie JM, Lippa SM, Hungerford L, French LM, Brickell TA, Lange RT. Cumulative Blast Exposure During a Military Career Negatively Impacts Recovery from Traumatic Brain Injury. J Neurotrauma 2024; 41:604-612. [PMID: 37675903 DOI: 10.1089/neu.2022.0192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Sub-concussive injuries have emerged as an important factor in the long-term brain health of athletes and military personnel. The objective of this study was to explore the relationship between service member and veterans (SMVs) lifetime blast exposure and recovery from a traumatic brain injury (TBI). A total of 558 SMVs with a history of TBI were examined. Lifetime blast exposure (LBE) was based on self-report (M = 79.4, standard deviation = 392.6; range = 0-7500) categorized into three groups: Blast Naive (n = 121), Low LBE (n = 223; LBE range 1-9), and High LBE (n = 214; LBE >10). Dependent variables were the Neurobehavioral Symptom Inventory (NSI) and Post-traumatic Stress Disorder Checklist-Civilian (PCL-C) and the Traumatic Brain Injury Quality of Life (TBI-QOL). Analyses controlled for demographic factors (age, gender, and race) as well as TBI factors (months since index TBI, index TBI severity, and total number lifetime TBIs). The Blast Naive group had significantly lower NSI and PCL-C scores compared with the Low LBE group and High LBE group, with small to medium effect sizes. On the TBI-QOL, the Blast Naïve group had better quality life on 10 of the 14 scales examined. The Low LBE did not differ from the High LBE group on the PCL-C, NSI, or TBI-QOL. Blast exposure over an SMV's career was associated with increased neurobehavioral and post-traumatic stress symptoms following a TBI. The influence of psychological trauma associated with blasts may be an important factor influencing symptoms as well as the accuracy of self-reported estimates of LBE.
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Affiliation(s)
- Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- Naval Medical Center San Diego, San Diego, California, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
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11
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Alosco ML, Adler CH, Dodick DW, Tripodis Y, Balcer LJ, Bernick C, Banks SJ, Barr WB, Wethe JV, Palmisano JN, Martin B, Hartlage K, Cantu RC, Geda YE, Katz DI, Mez J, Cummings JL, Shenton ME, Reiman EM, Stern RA. Examination of parkinsonism in former elite American football players. Parkinsonism Relat Disord 2024; 120:105903. [PMID: 37981539 PMCID: PMC10922636 DOI: 10.1016/j.parkreldis.2023.105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Former American football players are at risk for chronic traumatic encephalopathy (CTE) which may have parkinsonism as a clinical feature. OBJECTIVE Former football players were prospectively assessed for parkinsonism. METHODS 120 former professional football players, 58 former college football players, and 60 same-age asymptomatic men without repetitive head impacts, 45-74 years, were studied using the MDS-UPDRS to assess for parkinsonism, and the Timed Up and Go (TUG). Traumatic encephalopathy syndrome (TES), the clinical syndrome of CTE, was adjudicated and includes parkinsonism diagnosis. Fisher's Exact Test compared groups on parkinsonism due to small cell sizes; analysis of covariance or linear regressions controlling for age and body mass index were used otherwise. RESULTS Twenty-two (12.4%) football players (13.3% professional, 10.3% college) met parkinsonism criteria compared with two (3.3%) in the unexposed group. Parkinsonism was higher in professional (p = 0.037) but not college players (p = 0.16). There were no differences on the MDS-UPDRS Part III total scores. Scores on the individual MDS-UPDRS items were low. TUG times were longer in former professional but not college players compared with unexposed men (13.09 versus 11.35 s, p < 0.01). There were no associations between years of football, age of first exposure, position or level of play on motor outcomes. TES status was not associated with motor outcomes. CONCLUSIONS Parkinsonism rates in this sample of football players was low and highest in the professional football players. The association between football and parkinsonism is inconclusive and depends on factors related to sample selection, comparison groups, and exposure characteristics.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - David W Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Sarah J Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA
| | - William B Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Kaitlin Hartlage
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Robert C Cantu
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Douglas I Katz
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Framingham Heart Study, Framingham, MA, USA
| | - Jeffery L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, And Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian, Boston, MA, USA
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12
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Alexander A, Alvarez VE, Huber BR, Alosco ML, Mez J, Tripodis Y, Nicks R, Katz DI, Dwyer B, Daneshvar DH, Martin B, Palmisano J, Goldstein LE, Crary JF, Nowinski C, Cantu RC, Kowall NW, Stern RA, Delalle I, McKee AC, Stein TD. Cortical-sparing chronic traumatic encephalopathy (CSCTE): a distinct subtype of CTE. Acta Neuropathol 2024; 147:45. [PMID: 38407651 DOI: 10.1007/s00401-024-02690-5] [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: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive head impacts (RHI) and pathologically defined as neuronal phosphorylated tau aggregates around small blood vessels and concentrated at sulcal depths. Cross-sectional studies suggest that tau inclusions follow a stereotyped pattern that begins in the neocortex in low stage disease, followed by involvement of the medial temporal lobe and subcortical regions with significant neocortical burden in high stage CTE. Here, we define a subset of brain donors with high stage CTE and with a low overall cortical burden of tau inclusions (mean semiquantitative value ≤1) and classify them as cortical-sparing CTE (CSCTE). Of 620 brain donors with pathologically diagnosed CTE, 66 (11%) met criteria for CSCTE. Compared to typical high stage CTE, those with CSCTE had a similar age at death and years of contact sports participation and were less likely to carry apolipoprotein ε4 (p < 0.05). CSCTE had less overall tau pathology severity, but a proportional increase of disease burden in medial temporal lobe and brainstem regions compared to the neocortex (p's < 0.001). CSCTE also had lower prevalence of comorbid neurodegenerative disease. Clinically, CSCTE participants were less likely to have dementia (p = 0.023) and had less severe cognitive difficulties (as reported by informants using the Functional Activities Questionnaire (FAQ); p < 0.001, meta-cognitional index T score; p = 0.002 and Cognitive Difficulties Scale (CDS); p < 0.001,) but had an earlier onset age of behavioral (p = 0.006) and Parkinsonian motor (p = 0.013) symptoms when compared to typical high stage CTE. Other comorbid tauopathies likely contributed in part to these differences: when cases with concurrent Alzheimer dementia or frontal temporal lobar degeneration with tau pathology were excluded, differences were largely retained, but only remained significant for FAQ (p = 0.042), meta-cognition index T score (p = 0.014) and age of Parkinsonian motor symptom onset (p = 0.046). Overall, CSCTE appears to be a distinct subtype of high stage CTE with relatively greater involvement of subcortical and brainstem regions and less severe cognitive symptoms.
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Affiliation(s)
- Abigail Alexander
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Douglas I Katz
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Nowinski
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ivana Delalle
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- , 150 S. Huntington Avenue, Boston, MA, 02130, USA.
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13
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Agrawal S, Leurgans SE, Barnes LL, Dams-O’Connor K, Mez J, Bennett DA, Schneider JA. Chronic traumatic encephalopathy and aging-related tau astrogliopathy in community-dwelling older persons with and without moderate-to-severe traumatic brain injury. J Neuropathol Exp Neurol 2024; 83:181-193. [PMID: 38300796 PMCID: PMC10880068 DOI: 10.1093/jnen/nlae007] [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] [Indexed: 02/03/2024] Open
Abstract
This study examined the frequency of chronic traumatic encephalopathy-neuropathologic change (CTE-NC) and aging-related tau astrogliopathy (ARTAG) in community-dwelling older adults and tested the hypothesis that these tau pathologies are associated with a history of moderate-to-severe traumatic brain injury (msTBI), defined as a TBI with loss of consciousness >30 minutes. We evaluated CTE-NC, ARTAG, and Alzheimer disease pathologies in 94 participants with msTBI and 94 participants without TBI matched by age, sex, education, and dementia status TBI from the Rush community-based cohorts. Six (3%) of brains showed the pathognomonic lesion of CTE-NC; only 3 of these had a history of msTBI. In contrast, ARTAG was common in older brains (gray matter ARTAG = 77%; white matter ARTAG = 54%; subpial ARTAG = 51%); there were no differences in severity, type, or distribution of ARTAG pathology with respect to history of msTBI. Furthermore, those with msTBI did not have higher levels of PHF-tau tangles density but had higher levels of amyloid-β load (Estimate = 0.339, SE = 0.164, p = 0.040). These findings suggest that CTE-NC is infrequent while ARTAG is common in the community and that both pathologies are unrelated to msTBI. The association of msTBI with amyloid-β, rather than with tauopathies suggests differential mechanisms of neurodegeneration in msTBI.
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Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sue E Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Mt Sinai School of Medicine, New York, New York, USA
- Department of Neurology, Mt Sinai School of Medicine, New York, New York, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Boston University Chronic Traumatic Encephalopathy Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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14
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Saltiel N, Tripodis Y, Menzin T, Olaniyan A, Baucom Z, Yhang E, Palmisano JN, Martin B, Uretsky M, Nair E, Abdolmohammadi B, Shah A, Nicks R, Nowinski C, Cantu RC, Daneshvar DH, Dwyer B, Katz DI, Stern RA, Alvarez V, Huber B, Boyle PA, Schneider JA, Mez J, McKee A, Alosco ML, Stein TD. Relative Contributions of Mixed Pathologies to Cognitive and Functional Symptoms in Brain Donors Exposed to Repetitive Head Impacts. Ann Neurol 2024; 95:314-324. [PMID: 37921042 PMCID: PMC10842014 DOI: 10.1002/ana.26823] [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: 04/09/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Exposure to repetitive head impacts (RHI) is associated with later-life cognitive symptoms and neuropathologies, including chronic traumatic encephalopathy (CTE). Cognitive decline in community cohorts is often due to multiple pathologies; however, the frequency and contributions of these pathologies to cognitive impairment in people exposed to RHI are unknown. Here, we examined the relative contributions of 13 neuropathologies to cognitive symptoms and dementia in RHI-exposed brain donors. METHODS Neuropathologists examined brain tissue from 571 RHI-exposed donors and assessed for the presence of 13 neuropathologies, including CTE, Alzheimer disease (AD), Lewy body disease (LBD), and transactive response DNA-binding protein 43 (TDP-43) inclusions. Cognitive status was assessed by presence of dementia, Functional Activities Questionnaire, and Cognitive Difficulties Scale. Spearman rho was calculated to assess intercorrelation of pathologies. Additionally, frequencies of pathological co-occurrence were compared to a simulated distribution assuming no intercorrelation. Logistic and linear regressions tested associations between neuropathologies and dementia status and cognitive scale scores. RESULTS The sample age range was 18-97 years (median = 65.0, interquartile range = 46.0-76.0). Of the donors, 77.2% had at least one moderate-severe neurodegenerative or cerebrovascular pathology. Stage III-IV CTE was the most common neurodegenerative disease (43.1%), followed by TDP-43 pathology, AD, and hippocampal sclerosis. Neuropathologies were intercorrelated, and there were fewer unique combinations than expected if pathologies were independent (p < 0.001). The greatest contributors to dementia were AD, neocortical LBD, hippocampal sclerosis, cerebral amyloid angiopathy, and CTE. INTERPRETATION In this sample of RHI-exposed brain donors with wide-ranging ages, multiple neuropathologies were common and correlated. Mixed neuropathologies, including CTE, underlie cognitive impairment in contact sport athletes. ANN NEUROL 2024;95:314-324.
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Affiliation(s)
- Nicole Saltiel
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Talia Menzin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Aliyah Olaniyan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Zach Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Eukyung Yhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N. Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Evan Nair
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Raymond Nicks
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | | | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Daniel H. Daneshvar
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor Alvarez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Bertrand Huber
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann McKee
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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15
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Ly MT, Tuz-Zahra F, Tripodis Y, Adler CH, Balcer LJ, Bernick C, Zetterberg H, Blennow K, Peskind ER, Au R, Banks SJ, Barr WB, Wethe JV, Bondi MW, Delano-Wood LM, Cantu RC, Coleman MJ, Dodick DW, McClean MD, Mez JB, Palmisano J, Martin B, Hartlage K, Lin AP, Koerte IK, Cummings JL, Reiman EM, Shenton ME, Stern RA, Bouix S, Alosco ML. Association of Vascular Risk Factors and CSF and Imaging Biomarkers With White Matter Hyperintensities in Former American Football Players. Neurology 2024; 102:e208030. [PMID: 38165330 PMCID: PMC10870736 DOI: 10.1212/wnl.0000000000208030] [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: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recent data link exposure to repetitive head impacts (RHIs) from American football with increased white matter hyperintensity (WMH) burden. WMH might have unique characteristics in the context of RHI beyond vascular risk and normal aging processes. We evaluated biological correlates of WMH in former American football players, including markers of amyloid, tau, inflammation, axonal injury, neurodegeneration, and vascular health. METHODS Participants underwent clinical interviews, MRI, and lumbar puncture as part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project. Structural equation modeling tested direct and indirect effects between log-transformed total fluid-attenuated inversion recovery (FLAIR) lesion volumes (TLV) and the revised Framingham stroke risk profile (rFSRP), MRI-derived global metrics of cortical thickness and fractional anisotropy (FA), and CSF levels of amyloid β1-42, p-tau181, soluble triggering receptor expressed on myeloid cells 2 (sTREM2), and neurofilament light. Covariates included age, race, education, body mass index, APOE ε4 carrier status, and evaluation site. Models were performed separately for former football players and a control group of asymptomatic men unexposed to RHI. RESULTS In 180 former football players (mean age = 57.2, 36% Black), higher log(TLV) had direct associations with the following: higher rFSRP score (B = 0.26, 95% CI 0.07-0.40), higher p-tau181 (B = 0.17, 95% CI 0.01-0.43), lower FA (B = -0.28, 95% CI -0.42 to -0.13), and reduced cortical thickness (B = -0.25, 95% CI -0.45 to -0.08). In 60 asymptomatic unexposed men (mean age = 59.3, 40% Black), there were no direct effects on log(TLV) (rFSRP: B = -0.03, 95% CI -0.48 to 0.57; p-tau181: B = -0.30, 95% CI -1.14 to 0.37; FA: B = -0.07, 95% CI -0.48 to 0.42; or cortical thickness: B = -0.28, 95% CI -0.64 to 0.10). The former football players showed stronger associations between log(TLV) and rFSRP (1,069% difference in estimates), p-tau181 (158%), and FA (287%) than the unexposed men. DISCUSSION Risk factors and biological correlates of WMH differed between former American football players and asymptomatic unexposed men. In addition to vascular health, p-tau181 and diffusion tensor imaging indices of white matter integrity showed stronger associations with WMH in the former football players. FLAIR WMH may have specific risk factors and pathologic underpinnings in RHI-exposed individuals.
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Affiliation(s)
- Monica T Ly
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Fatima Tuz-Zahra
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Yorghos Tripodis
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Charles H Adler
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Laura J Balcer
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Charles Bernick
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Henrik Zetterberg
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Kaj Blennow
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Elaine R Peskind
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Rhoda Au
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Sarah J Banks
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - William B Barr
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jennifer V Wethe
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Mark W Bondi
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Lisa M Delano-Wood
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Robert C Cantu
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael J Coleman
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - David W Dodick
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael D McClean
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jesse B Mez
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Joseph Palmisano
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Brett Martin
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Kaitlin Hartlage
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Alexander P Lin
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Inga K Koerte
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jeffrey L Cummings
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Eric M Reiman
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Martha E Shenton
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Robert A Stern
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Sylvain Bouix
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael L Alosco
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
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Lange RT, French LM, Lippa SM, Gillow K, Tippett CE, Barnhart EA, Glazer ME, Bailie JM, Hungerford L, Brickell TA. High Lifetime Blast Exposure Using the Blast Exposure Threshold Survey Is Associated With Worse Warfighter Brain Health Following Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:186-198. [PMID: 37650835 DOI: 10.1089/neu.2023.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
The purpose of this study was to extend previous research by examining the relationship between lifetime blast exposure and neurobehavioral functioning after mild TBI (MTBI) by (a) using a comprehensive measure of lifetime blast exposure, and (b) controlling for the influence of post-traumatic stress disorder (PTSD). Participants were 103 United States service members and veterans (SMVs) with a medically documented diagnosis of MTBI, recruited from three military treatment facilities (74.8%) and community-based recruitment initiatives (25.2%, e.g., social media, flyers). Participants completed a battery of neurobehavioral measures 12 or more months post-injury (Neurobehavioral Symptom Inventory, PTSD-Checklist PCLC, TBI-Quality of Life), including the Blast Exposure Threshold Survey (BETS). The sample was classified into two lifetime blast exposure (LBE) groups: High (n = 57) and Low (n = 46) LBE. In addition, the sample was classified into four LBE/PTSD subgroups: High PTSD/High LBE (n = 38); High PTSD/Low LBE (n = 19); Low PTSD/High LBE (n = 19); and Low PTSD/Low LBE (n = 27). The High LBE group had consistently worse scores on all neurobehavioral measures compared with the Low LBE group. When controlling for the influence of PTSD (using ANCOVA), however, only a handful of group differences remained. When comparing measures across the four LBE/PTSD subgroups, in the absence of clinically meaningful PTSD symptoms (i.e., Low PTSD), participants with High LBE had worse scores on the majority of neurobehavioral measures (e.g., post-concussion symptoms, sleep, fatigue). When examining the total number of clinically elevated measures, the High LBE subgroup consistently had a greater number of clinically elevated scores compared with the Low LBE subgroup for the majority of comparisons (i.e., four to 15 or more elevated symptoms). In contrast, in the presence of clinically meaningful PTSD symptoms (i.e., High PTSD), there were no differences between High versus Low LBE subgroups for all measures. When examining the total number of clinically elevated measures, however, there were meaningful differences between High versus Low LBE subgroups for those comparisons that included a high number of clinically elevated scores (i.e., six to 10 or more), but not for a low number of clinically elevated scores (i.e., one to five or more). High LBE, as quantified using a more comprehensive measure than utilized in past research (i.e., BETS), was associated with worse overall neurobehavioral functioning after MTBI. This study extends existing literature showing that lifetime blast exposure, that is largely subconcussive, may negatively impact warfighter brain health and readiness beyond diagnosable brain injury.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kelly Gillow
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, CICONIX, Annapolis, Maryland, USA
| | - Corie E Tippett
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, CICONIX, Annapolis, Maryland, USA
| | - Elizabeth A Barnhart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Contractor, Henry Jackson Foundation, Bethesda, Maryland, USA
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Megan E Glazer
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, Henry Jackson Foundation, Bethesda, Maryland, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- 33 Area Branch Clinic Camp Pendleton, California, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Naval Medical Center, San Diego, California, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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17
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Hageman G, Hageman I, Nihom J. Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases. Clin J Sport Med 2024; 34:69-80. [PMID: 37403989 DOI: 10.1097/jsm.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Exposure to repetitive sports-related concussions or (sub)concussive head trauma may lead to chronic traumatic encephalopathy (CTE). Which impact (heading or concussion) poses the greatest risk of CTE development in soccer players? DESIGN Narrative review. SETTING Teaching hospital and University of Applied sciences. PATIENTS A literature search (PubMed) was conducted for neuropathologic studies in the period 2005-December 2022, investigating soccer players with dementia and a CTE diagnosis, limited to English language publications. 210 papers were selected for final inclusion, of which 7 papers described 14 soccer players. ASSESSMENT Magnetic resonance imaging studies in soccer players show that lifetime estimates of heading numbers are inversely correlated with cortical thickness, grey matter volume, and density of the anterior temporal cortex. Using diffusion tensor imaging-magnetic resonance imaging, higher frequency of headings-particularly with rotational accelerations-are associated with impaired white matter integrity. Serum neurofilament light protein is elevated after heading. MAIN OUTCOME MEASURES Chronic traumatic encephalopathy pathology, history of concussion, heading frequency. RESULTS In 10 of 14 soccer players, CTE was the primary diagnosis. In 4 cases, other dementia types formed the primary diagnosis and CTE pathology was a concomitant finding. Remarkably, 6 of the 14 cases had no history of concussion, suggesting that frequent heading may be a risk for CTE in patients without symptomatic concussion. Rule changes in heading duels, management of concussion during the game, and limiting the number of high force headers during training are discussed. CONCLUSIONS Data suggest that heading frequency and concussions are associated with higher risk of developing CTE in (retired) soccer players. However based on this review of only 14 players, questions persist as to whether or not heading is a risk factor for CTE or long-term cognitive decline.
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Affiliation(s)
- Gerard Hageman
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
| | - Ivar Hageman
- Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Jik Nihom
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
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18
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Stewart W, Buckland ME, Abdolmohammadi B, Affleck AJ, Alvarez VE, Gilchrist S, Huber BR, Lee EB, Lyall DM, Nowinski CJ, Russell ER, Stein TD, Suter CM, McKee AC. Risk of chronic traumatic encephalopathy in rugby union is associated with length of playing career. Acta Neuropathol 2023; 146:829-832. [PMID: 37872234 PMCID: PMC10627955 DOI: 10.1007/s00401-023-02644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Affiliation(s)
- William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK.
- Department of Neuropathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Bobak Abdolmohammadi
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Victor E Alvarez
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Shannon Gilchrist
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Bertrand R Huber
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christopher J Nowinski
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
| | - Emma R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Thor D Stein
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Ann C McKee
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
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19
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Casson IR, Viano DC. Using the NINDS Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome on 4 Cohorts of Retired Contact Sport Athletes. Sports Health 2023; 15:842-847. [PMID: 36517991 PMCID: PMC10606970 DOI: 10.1177/19417381221139259] [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: 12/23/2022] Open
Abstract
BACKGROUND A 2021 National Institute for Neurological Disorders and Stroke (NINDS) consensus panel proposed a set of clinical diagnostic criteria for traumatic encephalopathy syndrome (TES) and determined provisional levels of certainty for chronic traumatic encephalopathy (CTE) pathology based on neuropathological evidence. The panel suggested the criteria needed to be validated by clinical studies of living populations exposed to repetitive head impacts (RHIs). HYPOTHESIS As the consensus criteria were developed solely from neuropathologically diagnosed cases of CTE, we hypothesized that they may not be readily applicable to the clinical impressions developed from the histories and examination findings of living patients whose neuropathology was unknown. STUDY DESIGN We applied the consensus criteria to 4 groups of living retired contact sports athletes collected from previously published articles in the medical literature. LEVEL OF EVIDENCE Level 4. METHODS Clinical evidence from 4 groups of living retired athletes (boxers and American football players) with extensive RHI exposure was available. We used the NINDS consensus criteria to determine for each athlete whether or not they met the criteria for TES. For those who met the criteria, we determined their provisional level of certainty for CTE pathology. RESULTS Among all 80 subjects, the prevalence of TES was 21.3% (17 of 80), the prevalence of possible CTE was 12.5% (10 of 80), and the prevalence of probable CTE was 2.5% (2 of 80). Among the 45 retired football players, the prevalence of TES was 24.4% (11 of 45) and the prevalence of possible CTE was 17.7% (8 of 45). None of the retired football players met the criteria for probable CTE. Among the 35 total retired boxers (from all 3 groups), the prevalence of TES was 17.1% (6 of 35), the prevalence of possible CTE was 5.7% (2 of 35), and the prevalence of probable CTE was 5.7% (2 of 35). CONCLUSION Applying the NINDS consensus criteria to this historical cohort of living retired athletes with extensive RHI exposure resulted in a relatively low prevalence of TES and possible/probable certainties of CTE pathology, which might suggest limitations on the sensitivity of the NINDS criteria. CLINICAL RELEVANCE Physicians are often asked by retired contact sports athletes and their families to determine if their clinical picture is related to TES and/or CTE. Physicians may turn to the NINDS consensus criteria for guidance in making such determinations. The data presented here may assist physicians in evaluating the reliability and validity of using the consensus criteria in living subjects.
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Affiliation(s)
- Ira R Casson
- Private Practice Neurology, Rockville Centre, New York
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20
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Pearce AJ, Kidgell DJ, Frazer AK, Rist B, Tallent J. Evidence of altered corticomotor inhibition in older adults with a history of repetitive neurotrauma. A transcranial magnetic stimulation study. J Neurol Sci 2023; 453:120777. [PMID: 37677860 DOI: 10.1016/j.jns.2023.120777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/26/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
International concern continues regarding the association between the long-term neurophysiologic changes from repetitive neurotrauma associated with contact and collision sports. This study describes corticomotor changes in retired contact/collision sport athletes and controls, between the ages of 30 and 70 years. Retired athletes (n = 152; 49.1 ± 8.5 years) and controls (n = 72; 47.8 ± 9.5 years) were assessed using single and paired-pulse transcranial magnetic stimulation (TMS) for active motor threshold (aMT), motor evoked potential and cortical silent period duration (expressed as MEP:cSP ratio), and short- and long-interval intracortical inhibition (SICI and LICI). Motor threshold, MEP:cSP, SICI and LICI for both groups were correlated across age. Controls showed significant moderate correlations for MEP:cSP ratios at 130% (rho = 0.48, p < 0.001), 150% (rho = 0.49, p < 0.001) and 170% aMT (rho = 0.42; p < 0.001) and significant small negative correlation for SICI (rho = -0.27; p = 0.030), and moderate negative correlation for LICI (rho = -0.43; p < 0.001). Group-wise correlation analysis comparisons showed significant correlation differences between groups for 130% (p = 0.016) and 150% aMT (p = 0.009), specifically showing retired athletes were displaying increased corticomotor inhibition. While previous studies have focussed studies on older athletes (>50 years), this study is the first to characterize corticomotor differences between retired athletes and controls across the lifespan. These results, demonstrating pathophysiological differences in retired athletes across the lifespan, provide a foundation to utilise evoked potentials as a prodromal marker in supplementing neurological assessment for traumatic encephalopathy syndrome associated with contact/collision sport athletes that is currently lacking physiological biomarkers.
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Affiliation(s)
- Alan J Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia.
| | - Dawson J Kidgell
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Ashlyn K Frazer
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Billymo Rist
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia; Australian Football League Players Association, Melbourne 32067, Australia
| | - Jamie Tallent
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex CO4 3SQ, UK
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21
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Stern RA, Trujillo-Rodriguez D, Tripodis Y, Pulukuri SV, Alosco ML, Adler CH, Balcer LJ, Bernick C, Baucom Z, Marek KL, McClean MD, Johnson KA, McKee AC, Stein TD, Mez J, Palmisano JN, Cummings JL, Shenton ME, Reiman EM. Amyloid PET across the cognitive spectrum in former professional and college American football players: findings from the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2023; 15:166. [PMID: 37798671 PMCID: PMC10552261 DOI: 10.1186/s13195-023-01315-5] [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: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Exposure to repetitive head impacts (RHI) in American football players can lead to cognitive impairment and dementia due to neurodegenerative disease, particularly chronic traumatic encephalopathy (CTE). The pathognomonic lesion of CTE consists of perivascular aggregates of hyper-phosphorylated tau in neurons at the depths of cortical sulci. However, it is unclear whether exposure to RHI accelerates amyloid-β (Aβ) plaque formation and increases the risk for Alzheimer's disease (AD). Although the Aβ neuritic plaques characteristic of AD are observed in a minority of later-stage CTE cases, diffuse plaques are more common. This study examined whether former professional and college American football players, including those with cognitive impairment and dementia, have elevated neuritic Aβ plaque density, as measured by florbetapir PET. Regardless of cognitive and functional status, elevated levels of florbetapir uptake were not expected. METHODS We examined 237 men ages 45-74, including 119 former professional (PRO) and 60 former college (COL) football players, with and without cognitive impairment and dementia, and 58 same-age men without a history of contact sports or TBI (unexposed; UE) and who denied cognitive or behavioral symptoms at telephone screening. Former players were categorized into four diagnostic groups: normal cognition, subjective memory impairment, mild cognitive impairment, and dementia. Positive florbetapir PET was defined by cortical-cerebellar average SUVR of ≥ 1.10. Multivariable linear regression and analysis of covariance (ANCOVA) compared florbetapir average SUVR across diagnostic and exposure groups. Multivariable logistic regression compared florbetapir positivity. Race, education, age, and APOE4 were covariates. RESULTS There were no diagnostic group differences either in florbetapir average SUVR or the proportion of elevated florbetapir uptake. Average SUVR means also did not differ between exposure groups: PRO-COL (p = 0.94, 95% C.I. = [- 0.033, 0.025]), PRO-UE (p = 0.40, 95% C.I. = [- 0.010, 0.029]), COL-UE (p = 0.36, 95% CI = [0.0004, 0.039]). Florbetapir was not significantly associated with years of football exposure, cognition, or daily functioning. CONCLUSIONS Cognitive impairment in former American football players is not associated with PET imaging of neuritic Aβ plaque deposition. These findings are inconsistent with a neuropathological diagnosis of AD in individuals with substantial RHI exposure and have both clinical and medico-legal implications. TRIAL REGISTRATION NCT02798185.
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Affiliation(s)
- Robert A Stern
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA.
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Diana Trujillo-Rodriguez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Graduate Program in Neuroscience, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Surya V Pulukuri
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
| | - Michael L Alosco
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Zachary Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Harvard Medical School, Gordon Center for Medical Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann C McKee
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Thor D Stein
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey L Cummings
- Department of Brain Health, School of Integrated Health Sciences, Chambers-Grundy Center for Transformative Neuroscience, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
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McAlister KL, Mack WJ, Bir C, Baron DA, Som C, Li K, Chavarria-Garcia A, Sawardekar S, Baron D, Toth Z, Allem C, Beatty N, Nakayama J, Kelln R, Zaslow T, Bansal R, Peterson BS. Longitudinal, prospective study of head impacts in male high school football players. PLoS One 2023; 18:e0291374. [PMID: 37682984 PMCID: PMC10490840 DOI: 10.1371/journal.pone.0291374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Repetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players. METHODS In this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration. RESULTS 4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g's higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g's higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g's higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g's higher (0.8), p<0.001]. CONCLUSION Including screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.
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Affiliation(s)
- Kelsey L. McAlister
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Cynthia Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States of America
| | - David A. Baron
- Western University, Pomona, CA, United States of America
| | - Christine Som
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Karen Li
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Anthony Chavarria-Garcia
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Siddhant Sawardekar
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - David Baron
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Zachary Toth
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Courtney Allem
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Nicholas Beatty
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Junko Nakayama
- Crescenta Valley High School, La Crescenta, CA, United States of America
| | - Ryan Kelln
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Tracy Zaslow
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Ravi Bansal
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Bradley S. Peterson
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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23
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Zou Y, Qi B, Tan J, Guan L, Zhang Q, Sun Y, Huang F. Deciphering the Inhibitory Mechanism of Naphthoquinone-Dopamine on the Aggregation of Tau Core Fragments PHF6* and PHF6. ACS Chem Neurosci 2023; 14:3265-3277. [PMID: 37585669 DOI: 10.1021/acschemneuro.3c00434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
The formation of neurofibrillary tangles by abnormal aggregation of tau protein is considered to be an important pathological characteristic of tauopathies, including Alzheimer's disease and chronic traumatic encephalopathy. Two hexapeptides 275VQIINK280 and 306VQIVYK311 in the microtubule binding region, named PHF6* and PHF6, are known to be aggregation-prone and responsible for tau fibrillization. Previous experiments reported that naphthoquinone-dopamine (NQDA) could effectively inhibit the aggregation of PHF6* and PHF6 and disrupt the fibrillar aggregates into nontoxic species, displaying a dual effect on the amyloid aggregation. However, the underlying molecular mechanism remains mostly elusive. Herein, we performed all-atom molecular dynamics (MD) simulations for 114 μs in total to systematically investigate the impacts of NQDA on the oligomerization of PHF6* and PHF6. The conformational ensembles of PHF6* and PHF6 peptides generated by replica exchange MD simulations show that NQDA could effectively prevent the hydrogen bond formation, reduce the ability of peptides to self-assemble into long β-strand and large β-sheets, and induce peptides to form a loosely packed and coil-rich oligomer. The interaction analysis shows that the binding of NQDA to PHF6* is mainly through hydrophobic interactions with residue I277 and hydrogen bonding interactions with Q276; for the PHF6 peptides, NQDA displays a strong π-π stacking interaction with residue Y310, thus impeding the Y310-Y310 π-π stacking and I308-Y310 CH-π interactions. The DA group of NQDA displays a stronger cation-π interaction than the NQ group, while the NQ group exhibits a stronger π-π stacking interaction. MD simulations demonstrate that NQDA prevents the conformational conversion to β-sheet-rich aggregates and displays an inhibitory effect on the oligomerization dynamics of PHF6* and PHF6. Our results provide a complete picture of inhibitory mechanisms of NQDA on PHF6* and PHF6 oligomerization, which may pave the way for designing drug candidates for the treatment of tauopathies.
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Affiliation(s)
- Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Bote Qi
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Jingwang Tan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Lulu Guan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Qingwen Zhang
- College of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, P. R. China
| | - Yunxiang Sun
- Department of Physics, Ningbo University, 818 Fenghua Road, Ningbo 315211, Zhejiang, P. R. China
| | - Fengjuan Huang
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo 315211, Zhejiang, P. R. China
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Rossi C, Campese N, Colosimo C. Emerging Symptomatic Treatment of Chronic Traumatic Encephalopathy (CTE): a narrative review. Expert Opin Pharmacother 2023; 24:1415-1425. [PMID: 37300418 DOI: 10.1080/14656566.2023.2224501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is an emergent neurodegenerative tauopathy well characterized pathologically but with limited consensus about clinical criteria. The clinical features include cognitive, behavioral, and motor symptoms such as parkinsonism, gait, balance disorder, and bulbar impairment. Their recognition derives from retrospective studies in pathologically confirmed CTE patients. This is one of the main reasons for the lack of specific pharmacological studies targeting symptoms or pathologic pathways of this disease. AREAS COVERED In this narrative review, we overview the possible symptomatic treatment options for CTE, based on pathological similarities with other neurodegenerative diseases that may share common pathological pathways with CTE. The PubMed database was screened for articles addressing the symptomatic treatment of CTE and Traumatic Encephalopathy Syndrome (TES). Additional references were retrieved by reference cross-check and retained if pertinent to the subject. The clinicaltrials.gov database was screened for ongoing trials on the treatment of CTE. EXPERT OPINION The similarities with the other tauopathies allow us, in the absence of disease-specific evidence, to translate some knowledge from these neurodegenerative disorders to CTE's symptomatic treatment, but any conclusion should be drawn cautiously and a patient-tailored strategy should be always preferred balancing the risks and benefits of each treatment.
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Affiliation(s)
- Carlo Rossi
- Neurology Unit, F. Lotti Hospital of Pontedera. Azienda Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy
| | - Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carlo Colosimo
- Department of Neurology, S. Maria University Hospital, Terni, Italy
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25
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Suter CM, Affleck AJ, Pearce AJ, Junckerstorff R, Lee M, Buckland ME. Chronic traumatic encephalopathy in a female ex-professional Australian rules footballer. Acta Neuropathol 2023; 146:547-549. [PMID: 37391669 PMCID: PMC10412665 DOI: 10.1007/s00401-023-02610-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alan J Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | | | - Maggie Lee
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia.
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26
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Lee CD, Meehan WP, Bazarian J. Participation of Children in American Football. N Engl J Med 2023; 389:660-662. [PMID: 37585634 DOI: 10.1056/nejmclde2302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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27
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Rosen G, Kirsch D, Horowitz S, Cherry JD, Nicks R, Kelley H, Uretsky M, Dell'Aquila K, Mathias R, Cormier KA, Kubilus CA, Mez J, Tripodis Y, Stein TD, Alvarez VE, Alosco ML, McKee AC, Huber BR. Three dimensional evaluation of cerebrovascular density and branching in chronic traumatic encephalopathy. Acta Neuropathol Commun 2023; 11:123. [PMID: 37491342 PMCID: PMC10369801 DOI: 10.1186/s40478-023-01612-y] [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: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI) and characterized by perivascular accumulations of hyperphosphorylated tau protein (p-tau) at the depths of the cortical sulci. Studies of living athletes exposed to RHI, including concussive and nonconcussive impacts, have shown increased blood-brain barrier permeability, reduced cerebral blood flow, and alterations in vasoreactivity. Blood-brain barrier abnormalities have also been reported in individuals neuropathologically diagnosed with CTE. To further investigate the three-dimensional microvascular changes in individuals diagnosed with CTE and controls, we used SHIELD tissue processing and passive delipidation to optically clear and label blocks of postmortem human dorsolateral frontal cortex. We used fluorescent confocal microscopy to quantitate vascular branch density and fraction volume. We compared the findings in 41 male brain donors, age at death 31-89 years, mean age 64 years, including 12 donors with low CTE (McKee stage I-II), 13 with high CTE (McKee stage III-IV) to 16 age- and sex-matched non-CTE controls (7 with RHI exposure and 9 with no RHI exposure). The density of vessel branches in the gray matter sulcus was significantly greater in CTE cases than in controls. The ratios of sulcus versus gyrus vessel branch density and fraction volume were also greater in CTE than in controls and significantly above one for the CTE group. Hyperphosphorylated tau pathology density correlated with gray matter sulcus fraction volume. These findings point towards increased vascular coverage and branching in the dorsolateral frontal cortex (DLF) sulci in CTE, that correlates with p-tau pathology.
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Affiliation(s)
- Grace Rosen
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Daniel Kirsch
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Sarah Horowitz
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA
| | - Jonathan D Cherry
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Hunter Kelley
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Kevin Dell'Aquila
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Rebecca Mathias
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Kerry A Cormier
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Caroline A Kubilus
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Thor D Stein
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
| | - Ann C McKee
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA
- VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, USA
| | - Bertrand R Huber
- VA Boston Healthcare System, US Department of Veterans Affairs, 150 S Huntington Avenue, Boston, MA, 02130, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
- Boston University Alzheimer's Disease Research Center and Boston University CTE Center, Boston, USA.
- National Center for PTSD, US Department of Veterans Affairs, Boston, MA, USA.
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Asken BM, Tanner JA, Gaynor LS, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, Fonseca C, Shankar R, Grant H, Smith K, Lago AL, Xu H, La Joie R, Cobigo Y, Rosen H, Perry DC, Rojas JC, Miller BL, Gardner RC, Wang KKW, Kramer JH, Rabinovici GD. Alzheimer's pathology is associated with altered cognition, brain volume, and plasma biomarker patterns in traumatic encephalopathy syndrome. Alzheimers Res Ther 2023; 15:126. [PMID: 37480088 PMCID: PMC10360257 DOI: 10.1186/s13195-023-01275-w] [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] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Traumatic encephalopathy syndrome (TES) is a clinical phenotype sensitive but non-specific to underlying chronic traumatic encephalopathy (CTE) neuropathology. However, cognitive symptoms of TES overlap with Alzheimer's disease (AD), and features of AD pathology like beta-amyloid (Aβ) plaques often co-occur with CTE, making clinical-to-pathological conclusions of TES diagnoses challenging. We investigated how Alzheimer's neuropathological changes associated with cognition, brain volume, and plasma biomarkers in patients with repetitive head impacts (RHI)/TES, clinical AD, or typically aging controls. METHODS We studied 154 participants including 33 with RHI/TES (age 61.5 ± 11.5, 100% male, 11/33 Aβ[ +]), 62 with AD and no known prior RHI (age 67.1 ± 10.2, 48% male, 62/62 Aβ[ +]), and 59 healthy controls without RHI (HC; age 73.0 ± 6.2, 40% male, 0/59 Aβ[ +]). Patients completed neuropsychological testing (memory, executive functioning, language, visuospatial) and structural MRI (voxel-based morphometry analysis), and provided plasma samples analyzed for GFAP, NfL, IL-6, IFN-γ, and YKL-40. For cognition and plasma biomarkers, patients with RHI/TES were stratified as Aβ[ +] or Aβ[ -] and compared to each other plus the AD and HC groups (ANCOVA adjusting for age and sex). Differences with at least a medium effect size (Cohen's d > 0.50) were interpreted as potentially meaningful. RESULTS Cognitively, within the TES group, Aβ[ +] RHI/TES performed worse than Aβ[-] RHI/TES on visuospatial (p = .04, d = 0.86) and memory testing (p = .07, d = 0.74). Comparing voxel-wise brain volume, both Aβ[ +] and Aβ[ -] RHI/TES had lower medial and anterior temporal lobe volume than HC and did not significantly differ from AD. Comparing plasma biomarkers, Aβ[ +] RHI/TES had higher plasma GFAP than HC (p = .01, d = 0.88) and did not significantly differ from AD. Conversely, Aβ[ -] RHI/TES had higher NfL than HC (p = .004, d = 0.93) and higher IL-6 than all other groups (p's ≤ .004, d's > 1.0). CONCLUSIONS Presence of Alzheimer's pathology in patients with RHI/TES is associated with altered cognitive and biomarker profiles. Patients with RHI/TES and positive Aβ-PET have cognitive and plasma biomarker changes that are more like patients with AD than patients with Aβ[ -] RHI/TES. Measuring well-validated Alzheimer's biomarkers in patients with RHI/TES could improve interpretation of research findings and heighten precision in clinical management.
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Affiliation(s)
- Breton M Asken
- Department of Clinical & Health Psychology, 1Florida Alzheimer's Disease Research Center, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Jeremy A Tanner
- Department of Neurology, Biggs Institute for Alzheimer's and Neurodegenerative Diseases, South Texas Alzheimer's Disease Research Center, University of Texas Health - San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Leslie S Gaynor
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Lawren VandeVrede
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - William G Mantyh
- Department of Neurology, University of Minnesota, PWB 12-100, 516 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Adam M Staffaroni
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Corrina Fonseca
- Department of Neuroscience, Helen Wills Neuroscience Institute, University of California, 132 Barker Hall MC#3190, Berkeley, CA, 94720, USA
| | - Ranjani Shankar
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Harli Grant
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Karen Smith
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Argentina Lario Lago
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Haiyan Xu
- Department of Surgery, University of Florida, PO Box 100128, Gainesville, FL, 32610, USA
| | - Renaud La Joie
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Yann Cobigo
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Howie Rosen
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - David C Perry
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Julio C Rojas
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Raquel C Gardner
- Sheba Medical Center, Tel Hashomer City of Health, Tel Aviv District, Derech Sheba 2, Ramat Gan, Israel
| | - Kevin K W Wang
- Department of Neurobiology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Joel H Kramer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
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Sundaram V, Sundar V, Pearce AJ. Biomechanical characteristics of concussive and sub-concussive impacts in youth sports athletes: A systematic review and meta-analysis. J Sports Sci 2023:1-15. [PMID: 37393593 DOI: 10.1080/02640414.2023.2231317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
This study aimed to quantitatively investigate and report the biomechanical characteristics of concussive and sub-concussive impacts in youth sports. A systematic search was conducted in September 2022 to identify biomechanical impact studies in athletes ≤18 years of age. Twenty-six studies met the inclusion criteria for quantitative synthesis and analysis. DerSimonian Laird random effects model was used to pool data across the included studies. The pooled estimate of mean peak linear and rotational acceleration of concussive impacts in male youth athletes was 85.56 g (95% CI 69.34-101.79) and 4505.58 rad/s2 (95% CI 2870.28-6140.98), respectively. The pooled estimate of mean peak linear and rotational acceleration of sub-concussive impacts in youth athletes was 22.89 g (95% CI 20.69-25.08) and 1290.13 rad/s2 (95% CI 1050.71-1529.55), respectively. A male vs female analysis in sub-concussive impacts revealed higher linear and rotational acceleration in males and females, respectively. This is the first study to report on impact data in both sexes of youth athletes. Disparity in kinematic impact values suggests future research should aim for standardised measures to reduce heterogeneity in data. Despite this, the data reveals notable impact data that youth athletes are exposed to, suggesting modifications may be required to reduce long-term neurological risks.
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Affiliation(s)
- Vasanth Sundaram
- Department of Sports Biomechanics and Kinesiology, Tamil Nadu Physical Education and Sports University, Chennai, India
| | - Viswanath Sundar
- Physical Education and Sports Science, Visva-Bharati University, West Bengal, India
| | - Alan J Pearce
- College of Science, Health, and Engineering, La Trobe University, Bundoora, Melbourne, Australia
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30
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Kraus N, Colegrove D, Otto-Meyer R, Bonacina S, Nicol T, Cunningham J, Krizman J. Subconcussion revealed by sound processing in the brain. EXERCISE, SPORT, & MOVEMENT 2023; 1:1-4. [PMID: 38130893 PMCID: PMC10735248 DOI: 10.1249/esm.0000000000000011] [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: 12/23/2023]
Abstract
Introduction/Purpose We tested the hypothesis that an objective measure of auditory processing reveals a history of head trauma that does not meet the clinical definition of concussion. Methods Division I collegiate student-athletes (n = 709) across 19 sports were divided into groups, based on their sport, using prevailing classifications of "contact" (317 males, 212 females) and "noncontact" (58 males, 122 females). Participants were evaluated using the frequency-following response (FFR) to speech. The amplitude of FFR activity in a frequency band corresponding to the fundamental frequency (F0)-the voice pitch-of the speech stimulus, an outcome reduced in individuals with concussions, was critically examined. Results We found main effects of contact level and sex. The FFR-F0 was smaller in contact athletes than noncontact athletes and larger in females than males. There was a contact by sex interaction, with the FFR-F0 of males in the contact group being smaller than the three other groups. Secondary analyses found a correlation between FFR-F0 and length of participation in contact sports in male athletes. Conclusion These findings suggest that the disruption of sensory processing in the brain can be observed in individuals without a concussion but whose sport features regular physical contact. This evidence identifies sound processing in the brain as an objective marker of subconcussion in athletes.
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Affiliation(s)
- Nina Kraus
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Chicago, IL, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern University, Evanston, IL, USA
| | - Rembrandt Otto-Meyer
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Silvia Bonacina
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Trent Nicol
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Jenna Cunningham
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Jennifer Krizman
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
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31
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Daneshvar DH, Nair ES, Baucom ZH, Rasch A, Abdolmohammadi B, Uretsky M, Saltiel N, Shah A, Jarnagin J, Baugh CM, Martin BM, Palmisano JN, Cherry JD, Alvarez VE, Huber BR, Weuve J, Nowinski CJ, Cantu RC, Zafonte RD, Dwyer B, Crary JF, Goldstein LE, Kowall NW, Katz DI, Stern RA, Tripodis Y, Stein TD, McClean MD, Alosco ML, McKee AC, Mez J. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat Commun 2023; 14:3470. [PMID: 37340004 PMCID: PMC10281995 DOI: 10.1038/s41467-023-39183-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI), but the components of RHI exposure underlying this relationship are unclear. We create a position exposure matrix (PEM), composed of American football helmet sensor data, summarized from literature review by player position and level of play. Using this PEM, we estimate measures of lifetime RHI exposure for a separate cohort of 631 football playing brain donors. Separate models examine the relationship between CTE pathology and players' concussion count, athletic positions, years of football, and PEM-derived measures, including estimated cumulative head impacts, linear accelerations, and rotational accelerations. Only duration of play and PEM-derived measures are significantly associated with CTE pathology. Models incorporating cumulative linear or rotational acceleration have better model fit and are better predictors of CTE pathology than duration of play or cumulative head impacts alone. These findings implicate cumulative head impact intensity in CTE pathogenesis.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA.
| | - Evan S Nair
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Zachary H Baucom
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Abigail Rasch
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nicole Saltiel
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arsal Shah
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Johnny Jarnagin
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brett M Martin
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Christopher J Nowinski
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - John F Crary
- Neuropathology Brain Bank & Research Core, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael D McClean
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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32
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Schaffert J, Didehbani N, LoBue C, Hart J, Wilmoth K, Cullum CM. No association between age beginning tackle football, or years played and neurocognitive performance later-in-life among older National Football League retirees. Arch Clin Neuropsychol 2023; 38:644-649. [PMID: 36533487 PMCID: PMC10202547 DOI: 10.1093/arclin/acac101] [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: 11/15/2022] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE In a retrospective cohort, we evaluated whether age beginning tackle football (ABTF) and more total years of playing football (TYPF) were associated with worse later-in-life neuropsychological change among older retired National Football League (NFL) players. METHOD Participants were 19 older NFL retirees aged 54-79, including 12 who returned for follow-up evaluation 15-51 months later. Mixed-linear models evaluated the association between ABTF/TYFP and baseline neuropsychological composite scores (executive functioning/attention/speed, language, memory), and neuropsychological composites over time. RESULTS ABTF and TYPF were not significantly associated with neuropsychological composites at baseline or over time (all p's > .05). There were no significant differences in neuropsychological performance between those ABTF <12 and ≥ 12 years old (all p's ≥ .475) or between those with TYPF <19 or ≥ 19 years played (median split; all p's ≥ .208). CONCLUSIONS Preliminary findings suggest that ABTF and TYPF does not worsen neurocognitive decline later-in-life among older NFL retirees.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristin Wilmoth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hunzinger KJ, Caccese JB, Mannix R, Meehan WP, Hafer JF, Swanik CB, Buckley TA. Effects of contact/collision sport history on gait in early- to mid-adulthood. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:398-405. [PMID: 36496131 DOI: 10.1016/j.jshs.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/22/2022] [Accepted: 11/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND To determine the effect of contact/collision sport participation on measures of single-task (ST) and dual-task (DT) gait among early- to middle-aged adults. METHODS The study recruited 113 adults (34.88 ± 11.80 years, (mean ± SD); 53.0% female) representing 4 groups. Groups included (a) former non-contact/collision athletes and non-athletes who are not physically active (n = 28); (b) former non-contact/collision athletes who are physically active (n = 29); (c) former contact/collision sport athletes who participated in high-risk sports and are physically active (n = 29); and (d) former rugby players with prolonged repetitive head impact exposure history who are physically active (n = 27). Gait parameters were collected using inertial measurement units during ST and DT gait. DT cost was calculated for all gait parameters (double support, gait speed, and stride length). Groups were compared first using one-way analysis of covariance. Then a multiple regression was performed for participants in the high-risk sport athletes and repetitive head impact exposure athletes groups only to predict gait outcomes from contact/collision sport career duration. RESULTS There were no significant differences between groups on any ST, DT, or DT cost outcomes (p > 0.05). Contact/collision sport duration did not predict any ST, DT, or DT cost gait outcomes. CONCLUSION Years and history of contact/collision sport participation does not appear to negatively affect or predict neurobehavioral function in early- to mid-adulthood among physically active individuals.
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Affiliation(s)
- Katherine J Hunzinger
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - William P Meehan
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA 02453, USA; Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA 02453, USA
| | - Jocelyn F Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA
| | - C Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA.
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Nicks R, Clement NF, Alvarez VE, Tripodis Y, Baucom ZH, Huber BR, Mez J, Alosco ML, Aytan N, Cherry JD, Cormier KA, Kubilius C, Mathias R, Svirsky SE, Pothast MJ, Hildebrandt AM, Chung J, Han X, Crary JF, McKee AC, Frosch MP, Stein TD. Repetitive head impacts and chronic traumatic encephalopathy are associated with TDP-43 inclusions and hippocampal sclerosis. Acta Neuropathol 2023; 145:395-408. [PMID: 36681782 DOI: 10.1007/s00401-023-02539-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is associated with advanced age as well as transactive response DNA-binding protein with 43 kDa (TDP-43) deposits. Both hippocampal sclerosis and TDP-43 proteinopathy have also been described in chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to exposure to repetitive head impacts (RHI). However, the prevalence of HS in CTE, the pattern of TDP-43 pathology, and associations of HS and TDP-43 with RHI are unknown. A group of participants with a history of RHI and CTE at autopsy (n = 401) as well as a group with HS-aging without CTE (n = 33) was examined to determine the prevalence of HS and TDP-43 inclusions in CTE and to compare the clinical and pathological features of HS and TDP-43 inclusions in CTE to HS-aging. In CTE, HS was present in 23.4%, and TDP-43 inclusions were present in 43.3% of participants. HS in CTE occurred at a relatively young age (mean 77.0 years) and was associated with a greater number of years of RHI than CTE without HS adjusting for age (p = 0.029). In CTE, TDP-43 inclusions occurred frequently in the frontal cortex and occurred both with and without limbic TDP-43. Additionally, structural equation modeling demonstrated that RHI exposure years were associated with hippocampal TDP-43 inclusions (p < 0.001) through increased CTE stage (p < 0.001). Overall, RHI and the development of CTE pathology may contribute to TDP-43 deposition and hippocampal sclerosis.
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Affiliation(s)
- Raymond Nicks
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Nathan F Clement
- C.S. Kubik Laboratory for Neuropathology, Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology and Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Zachery H Baucom
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Nurgul Aytan
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Kerry A Cormier
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Carol Kubilius
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Rebecca Mathias
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Sarah E Svirsky
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | - Morgan J Pothast
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
| | | | - Jaeyoon Chung
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Xudong Han
- Boston University Bioinformatics Graduate Program, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew P Frosch
- C.S. Kubik Laboratory for Neuropathology, Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, 02130, USA.
- VA Boston Healthcare System, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.
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Alosco ML, Tripodis Y, Baucom ZH, Adler CH, Balcer LJ, Bernick C, Mariani ML, Au R, Banks SJ, Barr WB, Wethe JV, Cantu RC, Coleman MJ, Dodick DW, McClean MD, McKee AC, Mez J, Palmisano JN, Martin B, Hartlage K, Lin AP, Koerte IK, Cummings JL, Reiman EM, Stern RA, Shenton ME, Bouix S. White matter hyperintensities in former American football players. Alzheimers Dement 2023; 19:1260-1273. [PMID: 35996231 PMCID: PMC10351916 DOI: 10.1002/alz.12779] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/24/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The presentation, risk factors, and etiologies of white matter hyperintensities (WMH) in people exposed to repetitive head impacts are unknown. We examined the burden and distribution of WMH, and their association with years of play, age of first exposure, and clinical function in former American football players. METHODS A total of 149 former football players and 53 asymptomatic unexposed participants (all men, 45-74 years) completed fluid-attenuated inversion recovery magnetic resonance imaging, neuropsychological testing, and self-report neuropsychiatric measures. Lesion Segmentation Toolbox estimated WMH. Analyses were performed in the total sample and stratified by age 60. RESULTS In older but not younger participants, former football players had greater total, frontal, temporal, and parietal log-WMH compared to asymptomatic unexposed men. In older but not younger former football players, greater log-WMH was associated with younger age of first exposure to football and worse executive function. DISCUSSION In older former football players, WMH may have unique presentations, risk factors, and etiologies. HIGHLIGHTS Older but not younger former football players had greater total, frontal, temporal, and parietal lobe white matter hyperintensities (WMH) compared to same-age asymptomatic unexposed men. Younger age of first exposure to football was associated with greater WMH in older but not younger former American football players. In former football players, greater WMH was associated with worse executive function and verbal memory.
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Affiliation(s)
- Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Zachary H. Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Laura J. Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV
- Department of Neurology, University of Washington, Seattle, WA
| | - Megan L. Mariani
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA
| | - Rhoda Au
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Sarah J. Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA
| | - William B. Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Jennifer V. Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Michael J. Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- VA Boston Healthcare System, Boston, MA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
| | - Joseph N. Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Kaitlin Hartlage
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Alexander P. Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Jeffrey L. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer’s Consortium, Phoenix, AZ
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
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McKee AC, Stein TD, Huber BR, Crary JF, Bieniek K, Dickson D, Alvarez VE, Cherry JD, Farrell K, Butler M, Uretsky M, Abdolmohammadi B, Alosco ML, Tripodis Y, Mez J, Daneshvar DH. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathol 2023; 145:371-394. [PMID: 36759368 PMCID: PMC10020327 DOI: 10.1007/s00401-023-02540-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
Over the last 17 years, there has been a remarkable increase in scientific research concerning chronic traumatic encephalopathy (CTE). Since the publication of NINDS-NIBIB criteria for the neuropathological diagnosis of CTE in 2016, and diagnostic refinements in 2021, hundreds of contact sport athletes and others have been diagnosed at postmortem examination with CTE. CTE has been reported in amateur and professional athletes, including a bull rider, boxers, wrestlers, and American, Canadian, and Australian rules football, rugby union, rugby league, soccer, and ice hockey players. The pathology of CTE is unique, characterized by a pathognomonic lesion consisting of a perivascular accumulation of neuronal phosphorylated tau (p-tau) variably alongside astrocytic aggregates at the depths of the cortical sulci, and a distinctive molecular structural configuration of p-tau fibrils that is unlike the changes observed with aging, Alzheimer's disease, or any other tauopathy. Computational 3-D and finite element models predict the perivascular and sulcal location of p-tau pathology as these brain regions undergo the greatest mechanical deformation during head impact injury. Presently, CTE can be definitively diagnosed only by postmortem neuropathological examination; the corresponding clinical condition is known as traumatic encephalopathy syndrome (TES). Over 97% of CTE cases published have been reported in individuals with known exposure to repetitive head impacts (RHI), including concussions and nonconcussive impacts, most often experienced through participation in contact sports. While some suggest there is uncertainty whether a causal relationship exists between RHI and CTE, the preponderance of the evidence suggests a high likelihood of a causal relationship, a conclusion that is strengthened by the absence of any evidence for plausible alternative hypotheses. There is a robust dose-response relationship between CTE and years of American football play, a relationship that remains consistent even when rigorously accounting for selection bias. Furthermore, a recent study suggests that selection bias underestimates the observed risk. Here, we present the advances in the neuropathological diagnosis of CTE culminating with the development of the NINDS-NIBIB criteria, the multiple international studies that have used these criteria to report CTE in hundreds of contact sports players and others, and the evidence for a robust dose-response relationship between RHI and CTE.
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Affiliation(s)
- Ann C McKee
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA.
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA.
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
| | - Thor D Stein
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Bertrand R Huber
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John F Crary
- Departments of Pathology, Neuroscience, and Artificial Intelligence and Human Health, Neuropathology Brain Bank and Research Core, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Bieniek
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dennis Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Jonathan D Cherry
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kurt Farrell
- Departments of Pathology, Neuroscience, and Artificial Intelligence and Human Health, Neuropathology Brain Bank and Research Core, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgane Butler
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease Research Center and CTE Centers, Department of Neurology, Boston University School of Medicine, 150 S Huntington Ave, Boston, MA, 02130, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Labadorf A, Agus F, Aytan N, Cherry J, Mez J, McKee A, Stein TD. Inflammation and neuronal gene expression changes differ in early versus late chronic traumatic encephalopathy brain. BMC Med Genomics 2023; 16:49. [PMID: 36895005 PMCID: PMC9996917 DOI: 10.1186/s12920-023-01471-5] [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: 08/10/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Our understanding of the molecular underpinnings of chronic traumatic encephalopathy (CTE) and its associated pathology in post-mortem brain is incomplete. Factors including years of play and genetic risk variants influence the extent of tau pathology associated with disease expression, but how these factors affect gene expression, and whether those effects are consistent across the development of disease, is unknown. METHODS To address these questions, we conducted an analysis of the largest post-mortem brain CTE mRNASeq whole-transcriptome dataset available to date. We examined the genes and biological processes associated with disease by comparing individuals with CTE with control individuals with a history of repetitive head impacts that lack CTE pathology. We then identified genes and biological processes associated with total years of play as a measure of exposure, amount of tau pathology present at time of death, and the presence of APOE and TMEM106B risk variants. Samples were stratified into low and high pathology groups based on McKee CTE staging criteria to model early versus late changes in response to exposure, and the relative effects associated with these factors were compared between these groups. RESULTS Substantial gene expression changes were associated with severe disease for most of these factors, primarily implicating diverse, strongly involved neuroinflammatory and neuroimmune processes. In contrast, low pathology groups had many fewer genes and processes implicated and show striking differences for some factors when compared with severe disease. Specifically, gene expression associated with amount of tau pathology showed a nearly perfect inverse relationship when compared between these two groups. CONCLUSIONS Together, these results suggest the early CTE disease process may be mechanistically different than what occurs in late stages, that total years of play and tau pathology influence disease expression differently, and that related pathology-modifying risk variants may do so via distinct biological pathways.
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Affiliation(s)
- Adam Labadorf
- Neurology, Boston University School of Medicine, Boston, MA USA
- Bioinformatics Program, Boston University, Boston, MA USA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA USA
- VA Boston Healthcare System, Boston, MA USA
| | - Filisia Agus
- Neurology, Boston University School of Medicine, Boston, MA USA
| | - Nurgul Aytan
- Neurology, Boston University School of Medicine, Boston, MA USA
- VA Boston Healthcare System, Boston, MA USA
| | - Jonathan Cherry
- Neurology, Boston University School of Medicine, Boston, MA USA
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA USA
| | - Jesse Mez
- Neurology, Boston University School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA USA
| | - Ann McKee
- Neurology, Boston University School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA USA
- Department of Veterans Affairs Medical Center, Medford, MA USA
| | - Thor D. Stein
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA USA
- Department of Veterans Affairs Medical Center, Medford, MA USA
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Alosco ML, Ly M, Mosaheb S, Saltiel N, Uretsky M, Tripodis Y, Martin B, Palmisano J, Delano-Wood L, Bondi MW, Meng G, Xia W, Daley S, Goldstein LE, Katz DI, Dwyer B, Daneshvar DH, Nowinski C, Cantu RC, Kowall NW, Stern RA, Alvarez VE, Mez J, Huber BR, McKee AC, Stein TD. Decreased myelin proteins in brain donors exposed to football-related repetitive head impacts. Brain Commun 2023; 5:fcad019. [PMID: 36895961 PMCID: PMC9990992 DOI: 10.1093/braincomms/fcad019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 03/09/2023] Open
Abstract
American football players and other individuals exposed to repetitive head impacts can exhibit a constellation of later-life cognitive and neuropsychiatric symptoms. While tau-based diseases such as chronic traumatic encephalopathy can underpin certain symptoms, contributions from non-tau pathologies from repetitive head impacts are increasingly recognized. We examined cross-sectional associations between myelin integrity using immunoassays for myelin-associated glycoprotein and proteolipid protein 1 with risk factors and clinical outcomes in brain donors exposed to repetitive head impacts from American football. Immunoassays for myelin-associated glycoprotein and proteolipid protein 1 were conducted on dorsolateral frontal white matter tissue samples of 205 male brain donors. Proxies of exposure to repetitive head impacts included years of exposure and age of first exposure to American football play. Informants completed the Functional Activities Questionnaire, Behavior Rating Inventory of Executive Function-Adult Version (Behavioral Regulation Index), and Barratt Impulsiveness Scale-11. Associations between myelin-associated glycoprotein and proteolipid protein 1 with exposure proxies and clinical scales were tested. Of the 205 male brain donors who played amateur and professional football, the mean age was 67.17 (SD = 16.78), and 75.9% (n = 126) were reported by informants to be functionally impaired prior to death. Myelin-associated glycoprotein and proteolipid protein 1 correlated with the ischaemic injury scale score, a global indicator of cerebrovascular disease (r = -0.23 and -0.20, respectively, Ps < 0.01). Chronic traumatic encephalopathy was the most common neurodegenerative disease (n = 151, 73.7%). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with chronic traumatic encephalopathy status, but lower proteolipid protein 1 was associated with more severe chronic traumatic encephalopathy (P = 0.03). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with other neurodegenerative disease pathologies. More years of football play was associated with lower proteolipid protein 1 [beta = -2.45, 95% confidence interval (CI) [-4.52, -0.38]] and compared with those who played <11 years of football (n = 78), those who played 11 or more years (n = 128) had lower myelin-associated glycoprotein (mean difference = 46.00, 95% CI [5.32, 86.69]) and proteolipid protein 1 (mean difference = 24.72, 95% CI [2.40, 47.05]). Younger age of first exposure corresponded to lower proteolipid protein 1 (beta = 4.35, 95% CI [0.25, 8.45]). Among brain donors who were aged 50 or older (n = 144), lower proteolipid protein 1 (beta = -0.02, 95% CI [-0.047, -0.001]) and myelin-associated glycoprotein (beta = -0.01, 95% CI [-0.03, -0.002]) were associated with higher Functional Activities Questionnaire scores. Lower myelin-associated glycoprotein correlated with higher Barratt Impulsiveness Scale-11 scores (beta = -0.02, 95% CI [-0.04, -0.0003]). Results suggest that decreased myelin may represent a late effect of repetitive head impacts that contributes to the manifestation of cognitive symptoms and impulsivity. Clinical-pathological correlation studies with prospective objective clinical assessments are needed to confirm our findings.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Monica Ly
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Sydney Mosaheb
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nicole Saltiel
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | | | - Weiming Xia
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah Daley
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - Douglas I Katz
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Robert C Cantu
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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40
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Abed V, Hawk GS, Akarakian R, Stone AV. Epidemiological analysis of concussions in youth ice hockey players: A national emergency room database study. Am J Emerg Med 2023; 67:130-134. [PMID: 36871481 DOI: 10.1016/j.ajem.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE To evaluate the epidemiology of concussions in youth ice hockey players. METHODS The National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during ice hockey participation in youth patients (4-21 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 7 categories: head-to-player, head-to-puck, head-to-ice, head-to-board/glass, head-to-stick, head-to-goal post, and unknown. Hospitalization rates were also tabulated. Linear regression models were used to assess changes in yearly concussion and hospitalization rates over the study period. Results from these models were reported using parameter estimates [with 95% confidence intervals (CI)] and the estimated Pearson correlation coefficient. Additionally, logistic regression was used to model the risk of hospitalization across the different cause categories. RESULTS A total of 819 ice hockey related concussions were analyzed between 2012 and 2021. The average age of our cohort was 13.4 years, with 89.3% (n = 731) of concussions occurring in males. The incidence of head-to-ice, head-to-board/glass, head-to-player, and head-to-puck concussion mechanisms decreased significantly over the study period (slope estimate = -2.1 concussions/year [CI: (-3.9, -0.2)], r = -0.675, p = 0.032), (slope estimate = -2.7 concussions/year [CI: (-4.3, -1.2)], r = -0.816, p = 0.004), (slope estimate = -2.2 concussions/year [CI: (-3.4, -1.0)], r = -0.832, p = 0.003), and (slope estimate = -0.4 concussions/year [CI: (-0.62, -0.09)], r = -0.768, p = 0.016), respectively. Majority of patients were discharged from the emergency department (ED) to their home, as only 20 people (2.4%) were hospitalized over our study period. The majority of concussions were due to head-to-ice (n = 285, 34.8%), followed by head-to-board/glass (n = 217, 26.5%) and head-to-player (n = 207, 25.3%). The most common cause for hospitalizations due to concussions was head-to-board/glass (n = 7, 35%), followed by head-to-player (n = 6, 30%) and head-to-ice (n = 5, 25%). CONCLUSION The most common mechanism of youth ice hockey concussions was head-to-ice in our 10-year study period, while head-to-board/glass was the most common cause of hospitalizations. IRB: This project did not require review by the institutional review board.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, United States of America.
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, United States of America.
| | - Roy Akarakian
- Department of Emergency Medicine, Keck School of Medicine of USC, United States of America.
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, United States of America.
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Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Hamblin MR, Fedoruk AE, Poole LG, Cheng C, Koo B. Transcranial Photobiomodulation Treatment: Significant Improvements in Four Ex-Football Players with Possible Chronic Traumatic Encephalopathy. J Alzheimers Dis Rep 2023; 7:77-105. [PMID: 36777329 PMCID: PMC9912826 DOI: 10.3233/adr-220022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background Chronic traumatic encephalopathy, diagnosed postmortem (hyperphosphorylated tau), is preceded by traumatic encephalopathy syndrome with worsening cognition and behavior/mood disturbances, over years. Transcranial photobiomodulation (tPBM) may promote improvements by increasing ATP in compromised/stressed cells and increasing local blood, lymphatic vessel vasodilation. Objective Aim 1: Examine cognition, behavior/mood changes Post-tPBM. Aim 2: MRI changes - resting-state functional-connectivity MRI: salience, central executive, default mode networks (SN, CEN, DMN); magnetic resonance spectroscopy, cingulate cortex. Methods Four ex-players with traumatic encephalopathy syndrome/possible chronic traumatic encephalopathy, playing 11- 16 years, received In-office, red/near-infrared tPBM to scalp, 3x/week for 6 weeks. Two had cavum septum pellucidum. Results The three younger cases (ages 55, 57, 65) improved 2 SD (p < 0.05) on three to six neuropsychological tests/subtests at 1 week or 1 month Post-tPBM, compared to Pre-Treatment, while the older case (age 74) improved by 1.5 SD on three tests. There was significant improvement at 1 month on post-traumatic stress disorder (PTSD), depression, pain, and sleep. One case discontinued narcotic pain medications and had reduced tinnitus. The possible placebo effect is unknown. At 2 months Post-tPBM, two cases regressed. Then, home tPBM was applied to only cortical nodes, DMN (12 weeks); again, significant improvements were seen. Significant correlations for increased SN functional connectivity (FC) over time, with executive function, attention, PTSD, pain, and sleep; and CEN FC, with verbal learning/memory, depression. Increased n-acetyl-aspartate (NAA) (oxygen consumption, mitochondria) was present in anterior cingulate cortex (ACC), parallel to less pain and PTSD. Conclusion After tPBM, these ex-football players improved. Significant correlations of increased SN FC and CEN FC with specific cognitive tests and behavior/mood ratings, plus increased NAA in ACC support beneficial effects from tPBM.
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Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Correspondence to: Margaret A. Naeser, PhD, VA Boston Healthcare System (12A), Jamaica Plain Campus, 150 So. Huntington Ave., Boston, MA 02130 USA. E-mail:
| | - Paula I. Martin
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael D. Ho
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - Maxine H. Krengel
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yelena Bogdanova
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey A. Knight
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,National Center for PTSD - Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa,Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Luke G. Poole
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - ChiaHsin Cheng
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
| | - BangBon Koo
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
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42
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Liang B, Alosco ML, Armañanzas R, Martin BM, Tripodis Y, Stern RA, Prichep LS. Long-Term Changes in Brain Connectivity Reflected in Quantitative Electrophysiology of Symptomatic Former National Football League Players. J Neurotrauma 2023; 40:309-317. [PMID: 36324216 PMCID: PMC9902050 DOI: 10.1089/neu.2022.0029] [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] [Indexed: 11/06/2022] Open
Abstract
Exposure to repetitive head impacts (RHI) has been associated with long-term disturbances in cognition, mood, and neurobehavioral dysregulation, and reflected in neuroimaging. Distinct patterns of changes in quantitative features of the brain electrical activity (quantitative electroencephalogram [qEEG]) have been demonstrated to be sensitive to brain changes seen in neurodegenerative disorders and in traumatic brain injuries (TBI). While these qEEG biomarkers are highly sensitive at time of injury, the long-term effects of exposure to RHI on brain electrical activity are relatively unexplored. Ten minutes of eyes closed resting EEG data were collected from a frontal and frontotemporal electrode montage (BrainScope Food and Drug Administration-cleared EEG acquisition device), as well as assessments of neuropsychiatric function and age of first exposure (AFE) to American football. A machine learning methodology was used to derive a qEEG-based algorithm to discriminate former National Football League (NFL) players (n = 87, 55.40 ± 7.98 years old) from same-age men without history of RHI (n = 68, 54.94 ± 7.63 years old), and a second algorithm to discriminate former players with AFE <12 years (n = 33) from AFE ≥12 years (n = 54). The algorithm separating NFL retirees from controls had a specificity = 80%, a sensitivity = 60%, and an area under curve (AUC) = 0.75. Within the NFL population, the algorithm separating AFE <12 from AFE ≥12 resulted in a sensitivity = 76%, a specificity = 52%, and an AUC = 0.72. The presence of a profile of EEG abnormalities in the NFL retirees and in those with younger AFE includes features associated with neurodegeneration and the disruption of neuronal transmission between regions. These results support the long-term consequences of RHI and the potential of EEG as a biomarker of persistent changes in brain function.
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Affiliation(s)
- Bo Liang
- BrainScope Company, Chevy Chase, Maryland, USA
| | - Michael L. Alosco
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Ruben Armañanzas
- BrainScope Company, Chevy Chase, Maryland, USA
- Institute for Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain
- Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Brett M. Martin
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University, Boston, Massachusetts, USA
| | - Robert A. Stern
- Boston University CTE Center, Boston University, Boston, Massachusetts, USA
- Department of Neurology, Boston University, Boston, Massachusetts, USA
- Departments of Neurosurgery and Anatomy & Neurobiology, Boston University, Boston, Massachusetts, USA
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43
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van Tonder R, Starling L, Surmon S, Viviers P, Kraak W, Boer PH, Jordaan E, Hendricks S, Stokes KA, Derman W, Brown JC. Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - a cross-sectional analytical study. Inj Prev 2023; 29:56-61. [PMID: 36600566 PMCID: PMC9887377 DOI: 10.1136/ip-2022-044714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Rugby union ('rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby. DESIGN Cross-sectional analytical study: 2018 (control-standard tackle height) and 2019 (intervention-lowered legal tackle height) seasons. SETTING South African collegiate student rugby competition. PARTICIPANTS Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year. INTERVENTION Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit. OUTCOME MEASURES Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables). RESULTS There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle. CONCLUSIONS Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.
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Affiliation(s)
- Riaan van Tonder
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa .,IOC Research Centre, Cape Town, South Africa
| | | | - Sean Surmon
- Maties Sport, Stellenbosch University, Stellenbosch, South Africa
| | - Pierre Viviers
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,Campus Health Service, Stellenbosch University, Stellenbosch, South Africa
| | - Wilbur Kraak
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Pieter-Henk Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK,Medical Services, Rugby Football Union, London, UK
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,IOC Research Centre, Cape Town, South Africa
| | - James Craig Brown
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,IOC Research Centre, Cape Town, South Africa
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44
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Kirsch D, Shah A, Dixon E, Kelley H, Cherry JD, Xia W, Daley S, Aytan N, Cormier K, Kubilus C, Mathias R, Alvarez VE, Huber BR, McKee AC, Stein TD. Vascular injury is associated with repetitive head impacts and tau pathology in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 2023; 82:127-139. [PMID: 36617181 PMCID: PMC9852946 DOI: 10.1093/jnen/nlac122] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head impacts (RHI) and characterized by perivascular hyperphosphorylated tau (p-tau) deposits. The role of vascular injury, blood-brain barrier leakage, and neuroinflammation in CTE pathogenesis is not well understood. We performed quantitative immunoassays for intercellular adhesion molecule 1 (ICAM1), vascular cellular adhesion molecule 1 (VCAM1), and C-reactive protein (CRP) within the postmortem dorsolateral frontal cortex of participants with and without a history of RHI and CTE (n = 156), and tested for associations with RHI, microgliosis, and tau pathology measures. Levels of vascular injury-associated markers ICAM1, VCAM1, and CRP were increased in CTE compared to RHI-exposed and -naïve controls. ICAM1 and CRP increased with RHI exposure duration (p < 0.01) and were associated with increased microglial density (p < 0.001) and tau pathology (AT8, p-tau396, p-tau202; p < 0.05). Histologically, there was significantly increased ICAM1 staining of the microvasculature, extracellular space, and astrocytes at the sulcal depths in high stage CTE compared to both low stage CTE and controls. Multifocal perivascular immunoreactivity for serum albumin was present in all RHI-exposed individuals. These findings demonstrate that vascular injury markers are associated with RHI exposure, duration, and microgliosis, are elevated in CTE, and increase with disease severity.
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Affiliation(s)
- Daniel Kirsch
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Erin Dixon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Hunter Kelley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jonathan D Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Sarah Daley
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nurgul Aytan
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kerry Cormier
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Carol Kubilus
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Rebecca Mathias
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Victor E Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann C McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
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Alosco ML, Su Y, Stein TD, Protas H, Cherry JD, Adler CH, Balcer LJ, Bernick C, Pulukuri SV, Abdolmohammadi B, Coleman MJ, Palmisano JN, Tripodis Y, Mez J, Rabinovici GD, Marek KL, Beach TG, Johnson KA, Huber BR, Koerte I, Lin AP, Bouix S, Cummings JL, Shenton ME, Reiman EM, McKee AC, Stern RA. Associations between near end-of-life flortaucipir PET and postmortem CTE-related tau neuropathology in six former American football players. Eur J Nucl Med Mol Imaging 2023; 50:435-452. [PMID: 36152064 PMCID: PMC9816291 DOI: 10.1007/s00259-022-05963-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Flourine-18-flortaucipir tau positron emission tomography (PET) was developed for the detection for Alzheimer's disease. Human imaging studies have begun to investigate its use in chronic traumatic encephalopathy (CTE). Flortaucipir-PET to autopsy correlation studies in CTE are needed for diagnostic validation. We examined the association between end-of-life flortaucipir PET and postmortem neuropathological measurements of CTE-related tau in six former American football players. METHODS Three former National Football League players and three former college football players who were part of the DIAGNOSE CTE Research Project died and agreed to have their brains donated. The six players had flortaucipir (tau) and florbetapir (amyloid) PET prior to death. All brains from the deceased participants were neuropathologically evaluated for the presence of CTE. On average, the participants were 59.0 (SD = 9.32) years of age at time of PET. PET scans were acquired 20.33 (SD = 13.08) months before their death. Using Spearman correlation analyses, we compared flortaucipir standard uptake value ratios (SUVRs) to digital slide-based AT8 phosphorylated tau (p-tau) density in a priori selected composite cortical, composite limbic, and thalamic regions-of-interest (ROIs). RESULTS Four brain donors had autopsy-confirmed CTE, all with high stage disease (n = 3 stage III, n = 1 stage IV). Three of these four met criteria for the clinical syndrome of CTE, known as traumatic encephalopathy syndrome (TES). Two did not have CTE at autopsy and one of these met criteria for TES. Concomitant pathology was only present in one of the non-CTE cases (Lewy body) and one of the CTE cases (motor neuron disease). There was a strong association between flortaucipir SUVRs and p-tau density in the composite cortical (ρ = 0.71) and limbic (ρ = 0.77) ROIs. Although there was a strong association in the thalamic ROI (ρ = 0.83), this is a region with known off-target binding. SUVRs were modest and CTE and non-CTE cases had overlapping SUVRs and discordant p-tau density for some regions. CONCLUSIONS Flortaucipir-PET could be useful for detecting high stage CTE neuropathology, but specificity to CTE p-tau is uncertain. Off-target flortaucipir binding in the hippocampus and thalamus complicates interpretation of these associations. In vivo biomarkers that can detect the specific p-tau of CTE across the disease continuum are needed.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yi Su
- Banner Alzheimer's Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Hillary Protas
- Banner Alzheimer's Institute, Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jonathan D Cherry
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Surya Vamsi Pulukuri
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Departments of Neurology, Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
| | - Inga Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
- NICUM (NeuroImaging Core Unit Munich), Ludwig Maximilians University, Munich, Germany
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- VA Boston Healthcare System, Boston, MA, USA
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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Schaffert J, Didehbani N, LoBue C, Hart J, Motes M, Rossetti H, Wilmoth K, Goette W, Lacritz L, Cullum CM. Neurocognitive outcomes of older National Football League retirees. Brain Inj 2022; 36:1364-1371. [PMID: 36437496 DOI: 10.1080/02699052.2022.2143567] [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: 11/29/2022]
Abstract
OBJECTIVE Determine if head-injury exposure relates to later-in-life cognitive decline in older National Football League (NFL) retirees. METHOD NFL retirees (aged 50+) with or without cognitive impairment underwent baseline (n = 53) and follow-up (n = 29; 13-59 months later) neuropsychological evaluations. Cognitively normal (CN) retirees (n = 26) were age- and education-matched to healthy controls (n = 26). Cognitively impaired (CI) retirees with mild cognitive impairment or dementia (n = 27) were matched to a clinical sample (CS) by age, sex, education, and diagnosis (n = 83). ANOVAs compared neuropsychological composites at baseline and over time between retirees and their matched groups. Regression models evaluated whether concussions, concussions with loss of consciousness (LOC), or games played predicted neuropsychological functioning. RESULTS At baseline, CN retirees had slightly worse memory than controls (MCN retirees = 50.69, SECN retirees = 1.320; MHealthy controls = 57.08, SEHealthy controls = 1.345; p = 0.005). No other group diferences were observed, and head-injury exposure did not predict neurocognitive performance at baseline or over time. CONCLUSIONS Head-injury exposure was not associated with later-in-life cognition, regardless of cognitive diagnosis. Some retirees may exhibit lower memory scores compared to age-matched peers, though this is of unclear clinical significance.
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Affiliation(s)
- Jeff Schaffert
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nyaz Didehbani
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian LoBue
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Hart
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Motes
- Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Heidi Rossetti
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristin Wilmoth
- Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Will Goette
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura Lacritz
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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47
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Butler MLMD, Dixon E, Stein TD, Alvarez VE, Huber B, Buckland ME, McKee AC, Cherry JD. Tau Pathology in Chronic Traumatic Encephalopathy is Primarily Neuronal. J Neuropathol Exp Neurol 2022; 81:773-780. [PMID: 35903039 PMCID: PMC9487650 DOI: 10.1093/jnen/nlac065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Millions of individuals are exposed to repetitive head impacts (RHI) each year through contact sports, military blast, and interpersonal violence. RHI is the major risk factor for developing chronic traumatic encephalopathy (CTE), a neurodegenerative tauopathy. Recent consensus criteria defined the pathognomonic lesion in CTE as perivascular, hyperphosphorylated tau (p-tau) in neuronal aggregates. Astroglial p-tau is an inconsistent supporting feature and not in itself diagnostic of CTE. This study quantitated the spatial and cellular distribution of p-tau pathology in postmortem dorsolateral frontal cortex of 150 individuals with CTE, from ages 21 to 80 years old, without comorbid pathology. p-Tau-immunoreactive cells were quantitated in the gray matter sulcus, crest, subpial region, and within pathognomonic CTE lesions. Significantly more neuronal p-tau than astrocytic p-tau was found across all cortical regions (p < 0.0001). Sulcal astrocytic p-tau was primarily (75%, p < 0.0001) localized to subpial regions as thorn-shaped astrocytes, a form of age-related tau astrogliopathy. Neuronal p-tau was significantly associated with age, years of RHI exposure, and CTE severity; astrocytic p-tau pathology was only significantly associated with age. These findings strongly support neuronal degeneration as a driving feature of CTE and will help inform future research and the development of fluid biomarkers for the detection of neuronal degeneration in CTE.
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Affiliation(s)
- Morgane L M D Butler
- From the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Erin Dixon
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thor D Stein
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Victor E Alvarez
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Bertrand Huber
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Ann C McKee
- From the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan D Cherry
- Send correspondence to: Jonathan D. Cherry, PhD, VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, USA; E-mail:
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48
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Baragi VM, Gattu R, Trifan G, Woodard JL, Meyers K, Halstead TS, Hipple E, Haacke EM, Benson RR. Neuroimaging Markers for Determining Former American Football Players at Risk for Alzheimer's Disease. Neurotrauma Rep 2022; 3:398-414. [PMID: 36204386 PMCID: PMC9531889 DOI: 10.1089/neur.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
NFL players, by virtue of their exposure to traumatic brain injury (TBI), are at higher risk of developing dementia and Alzheimer's disease (AD) than the general population. Early recognition and intervention before the onset of clinical symptoms could potentially avert/delay the long-term consequences of these diseases. Given that AD is thought to have a long pre-clinical incubation period, the aim of the current research was to determine whether former NFL players show evidence of incipient dementia in their structural imaging before diagnosis of AD. To identify neuroimaging markers of AD, against which former NFL players would be compared, we conducted a whole-brain volumetric analysis using a cohort of AD patients (ADNI clinical database) to produce a set of brain regions demonstrating sensitivity to early AD pathology (i.e., the “AD fingerprint”). A group of 46 former NFL players' brain magnetic resonance images were then interrogated using the AD fingerprint, that is, the former NFL subjects were compared volumetrically to AD patients using a T1-weighted magnetization-prepared rapid gradient echo sequence. The FreeSurfer image analysis suite (version 6.0) was used to obtain volumetric and cortical thickness data. The Automated Neuropsychological Assessment Metric-Version 4 was used to assess current cognitive functioning. A total of 55 brain regions demonstrated significant atrophy or ex vacuo dilatation bilaterally in AD patients versus controls. Of the 46 former NFL players, 41% demonstrated a greater than expected number of atrophied/dilated AD regions compared with age-matched controls, presumably reflecting AD pathology.
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Affiliation(s)
| | - Ramtilak Gattu
- Center for Neurological Studies, Dearborn, Michigan, USA
| | | | | | | | | | | | - Ewart Mark Haacke
- HUH-MR Research/Radiology, Wayne State University/Detroit Receiving Hospital, Detroit, Michigan, USA
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49
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Bellomo G, Piscopo P, Corbo M, Pupillo E, Stipa G, Beghi E, Vanacore N, Lacorte E. A systematic review on the risk of neurodegenerative diseases and neurocognitive disorders in professional and varsity athletes. Neurol Sci 2022; 43:6667-6691. [PMID: 35976476 PMCID: PMC9663371 DOI: 10.1007/s10072-022-06319-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/01/2022] [Indexed: 01/01/2023]
Abstract
Abstract
Objective
The aim of this systematic review (SR) was to gather all available epidemiological evidence on former participation in any type of sport, at a professional and varsity level, as a potential risk factor for neurodegenerative diseases (NDs) and neurocognitive disorders (NCDs).
Design
Systematic searches were performed on PubMed, the Cochrane databases, and the ISI Web of Knowledge databases. Included studies were assessed using the NOS checklist.
Eligibility criteria for selecting studies
All epidemiological studies reporting data on the possible association between a clinical diagnosis of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND), dementia or mild cognitive impairment (MCI), Parkinson’s disease (PD), chronic traumatic encephalopathy (CTE) at any stage and with any clinical pattern and the former participation in any types of sport at a varsity and professional level were included.
Results
Data from the 17 included studies showed a higher frequency of NDs and NCDs in former soccer and American football players. Updating the previous SR confirmed a higher frequency of ALS/MND in former soccer players. Data reported a significantly higher risk of dementia/AD in former soccer players, and of MCI in former American football players. Results also showed a significantly higher risk of PD in former soccer and American football players, and a significantly higher risk of CTE in former boxers and American football players.
Summary/conclusions
This SR confirmed a higher risk of NDs and NCDs in former professional/varsity athletes. However, the pathological mechanisms underlying this association remain unclear, and further high-quality studies should be performed to clarify whether the association could be sport specific.
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Affiliation(s)
- G Bellomo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - P Piscopo
- Department of Neurosciences, Italian National Institute of Health, Rome, Italy
| | - M Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - E Pupillo
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Stipa
- Clinical Neurophysiology Division, Neuroscience Department, S. Maria University Hospital, Terni, Italy
| | - E Beghi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - N Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - E Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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50
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Asken BM, Tanner JA, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, La Joie R, Iaccarino L, Soleimani-Meigooni D, Rojas JC, Gardner RC, Miller BL, Grinberg LT, Boxer AL, Kramer JH, Rabinovici GD. Plasma P-tau181 and P-tau217 in Patients With Traumatic Encephalopathy Syndrome With and Without Evidence of Alzheimer Disease Pathology. Neurology 2022; 99:e594-e604. [PMID: 35577574 PMCID: PMC9442622 DOI: 10.1212/wnl.0000000000200678] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic encephalopathy syndrome (TES) has overlapping clinical symptoms with Alzheimer disease (AD). AD pathology commonly co-occurs with chronic traumatic encephalopathy (CTE) pathology. There are currently no validated CTE biomarkers. AD-specific biomarkers such as plasma P-tau181 and P-tau217 may help to identify patients with TES who have AD pathology. METHODS We measured plasma P-tau181 and P-tau217 (Meso Scale Discovery electrochemiluminescence) in patients with TES, mild cognitive impairment/dementia with biomarker-confirmed AD ("AD"), and healthy controls ("HC"). Patients underwent amyloid-beta (Aβ)-PET and a subset underwent tau-PET using [18F]Flortaucipir. We compared plasma P-tau levels controlling for age and sex and also performed AUC analyses to evaluate the accuracy of group differentiation. In patients with TES, we evaluated associations between plasma P-tau, years of repetitive head impact exposure, and tau-PET. Four TES patients with autopsy-confirmed CTE were described qualitatively. RESULTS The sample included 131 participants (TES, N = 18; AD, N = 65; HC, N = 48). Aβ(+) patients with TES (N = 10), but not Aβ(-) TES, had significantly higher plasma P-tau levels than HC (P-tau181: p < 0.001, d = 1.34; P-tau217: p < 0.001, d = 1.59). There was a trend for Aβ(+) TES having higher plasma P-tau than Aβ(-) TES (P-tau181: p = 0.06, d = 1.06; P-tau217: p = 0.09, d = 0.93). AUC analyses showed good classification of Aβ(+) TES from HC for P-tau181 (AUC = 0.87 [0.71-1.00]) and P-tau217 (AUC = 0.93 [0.86-1.00]). Plasma P-tau217 showed fair differentiation of Aβ(+) TES from Aβ(-) TES (AUC = 0.79 [0.54-1.00], p = 0.04), whereas classification accuracy of P-tau181 was slightly lower and not statistically significant (AUC = 0.71 [0.46-0.96], p = 0.13). Patients with AD had higher tau-PET tracer uptake than Aβ(+) TES and were well differentiated using P-tau181 (AUC = 0.81 [0.68-0.94]) and P-tau217 (AUC = 0.86 [0.73-0.98]). Plasma P-tau correlated with the tau-PET signal in Aβ(+) TES but not in Aβ(-) TES, and there was no association between plasma P-tau and years of repetitive head impact exposure. TES patients with severe CTE and no AD at autopsy had low P-tau181 and P-tau217 levels. DISCUSSION Measuring P-tau181 and P-tau217 in plasma may be a feasible and scalable fluid biomarker for identifying AD pathology in TES. Low plasma P-tau levels may be used to increase clinical suspicion of CTE over AD as a primary pathology in TES. Currently, there is no support for P-tau181 or P-tau217 as in vivo biomarkers of CTE tau. Larger studies of patients with pathologically confirmed CTE are needed. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that (1) among patients with TES and abnormal Aβ-PET scans, elevated plasma P-tau can differentiate between affected individuals and HCs; (2) low plasma P-tau may help identify patients with TES who do not have Alzheimer; and (3) plasma P-tau181 and P-tau217 are not useful biomarkers of patients with TES who do not have AD.
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Affiliation(s)
- Breton M Asken
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco.
| | - Jeremy A Tanner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lawren VandeVrede
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - William G Mantyh
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Kaitlin B Casaletto
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam M Staffaroni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Renaud La Joie
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Leonardo Iaccarino
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - David Soleimani-Meigooni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Julio C Rojas
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Raquel C Gardner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Bruce L Miller
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lea T Grinberg
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam L Boxer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Joel H Kramer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Gil D Rabinovici
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
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