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Taghdiri F, Khodadadi M, Sadia N, Mushtaque A, Scott OFT, Hirsch‐Reinhagen V, Tator C, Wennberg R, Kovacs GG, Tartaglia MC. Unusual combinations of neurodegenerative pathologies with chronic traumatic encephalopathy (CTE) complicates clinical prediction of CTE. Eur J Neurol 2024; 31:e16259. [PMID: 38404144 PMCID: PMC11235773 DOI: 10.1111/ene.16259] [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: 09/23/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND PURPOSE Chronic traumatic encephalopathy (CTE) has gained widespread attention due to its association with multiple concussions and contact sports. However, CTE remains a postmortem diagnosis, and the link between clinical symptoms and CTE pathology is poorly understood. This study aimed to investigate the presence of copathologies and their impact on symptoms in former contact sports athletes. METHODS This was a retrospective case series design of 12 consecutive cases of former contact sports athletes referred for autopsy. Analyses are descriptive and include clinical history as well as the pathological findings of the autopsied brains. RESULTS All participants had a history of multiple concussions, and all but one had documented progressive cognitive, psychiatric, and/or motor symptoms. The results showed that 11 of the 12 participants had evidence of CTE in the brain, but also other copathologies, including different combinations of tauopathies, and other rare entities. CONCLUSIONS The heterogeneity of symptoms after repetitive head injuries and the diverse pathological combinations accompanying CTE complicate the prediction of CTE in clinical practice. It is prudent to consider the possibility of multiple copathologies when clinically assessing patients with repetitive head injuries, especially as they age, and attributing neurological or cognitive symptoms solely to presumptive CTE in elderly patients should be discouraged.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Mozhgan Khodadadi
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Nusrat Sadia
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Asma Mushtaque
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Olivia F. T. Scott
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Veronica Hirsch‐Reinhagen
- Division of NeuropathologyVancouver General HospitalVancouverBritish ColumbiaCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Charles Tator
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Richard Wennberg
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Laboratory Medicine ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders ClinicToronto Western HospitalTorontoOntarioCanada
| | - M. Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
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Polich G, Baslet G, O'Neal MA, Gupta R, Raynor LG. Functional Neurological Disorder Presenting After Concussion: A Retrospective Case Series. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230154. [PMID: 38720622 DOI: 10.1176/appi.neuropsych.20230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Although a majority of individuals recover from a concussion within weeks of the index injury, a substantial minority of patients report persistent postconcussion symptoms. Some of these symptoms may reflect a diagnosis of functional neurological disorder (FND). The authors evaluated the relationship between persistent postconcussion symptoms and FND symptoms. METHODS In this retrospective chart review, the authors characterized demographic and clinical information from 50 patients with a confirmed diagnosis of FND whose functional neurological symptoms started after a concussion. RESULTS Patients who developed FND after a concussion had high rates of baseline risk factors for both persistent postconcussion symptoms and FND. After the concussive event, functional neurological symptoms presented abruptly or developed insidiously over time. Functional neurological symptoms ranged widely and included gait symptoms, seizures, speech and language symptoms, weakness, sensory symptoms, tremors, and vision and oculomotor symptoms. CONCLUSIONS Functional neurological symptoms can arise after a concussion. FND should be considered in the differential diagnosis of individuals presenting with neurological symptoms beginning after a concussion. By failing to recognize functional symptoms, clinicians may inadvertently reinforce negative health-related beliefs regarding a patient's injured brain.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O'Neal), Brigham and Women's Hospital, Boston; Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor)
| | - Gaston Baslet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O'Neal), Brigham and Women's Hospital, Boston; Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor)
| | - Mary Angela O'Neal
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O'Neal), Brigham and Women's Hospital, Boston; Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor)
| | - Rishab Gupta
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O'Neal), Brigham and Women's Hospital, Boston; Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor)
| | - Lcdr Geoffrey Raynor
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston (Polich); Departments of Physical Medicine and Rehabilitation (Polich), Psychiatry (Baslet, Raynor), and Neurology (O'Neal), Brigham and Women's Hospital, Boston; Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston (Gupta); Department of Psychiatry, Naval Medical Center San Diego, San Diego (Raynor)
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3
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Farrell K, Iida MA, Cherry JD, Casella A, Stein TD, Bieniek KF, Walker JM, Richardson TE, White CL, Alvarez VE, Huber BR, Dickson DW, Insausti R, Dams-O'Connor K, McKee AC, Crary JF. Differential Vulnerability of Hippocampal Subfields in Primary Age-Related Tauopathy and Chronic Traumatic Encephalopathy. J Neuropathol Exp Neurol 2022; 81:781-789. [PMID: 36004533 PMCID: PMC9487677 DOI: 10.1093/jnen/nlac066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a tauopathy associated with repetitive mild head impacts characterized by perivascular hyperphosphorylated tau (p-tau) in neurofibrillary tangles (NFTs) and neurites in the depths of the neocortical sulci. In moderate to advanced CTE, NFTs accumulate in the hippocampus, potentially overlapping neuroanatomically with primary age-related tauopathy (PART), an age-related tauopathy characterized by Alzheimer disease-like tau pathology in the hippocampus devoid of amyloid plaques. We measured p-tau burden using positive-pixel counts on immunohistochemically stained and neuroanatomically segmented hippocampal tissue. Subjects with CTE had a higher total p-tau burden than PART subjects in all sectors (p = 0.005). Within groups, PART had significantly higher total p-tau burden in CA1/subiculum compared to CA3 (p = 0.02) and CA4 (p = 0.01) and total p-tau burden in CA2 trended higher than CA4 (p = 0.06). In CTE, total p-tau burden in CA1/subiculum was significantly higher than in the dentate gyrus; and CA2 also trended higher than dentate gyrus (p = 0.01, p = 0.06). When controlling for p-tau burden across the entire hippocampus, CA3 and CA4 had significantly higher p-tau burden in CTE than PART (p < 0.0001). These data demonstrate differences in hippocampal p-tau burden and regional distribution in CTE compared to PART that might be helpful in differential diagnosis and reveal insights into disease pathogenesis.
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Affiliation(s)
- Kurt Farrell
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan A Iida
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan D Cherry
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alicia Casella
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thor D Stein
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kevin F Bieniek
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jamie M Walker
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Timothy E Richardson
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victor E Alvarez
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand R Huber
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dennis W Dickson
- Departments of Pathology and Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Ricardo Insausti
- Human Neuroanatomy Laboratory, School of Medicine, University of Castilla-La Mancha, Albacete, Spain
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ann C McKee
- Department of Pathology, Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - John F Crary
- Departments of Pathology, Artificial Intelligence & Human Health, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Neuropathology Brain Bank & Research CoRE, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Filley CM, Arciniegas DB, Brenner LA, Anderson CA, Kelly JP. Chronic Traumatic Encephalopathy: A Clinical Perspective. J Neuropsychiatry Clin Neurosci 2019; 31:170-172. [PMID: 31012827 DOI: 10.1176/appi.neuropsych.18100223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Filley
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - David B Arciniegas
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - Lisa A Brenner
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - C Alan Anderson
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - James P Kelly
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
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6
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Leggieri MJ, Gupta RK, Hinds SR. International State-of-the-Science Meeting Exploring the Potential Relationship between Blast-Related Trauma and the Development of Chronic Traumatic Encephalopathy. J Neurotrauma 2019; 34:S1-S3. [PMID: 28937956 DOI: 10.1089/neu.2017.29013.introduction] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Leggieri
- US Department of Defense Blast Injury Research Program Coordinating Office, Fort Detrick, Maryland
| | - Raj K Gupta
- US Department of Defense Blast Injury Research Program Coordinating Office, Fort Detrick, Maryland
| | - Sidney R Hinds
- US Department of Defense Blast Injury Research Program Coordinating Office, Fort Detrick, Maryland
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7
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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8
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Brown S, O’Rourke S, Schwannauer M. Risk factors for inpatient violence and self-harm in forensic psychiatry: the role of head injury, schizophrenia and substance misuse. Brain Inj 2018; 33:313-321. [DOI: 10.1080/02699052.2018.1553064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sarah Brown
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Suzanne O’Rourke
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, The State Hospital, Carstairs, UK
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9
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Aldag M, Armstrong RC, Bandak F, Bellgowan PSF, Bentley T, Biggerstaff S, Caravelli K, Cmarik J, Crowder A, DeGraba TJ, Dittmer TA, Ellenbogen RG, Greene C, Gupta RK, Hicks R, Hoffman S, Latta RC, Leggieri MJ, Marion D, Mazzoli R, McCrea M, O'Donnell J, Packer M, Petro JB, Rasmussen TE, Sammons-Jackson W, Shoge R, Tepe V, Tremaine LA, Zheng J. The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review. J Neurotrauma 2018; 34:S26-S43. [PMID: 28937953 DOI: 10.1089/neu.2017.5218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The United States Department of Defense Blast Injury Research Program Coordinating Office organized the 2015 International State-of-the-Science meeting to explore links between blast-related head injury and the development of chronic traumatic encephalopathy (CTE). Before the meeting, the planning committee examined articles published between 2005 and October 2015 and prepared this literature review, which summarized broadly CTE research and addressed questions about the pathophysiological basis of CTE and its relationship to blast- and nonblast-related head injury. It served to inform participants objectively and help focus meeting discussion on identifying knowledge gaps and priority research areas. CTE is described generally as a progressive neurodegenerative disorder affecting persons exposed to head injury. Affected individuals have been participants primarily in contact sports and military personnel, some of whom were exposed to blast. The symptomatology of CTE overlaps with Alzheimer's disease and includes neurological and cognitive deficits, psychiatric and behavioral problems, and dementia. There are no validated diagnostic criteria, and neuropathological evidence of CTE has come exclusively from autopsy examination of subjects with histories of exposure to head injury. The perivascular accumulation of hyperphosphorylated tau (p-tau) at the depths of cortical sulci is thought to be unique to CTE and has been proposed as a diagnostic requirement, although the contribution of p-tau and other reported pathologies to the development of clinical symptoms of CTE are unknown. The literature on CTE is limited and is focused predominantly on head injuries unrelated to blast exposure (e.g., football players and boxers). In addition, comparative analyses of clinical case reports has been challenging because of small case numbers, selection biases, methodological differences, and lack of matched controls, particularly for blast-exposed individuals. Consequently, the existing literature is not sufficient to determine whether the development of CTE is associated with head injury frequency (e.g., single vs. multiple exposures) or head injury type (e.g., impact, nonimpact, blast-related). Moreover, the incidence and prevalence of CTE in at-risk populations is unknown. Future research priorities should include identifying additional risk factors, pursuing population-based longitudinal studies, and developing the ability to detect and diagnose CTE in living persons using validated criteria.
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Affiliation(s)
- Matt Aldag
- 1 Booz Allen Hamilton , McLean, Virginia
| | - Regina C Armstrong
- 2 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Faris Bandak
- 3 Defense Advanced Research Projects Agency , Arlington, Virginia
| | | | | | - Sean Biggerstaff
- 6 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | | | - Joan Cmarik
- 7 Office of the Principal Assistant for Acquisition, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Alicia Crowder
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | | | | | - Richard G Ellenbogen
- 10 Departments of Neurological Surgery and Global Health Medicine, University of Washington , Seattle, Washington
| | - Colin Greene
- 11 Joint Trauma Analysis and Prevention of Injuries in Combat Program, Frederick, Maryland
| | - Raj K Gupta
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | | | | | | | - Michael J Leggieri
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Donald Marion
- 16 Defense and Veterans Brain Injury Center , Silver Spring, Maryland
| | | | | | | | - Mark Packer
- 20 Hearing Center of Excellence , Lackland, Texas
| | - James B Petro
- 21 Office of the Assistant Secretary of Defense, Research and Engineering, Arlington, Virginia
| | - Todd E Rasmussen
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Wendy Sammons-Jackson
- 22 Office of the Principal Assistant for Research and Technology , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Richard Shoge
- 23 Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command , Fort Detrick, Maryland
| | | | | | - James Zheng
- 25 Program Executive Office Soldier , Fort Belvoir, Virginia
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Diekfuss JA, De Larwelle J, McFadden SH. Diagnosis makes a difference: Perceptions of older persons with dementia symptoms. Exp Aging Res 2018; 44:148-161. [PMID: 29400641 DOI: 10.1080/0361073x.2017.1422475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background/Study Context: Employing the stereotype content model and terror management theory, we examined whether stereotypes and feelings about persons with dementia vary depending on the type of dementia diagnosis and purported causes of the dementia. METHODS Participants were randomly assigned to read one of four vignettes that depicted a man who consulted his doctor because of memory problems. All vignettes described the same symptoms and diagnostic tests, but each of four groups read a different result: all tests normal (Normal); Alzheimer's disease (AD); Wernicke-Korsakoff Syndrome (WKS) associated with alcohol abuse; and chronic traumatic encephalopathy (CTE) associated with head injuries from playing football in high school and college. Measures included a word fragment completion task, a stereotype content scale, and an emotions scale. RESULTS Results showed no differences in the number of death-related words generated in the word fragment completion task and no differences in assessment of competence across the four groups. Those in the Normal, AD, and CTE groups evaluated the man as warmer than those in the WKS group. Participants in the AD condition showed more empathy than those in the WKS group. There were no differences in pity or fear but the CTE condition produced more envy and admiration and the WKS condition produced more contempt. CONCLUSION These results suggest that different forms of dementia elicit varying emotional and cognitive responses.
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Affiliation(s)
- Jed A Diekfuss
- a The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH
| | | | - Susan H McFadden
- c Department of Psychology , The University of Wisconsin Oshkosh , Oshkosh , WI
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11
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Mahar I, Alosco ML, McKee AC. Psychiatric phenotypes in chronic traumatic encephalopathy. Neurosci Biobehav Rev 2017; 83:622-630. [PMID: 28888534 DOI: 10.1016/j.neubiorev.2017.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder involving cognitive, motor, and psychiatrically-relevant symptoms resulting from repetitive head impacts. Psychiatric phenotypes of CTE, including depression and suicidality, present particular challenges for CTE research, given that the diagnosis requires postmortem neuropathological examination. The pathognomonic lesion of CTE is the perivascular accumulation of hyperphosphorylated tau (ptau) protein at the depths of cortical sulci. These lesions are found in the earliest disease stages, and with advancing pathological severity, ptau deposition occurs in widespread brain regions in a four-stage scheme of severity. We review the psychiatric phenotypes of individuals neuropathologically diagnosed with CTE, and suggest that earlier CTE stages hold particular interest for psychiatric CTE research. In the early CTE stages, there is ptau pathology in frontal cortex and axonal loss in the frontal white matter, followed by progressive ptau neurofibrillary degeneration in the amygdala and hippocampus. Neuropathological changes in the frontal and medial temporal lobes may underlie psychiatric phenotypes. Additional insight into the association between CTE pathology and psychiatric sequelae may come from advancements in in vivo methods of CTE detection. Further epidemiological, clinical, and postmortem studies are needed to validate the nature of psychiatric sequelae in CTE.
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Affiliation(s)
- Ian Mahar
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Dept. of Pathology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA.
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Yerramsetti AP, Simons DD, Coonan L, Stolar A. Veteran treatment courts: A promising solution. BEHAVIORAL SCIENCES & THE LAW 2017; 35:512-522. [PMID: 28913894 DOI: 10.1002/bsl.2308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Abstract
The high prevalence of substance use, traumatic brain injury, post-traumatic stress disorder, and other mental illness in the veteran population presents unique public health and social justice challenges. Veteran involvement in the justice system has been identified as a national concern. Criminal justice involvement compounds pre-existing socioeconomic stressors and further strains support systems. The point of contact with the criminal justice system, however, presents an opportunity to establish mental health treatment. This is consistent with the concept of the sequential intercept model that seeks to divert offenders with mental illness from the criminal justice system into treatment. In recent years, many jurisdictions have established veterans treatment courts (VTCs), a type of problem-solving court serving this diversion function for military veterans. This article presents an overview of the problem, the ethical basis for their development, a brief history of the courts, and their potential for success. The Harris County Veterans Court is presented as an example.
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Affiliation(s)
| | | | - Loretta Coonan
- Baylor College of Medicine, Houston, TX, U.S.A
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, U.S.A
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13
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Brix KA, Brody DL, Grimes JB, Yitzhak A, Working Group Members. Military Blast Exposure and Chronic Neurodegeneration: Summary of Working Groups and Expert Panel Findings and Recommendations. J Neurotrauma 2017. [DOI: 10.1089/neu.2017.5222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - David L. Brody
- Washington University School of Medicine, St. Louis, Missouri
| | - Jamie B. Grimes
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
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14
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Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, Castellani RJ, Turner M, Jordan BD, Randolph C, Dvořák J, Hayden KA, Tator CH, McCrory P, Iverson GL. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017; 51:969-977. [PMID: 28455362 PMCID: PMC5466926 DOI: 10.1136/bjsports-2017-097791] [Citation(s) in RCA: 389] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/14/2022]
Abstract
Objective Systematic review of possible long-term effects of sports-related concussion in retired athletes. Data sources Ten electronic databases. Study selection Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury. Data extraction Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors. Results Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes. Conclusion Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
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Affiliation(s)
- Geoff Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina, Chapel Hill, USA
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Co-Director, NorthShore Neurological Institute; University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Robert C Cantu
- Department of Neurosurgery, Emerson Hospital, Concord, MA, and Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, USA
| | - Rudolph J Castellani
- Center for Neuropathology, Western Michigan University, and Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Michael Turner
- The International Concussion and Head Injury Research Foundation, Marylebone, UK
| | | | | | - Jiří Dvořák
- Department of Nerology, University of Zurich, Schulthess Clinic, Swiss Concussion Center, Zurich, Switzerland
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Charles H Tator
- Canadian Concussion Centre, Toronto Western Hospital, University of Toronto, Krembil Neuroscience Centre, Toronto, Canada
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA
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15
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Rao V, Syeda A, Roy D, Peters ME, Vaishnavi S. Neuropsychiatric aspects of concussion: acute and chronic sequelae. ACTA ACUST UNITED AC 2017; 2:CNC29. [PMID: 30202570 PMCID: PMC6094361 DOI: 10.2217/cnc-2016-0018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 01/05/2023]
Abstract
Concussion – also known as mild traumatic brain injury – is a transient disturbance of neurological function resulting from traumatic forces imparted to the brain that often produce cognitive, behavioral and systemic symptoms. In this review of the literature, we discuss the pathophysiology of both acute and chronic neuropsychiatric sequelae of concussions, followed by a brief overview of evaluation and management of these sequelae.
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Affiliation(s)
- Vani Rao
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Arshiya Syeda
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Durga Roy
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Matthew E Peters
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Sandeep Vaishnavi
- The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA
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16
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Walker WC, Carne W, Franke LM, Nolen T, Dikmen SD, Cifu DX, Wilson K, Belanger HG, Williams R. The Chronic Effects of Neurotrauma Consortium (CENC) multi-centre observational study: Description of study and characteristics of early participants. Brain Inj 2016; 30:1469-1480. [DOI: 10.1080/02699052.2016.1219061] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Lehman EJ, Hein MJ, Gersic CM. Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons. Am J Sports Med 2016; 44:2486-2491. [PMID: 27159317 PMCID: PMC5048489 DOI: 10.1177/0363546516645093] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is current disagreement in the scientific literature about the relationship between playing football and suicide risk, particularly among professional players in the National Football League (NFL). While some research indicates players are at high risk of football-related concussions, which may lead to chronic traumatic encephalopathy and suicide, other research finds such a connection to be speculative and unsupported by methodologically sound research. PURPOSE To compare the suicide mortality of a cohort of NFL players to what would be expected in the general population of the United States. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A cohort of 3439 NFL players with at least 5 credited playing seasons between 1959 and 1988 was assembled for statistical analysis. The vital status for this cohort was updated through 2013. Standardized mortality ratios (SMRs), the ratio of observed deaths to expected deaths, and 95% CIs were computed for the cohort; 95% CIs that excluded unity were considered statistically significant. For internal comparison purposes, standardized rate ratios were calculated to compare mortality results between players stratified into speed and nonspeed position types. RESULTS Suicide among this cohort of professional football players was significantly less than would be expected in comparison with the United States population (SMR = 0.47; 95% CI, 0.24-0.82). There were no significant differences in suicide mortality between speed and nonspeed position players. CONCLUSION There is no indication of elevated suicide risk in this cohort of professional football players with 5 or more credited seasons of play. Because of the unique nature of this cohort, these study results may not be applicable to professional football players who played fewer than 5 years or to college or high school players.
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Affiliation(s)
- Everett J. Lehman
- Address correspondence to Everett J. Lehman, MS, c/o Douglas Trout, MD, National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Centers for Disease Control and Prevention, 4676 Columbia Parkway, R-12, Cincinnati, OH 45226, USA ()
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18
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Laker SR, Meron A, Greher MR, Wilson J. Retirement and Activity Restrictions Following Concussion. Phys Med Rehabil Clin N Am 2016; 27:487-501. [PMID: 27154858 DOI: 10.1016/j.pmr.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sport-related concussion is prevalent at all levels of play. Increased attention from sports media and scientific and medical communities has prompted players and physicians to explore the long-term effects of concussion and ask the questions of when and how players should begin to mitigate their concussion risk. The authors evaluate their risks from the perspective of epidemiology, symptomatology, neuropsychological performance, and biomechanics. The authors propose that there is not a set number of concussions that necessitates retirement in athletes and, aside from a few absolute contraindications to return to collision sport, return to play should be an individualized process.
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Affiliation(s)
- Scott R Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO 80045, USA.
| | - Adele Meron
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Michael R Greher
- University of Colorado School of Medicine, Department of Neurosurgery, Academic Office One, 12631 E. 17th Avenue, Suite 5001, Aurora, CO 80045, USA
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19
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Chronic Traumatic Encephalopathy and Traumatic Brain Injury: Bridging Pathology, Function, and Prognosis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Affiliation(s)
- Christopher M Filley
- From the Departments of Psychiatry and Neurology (C.M.F.), University of Colorado School of Medicine, Aurora; Denver Veterans Affairs Medical Center (C.M.F.), Denver, CO; and Lou Ruvo Center for Brain Health (C.B.), Cleveland Clinic, Cleveland, OH.
| | - Charles Bernick
- From the Departments of Psychiatry and Neurology (C.M.F.), University of Colorado School of Medicine, Aurora; Denver Veterans Affairs Medical Center (C.M.F.), Denver, CO; and Lou Ruvo Center for Brain Health (C.B.), Cleveland Clinic, Cleveland, OH
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21
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Su SH, Xu W, Li M, Zhang L, Wu YF, Yu F, Hai J. Elevated C-reactive protein levels may be a predictor of persistent unfavourable symptoms in patients with mild traumatic brain injury: a preliminary study. Brain Behav Immun 2014; 38:111-7. [PMID: 24456846 DOI: 10.1016/j.bbi.2014.01.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/27/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022] Open
Abstract
The pathogenesis of persistent unfavourable outcomes following mild traumatic brain injury (mTBI) are not fully understood. Low-grade systemic inflammation might contribute to the development of persistent unfavourable outcomes in patients with mTBI. We used plasma high-sensitivity C-reactive protein (CRP) levels as the biomarker of systemic inflammation to investigate whether elevated CRP levels were associated with persistent adverse outcomes in these patients. A total of 213 consecutive patients with mTBI were identified in our study. Plasma high-sensitivity CRP levels were measured at baseline, 1month, 2months and 3months after initial traumatic brain injury. The study endpoints included persistent postconcussion syndrome (PCS), persistent psychological problems (depression and anxiety), persistent physiological problems (frequent headache, nausea, insomnia, dizziness and fatigue) and persistent cognitive impairment, which were screened by International Classification of Diseases (ICD-10), diagnostic and statistical manual of mental disorders (DSM-IV), Beck anxiety inventory (BAI), Beck depression inventory (BDI) and montreal cognitive assessment (MoCA) 3months post-injury. The associations between baseline CRP levels and persistent unfavourable outcomes were estimated from multiple regression models adjusting for various confounding covariates. Elevated baseline CRP levels were associated with a significant increase in the incidence of persistent PCS (odds ratio [OR], 2.719; 95% confidence interval [CI], 1.609-4.594; p=0.000), persistent psychological problems (OR, 1.535; 95% CI, 1.063-2.216; p=0.022), and persistent cognitive impairment (OR, 1.687; 95% CI, 1.135-2.507; p=0.010). However, elevated CRP levels were not associated with persistent physiological problems (OR, 1.330; 95% CI, 0.905-1.956; p=0.146). Furthermore, three adjusted models did not essentially affect the OR of elevated CRP levels for these persistent unfavourable outcomes. Among patients with mTBI, baseline elevated CRP levels may be an independent predictor of persistent persistent PCS, psychological problems and cognitive impairment.
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Affiliation(s)
- Shao-Hua Su
- The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
| | - Wei Xu
- The Department of Trauma Center, Emergency, Shanghai Changning Central Hospital, Shanghai 200036, China
| | - Ming Li
- The Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Lin Zhang
- The Department of Neurosurgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200003, China
| | - Yi-Fang Wu
- The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Fei Yu
- The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Jian Hai
- The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
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22
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Tartaglia MC, Hazrati LN, Davis KD, Green REA, Wennberg R, Mikulis D, Ezerins LJ, Keightley M, Tator C. Chronic traumatic encephalopathy and other neurodegenerative proteinopathies. Front Hum Neurosci 2014; 8:30. [PMID: 24550810 PMCID: PMC3907709 DOI: 10.3389/fnhum.2014.00030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 01/14/2014] [Indexed: 12/14/2022] Open
Abstract
"Chronic traumatic encephalopathy" (CTE) is described as a slowly progressive neurodegenerative disease believed to result from multiple concussions. Traditionally, concussions were considered benign events and although most people recover fully, about 10% develop a post-concussive syndrome with persisting neurological, cognitive and neuropsychiatric symptoms. CTE was once thought to be unique to boxers, but it has now been observed in many different athletes having suffered multiple concussions as well as in military personal after repeated blast injuries. Much remains unknown about the development of CTE but its pathological substrate is usually tau, similar to that seen in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). The aim of this "perspective" is to compare and contrast clinical and pathological CTE with the other neurodegenerative proteinopathies and highlight that there is an urgent need for understanding the relationship between concussion and the development of CTE as it may provide a window into the development of a proteinopathy and thus new avenues for treatment.
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Affiliation(s)
- Maria Carmela Tartaglia
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - Lili-Naz Hazrati
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada ; Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, ON, Canada
| | - Karen D Davis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, University Health Network, University of Toronto Toronto, ON, Canada ; Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada ; Department of Surgery, University of Toronto Toronto, ON, Canada ; Institute of Medical Science, University of Toronto Toronto, ON, Canada
| | - Robin E A Green
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - David Mikulis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, The University of Toronto Toronto, ON, Canada
| | - Leo J Ezerins
- Canadian Sports Concussion Project Toronto, ON, Canada ; Executive Director, Canadian Football League Alumni Association Toronto, ON, Canada
| | - Michelle Keightley
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada ; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Occupational Science and Occupational Therapy, University of Toronto Toronto, ON, Canada ; Graduate Department of Rehabilitation Science, University of Toronto Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Charles Tator
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto Toronto, ON, Canada
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Chronic traumatic encephalopathy and suicide: a systematic review. BIOMED RESEARCH INTERNATIONAL 2013; 2013:424280. [PMID: 24328030 PMCID: PMC3847964 DOI: 10.1155/2013/424280] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/06/2013] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is a global health concern, and the recent literature
reports that a single mild TBI can result in chronic traumatic encephalopathy (CTE).
It has been suggested that CTE may lead to death by suicide, raising important prevention,
treatment, and policy implications. Thus, we conducted a systematic review of the
medical literature to answer the key question: What is the existing evidence
in support of a relationship between CTE and suicide? Systematic
searches of CTE and suicide yielded 85 unique abstracts. Seven articles were
identified for full text review. Only two case series met inclusion criteria and included
autopsies from 17 unique cases, 5 of whom died by suicide. Neither studies used blinding,
control cases, or systematic data collection regarding TBI exposure and/or
medical/neuropsychiatric history. The identified CTE literature revealed divergent
opinions regarding neuropathological elements of CTE and heterogeneity regarding
clinical manifestations. Overall quality of evidence regarding a relationship between
CTE and suicide was rated as very low using Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) criteria. Further studies of
higher quality and methodological rigor are needed to determine the existence and
nature of any relationship between CTE and suicide.
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