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Esagoff AI, Gifford MK, Narapareddy BR, Sair HI, Luna LP, Raj D, Shan G, Peters M, Bernick C. Prior football or rugby exposure and white matter signal abnormalities in professional male mixed martial arts fighters. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 39022864 DOI: 10.1080/00913847.2024.2382085] [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: 01/04/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND White matter signal abnormalities have been associated with traumatic brain injury (TBI) and repetitive head impacts (RHI) in contact sports (e.g. American football, rugby). However, previous studies of mixed martial arts (MMA) fighters from the Professional Fighters Brain Health Study have not found greater white matter signal abnormalities in fighters versus controls. OBJECTIVE This study aims to explore the varying white matter effects of football/rugby and MMA by analyzing how football/rugby history in mixed martial arts fighters may relate to white matter signal abnormalities, helping to further our understanding of sport-specific brain health risks. METHODS Baseline visits for 90 active, professional, male mixed martial arts fighters and 27 unexposed male controls were cross-sectionally analyzed. Wilcoxon and Kruskal-Wallis tests compared demographics and white matter signal abnormalities, and multivariable regression models examined the associations between football/rugby history and white matter signal abnormality burden in fighters, adjusting for age, education, race, fights, MRI scanner, and supratentorial volume. RESULTS 37/90 fighters had football/rugby history (mean: 4 years; range: 1-12 years). White matter signal abnormalities were significantly greater in fighters with football/rugby history compared to fighters without football/rugby history (Wilcoxon, p = 0.0190). Football/rugby history was significantly associated with white matter signal abnormality burden >75th percentile (OR: 12, CI: 3.3-61, p < 0.001) and >50th percentile (OR: 3.2, CI: 1.2-9.4, p = 0.024) in fighters. Years of football/rugby were also significantly associated with white matter signal abnormalities. CONCLUSION Our findings expand on previous literature by demonstrating a significant relationship between white matter signal abnormalities (WMSAs) and football/rugby history but not MMA. Furthermore, our study suggests an added risk for WMSAs in MMA fighters with a history of football/rugby. Future research should further evaluate WMSAs in contact sports, helping to inform athletes, regulatory bodies, and healthcare providers of the potential brain health risks of contact sports.
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Affiliation(s)
- Aaron I Esagoff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mia K Gifford
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Haris I Sair
- Department of Radiology and Radiological Science - Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Licia P Luna
- Department of Radiology and Radiological Science - Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divyaansh Raj
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guogen Shan
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew Peters
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Bryant BR, Esagoff AI, Young L, Kosyakova N, Bray MJC, Richey LN, Vohra V, Shan G, Schneider ALC, Peters ME, Bernick CB, Narapareddy BR. Association of Win-Loss Record With Neuropsychiatric Symptoms and Brain Health Among Professional Fighters. J Neuropsychiatry Clin Neurosci 2024; 36:118-124. [PMID: 38258377 DOI: 10.1176/appi.neuropsych.20230108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Repetitive head impacts in professional fighting commonly lead to head injuries. Increased exposure to repetitive head trauma, measured by the number of professional fights and years of fighting, has been associated with slower processing speed and smaller brain volumes. The impact of win-loss outcomes has been investigated in other sports, with several studies suggesting that individuals on losing teams experience more head injuries. Here, the authors hypothesized that fighters with a worse fight record would exhibit poorer brain health outcomes. METHODS The Professional Fighters Brain Health Study examined changes in neuropsychiatric symptoms, regional brain volume, and cognition among professional boxers and mixed martial arts fighters. These data were used to evaluate the relationship between win-loss ratios and brain health outcomes among professional fighters (N=212) by using validated neuropsychiatric symptom and cognitive measures and MRI data. RESULTS Retired fighters with a better record demonstrated more impulsiveness (B=0.21, df=48) and slower processing speed (B=-0.42, df=31). More successful fighters did not perform better than fighters with worse records on any neuropsychiatric or cognitive test. Retired fighters with better fight records had smaller brain volumes in the subcortical gray matter, anterior corpus callosum, left and right hippocampi, left and right amygdala, and left thalamus. More successful active fighters had a smaller left amygdala volume. CONCLUSIONS These findings suggest that among retired fighters, a better fight record was associated with greater impulsiveness, slower processing speed, and smaller brain volume in certain regions. This study shows that even successful fighters experience adverse effects on brain health.
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Affiliation(s)
- Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Aaron I Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Lisa Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Natalia Kosyakova
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Varun Vohra
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Guogen Shan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Andrea L C Schneider
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Charles B Bernick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
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