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Fortington LV, Cassidy JD, Castellani RJ, Gardner AJ, McIntosh AS, Austen M, Kerr ZY, Quarrie KL. Epidemiological Principles in Claims of Causality: An Enquiry into Repetitive Head Impacts (RHI) and Chronic Traumatic Encephalopathy (CTE). Sports Med 2024:10.1007/s40279-024-02102-4. [PMID: 39277838 DOI: 10.1007/s40279-024-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/17/2024]
Abstract
Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public.
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Affiliation(s)
- Lauren V Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rudolph J Castellani
- Division of Neuropathology, Northwestern University Feinberg School of Medicine and Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Chicago, IL, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew S McIntosh
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Michael Austen
- Australasian Faculty of Occupational and Environmental Medicine, Royal Australasian College of Physicians, Sydney, Australia
- Royal New Zealand College of Urgent Care, Auckland, New Zealand
- High Court of New Zealand, Auckland, New Zealand
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth L Quarrie
- New Zealand Rugby, 100 Molesworth Street, Wellington, New Zealand
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Auckland Bioengineering Institute (ABI), The University of Auckland, Auckland, Auckland, New Zealand
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Mund FK, Feddermann-Demont N, Welsch G, Schuenemann C, Fiehler J, Junge A, Reinsberger C. Heading during the season and its potential impact on brain structure and neurocognitive performance in high-level male football players: An observational study. J Sci Med Sport 2024; 27:603-609. [PMID: 38965004 DOI: 10.1016/j.jsams.2024.05.012] [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: 02/15/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES To investigate potential effects of heading on the neurocognitive performance and the white matter (WM) of the brain in high-level adult male football players. DESIGN Prospective longitudinal. METHODS Football players engaging in the highest football leagues in Germany were included. Neurocognitive performance tests and diffusion tensor imaging (DTI) were executed before and after the observation period. Video recordings of each training session and each match play during the observation period were analyzed regarding heading exposure and characteristics. Four DTI measures from tract-based spatial statistics (fractional anisotropy, mean, axial, and radial diffusivity) were investigated. Associations between heading variables and DTI and neurocognitive parameters were tested subsequently. RESULTS 8052 headers of 22 players (19.9 ± 2.7 years) were documented in a median of 16.9 months. The individual total heading number ranged from 57 to 943 (median: 320.5). Header characteristics differed between training sessions and matches. Neurocognitive performance (n = 22) and DTI measures (n = 14) showed no significant differences from pre- to post-test. After correction for multiple comparisons, no significant correlations with the total heading number were found. However, the change in fractional anisotropy in the splenium of the corpus callosum correlated significantly with the total amount of long-distance headers (Pearson's r = -0.884; p < 0.0001). CONCLUSIONS Over the median observation period of 16.9 months, DTI measures and neurocognitive performance remained unchanged. To elucidate the meaning of the association between individual change in fractional anisotropy and long-distance headers further investigations with larger samples, longer observations, and various cohorts regarding age and level of play are required.
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Affiliation(s)
- Franziska K Mund
- Institute of Sports Medicine, Department of Exercise and Health, Paderborn University, Germany
| | - Nina Feddermann-Demont
- Department of Neurology, University and University Hospital Zurich, Switzerland; BrainCare, Switzerland
| | - Götz Welsch
- Hamburger Sport-Verein, Germany; UKE Athleticum and Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Jens Fiehler
- Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Germany
| | - Astrid Junge
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Department of Exercise and Health, Paderborn University, Germany; Division of Sports Neurology & Neurosciences, Department of Neurology, Mass General Brigham, Boston, MA, USA.
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3
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Malcolm D. Some problems of research exploring sex differences in sport-related concussions: a narrative review. Res Sports Med 2024; 32:810-819. [PMID: 37856512 DOI: 10.1080/15438627.2023.2271604] [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: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
This narrative review scrutinizes research exploring sex-based differences in experiences of sport-related concussion. The article argues that the limitations of epidemiological studies identifying the greater incidence and severity of concussion among females require that these findings are read with caution. It secondly argues that the dominant explanations for these data are based on and extend historical tendencies to "other" female participation in sport and construct male experiences as the "norm". Finally, the article critiques policy recommendations related to these research findings, arguing that they are likely to embed rather than challenge sex inequality in sport, and that they are both impractical and unethical. While this commentary builds on a broader body of work advocating greater sex/gender equality in sports science research, the prominence of social concerns about concussions in sport makes the broader implications of the focus on sex and sport-related concussion particularly problematic and thus in need of redress.
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Affiliation(s)
- Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Bradbery E, Cairns R, Peek K. The relationship between header type and head acceleration during heading in male youth football players. Phys Ther Sport 2024; 70:36-43. [PMID: 39241394 DOI: 10.1016/j.ptsp.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To explore head impact magnitude (linear head acceleration and rotational velocity) during heading for four different header types in youth male footballers. A secondary objective was to explore whether head impact magnitude was influenced by player-related factors (i.e. age, neck strength). DESIGN An observational field-based research design was utilised for this research. PARTICIPANTS 27 youth male footballers (mean age14.81, SD1.88) from one football club. MAIN OUTCOME MEASURES Peak linear acceleration and peak angular velocity were measured during four different header types (two from 15-m and two from 5-m). Maximal isometric neck strength of each player was also assessed (flexors, extensors, left and right-side flexors). RESULTS Statistically significant differences were observed between header type and both peak linear acceleration (F(3,78) = 60.90, R2 = 0.76, p=<0.001) and peak angular velocity (F(3,78) = 43.63, R2 = 0.75, p=<0.001). In terms of players related factors, for linear acceleration, 6% (P = 0.008) of the variance was predicted by age, and for angular velocity, 12% (P = 0.003) was predicted by age, with neck strength accounting for <9% of the variance. CONCLUSIONS In this youth cohort, head impact magnitude during heading is influenced by the type of header being performed.
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Affiliation(s)
- Ewen Bradbery
- Australian Institute of Sport, Bruce, ACT, Australia; Newcastle Sports Medicine, Warners Bay, NSW, Australia.
| | - Ross Cairns
- Newcastle Sports Medicine, Warners Bay, NSW, Australia
| | - Kerry Peek
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Asken BM, Bove JM, Bauer RM, Tanner JA, Casaletto KB, Staffaroni AM, VandeVrede L, Alosco ML, Mez JB, Stern RA, Miller BL, Grinberg LT, Boxer AL, Gorno-Tempini ML, Rosen HJ, Rabinovici GD, Kramer JH. Clinical implications of head trauma in frontotemporal dementia and primary progressive aphasia. Alzheimers Res Ther 2024; 16:193. [PMID: 39210451 PMCID: PMC11363650 DOI: 10.1186/s13195-024-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications. METHODS We studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education). RESULTS Years of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p = .008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p = .003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p = .03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p = .009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p = .02, d = 1.1). CONCLUSIONS Lifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms.
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Affiliation(s)
- Breton M Asken
- Department of Clinical and Health Psychology, University of Florida, 1Florida Alzheimer's Disease Research Center, Fixel Institute for Neurological Diseases, PO Box 100165, Gainesville, FL, 32610, USA.
| | - Jessica M Bove
- Department of Clinical and Health Psychology, University of Florida, 1Florida Alzheimer's Disease Research Center, Fixel Institute for Neurological Diseases, PO Box 100165, Gainesville, FL, 32610, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, 1Florida Alzheimer's Disease Research Center, Fixel Institute for Neurological Diseases, PO Box 100165, 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
| | - Kaitlin B Casaletto
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 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, UCSF Alzheimer's Disease Research Center, 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, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Michael L Alosco
- Department of Neurology, Boston University, Boston University Alzheimer's Disease Research Center and CTE Center, 73 E. Concord Street, Boston, MA, 02118, USA
| | - Jesse B Mez
- Department of Neurology, Boston University, Boston University Alzheimer's Disease Research Center and CTE Center, 73 E. Concord Street, Boston, MA, 02118, USA
| | - Robert A Stern
- Department of Neurology, Boston University, Boston University Alzheimer's Disease Research Center and CTE Center, 73 E. Concord Street, Boston, MA, 02118, USA
| | - Bruce L Miller
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Lea T Grinberg
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Adam L Boxer
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Howie J Rosen
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 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, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Joel H Kramer
- Department of Neurology, Weill Institute for Neurosciences Memory and Aging Center, University of California, San Francisco, UCSF Alzheimer's Disease Research Center, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
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Grotewold N, Albin RL. Update: Protective and risk factors for Parkinson disease. Parkinsonism Relat Disord 2024; 125:107026. [PMID: 38879999 DOI: 10.1016/j.parkreldis.2024.107026] [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] [Received: 01/25/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
We review the epidemiologic literature on potential protective and risk factors in Parkinson's Disease (PD). Prior research identified numerous possible protective and risk factors. Potential protective factors include tobacco abuse, physical activity, urate levels, NSAID use, calcium channel blocker use, statin use, and use of some α1-adrenergic antagonists. Some potential protective factors could be products of reverse causation, including increased serum urate, tobacco abuse, and coffee-tea-caffeine consumption. Potential risk factors include traumatic brain injury, pesticide exposure, organic solvent exposure, lead exposure, air pollution, Type 2 Diabetes, some dairy products, cardiovascular disease, and some infections including Hepatitis C, H. pylori, and COVID-19. Potential non-environmental risk factors include bipolar disorder, essential tremor, bullous pemphigoid, and inflammatory bowel disease. There is an inverse relationship with PD and risk of most cancers. Though many potential protective and risk factors for PD were identified, research has not yet led to unique, rigorous prevention trials or successful disease-modifying interventions. While efforts to reduce exposure to some industrial toxicants are well justified, PD incidence might be most effectively reduced by mitigation of risks, such as Type 2 Diabetes, air pollution, traumatic brain injury, or physical inactivity, that are general public health intervention targets.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC & Neurology Service, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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7
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Parsanejad E, McKay MJ, Ross AG, Pappas E, Peek K. Heading in Football: insights from stakeholders in amateur football. SCI MED FOOTBALL 2024; 8:212-221. [PMID: 37293855 DOI: 10.1080/24733938.2023.2224282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
Despite emerging research questioning the long-term effect of purposeful heading on players' brain health, heading-related perspectives and behaviours of stakeholders in amateur football in Australia (a country without heading guidelines) remain unknown. This study aimed to explore the current heading-related perspectives and behaviours of football stakeholders. In total, 290 players (aged over 11 years), 54 coaches, 34 non-coaching staff and 14 medical staff completed the survey. Of the 290 players, 56.5% reported being formally trained in heading, with female players less likely to be trained than male players (p < 0.05). Players were the least concerned about the long-term effects of heading, while medical staff were the most concerned (33.1% and 57.1%, respectively). From proposed strategies to reduce heading burden, a heading ban for all ages was least popular (2.3%), while teaching heading technique was most popular (67.3%). Our study provides insights into football stakeholders' heading-related perspectives, which could be used, along with scientific evidence, to inform pragmatic future heading guidelines.
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Affiliation(s)
- Elia Parsanejad
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marnee J McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew G Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Evangelos Pappas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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8
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Jung LB, Wiegand TLT, Tuz-Zahra F, Tripodis Y, Iliff JJ, Piantino J, Arciniega H, Kim CL, Pankatz L, Bouix S, Lin AP, Alosco ML, Daneshvar DH, Mez J, Sepehrband F, Rathi Y, Pasternak O, Coleman MJ, Adler CH, Bernick C, Balcer L, Cummings JL, Reiman EM, Stern RA, Shenton ME, Koerte IK. Repetitive Head Impacts and Perivascular Space Volume in Former American Football Players. JAMA Netw Open 2024; 7:e2428687. [PMID: 39186275 DOI: 10.1001/jamanetworkopen.2024.28687] [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] [Indexed: 08/27/2024] Open
Abstract
Importance Exposure to repetitive head impacts (RHI) is associated with increased risk for neurodegeneration. Accumulation of toxic proteins due to impaired brain clearance is suspected to play a role. Objective To investigate whether perivascular space (PVS) volume is associated with lifetime exposure to RHI in individuals at risk for RHI-associated neurodegeneration. Design, Setting, and Participants This cross-sectional study was part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project, a 7-year multicenter study consisting of 4 US study sites. Data were collected from September 2016 to February 2020 and analyses were performed between May 2021 and October 2023. After controlling for magnetic resonance image (MRI) and processing quality, former American football players and unexposed asymptomatic control participants were included in analyses. Exposure Prior exposure to RHI while participating in American football was estimated using the 3 cumulative head impact indices (CHII-G, linear acceleration; CHII-R, rotational acceleration; and CHII, number of head impacts). Main Outcomes and Measures Individual PVS volume was calculated in the white matter of structural MRI. Cognitive impairment was based on neuropsychological assessment. Linear regression models were used to assess associations of PVS volume with neuropsychological assessments in former American football players. All analyses were adjusted for confounders associated with PVS volume. Results Analyses included 224 participants (median [IQR] age, 57 [51-65] years), with 170 male former football players (114 former professional athletes, 56 former collegiate athletes) and 54 male unexposed control participants. Former football players had larger PVS volume compared with the unexposed group (mean difference, 0.28 [95% CI, 0.00-0.56]; P = .05). Within the football group, PVS volume was associated with higher CHII-R (β = 2.71 × 10-8 [95% CI, 0.50 × 10-8 to 4.93 × 10-8]; P = .03) and CHII-G (β = 2.24 × 10-6 [95% CI, 0.35 × 10-6 to 4.13 × 10-6]; P = .03). Larger PVS volume was also associated with worse performance on cognitive functioning in former American football players (β = -0.74 [95% CI, -1.35 to -0.13]; P = .04). Conclusions and Relevance These findings suggest that impaired perivascular brain clearance, as indicated by larger PVS volume, may contribute to the association observed between RHI exposure and neurodegeneration.
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Affiliation(s)
- Leonard B Jung
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tim L T Wiegand
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey J Iliff
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Neurology, University of Washington School of Medicine, Seattle
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Juan Piantino
- Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland
| | - Hector Arciniega
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York
| | - Cara L Kim
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lara Pankatz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Département de génie logiciel et TI, École de technologie supérieure, Université du Québec, Montreal, Canada
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Farshid Sepehrband
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona Scottsdale, Arizona
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
| | - Laura Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
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Huber CM, Patton DA, Maheshwari J, Zhou Z, Kleiven S, Arbogast KB. Finite element brain deformation in adolescent soccer heading. Comput Methods Biomech Biomed Engin 2024; 27:1239-1249. [PMID: 37477178 PMCID: PMC10799973 DOI: 10.1080/10255842.2023.2236746] [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: 01/03/2023] [Revised: 02/27/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
Finite element (FE) modeling provides a means to examine how global kinematics of repetitive head loading in sports influences tissue level injury metrics. FE simulations of controlled soccer headers in two directions were completed using a human head FE model to estimate biomechanical loading on the brain by direction. Overall, headers were associated with 95th percentile peak maximum principal strains up to 0.07 and von Mises stresses up to 1450 Pa, and oblique headers trended toward higher values than frontal headers but below typical injury levels. These quantitative data provide insight into repetitive loading effects on the brain.
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Affiliation(s)
- Colin M. Huber
- Department of Bioengineeing, University of Pennsylvania, Philadelphia, United States of America
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Zhou Zhou
- Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Svein Kleiven
- Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
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10
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Huber CM, Thakore AD, Oeur RA, Margulies SS. Distinct Serum Glial Fibrillary Acidic Protein and Neurofilament Light Time-Courses After Rapid Head Rotations. J Neurotrauma 2024; 41:1914-1928. [PMID: 38698671 DOI: 10.1089/neu.2023.0660] [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: 05/05/2024] Open
Abstract
Traumatic brain injury (TBI) causes significant neurophysiological deficits and is typically associated with rapid head accelerations common in sports-related incidents and automobile accidents. There are over 1.5 million TBIs in the United States each year, with children aged 0-4 being particularly vulnerable. TBI diagnosis is currently achieved through interpretation of clinical signs and symptoms and neuroimaging; however, there is increasing interest in minimally invasive fluid biomarkers to detect TBI objectively across all ages. Pre-clinical porcine models offer controlled conditions to evaluate TBI with known biomechanical conditions and without comorbidities. The objective of the current study was to establish pediatric porcine healthy reference ranges (RRs) of common human serum TBI biomarkers and to report their acute time-course after nonimpact rotational head injury. A retrospective analysis was completed to quantify biomarker concentrations in porcine serum samples collected from 4-week-old female (n = 215) and uncastrated male (n = 6) Yorkshire piglets. Subjects were assigned to one of three experimental groups (sham, sagittal-single, sagittal-multiple) or to a baseline only group. A rapid nonimpact rotational head injury model was used to produce mild-to-moderate TBI in piglets following a single rotation and moderate-to-severe TBI following multiple rotations. The Quanterix Simoa Human Neurology 4-Plex A assay was used to quantify glial fibrillary acidic protein (GFAP), neurofilament light (Nf-L), tau, and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1). The 95% healthy RRs for females were calculated and validated for GFAP (6.3-69.4 pg/mL), Nf-L (9.5-67.2 pg/mL), and UCH-L1 (3.8-533.7 pg/mL). Rising early, GFAP increased significantly above the healthy RRs for sagittal-single (to 164 and 243 pg/mL) and increased significantly higher in sagittal-multiple (to 494 and 413 pg/mL) groups at 30 min and 1 h postinjury, respectively, returning to healthy RRs by 1-week postinjury. Rising later, Nf-L increased significantly above the healthy RRs by 1 day in sagittal-single (to 69 pg/mL) and sagittal-multiple groups (to 140 pg/mL) and rising further at 1 week (single = 231 pg/mL, multiple = 481 pg/mL). Sagittal-single and sagittal-multiple UCH-L1 serum samples did not differ from shams or the healthy RRs. Sex differences were observed but inconsistent. Serum GFAP and Nf-L levels had distinct time-courses following head rotations in piglets, and both corresponded to load exposure. We conclude that serum GFAP and Nf-L offer promise for early TBI diagnosis and intervention decisions for TBI and other neurological trauma.
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Affiliation(s)
- Colin M Huber
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University Atlanta, Atlanta, Georgia, USA
| | - Akshara D Thakore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University Atlanta, Atlanta, Georgia, USA
| | - R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University Atlanta, Atlanta, Georgia, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University Atlanta, Atlanta, Georgia, USA
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11
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Dooley J, Hughes JG, Needham EJ, Palios KA, Liston A. The potential of gene delivery for the treatment of traumatic brain injury. J Neuroinflammation 2024; 21:183. [PMID: 39069631 DOI: 10.1186/s12974-024-03156-x] [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: 04/01/2024] [Accepted: 06/17/2024] [Indexed: 07/30/2024] Open
Abstract
Therapeutics for traumatic brains injuries constitute a global unmet medical need. Despite the advances in neurocritical care, which have dramatically improved the survival rate for the ~ 70 million patients annually, few treatments have been developed to counter the long-term neuroinflammatory processes and accompanying cognitive impairments, frequent among patients. This review looks at gene delivery as a potential therapeutic development avenue for traumatic brain injury. We discuss the capacity of gene delivery to function in traumatic brain injury, by producing beneficial biologics within the brain. Gene delivery modalities, promising vectors and key delivery routes are discussed, along with the pathways that biological cargos could target to improve long-term outcomes for patients. Coupling blood-brain barrier crossing with sustained local production, gene delivery has the potential to convert proteins with useful biological properties, but poor pharmacodynamics, into effective therapeutics. Finally, we review the limitations and health economics of traumatic brain injury, and whether future gene delivery approaches will be viable for patients and health care systems.
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Affiliation(s)
- James Dooley
- Department of Pathology, University of Cambridge, Cambridge, UK.
| | - Jasmine G Hughes
- Department of Pathology, University of Cambridge, Cambridge, UK
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Edward J Needham
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | | | - Adrian Liston
- Department of Pathology, University of Cambridge, Cambridge, UK
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12
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Svenstrup M, Hougaard DD. Do high-risk head trauma sports athletes have impaired vestibular function? Am J Otolaryngol 2024; 45:104429. [PMID: 39094207 DOI: 10.1016/j.amjoto.2024.104429] [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: 05/20/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The primary aim of this study was to examine the vestibular function of athletes involved in high-risk head trauma sports by means of complete vHIT testing of all six semicircular canals (SCCs). The secondary objective was to investigate whether the vestibular function is significantly reduced among athletes within certain high-risk sports. METHODS A prospective cross-sectional study of 137 adult athletes in football, handball, boxing, horseback riding, and ice hockey with a minimum of one reported sports-related head injury within the past five years. All subjects underwent screening with a complete examination of all six SCCs with vHIT and fulfillment of the dizziness handicap inventory (DHI). RESULTS Two subjects (1.5 %) fulfilled the criteria of having a pathological vHIT. Some degree of impairment of the vestibular function was seen when data was divided into individual sports and time since the last head injury. Likewise, no subjective dizziness was seen in the group of athletes when evaluated by total DHI scores. This score did not differ significantly between groups when subgrouped into number of head injuries or time since the last head injury. When divided into type of sport, total DHI scores differed significantly between groups. These total DHI-scores did, however, all fall within the range of the "no dizziness handicap" classification. CONCLUSION The results suggest that the vestibular function of athletes in high-risk head trauma sports is unaffected by the practice of a high-risk head trauma sport. Therefore, vHIT has no clinical utility in the assessment of a sports-related concussion (SRC) in athletes with no subjective feeling of dizziness.
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Affiliation(s)
- Mads Svenstrup
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Dan Dupont Hougaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Balance & Dizziness Centre, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
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13
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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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14
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Alanazi N, Fitzgerald M, Hume P, Hellewell S, Horncastle A, Anyaegbu C, Papini MG, Hargreaves N, Halicki M, Entwistle I, Hind K, Chazot P. Concussion-Related Biomarker Variations in Retired Rugby Players and Implications for Neurodegenerative Disease Risk: The UK Rugby Health Study. Int J Mol Sci 2024; 25:7811. [PMID: 39063053 PMCID: PMC11276902 DOI: 10.3390/ijms25147811] [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: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
The health and well-being of retired rugby union and league players, particularly regarding the long-term effects of concussions, are of major concern. Concussion has been identified as a major risk factor for neurodegenerative diseases, such as Alzheimer's and Amyotrophic Lateral Sclerosis (ALS), in athletes engaged in contact sports. This study aimed to assess differences in specific biomarkers between UK-based retired rugby players with a history of concussion and a non-contact sports group, focusing on biomarkers associated with Alzheimer's, ALS, and CTE. We randomly selected a sample of male retired rugby or non-contact sport athletes (n = 56). The mean age was 41.84 ± 6.44, and the mean years since retirement from the sport was 7.76 ± 6.69 for participants with a history of substantial concussions (>5 concussions in their career) (n = 30). The mean age was 45.75 ± 11.52, and the mean years since retirement was 6.75 ± 4.64 for the healthy controls (n = 26). Serum biomarkers (t-tau, RBP-4, SAA, Nf-L, and retinol), plasma cytokines, and biomarkers associated with serum-derived exosomes (Aβ42, p-tau181, p-tau217, and p-tau231) were analyzed using validated commercial ELISA assays. The results of the selected biomarkers were compared between the two groups. Biomarkers including t-tau and p-tau181 were significantly elevated in the history of the substantial concussion group compared to the non-contact sports group (t-tau: p < 0.01; p-tau181: p < 0.05). Although between-group differences in p-tau217, p-tau231, SAA, Nf-L, retinol, and Aβ42 were not significantly different, there was a trend for higher levels of Aβ42, p-tau217, and p-tau231 in the concussed group. Interestingly, the serum-derived exosome sizes were significantly larger (p < 0.01), and serum RBP-4 levels were significantly reduced (p < 0.05) in the highly concussed group. These findings indicate that retired athletes with a history of multiple concussions during their careers have altered serum measurements of exosome size, t-tau, p-tau181, and RBP-4. These biomarkers should be explored further for the prediction of future neurodegenerative outcomes, including ALS, in those with a history of concussion.
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Affiliation(s)
- Norah Alanazi
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Patria Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, AUT Millennium, 17 Antares Place, Mairangi Bay, Private Bag 92006, Auckland 1142, New Zealand;
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Technology and Policy Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Sarah Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Alex Horncastle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Chidozie Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Melissa G. Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Natasha Hargreaves
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Michal Halicki
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Ian Entwistle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Karen Hind
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Paul Chazot
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
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15
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Recht G, Hou J, Buddenbaum C, Cheng H, Newman SD, Saykin AJ, Kawata K. Multiparameter cortical surface morphology in former amateur contact sport athletes. Cereb Cortex 2024; 34:bhae301. [PMID: 39077916 DOI: 10.1093/cercor/bhae301] [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: 04/26/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
The lifetime effects of repetitive head impacts have captured considerable public and scientific interest over the past decade, yet a knowledge gap persists in our understanding of midlife neurological well-being, particularly in amateur level athletes. This study aimed to identify the effects of lifetime exposure to sports-related head impacts on brain morphology in retired, amateur athletes. This cross-sectional study comprised of 37 former amateur contact sports athletes and 21 age- and sex-matched noncontact athletes. High-resolution anatomical, T1 scans were analyzed for the cortical morphology, including cortical thickness, sulcal depth, and sulcal curvature, and cognitive function was assessed using the Dementia Rating Scale-2. Despite no group differences in cognitive functions, the contact group exhibited significant cortical thinning particularly in the bilateral frontotemporal regions and medial brain regions, such as the cingulate cortex and precuneus, compared to the noncontact group. Deepened sulcal depth and increased sulcal curvature across all four lobes of the brain were also notable in the contact group. These data suggest that brain morphology of middle-aged former amateur contact athletes differs from that of noncontact athletes and that lifetime exposure to repetitive head impacts may be associated with neuroanatomical changes.
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Affiliation(s)
- Grace Recht
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
| | - Jiancheng Hou
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
- Research Center for Cross-Straits Cultural Development, Fujian Normal University, Cangshan Campus, No. 8 Shangshan Road, Cangshan District, Fuzhou, Fujian 350007, China
| | - Claire Buddenbaum
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
| | - Hu Cheng
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, 1101 E. 10th Street, Bloomington, IN 47405, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, United States
| | - Sharlene D Newman
- Alabama Life Research Institute, College of Arts & Sciences, University of Alabama, 211 Peter Bryce Blvd., Tuscaloosa, AL 35401, United States
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, United States
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd, Indianapolis, IN 46202, United States
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, United States
- Department of Pediatrics, Indiana University School of Medicine, 1130 W Michigan St, Indianapolis, IN 46202, United States
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16
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McCarthy S, Gulabivala K, St George G, Harvey S, Ng YL. Endodontic sequelae associated with repetitive impacts to the dentofacial region during boxing activities. Int Endod J 2024. [PMID: 39031867 DOI: 10.1111/iej.14111] [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: 12/21/2023] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 07/22/2024]
Abstract
AIM To explore self-reported dentofacial trauma and their potential endodontic sequelae in boxers using a questionnaire, followed by clinical and radiographic assessment to (1) compare the nature and number of self-reported dentofacial injuries with physical evidence of injury sequelae; and (2) investigate potential risk factors influencing dentofacial trauma and their endodontic sequelae. METHODOLOGY A focus group validated questionnaire was completed by 176 boxers recruited from 16 London boxing clubs; 61 boxers from this cohort then attended a London dental hospital, for a clinical and radiographic assessment. Data from the questionnaire and clinical assessments were then collated and analysed using Chi-squared or t-tests. RESULTS Questionnaire data revealed 87.5% of boxers reported a history of dentofacial trauma during boxing activity. The clinical and radiographic assessment detected evidence of dentofacial trauma in 91.8% of boxers and dental injury or endodontic-related injury sequelae in 68.9% of boxers. There was a significant association between dentofacial trauma and boxers who did not participate in weekly neck weight sessions (p < .001), and there was a significant association between trauma-related endodontic sequelae and: boxer age (p = .01); competitions per month (p = .002); and defensive skill (p = .007). CONCLUSIONS A majority of the cohort had suffered dentofacial injuries and endodontic sequelae. The questionnaire data under-reported musculoskeletal injuries and endodontic sequelae, suggesting that some hard-tissue injuries following repetitive dentofacial trauma may have a subclinical presentation. Injury risk may be related to increased boxer age, defensive skills, frequency of participation in competitions, and frequency of neck weight sessions per week.
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Affiliation(s)
- Sally McCarthy
- Endodontics Department, Royal National ENT and Eastman Dental Hospital, London, UK
| | - Kishor Gulabivala
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
| | - Geoffrey St George
- Endodontics Department, Royal National ENT and Eastman Dental Hospital, London, UK
| | - Simon Harvey
- Department of Radiology (Dental), Eastman Dental Hospital, University College London, London, UK
| | - Yuan-Ling Ng
- Unit of Endodontology, UCL Eastman Dental Institute, University College London, London, UK
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17
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Pérez-Carbonell L, Iranzo A. REM sleep and neurodegeneration. J Sleep Res 2024:e14263. [PMID: 38867555 DOI: 10.1111/jsr.14263] [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: 03/17/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
Several brainstem, subcortical and cortical areas are involved in the generation of rapid eye movement (REM) sleep. The alteration of these structures as a result of a neurodegenerative process may therefore lead to REM sleep anomalies. REM sleep behaviour disorder is associated with nightmares, dream-enacting behaviours and increased electromyographic activity in REM sleep. Its isolated form is a harbinger of synucleinopathies such as Parkinson's disease or dementia with Lewy bodies, and neuroprotective interventions are advocated. This link might also be present in patients taking antidepressants, with post-traumatic stress disorder, or with a history of repeated traumatic head injury. REM sleep likely contributes to normal memory processes. Its alteration has also been proposed to be part of the neuropathological changes occurring in Alzheimer's disease.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Centre, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Spain
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18
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Peek K, Ross A, Andersen TE, Meyer T, Dahlen S, Georgieva J, Williamson PR, Clarke M, Serner A. Heading in football: a systematic review of descriptors, definitions, and reporting methods used in heading incidence studies. SCI MED FOOTBALL 2024:1-18. [PMID: 38855969 DOI: 10.1080/24733938.2024.2362191] [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: 02/12/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
The primary objective of this systematic review was to describe the number and type of heading descriptors used in all published studies which report on heading incidence in football. The secondary objective was to detail the data collection and reporting methods used in the included studies to present heading incidence data. Eligible studies were identified through searches of five electronic databases: Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science, using a combination of free-text keywords (inception to 12th September 2023). Manual searching of reference lists and retrieved systematic reviews was also performed. A descriptive overview and synthesis of the results is presented. From 1620 potentially eligible studies, 71 studies were included, with the following key findings: 1) only 61% of studies defined a header with even fewer (23%) providing an operational definition of a header within the methods; 2) important study and player demographic data including year and country were often not reported; 3) reported heading descriptors and their coding options varied greatly; 4) visual identification of headers was essential when inertial measurement units were used to collect heading incidence data; and 5) there was a lack of standardisation in the reporting methods used in heading incidence studies making comparison between studies challenging. To address these findings, the development of a standardised, internationally supported, operational definition of a header and related heading descriptors should be prioritised. Further recommendations include the development of minimum reporting criteria for heading incidence research.
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Affiliation(s)
- Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, College of Sport, Health and Engineering, Victoria University, Melbourne, Australia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian Football Association's Sports Medical Centre, Oslo, Norway
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Sara Dahlen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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19
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Oesterschlink J, Reinsberger C. [Head injuries: What the team physician needs to know]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:415-419. [PMID: 38740669 DOI: 10.1007/s00132-024-04507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
A concussion is the mildest form of a mild traumatic brain injury (tbi) and resembles the most prevalent type of sports associated tbi. Diffuse axonal injuries, the main pathophysiological mechanism of concussion, leads to disruption of communication between different brain areas. The resulting clinical symptoms may relate to several clinical domains (cognition, fatigue, anxiety disorders, headaches/migraines or vestibulo-ocular problems), all of which need to be assessed in a clinical screening during an evaluation for possible concussion. Appropriate and consensus-based protocols to conduct clinical exams are provided by the Concussion in Sport Group (Sport Concussion Assessment Tool (SCAT), Sport Concussion Office Assessment Tool (SCOAT)) and should be used in the most up-to-date version. Therapeutically, slowly and incrementally increasing sub symptomatic activation consisting of daily routine activities, aerobic and cognitive exercises should be introduced early after the trauma. Education about concussion should be geared towards target audiences and will then greatly contribute to adherence and acceptance of medical management.
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Affiliation(s)
- Julian Oesterschlink
- Department Sport und Gesundheit, Sportmedizinisches Institut, Universität Paderborn, Warburger Straße 100, 33098, Paderborn, Deutschland
| | - Claus Reinsberger
- Department Sport und Gesundheit, Sportmedizinisches Institut, Universität Paderborn, Warburger Straße 100, 33098, Paderborn, Deutschland.
- Division of Sports Neurology and Neurosciences, Mass General Brigham, Harvard Medical School, Boston, USA.
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20
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Peek K, Franchi M, Lemmink K, Balsom P, Meyer T. Quality Criteria for Studies Assessing the Acute Effects of Heading: Results from a UEFA Expert Panel. Sports Med 2024; 54:1089-1095. [PMID: 38150166 PMCID: PMC11127840 DOI: 10.1007/s40279-023-01977-z] [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] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
There is increasing concern regarding the effects of heading in football on brain health including cognitive, behavioural and neuromotor function, with research suggesting an association between repeated ball-head impacts and neurodegenerative disease. While longitudinal studies to determine the long-term consequences of heading are challenging, there have been short-term 'acute' studies conducted, with some studies lacking appropriate methodology to ensure valid results. The Union of European Football Associations (UEFA) established a panel of experts to determine methodological recommendations for the conduct of studies that explore the acute effects of heading (defined as a single session of heading conducted either in a laboratory setting or following match play or a training session). The aim of this panel was to create quality criteria for acute heading studies that will form part of the eligibility assessment when applying for UEFA research funding (although the criteria can be applied to the conduct of acute heading research more widely). This process was deemed necessary to counter studies with poor methodological quality that used heading trials that did not accurately represent player exposure to ball-head impacts through football practice and match play (such as small sample sizes, unrealistically high heading exposure, and a lack of consideration of confounding variables). The panel identified core design decisions that authors should consider when designing and conducting acute heading research, with key methodological requirements for each domain pertaining to participants, heading trials, confounding variables, statistics and dependent/target variables and their measurement. After two rounds of reviews, the final list of quality criteria was agreed by the panel and will be applied to the next round of UEFA grant applications.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Martino Franchi
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Koen Lemmink
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul Balsom
- Swedish Football Association, Solna, Stockholm, Sweden
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarland, Germany
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21
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Diz JC, Rodríguez I, Iglesias-Sueiro S, Diz Ferreira E, Sanchez-Lastra MA, Ayán C. Mortality of Spanish soccer referees and coaches: a retrospective cohort study. SCI MED FOOTBALL 2024; 8:112-118. [PMID: 36862076 DOI: 10.1080/24733938.2023.2184485] [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] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
There is evidence that elite soccer players live longer than general population, but there is no information on soccer coaches and referees. We aimed to analyze the longevity of both professionals, comparing them with soccer players and with general population. In this retrospective cohort study, a total of 328 male Spanish soccer coaches, 287 referees, and 1230 soccer players, all born before 1950, were divided in two cohorts, matched 2:1 with coaches and referees. We compared the survival of the cohorts with the Kaplan-Meier estimator and significance with the log-rank test. We calculated hazard ratios of death for coaches and referees compared with male Spanish general population of the same period. Differences in survival among cohorts were found, but they did not reach statistical significance. The estimated median survival time was 80.1 years (95% CI 77.7-82.4) for referees, 78 years (95% CI 76.6-79.3) for coaches, 78.8 years (95% CI 77.6-80) for referees matched with players, and 76.6 years (95% CI 75.3-77.9) for coaches matched with players. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age. We found no differences in longevity among Spanish elite soccer referees, coaches and players born before 1950. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age.
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Affiliation(s)
- José Carlos Diz
- Departamento de Didácticas Especiais, Universidade de Vigo, Vigo, España
- Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO, Vigo, Spain
| | - Iván Rodríguez
- Departamento de Didácticas Especiais, Universidade de Vigo, Vigo, España
| | | | - Eva Diz Ferreira
- Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel A Sanchez-Lastra
- Departamento de Didácticas Especiais, Universidade de Vigo, Vigo, España
- Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO, Vigo, Spain
| | - Carlos Ayán
- Departamento de Didácticas Especiais, Universidade de Vigo, Vigo, España
- Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO, Vigo, Spain
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22
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Blaschke SJ, Rautenberg N, Endepols H, Jendro A, Konrad J, Vlachakis S, Wiedermann D, Schroeter M, Hoffmann B, Merkel R, Marklund N, Fink GR, Rueger MA. Early Blood-Brain Barrier Impairment as a Pathological Hallmark in a Novel Model of Closed-Head Concussive Brain Injury (CBI) in Mice. Int J Mol Sci 2024; 25:4837. [PMID: 38732053 PMCID: PMC11084321 DOI: 10.3390/ijms25094837] [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: 03/25/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Concussion, caused by a rotational acceleration/deceleration injury mild enough to avoid structural brain damage, is insufficiently captured in recent preclinical models, hampering the relation of pathophysiological findings on the cellular level to functional and behavioral deficits. We here describe a novel model of unrestrained, single vs. repetitive concussive brain injury (CBI) in male C56Bl/6j mice. Longitudinal behavioral assessments were conducted for up to seven days afterward, alongside the evaluation of structural cerebral integrity by in vivo magnetic resonance imaging (MRI, 9.4 T), and validated ex vivo by histology. Blood-brain barrier (BBB) integrity was analyzed by means of fluorescent dextran- as well as immunoglobulin G (IgG) extravasation, and neuroinflammatory processes were characterized both in vivo by positron emission tomography (PET) using [18F]DPA-714 and ex vivo using immunohistochemistry. While a single CBI resulted in a defined, subacute neuropsychiatric phenotype, longitudinal cognitive testing revealed a marked decrease in spatial cognition, most pronounced in mice subjected to CBI at high frequency (every 48 h). Functional deficits were correlated to a parallel disruption of the BBB, (R2 = 0.29, p < 0.01), even detectable by a significant increase in hippocampal uptake of [18F]DPA-714, which was not due to activation of microglia, as confirmed immunohistochemically. Featuring a mild but widespread disruption of the BBB without evidence of macroscopic damage, this model induces a characteristic neuro-psychiatric phenotype that correlates to the degree of BBB disruption. Based on these findings, the BBB may function as both a biomarker of CBI severity and as a potential treatment target to improve recovery from concussion.
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Affiliation(s)
- Stefan J. Blaschke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, 52428 Juelich, Germany
| | - Nora Rautenberg
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, 52428 Juelich, Germany
| | - Heike Endepols
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Nuclear Chemistry, Institute of Neuroscience and Medicine (INM-5), Research Centre Juelich, 52428 Juelich, Germany
| | - Aileen Jendro
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
| | - Jens Konrad
- Mechanobiology, Institute of Biological Information Processing (IBI-2), Research Centre Juelich, 52425 Juelich, Germany; (J.K.); (B.H.); (R.M.)
| | - Susan Vlachakis
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
| | - Dirk Wiedermann
- Multimodal Imaging Group, Max Planck Institute for Metabolism Research, 50931 Cologne, Germany;
| | - Michael Schroeter
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, 52428 Juelich, Germany
| | - Bernd Hoffmann
- Mechanobiology, Institute of Biological Information Processing (IBI-2), Research Centre Juelich, 52425 Juelich, Germany; (J.K.); (B.H.); (R.M.)
| | - Rudolf Merkel
- Mechanobiology, Institute of Biological Information Processing (IBI-2), Research Centre Juelich, 52425 Juelich, Germany; (J.K.); (B.H.); (R.M.)
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, 221 85 Lund, Sweden;
| | - Gereon R. Fink
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, 52428 Juelich, Germany
| | - Maria A. Rueger
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, 50923 Cologne, Germany; (N.R.); (A.J.); (M.S.); (G.R.F.); (M.A.R.)
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, 52428 Juelich, Germany
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23
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Zimmerman KA, Hain JA, Graham NSN, Rooney EJ, Lee Y, Del-Giovane M, Parker TD, Friedland D, Cross MJ, Kemp S, Wilson MG, Sylvester RJ, Sharp DJ. Prospective cohort study of long-term neurological outcomes in retired elite athletes: the Advanced BiomaRker, Advanced Imaging and Neurocognitive (BRAIN) Health Study protocol. BMJ Open 2024; 14:e082902. [PMID: 38663922 PMCID: PMC11043776 DOI: 10.1136/bmjopen-2023-082902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Although limited, recent research suggests that contact sport participation might have an adverse long-term effect on brain health. Further work is required to determine whether this includes an increased risk of neurodegenerative disease and/or subsequent changes in cognition and behaviour. The Advanced BiomaRker, Advanced Imaging and Neurocognitive Health Study will prospectively examine the neurological, psychiatric, psychological and general health of retired elite-level rugby union and association football/soccer players. METHODS AND ANALYSIS 400 retired athletes will be recruited (200 rugby union and 200 association football players, male and female). Athletes will undergo a detailed clinical assessment, advanced neuroimaging, blood testing for a range of brain health outcomes and neuropsychological assessment longitudinally. Follow-up assessments will be completed at 2 and 4 years after baseline visit. 60 healthy volunteers will be recruited and undergo an aligned assessment protocol including advanced neuroimaging, blood testing and neuropsychological assessment. We will describe the previous exposure to head injuries across the cohort and investigate relationships between biomarkers of brain injury and clinical outcomes including cognitive performance, clinical diagnoses and psychiatric symptom burden. ETHICS AND DISSEMINATION Relevant ethical approvals have been granted by the Camberwell St Giles Research Ethics Committee (Ref: 17/LO/2066). The study findings will be disseminated through manuscripts in clinical/academic journals, presentations at professional conferences and through participant and stakeholder communications.
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Affiliation(s)
- Karl A Zimmerman
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Jessica A Hain
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Neil S N Graham
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Erin Jane Rooney
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Ying Lee
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Martina Del-Giovane
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Thomas D Parker
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurodegenerative Disease, The Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel Friedland
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Matthew J Cross
- Carnegie Applied Rugby Research Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Premiership Rugby, London, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mathew G Wilson
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- HCA Healthcare Research Institute, London, UK
| | - Richard J Sylvester
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Sharp
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
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24
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Malcolm D, Matthews CR, Wiltshire G. Concussion in sport: It's time to drop the tobacco analogy. J Sci Med Sport 2024; 27:220-221. [PMID: 38320904 DOI: 10.1016/j.jsams.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
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25
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Barnes-Wood M, McCloskey H, Connelly S, Gilchrist MD, Annaidh AN, Theobald PS. Investigation of Head Kinematics and Brain Strain Response During Soccer Heading Using a Custom-Fit Instrumented Mouthguard. Ann Biomed Eng 2024; 52:934-945. [PMID: 38243139 PMCID: PMC10940496 DOI: 10.1007/s10439-023-03430-8] [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: 07/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Association football, also known as soccer in some regions, is unique in encouraging its participants to intentionally use their head to gain a competitive advantage, including scoring a goal. Repetitive head impacts are now being increasingly linked to an inflated risk of developing long-term neurodegenerative disease. This study investigated the effect of heading passes from different distances, using head acceleration data and finite element modelling to estimate brain injury risk. Seven university-level participants wore a custom-fitted instrumented mouthguard to capture linear and angular acceleration-time data. They performed 10 headers within a laboratory environment, from a combination of short, medium, and long passes. Kinematic data was then used to calculate peak linear acceleration, peak angular velocity, and peak angular acceleration as well as two brain injury metrics: head injury criterion and rotational injury criterion. Six degrees of freedom acceleration-time data were also inputted into a widely accepted finite element brain model to estimate strain-response using mean peak strain and cumulative strain damage measure values. Five headers were considered to have a 25% concussion risk. Mean peak linear acceleration equalled 26 ± 7.9 g, mean peak angular velocity 7.20 ± 2.18 rad/s, mean peak angular acceleration 1730 ± 611 rad/s2, and 95th percentile mean peak strain 0.0962 ± 0.252. Some of these data were similar to brain injury metrics reported from American football, which supports the need for further investigation into soccer heading.
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Affiliation(s)
- M Barnes-Wood
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - H McCloskey
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - S Connelly
- Football Association of Wales (FIFA Medical Centre of Excellence), Hensol, Pontyclun, CF72 8JY, UK
| | - M D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Ni Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - P S Theobald
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK.
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26
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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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27
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Wallis WEG, Al-Alem Q, Lorimer H, Smail OJ, Williams GKR, Bond B. The acute influence of amateur boxing on dynamic cerebral autoregulation and cerebrovascular reactivity to carbon dioxide. Eur J Appl Physiol 2024; 124:993-1003. [PMID: 37768343 PMCID: PMC10879355 DOI: 10.1007/s00421-023-05324-y] [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: 04/25/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The purpose of this study was to investigate the acute effect of head impacts, sustained over the course of three rounds of amateur boxing, on indices of cerebrovascular function. METHODS Eighteen university amateur boxers (six female) completed three experimental trials in a randomised order; (1) three rounds of boxing (BOX), (2) an equivalent bout of pad boxing (where no blows to the head were sustained; PAD), and (3) a time-matched seated control trial (CON). Indices of cerebrovascular function were determined immediately before and 45 min after each trial. Specifically, dynamic cerebral autoregulation (dCA) was determined by considering the relationship between changes in cerebral blood velocity and mean arterial pressure during 5 min of squat-stand manoeuvres at 0.05 and 0.10 Hz. Cerebrovascular reactivity was determined using serial breath holding and hyperventilation attempts. RESULTS Participants received an average of 40 ± 16 punches to the head during the BOX trial. Diastolic, mean and systolic dCA phase during squat stand manoeuvres at 0.05 Hz was lower after BOX compared to pre BOX (P ≤ 0.02, effect size (d) ≥ 0.74). No other alterations in dCA outcomes were observed at 0.05 or 0.10 Hz. The number of head impacts received during the BOX trial was associated with the change in systolic phase (r = 0.50, P = 0.03). No differences in cerebrovascular reactivity to breath holding or hyperventilation were observed. CONCLUSIONS A typical bout of amateur boxing (i.e., three rounds) can subtly alter cerebral pressure-flow dynamics, and the magnitude of this change may be related to head impact exposure.
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Affiliation(s)
- W E G Wallis
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Q Al-Alem
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - H Lorimer
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - O J Smail
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - G K R Williams
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - B Bond
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) research group, Sport and Health Sciences, Baring Court, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK.
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28
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Carmody S, Ranson J, Iqbal Z, Massey A, Kerkhoffs G, Gouttebarge V. Evaluation of a medical after-care intervention among deselected elite male Academy football players: a pilot study. BMJ Open Sport Exerc Med 2024; 10:e001891. [PMID: 38440745 PMCID: PMC10910530 DOI: 10.1136/bmjsem-2024-001891] [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] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Objective This pilot study aimed to evaluate the perception and satisfaction of deselected male Academy professional footballers towards a medical after-care intervention. Methods A quasiexperimental study design, with deselected players (aged≥18 years) at a single Premier League Academy during the 2022/2023 season, were invited to participate. The intervention included individualised health recommendations, key medical information and signposting to key support resources. Participants' perceptions and satisfaction were assessed through an electronic survey. Descriptive analyses (mean, SD, frequency and/or range) were performed for all variables. Results Twelve out of 15 eligible participants (80% response rate) provided informed consent and completed the survey (mean age: 19.5 years). All (100%) of the participants were satisfied with receiving the medical information. Ten out of 12 (83.3%) participants agreed that all Academy players should receive this medical intervention on deselection. Nine (75%) players felt more prepared for the next steps in their careers due to the medical information shared with them. Conclusion Deselected male Academy footballers expressed high satisfaction with an individualised medical intervention which shared key health information and signposted them to important resources (eg, mental health). Future studies across multiple clubs should explore the broader impact of this intervention among deselected male and female Academy footballers. Football clubs should consider integrating a medical after-care process for deselected players as part of routine care.
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Affiliation(s)
- Sean Carmody
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Medical Department, Crystal Palace Football Club, London, UK
| | - Joe Ranson
- Medical Department, Crystal Palace Football Club, London, UK
| | - Zafar Iqbal
- Medical Department, Crystal Palace Football Club, London, UK
| | | | - Gino Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, Amsterdam, Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Aging & Vitality, Musculoskeletal Health, Sports, Amsterdam, Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Football Players Worldwide (FIFPRO), Hoofddorp, Netherlands
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D'Souza S, Milne BJ, Li C, Anns F, Gardner A, Lumley T, Morton SMB, Murphy IR, Verhagen E, Wright C, Quarrie K. Kumanu Tāngata: the aftermatch study - protocol to examine the health outcomes of high-level male rugby union players using linked administrative data. BMJ Open Sport Exerc Med 2024; 10:e001795. [PMID: 38362564 PMCID: PMC10868174 DOI: 10.1136/bmjsem-2023-001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
There is increasing interest in the potential long-term outcomes of participation in contact and collision sports, driven by evidence of higher rates of neurodegenerative diseases among former athletes. Recent research has capitalised on large-scale administrative health data to examine health outcomes in contact sport athletes. However, there is limited research on outcomes associated with participation in rugby union, a contact sport with a relatively high incidence of head trauma and musculoskeletal injuries. Additionally, there is scope to investigate a greater range of health outcomes using large, population-based administrative data. The Kumanu Tāngata project is a retrospective cohort study that will use linked information from the New Zealand Rugby Register and health records within a comprehensive deidentified whole-population administrative research database known as the Integrated Data Infrastructure. First-class male rugby union players (N=13 227) will be compared with a general population comparison group (N=2 438 484; weighting will be applied due to demographic differences) on a range of mortality and morbidity outcomes (neurodegenerative diseases, musculoskeletal conditions, chronic physical conditions, mental health outcomes). A range of player-specific variables will also be investigated as risk factors. Analyses will consist primarily of Cox proportional hazards models. Ethics approval for the study has been granted by the Auckland Health Research Ethics Committee (Ref. AH23203). Primary research dissemination will be via peer-reviewed journal articles.
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Affiliation(s)
- Stephanie D'Souza
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Social Sciences, University of Auckland, Auckland, New Zealand
| | - Barry J Milne
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Social Sciences, University of Auckland, Auckland, New Zealand
| | - Chao Li
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
| | - Francesca Anns
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrew Gardner
- Sydney School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Research Institute for Innovative Solutions for Well-being and Health (INSIGHT), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ian R Murphy
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Evert Verhagen
- Department of Public and Occupational Health, EMGO, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Craig Wright
- Social Wellbeing Agency, Wellington, New Zealand
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Kern J, Gulde P, Hermsdörfer J. A prospective investigation of the effects of soccer heading on cognitive and sensorimotor performances in semi-professional female players. Front Hum Neurosci 2024; 18:1345868. [PMID: 38404611 PMCID: PMC10884128 DOI: 10.3389/fnhum.2024.1345868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Repetitive head impacts (RHI) from routine soccer (football) heading have been suggested to contribute to the long-term development of neurodegenerative disorders. However, scientific evidence concerning the actual risk of these RHI on brain health remains inconclusive. Moreover, female athletes-despite a presumably increased vulnerability toward the effects of RHI-are largely underrepresented in previous approaches. Therefore, our aim was to prospectively investigate the effects of heading on cognitive and sensorimotor performances, health perception, and concussion symptoms in semi-professional female soccer players. Methods An extensive test battery was used to assess cognitive and sensorimotor performances as well as health status (SF-36) and concussion symptoms (SCAT3) of a total of 27 female soccer players (22.2 ± 4.2 years) and 15 control subjects (23.2 ± 3.0 years) before and after one-and-a-half years. Throughout this period, soccer players' heading exposure was determined using video analysis. Results Subgroup comparisons (control [n = 12], low exposure [n = 7], high exposure [n = 8]) showed no time-dependent differences in SF-36 or SCAT3 scores. Similarly, across most behavioral tests, soccer players' performances evolved equally or more favorably as compared to the control subjects. However, there were significant effects pointing toward slightly negative consequences of heading on aspects of fine motor control (p = 0.001), which were confirmed by correlation and multiple regression analyses. The latter, further, yielded indications for a relationship between heading exposure and negative alterations in postural control (p = 0.002). Discussion Our findings do not provide evidence for negative effects of soccer heading on female players' health perception, concussion symptoms, and cognitive performances over the course of one-and-a-half years. However, we found subtle negative alterations in fine motor and postural control that could be attributed to heading exposure. Other factors, like the number of previous head injuries, were not linked to the observed changes. Given the reduction of our initial sample size due to player fluctuation, the results need to be interpreted with caution and validated in larger-scale studies. These should not only focus on cognitive outcomes but also consider sensorimotor changes as a result of RHI from soccer heading.
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Affiliation(s)
- Jan Kern
- Chair of Human Movement Science, Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Demetriades AK, Shah I, Marklund N, Clusmann H, Peul W. Sport-related concussion in soccer -a scoping review of available guidelines and a call for action to FIFA & soccer governing bodies. BRAIN & SPINE 2024; 4:102763. [PMID: 38510627 PMCID: PMC10951760 DOI: 10.1016/j.bas.2024.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
Introduction Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted. Research question We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations. Materials and methods A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education. Results Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines. Discussion and conclusion SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.
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Affiliation(s)
- Andreas K. Demetriades
- Leiden University Neurosurgical Center Holland, HMC-HAGA the Hague & LUMC Leiden, Netherlands
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK
| | - Imran Shah
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Wilco Peul
- Leiden University Neurosurgical Center Holland, HMC-HAGA the Hague & LUMC Leiden, Netherlands
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Monsour MA, Wolfson DI, Jo J, Terry DP, Zuckerman SL. Is contact sport participation associated with chronic traumatic encephalopathy or neurodegenerative decline? A systematic review and meta-analysis. J Neurosurg Sci 2024; 68:117-127. [PMID: 36779774 DOI: 10.23736/s0390-5616.22.05895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION We sought to evaluate a potential association between contact vs. non-contact sport participation and long-term neurologic outcomes and chronic traumatic encephalopathy (CTE). EVIDENCE ACQUISITION PubMed/Embase/PsycINFO/CINAHL databases were queried for studies between 1950-2020 with contact and non-contact sports, longitudinal assessment >10 years, and long-term neurologic outcomes in four-domains: I) clinical diagnosis; II) CTE neuropathology; III) neurocognition; and IV) neuroimaging. EVIDENCE SYNTHESIS Of 2561 studies, 37 met inclusion criteria, and 19 contained homogenous outcomes usable in the meta-analysis. Domain I: Across six studies, no significant relationship was seen between contact sport participation and antemortem diagnosis of neurodegenerative disease or death related to such a diagnosis (RR1.88, P=0.054, 95%CI0.99, 3.49); however, marginal significance (P<0.10) was obtained. Domain II: Across three autopsy studies, no significant relationship was seen between contact sport participation and CTE neuropathology (RR42.39, P=0.086, 95%CI0.59, 3057.46); however, marginal significance (P<0.10) was obtained. Domain III: Across five cognitive studies, no significant relationship was seen between contact sport participation and cognitive function on the Trail Making Test (TMT) scores A/B (A:d=0.17, P=0.275,95% CI-0.13, 0.47; B:d=0.13, P=0.310, 95%CI-0.12, 0.38). Domain IV: In 10 brain imaging-based studies, 32% comparisons showed significant differences between those with a history of contact sport vs. those without. CONCLUSIONS No statistically significant increased risk of neurodegenerative diagnosis, CTE neuropathology, or neurocognitive changes was found to be associated with contact sport participation, yet marginal significance was obtained in two domains. A minority of imaging comparisons showed differences of uncertain clinical significance. These results highlight the need for longitudinal investigations using standardized contact sport participation and neurodegenerative criteria.
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Affiliation(s)
- Meredith A Monsour
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel I Wolfson
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Jacob Jo
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas P Terry
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Nashville, TN, USA -
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Shibukawa K, Hoshikawa Y. Decrease in aerial challenges after revision of goal kick rules in Japan Professional Soccer League: explorative study of the possibility of a risk reduction for head injury, concussion, and brain damage by a rule revision. SCI MED FOOTBALL 2024; 8:15-20. [PMID: 36315233 DOI: 10.1080/24733938.2022.2142274] [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] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
In 2019, FIFA revised the goal kick (GLK) rule such that a GLK could be performed even if the kicker had teammates in the penalty area. This study aimed to examine whether the rule revision reduced the frequency of aerial challenge (AC) and long GLKs (LGLKs), which are risk factors for head injury and concussion in soccer. We analyzed all official league matches (306 matches/season) of the Japan Professional Soccer League 1st Division before (2018 season) and after the rule revision (2020 season). The analysis categorized GLKs into short GLKs (SGLKs) and LGLKs, depending on the GLK distance, and included the frequency and causes of AC, in each match following a GLK, which were compared between the 2018 and 2020 seasons. The average number of LGLKs per match in the 2020 season (8.85) decreased compared to that in the 2018 season (14.20). Additionally, for ACs following a GLK, the frequency of ACs decreased from 6.08 to 3.92 per match. Meanwhile, the frequency of LGLKs tended to increase toward the end of the first and second halves in matches. The results of this study revealed that the 2019 GLK rule revision reduced the number of LGLKs and ACs.
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Affiliation(s)
- Kenichi Shibukawa
- Sports & Health Sciences Lab, Faculty of Sciences, Toho University, Chiba, Japan
| | - Yoshihiro Hoshikawa
- Department of Sports Science, Japan Women's College of Physical Education, Tokyo, Japan
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Georgieva J, Arnold EJ, Peek K, Smith A, Lavender AP, Serner A, Fitzgerald M, Ma'ayah F, Campbell A. The incidence and characteristics of heading in the 2019 FIFA Women's World Cup™. SCI MED FOOTBALL 2024:1-8. [PMID: 38293754 DOI: 10.1080/24733938.2024.2305396] [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] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION To quantify the incidence and characteristics of purposeful heading and other head impacts in professional women's football at the 2019 FIFA Women's World Cup™. METHODS This cross-sectional cohort study analysed purposeful headers (uncontested and contested) and their characteristics (e.g. playing position, match situation, field location, and distance ball travelled), and other head impact events using video analysis. Total headers and head impact events, and incidence rate (IR) per 1000 match-hours were calculated for countries, positions, and other characteristics, such as location on the pitch. RESULTS Purposeful headers accounted for 76% of all coded events (uncontested: 71%; contested: 29%), followed by attempted headers (21%), unintentional ball-head impacts (2%), and other head impacts (1%). Headers ranged from 0 to 22 per player, per match with a mean of 4.8 [±1.2]. Of all field positions, centrebacks had the highest heading rates and wingers the lowest. Strikers performed significantly more contested headers than any other position, and significantly less uncontested headers. Most headers occurred in the middle third (48%), from free game play (72%) and from long balls (>20 m) (68%). CONCLUSION The findings of this study could assist the development of player heading risk profiles, sex-specific heading guidelines, and coaching practices.
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Affiliation(s)
- Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Eloise J Arnold
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Kerry Peek
- Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
| | - Andrew P Lavender
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Fadi Ma'ayah
- School of Education, Curtin University, Perth, WA, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
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Lember LM, Ntikas M, Mondello S, Wilson L, Di Virgilio TG, Hunter AM, Kobeissy F, Mechref Y, Donaldson DI, Ietswaart M. The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review. SPORTS MEDICINE - OPEN 2024; 10:12. [PMID: 38270708 PMCID: PMC10811313 DOI: 10.1186/s40798-023-00665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. OBJECTIVE This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. METHODS PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. RESULTS Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers-such as NfL-appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. CONCLUSION Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers' utility.
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Affiliation(s)
- Liivia-Mari Lember
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Michail Ntikas
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
- The School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Stefania Mondello
- Biomedical and Dental Sciences and Morphofunctional Imaging, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - Lindsay Wilson
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Thomas G Di Virgilio
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Angus M Hunter
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Department of Sports Science, Nottingham Trent University, Nottingham, UK
| | - Firas Kobeissy
- Center for Neurotrauma, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine (MSM), Multiomics & Biomarkers, Atlanta, GA, 30310, USA
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, USA
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, UK
| | - Magdalena Ietswaart
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
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Batty GD, Bell S, Kujala UM, Sarna SJ, Kaprio J. Dementia risk factors in former contact sports participants: prospective cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.15.24301327. [PMID: 38293048 PMCID: PMC10827262 DOI: 10.1101/2024.01.15.24301327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background The elevated dementia incidence in retired contact sport participants might be explained by a higher prevalence of established risk factors for the disease relative to the general population. Methods In this cohort study, former elite participants active between 1920 and 1965 in soccer (N=303), boxing (N=281), and wrestling (N=318) were recruited using sports yearbooks and records of sports associations. Men in a population control group were identified using records from a compulsory medical examination (N=1712). All study members were linked to hospital registers (1970-2015) and self-completion questionnaires were circulated (1985, 1995) from which we captured data on nine established risk factors for dementia: hypertension and diabetes status, alcohol intake, loneliness, depressive symptoms, cigarette smoking, body weight, educational attainment, and physical activity. Results There was little suggestion that former participants in contact sports had a higher prevalence of dementia risk factors relative to the general population. Rather, the balance of evidence was for more favourable risk factor levels in former athletes, as was particularly evident for ever having smoked cigarettes (range in odds ratios [95% confidence interval]: 0.32 [0.21, 0.48] for wrestling to 0.52 [0.36, 0.75] for soccer) and leisure-time physical activity (range in beta coefficients [95% confidence interval]: 1.34 [0.66, 2.02] for soccer to 1.80 [1.07, 2.52] for boxing). Conclusions The increased dementia rates in retired contact sport participants evident in epidemiological studies is unlikely to be explained by the risk factors examined here. This implicates other characteristics of contact sports, including a history of repeated head impact.
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Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steven Bell
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Seppo J Sarna
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
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Kader M, Pasternak B, Lim CE, Neovius M, Forssblad M, Svanström H, Ludvigsson JF, Ueda P. Depression and anxiety-related disorders and suicide among Swedish male elite football players: a nationwide cohort study. Br J Sports Med 2024; 58:66-72. [PMID: 37857446 PMCID: PMC10804025 DOI: 10.1136/bjsports-2023-107286] [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] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess whether male elite football players, during and after their active career, were at increased risk of depression and anxiety-related disorders and suicide, as compared with the general male population. METHODS We included male football players active in the Swedish top division 1924-2019 and general male population (matched to football players based on age and region of residence) aged <65 years in 1997. Using nationwide registers, we followed the football players from their first season in the top division (or the date of their first registered residency in Sweden) or 1 January 1997, and compared the risk of depression and anxiety-related disorders (captured through diagnoses from hospital admissions and outpatient visits, and use of prescription drugs) among football players versus controls. In a secondary analysis using data from death certificates, we compared the risk of suicide between football players and general population males who were alive in 1969 (when cause of death became available) . RESULTS During follow-up through 31 December 2020, 504 (13.6%) of 3719 football players and 7455 (22.3%) of 33 425 general population males had a depression or anxiety-related disorder. In analyses accounting for age, region of residence and calendar time, the risk of anxiety and depression-related disorders was lower among football players versus general population males (HR 0.61, 95% CI 0.55 to 0.66). The protective association was attenuated with increasing age, and from around age 70 years the risk was similar in the two groups. The risk of suicide was lower among football players versus general population males (HR 0.48, 95% CI 0.32 to 0.72). CONCLUSIONS In this nationwide cohort study in Sweden, elite male football players had a lower risk of depression and anxiety-related disorders and suicide as compared with the general population.
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Affiliation(s)
- Manzur Kader
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Carl-Emil Lim
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Svanström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Orebro, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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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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Helmich I, Chang YY, Gemmerich R, Rodrigo L, Funken J, Arun KM, Van de Vliet P. Neurobehavioral consequences of repetitive head impacts in Para swimming: A case report. J Sci Med Sport 2024; 27:16-19. [PMID: 37923648 DOI: 10.1016/j.jsams.2023.10.015] [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: 07/25/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Para swimmers with limb deficiency are faced with the particular situation that they must use their head to finish each competition by a hit to the wall. Repetitive head impacts may impair behavioral and brain functions. We therefore investigated neurobehavioral functions of a Para swimmer with dysmelia before and after repetitive head impacts (T1) and without (T2). Average head impact at T1 constituted 13.6 g with a mean impact force of 6689.9 N. Behavioral and brain functions decreased from pre to post at T1 but not at T2. Para swimmers with limb deficiency are therefore affected from the same consequences onto brain health that are observed after repeated sport-related concussions.
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Affiliation(s)
- I Helmich
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany.
| | - Y Y Chang
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - R Gemmerich
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - L Rodrigo
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - J Funken
- Institute of Biomechanics and Orthopaedics, GSU Cologne, Germany
| | - K M Arun
- Department of Biomechanics, University of Nebraska at Omaha, USA
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D'Souza GM, Churchill NW, Guan DX, Khoury MA, Graham SJ, Kumar S, Fischer CE, Schweizer TA. Interaction of Alzheimer Disease and Traumatic Brain Injury on Cortical Thickness. Alzheimer Dis Assoc Disord 2024; 38:14-21. [PMID: 38285961 DOI: 10.1097/wad.0000000000000607] [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: 09/12/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is associated with an accelerated course of dementia, although biological relationships are incompletely understood. METHODS The study examined 1124 participants, including 343 with Alzheimer disease (AD), 127 with AD with TBI, 266 cognitively normal adults with TBI, and 388 cognitively normal adults without TBI. Cortical thickness was quantified from T1-weighted magnetic resonance imaging data. Multiple linear regression was used to determine the interaction between AD and TBI on cortical thickness. RESULTS Among those with AD, TBI was associated with an earlier age of AD onset but, counterintuitively, less cortical thinning in frontotemporal regions relative to non-AD controls. DISCUSSION AD with TBI represents a distinct group from AD, likely with distinct pathologic contributions beyond gray matter loss. This finding has important implications for the diagnosis and treatment of AD in the presence of TBI and indicates that models of AD, aging, and neural loss should account for TBI history.
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Affiliation(s)
- Gina M D'Souza
- Institute of Medical Science, University of Toronto
- Keenan Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
| | - Nathan W Churchill
- Keenan Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
- Neuroscience Research Program, St. Michael's Hospital
- Physics Department, Toronto Metropolitan University
| | - Dylan X Guan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marc A Khoury
- Institute of Medical Science, University of Toronto
- Keenan Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
| | - Simon J Graham
- Departments of Medical Biophysics
- Physical Sciences Platform, Sunnybrook Research Institute
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute
| | - Sanjeev Kumar
- Institute of Medical Science, University of Toronto
- Psychiatry
- Centre for Addiction and Mental Health, Toronto, ON
| | - Corinne E Fischer
- Institute of Medical Science, University of Toronto
- Psychiatry
- Keenan Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
| | - Tom A Schweizer
- Institute of Medical Science, University of Toronto
- Department of Surgery, Division of Neurosurgery
- Keenan Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto
- Neuroscience Research Program, St. Michael's Hospital
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van Tonder R, Hendricks S, Starling L, Surmon S, Viviers P, Kraak W, Stokes KA, Derman W, Brown JC. Tackling the tackle 1: A descriptive analysis of 14,679 tackles and risk factors for high tackles in a community-level male amateur rugby union competition during a lowered tackle height law variation trial. J Sci Med Sport 2024; 27:57-62. [PMID: 37932203 DOI: 10.1016/j.jsams.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/21/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES In rugby union (rugby), the tackle is the most frequent cause of concussion and thus a target for intervention to reduce concussion incidence. The aim of this study is to describe tackle characteristics and factors associated with illegal high tackles in amateur community-level rugby during a lowered (armpit level) tackle height law variation trial. DESIGN Prospective observational cohort study. METHODS Video surveillance of a single season, four-league competition with coding of video data according to a predefined coding framework. Descriptive statistics of tackle detail and logistic regression was performed to analyse factors associated with high tackles. RESULTS One hundred and eight matches with 14,679 tackles and a mean of 137 (±30) tackles per match were analysed. High tackles (above armpit level) had significantly greater odds of occurring in the lower (2nd-4th) leagues (OR: 1.95; 95 % CI: 1.6-2.4; p < 0.001), front-on tackles (OR: 1.61; 95 % CI: 1.3-2.0; p < 0.001), arm tackles (OR: 1.65; 95 % CI: 1.3-2.1; p < 0.001), bent-at-waist ball carrier (OR: 1.93; 95 % CI: 1.6-2.4; p < 0.001), falling/diving ball carrier (OR: 2.21; 95 % CI: 1.6-3.1; p < 0.001), and an upright tackler (OR: 3.38; 95 % CI: 2.7-4.2; p < 0.001). A falling/diving tackler had significantly lower odds of being associated with a high tackle (OR: 0.44; 95 % CI: 0.3-0.6; p < 0.001). CONCLUSIONS Overall mean tackles per match were similar to those of senior amateur and elite rugby. League, tackle type, tackle aspect, and player body positions were associated with high tackles. These findings reiterate the need for ongoing efforts to identify and implement mitigating strategies to reduce tackle-related injury risk.
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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, South Africa; IOC Research Centre, 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, South Africa; Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, UK. https://twitter.com/sharief_h
| | - Lindsay Starling
- UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Bath, UK; Centre for Health and Injury and Illness Prevention in Sport, University of Bath, UK; World Rugby House, UK. https://twitter.com/starling_linds
| | - Sean Surmon
- Maties Sport, Stellenbosch University, South Africa. https://twitter.com/seansurmon
| | - Pierre Viviers
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Campus Health Service, Stellenbosch University, South Africa; IOC Research Centre, South Africa. https://twitter.com/thematiesdoc
| | - Wilbur Kraak
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Department of Sport, Recreation, and Exercise Science, University of the Western Cape, South Africa. https://twitter.com/Coachwilbur
| | - Keith A Stokes
- UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Bath, UK; Centre for Health and Injury and Illness Prevention in Sport, University of Bath, UK; Medical Services, Rugby Football Union, UK. https://twitter.com/drkeithstokes
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; IOC Research Centre, South Africa. https://twitter.com/wderman
| | - James Craig Brown
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, UK; IOC Research Centre, South Africa. https://twitter.com/jamesbrown06
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Russell ER, Spencer SJ, Atherton CM, Lyall DM, Mackay DF, Stewart K, MacLean JA, Pell JP, Stewart W. Increased risk of lower limb osteoarthritis among former professional soccer (football) players. Occup Med (Lond) 2023; 73:547-553. [PMID: 38070190 PMCID: PMC10824258 DOI: 10.1093/occmed/kqad132] [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] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Soccer is a high-speed contact sport with risk of injury. Despite long-standing concern, evidence to date remains inconsistent as to the association between playing professional-level soccer and lifelong musculoskeletal consequences. AIMS The objectives were to assess risk of osteoarthritis in former professional soccer players compared to matched general population controls, and subsequently assess associated musculoskeletal disorders which may contribute to, or result from, osteoarthritis-specifically meniscal injury and joint replacement. METHODS We conducted a retrospective cohort study using national electronic health records (EHRs) on a cohort of 7676 former professional soccer players aged 40 or over at recruitment, matched on year of birth, sex (all male) and socio-economic status with 23 028 general population controls. Outcomes of interest were obtained by utilizing individual-level record linkage to EHRs from general hospital inpatient and day-case admissions. RESULTS Compared to controls, former soccer players showed a greater risk of hospital admission for osteoarthritis (hazard ratio [HR] 3.01; 95% confidence interval [CI] 2.80-3.25; P < 0.001). This increased risk appeared age dependant, normalizing over age 80 years and reflective of increased risk of lower limb osteoarthritis. Further, risk of hospital admissions for meniscal injury (HR 2.73; 95% CI 2.42-3.08; P < 0.001) and joint replacement (HR 2.82; 95% CI 2.23-3.57; P < 0.001) were greater among former soccer players. CONCLUSIONS We report an increased risk of lower limb osteoarthritis in former soccer players when compared with matched population controls. The results of this research add data in support of lower limb osteoarthritis among former soccer players representing a potential industrial injury.
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Affiliation(s)
- E R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow G12 8QQ, UK
| | - S J Spencer
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - C M Atherton
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - D M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
| | - D F Mackay
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
| | - K Stewart
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
- Hampden Sports Clinic, Hampden Stadium, Glasgow G42 9ED, UK
| | - J A MacLean
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
- Hampden Sports Clinic, Hampden Stadium, Glasgow G42 9ED, UK
| | - J P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
| | - W Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [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: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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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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Santos-Rebouças CB, Cordovil Cotrin J, Dos Santos Junior GC. Exploring the interplay between metabolomics and genetics in Parkinson's disease: Insights from ongoing research and future avenues. Mech Ageing Dev 2023; 216:111875. [PMID: 37748695 DOI: 10.1016/j.mad.2023.111875] [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: 08/22/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
Parkinson's disease (PD) is a widespread neurodegenerative disorder, whose complex aetiology remains under construction. While rare variants have been associated with the monogenic PD form, most PD cases are influenced by multiple genetic and environmental aspects. Nonetheless, the pathophysiological pathways and molecular networks involved in monogenic/idiopathic PD overlap, and genetic variants are decisive in elucidating the convergent underlying mechanisms of PD. In this scenario, metabolomics has furnished a dynamic and systematic picture of the synergy between the genetic background and environmental influences that impact PD, making it a valuable tool for investigating PD-related metabolic dysfunctions. In this review, we performed a brief overview of metabolomics current research in PD, focusing on significant metabolic alterations observed in idiopathic PD from different biofluids and strata and exploring how they relate to genetic factors associated with monogenic PD. Dysregulated amino acid metabolism, lipid metabolism, and oxidative stress are the critical metabolic pathways implicated in both genetic and idiopathic PD. By merging metabolomics and genetics data, it is possible to distinguish metabolic signatures of specific genetic backgrounds and to pinpoint subgroups of PD patients who could derive personalized therapeutic benefits. This approach holds great promise for advancing PD research and developing innovative, cost-effective treatments.
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Affiliation(s)
- Cíntia Barros Santos-Rebouças
- Human Genetics Service, Department of Genetics, Institute of Biology Roberto Alcantara Gomes, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Juliana Cordovil Cotrin
- Human Genetics Service, Department of Genetics, Institute of Biology Roberto Alcantara Gomes, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Gilson Costa Dos Santos Junior
- LabMet, Department of Genetics, Institute of Biology Roberto Alcantara Gomes, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Rotundo MP, Sokol-Randell D, Bleakley C, Donnelly P, Tierney G. Characteristics of potential concussive events in elite hurling: a video-analysis study. Ir J Med Sci 2023; 192:3175-3185. [PMID: 36800054 PMCID: PMC10692028 DOI: 10.1007/s11845-023-03307-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND High-impact sports such as hurling place participants at risk of sport-related concussion (SRC). AIMS This study will evaluate the characteristics of potential concussive events (PCEs) that occur in elite male hurling to acquire an understanding of how they occur. METHODS The authors recorded PCEs and their characteristics throughout two seasons of inter-county GAA competition using broadcast footage based on a previously validated protocol. RESULTS A total of 183 PCEs were identified over 82 inter-county matches (2.23 per match; 59.5 per 1000 h of exposure). PCEs that occurred in the 4th quarter were significantly more likely to result in signs of SRC. Players most often intended to receive/control the sliotar (36.4%, n = 64) prior to PCEs. The most frequently observed mechanism was shoulder-to-head (20.2%, n = 37). Impacts to the lateral aspect of the head were 2.7 times more likely to result in visible signs than impacts to anteroposterior regions. CONCLUSIONS Players appear to be at a higher risk of SRC later in the match or when receiving the sliotar. Strikes to the lateral aspect of the head and those involving the shoulder appear to produce severe events. These findings provide initial guidance for the development of targeted player protection strategies.
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Affiliation(s)
- Mario P Rotundo
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK.
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Darek Sokol-Randell
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
- Department of Neurology, Memorial University of Newfoundland, St John's, Canada
| | - Chris Bleakley
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Paul Donnelly
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Gregory Tierney
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
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Dams-O'Connor K, Seifert AC, Crary JF, Delman BN, Del Bigio MR, Kovacs GG, Lee EB, Nolan AL, Pruyser A, Selmanovic E, Stewart W, Woodoff-Leith E, Folkerth RD. The neuropathology of intimate partner violence. Acta Neuropathol 2023; 146:803-815. [PMID: 37897548 PMCID: PMC10627910 DOI: 10.1007/s00401-023-02646-1] [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: 05/08/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd-8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd-9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan C Seifert
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - John F Crary
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Marc R Del Bigio
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, Room 401 Brodie Centre, 727 McDermot Avenue, Winnipeg, MB, Canada
- Diagnostic Services - Pathology, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND) and Department of Laboratory Medicine and Pathobiology, Krembil Discovery Tower, University of Toronto, 60 Leonard Ave, Toronto, ON, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Ariel Pruyser
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Enna Selmanovic
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Stewart
- Department of Neuropathology, Elizabeth University Hospital, Glasgow, G514TF, Queen, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G128QQ, UK
| | - Emma Woodoff-Leith
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Rebecca D Folkerth
- Office of Chief Medical Examiner, 520 First Avenue, New York, NY, 10116, USA.
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, USA.
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Vasilevskaya A, Martinez-Valbuena I, Anastassiadis C, Taghdiri F, Khodadadi M, Tarazi A, Green R, Colella B, Wennberg R, Mikulis D, Davis KD, Kovacs GG, Tator C, Tartaglia MC. Misfolded α-Synuclein in Cerebrospinal Fluid of Contact Sport Athletes. Mov Disord 2023; 38:2125-2131. [PMID: 37792643 DOI: 10.1002/mds.29621] [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: 06/14/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Misfolded α-synuclein in Parkinson's disease (PD) and dementia with Lewy bodies (DLB) can be detected using the real-time quaking-induced conversion (RT-QuIC) technique in cerebrospinal fluid (CSF). OBJECTIVES The objectives are (1) to examine misfolded CSF α-synuclein incidence, and (2) to compare clinical presentation, sports history, brain volumes, and RT-QuIC α-synuclein positivity in former athletes. METHODS Thirty former athletes with magnetic resonance imaging, neuropsychological testing, and CSF analyzed for phosphorylated tau 181 (p-tau), total tau (t-tau), amyloid-β 42 (Aβ42), and neurofilament light chain (NfL). CSF α-synuclein was detected using RT-QuIC. RESULTS Six (20%) former athletes were α-synuclein positive. α-Synuclein positive athletes were similar to α-synuclein negative athletes on demographics, sports history, clinical features, CSF p-tau, t-tau, Aβ42, and NfL; however, had lower grey matter volumes in the right inferior orbitofrontal, right anterior insula and right olfactory cortices. CONCLUSIONS α-Synuclein RT-QuIC analysis of CSF may be useful as a prodromal biofluid marker of PD and DLB. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anna Vasilevskaya
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Martinez-Valbuena
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Chloe Anastassiadis
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Apameh Tarazi
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Robin Green
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Brenda Colella
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - David Mikulis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Karen Deborah Davis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Brain, Imaging, and Behaviour; Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Charles Tator
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
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Hunzinger KJ, Caccese JB, Mannix R, Meehan WP, Swanik CB, Buckley TA. Contact or Collision Sport History, Repetitive Neurotrauma, and Patient-Reported Outcomes in Early to Midadulthood. J Athl Train 2023; 58:952-961. [PMID: 36913638 PMCID: PMC10784886 DOI: 10.4085/1062-6050-0017.23] [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: 03/15/2023]
Abstract
CONTEXT Data on the early to midlife effects of repetitive neurotrauma on patient-reported outcomes have been delimited to homogeneous samples of male athletes without comparison groups or accounting for modifying factors such as physical activity. OBJECTIVE To determine the effect of contact or collision sport participation and repetitive neurotrauma on patient-reported outcomes among early to middle-aged adults. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 113 adults (53 [46.9%] men, 60 [53.1%] women; age = 34.88 ± 11.80 years) in 4 groups: (1) physically inactive individuals with no repetitive head impact (RHI) exposure (NON); (2) noncontact sport athletes and nonathletes with no RHI exposure who were currently physically active (NCA); (3) former high-risk sport athletes with an RHI history who were physically active (HRS); and (4) former rugby players with prolonged RHI exposure who remained physically active. MAIN OUTCOME MEASURE(S) The 12-Item Short-Form Health Survey (SF-12), Apathy Evaluation Scale-self-rated version (AES-S), Satisfaction With Life Scale (SWLS), and Sport Concussion Assessment Tool-5th Edition (SCAT5) Symptom and Symptom Severity Checklist. RESULTS The NON group had worse self-rated physical function than the NCA group as assessed by the SF-12 physical component summary (P = .03) and worse self-rated apathy (AES-S) and satisfaction with life (SWLS) than the NCA (P = .03 for both) and HRS groups (P = .03 and P = .040, respectively). We observed no group differences for self-rated mental health (SF-12 mental component summary; P = .26) or symptoms (SCAT5; P = .42). Career duration was not associated with any patient-reported outcomes. CONCLUSIONS A history of contact or collision sport participation and career duration did not negatively affect patient-reported outcomes in physically active, early to middle-aged adults. However, physical inactivity status was negatively associated with patient-reported outcomes in these individuals in the absence of an RHI history.
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Affiliation(s)
- Katherine J. Hunzinger
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | - Jaclyn B. Caccese
- School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus
| | - Rebekah Mannix
- Divisions of Emergency Medicine, Boston Children’s Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - William P. Meehan
- Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, MA
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
- Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - C. Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
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50
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Weber J, Reinsberger C, Krutsch V, Seiffert R, Huber L, Alt V, Krutsch W. Heading and risk of injury situations for the head in professional German football: a video analysis of over 150,000 headers in 110,000 match minutes. SCI MED FOOTBALL 2023; 7:307-314. [PMID: 35994618 DOI: 10.1080/24733938.2022.2114602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
To provide detailed epidemiological data on situations with a propensity of head injuries due to heading in professional football. In a prospective cohort study including the four highest professional football leagues in Germany, headers carried out in 1244 official matches and critical situations (CI) with a potential risk for injuries over one season were assessed by video analysis and a standardised video protocol. Results: 154,766 headers in 111,960 match minutes were recorded (1.4 headings/min). Video analysis showed a mean of 6.2 headers per field player and match (SD: 2,9; min: 0; max: 19) in the entire study population with a peak in the third league (7.1 per player and match). Headers were predominantly carried out with the forehead (78.5%), and nearly two-thirds occurred during defence (64.3%). 49.9% of all headers occurred during tackling, of which 78.3% involved body contact with an opponent. Video analysis yielded 848 CI. 74.5% of all critical incidents occurred during heading duels as a part of tackling (odds ratio: 3.6, 95%-CI: 2.4-5.2), and 99.4% involved body contact (odds ratio: 5.9, 95%-CI: 2,8-12,7). This study is the first to provide detailed epidemiological data on heading and critical incidences with high risk for head injuries in professional football. Heading duels bear a high risk of head injury and thus represent a key target for prevention strategies. The impacts of headers should be critically investigated regarding neurological consequences in further studies, by including the mean heading rate per mal field player and match.
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Affiliation(s)
- Johannes Weber
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Volker Krutsch
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Robin Seiffert
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Lorenz Huber
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma, Orthopaedic and Sports Surgery, University Medical Centre Regensburg, Regensburg, Germany
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