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Laskowitz S, Baird CL, Huggins A, Nadareishvili N, Bride J, Wagner HR, Briggs M, Morey RA, Turner RW. Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes. Brain Inj 2024; 38:869-879. [PMID: 38727539 PMCID: PMC11323146 DOI: 10.1080/02699052.2024.2347552] [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: 07/06/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment. SETTING Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7). DESIGN Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms. RESULTS Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08). CONCLUSIONS Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC.
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Affiliation(s)
- Sarah Laskowitz
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - C Lexi Baird
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley Huggins
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
| | - Nino Nadareishvili
- School of Medicine and Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, District of Columbia, USA
| | - Jessica Bride
- School of Medicine and Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, District of Columbia, USA
| | - H Ryan Wagner
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Melvin Briggs
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Rajendra A Morey
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, School of Medicine & Health Sciences, The George Washington University, Washington, USA
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Wolff B, Glasson EJ, Babikian T, Pestell CF. Self-Reported Traumatic Brain Injury and Its Biopsychosocial Risk Factors in Siblings of Individuals with Neurodevelopmental Conditions. Dev Neuropsychol 2024; 49:225-242. [PMID: 38994713 DOI: 10.1080/87565641.2024.2377689] [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: 01/16/2024] [Revised: 05/11/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Siblings of individuals with neurodevelopmental conditions (NDCs) are situated within a complex system of risk and resilience factors for poor outcomes, many of which overlap with the risk of traumatic brain injury (TBI) and correlate with poorer recovery trajectories. This study used Bayesian analyses to characterize and compare TBI and biopsychosocial risk factors among 632 siblings (207 NDC, 425 controls; mean age 20.54 years, range 10-30, 78.48% female). NDC siblings had a higher self-reported lifetime history of TBI compared to controls (14.98% versus 6.35%), with most reporting more than one TBI, and at an earlier age. TBI history was associated with psychiatric diagnoses and subclinical NDC features. Family and structural factors related to TBI included poorer parent-child relationship, NDC diagnoses of autism or fetal alcohol spectrum disorder, minority ethnicity, and lower income. Findings have implications for health literacy, TBI education and screening, and implementation of family support.
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Affiliation(s)
- Brittany Wolff
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences and UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, US
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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Gunther OE, Garneau M, Geoffroy MC, Martin-Storey A, Latimer E, Déry M, Temcheff CE. Comparison of concordance and predictive validity of head injuries from parental reports and medical records. Brain Inj 2024:1-7. [PMID: 39041545 DOI: 10.1080/02699052.2024.2381046] [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: 06/19/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD). DESIGN AND SETTING Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database. PARTICIPANTS Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury. MAIN MEASURES Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers. RESULTS Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.
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Affiliation(s)
- Olivia E Gunther
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Mathilde Garneau
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Alexa Martin-Storey
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eric Latimer
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Michèle Déry
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Caroline E Temcheff
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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Bruce HJ, Tripodis Y, McClean M, Korell M, Tanner CM, Contreras B, Gottesman J, Kirsch L, Karim Y, Martin B, Palmisano J, Abdolmohammadi B, Shih LC, Stein TD, Stern RA, Adler CH, Mez J, Nowinski C, McKee AC, Alosco ML. American Football Play and Parkinson Disease Among Men. JAMA Netw Open 2023; 6:e2328644. [PMID: 37566412 PMCID: PMC10422187 DOI: 10.1001/jamanetworkopen.2023.28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Parkinsonism and Parkinson disease (PD) are known to result from repetitive head impacts from boxing. Repetitive head impacts from American football may also be associated with increased risk of neurodegenerative pathologies that cause parkinsonism, yet in vivo research on the association between football play and PD is scarce and limited by small samples and equivocal findings. Objective To evaluate the association between football participation and self-reported parkinsonism or PD diagnosis. Design, Setting, and Participants This cross-sectional study leveraged data from the online Fox Insight study. Participants completed online questionnaires and self-reported whether they currently had a diagnosis of Parkinson disease or parkinsonism by a physician or other health care professional. In November 2020, the Boston University Head Impact Exposure Assessment was launched for data collection on repetitive head impacts. Data used for this manuscript were obtained from the Fox Insight database on June 9, 2022. A total of 1875 men who endorsed playing any organized sport were included. Former athletes were divided into those who participated in football (n = 729 [38.9%]) and those who participated in other sports (reference group). Exposures Self-reported participation in football, duration and level of football play, age at first exposure. Main Outcomes and Measures Logistic regression tested associations between PD status and history of football play, duration of football play, highest level played, and age at first exposure, controlling for age, education, history of diabetes or heart disease, body mass index, history of traumatic brain injury with loss of consciousness, and family history of PD. Results In this sample of 1875 men (mean [SD] age, 67.69 [9.84] years) enriched for parkinsonism or PD (n = 1602 [85.4%]), 729 (38.9%) played football (mean [SD] duration, 4.35 [2.91] years). History of playing football was associated with higher odds of having a parkinsonism or PD diagnosis (odds ratio [OR], 1.61; 95% CI, 1.19-2.17). Among the entire sample, longer duration of play was associated with higher odds of having a parkinsonism or PD diagnosis (OR, 1.12; 95% CI, 1.06-1.19). Among football players, longer duration of football play (OR, 1.12; 95% CI, 1.02-1.23) and higher level of play (OR, 2.93; 95% CI, 1.28-6.73) were associated with higher odds of having parkinsonism or PD. Conclusions and Relevance In this cross-sectional study of participants enriched for PD, participation in football was associated with higher odds of having a reported parkinsonism or PD diagnosis.
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Affiliation(s)
- Hannah J. Bruce
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Monica Korell
- Department of Neurology, University of California San Francisco
| | | | | | - Joshua Gottesman
- The Michael J. Fox Foundation for Parkinson’s Research, New York, New York
| | - Leslie Kirsch
- The Michael J. Fox Foundation for Parkinson’s Research, New York, New York
| | - Yasir Karim
- The Michael J. Fox Foundation for Parkinson’s Research, New York, New York
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Bobak Abdolmohammadi
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ludy C. Shih
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, United States Department of Veteran Affairs, Boston, Massachusetts
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
| | | | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, United States Department of Veteran Affairs, Boston, Massachusetts
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center, Boston University Chronic Traumatic Encephalopathy Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Alosco ML, Tripodis Y, Baucom ZH, Adler CH, Balcer LJ, Bernick C, Mariani ML, Au R, Banks SJ, Barr WB, Wethe JV, Cantu RC, Coleman MJ, Dodick DW, McClean MD, McKee AC, Mez J, Palmisano JN, Martin B, Hartlage K, Lin AP, Koerte IK, Cummings JL, Reiman EM, Stern RA, Shenton ME, Bouix S. White matter hyperintensities in former American football players. Alzheimers Dement 2023; 19:1260-1273. [PMID: 35996231 PMCID: PMC10351916 DOI: 10.1002/alz.12779] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/24/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The presentation, risk factors, and etiologies of white matter hyperintensities (WMH) in people exposed to repetitive head impacts are unknown. We examined the burden and distribution of WMH, and their association with years of play, age of first exposure, and clinical function in former American football players. METHODS A total of 149 former football players and 53 asymptomatic unexposed participants (all men, 45-74 years) completed fluid-attenuated inversion recovery magnetic resonance imaging, neuropsychological testing, and self-report neuropsychiatric measures. Lesion Segmentation Toolbox estimated WMH. Analyses were performed in the total sample and stratified by age 60. RESULTS In older but not younger participants, former football players had greater total, frontal, temporal, and parietal log-WMH compared to asymptomatic unexposed men. In older but not younger former football players, greater log-WMH was associated with younger age of first exposure to football and worse executive function. DISCUSSION In older former football players, WMH may have unique presentations, risk factors, and etiologies. HIGHLIGHTS Older but not younger former football players had greater total, frontal, temporal, and parietal lobe white matter hyperintensities (WMH) compared to same-age asymptomatic unexposed men. Younger age of first exposure to football was associated with greater WMH in older but not younger former American football players. In former football players, greater WMH was associated with worse executive function and verbal memory.
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Affiliation(s)
- Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Zachary H. Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Laura J. Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV
- Department of Neurology, University of Washington, Seattle, WA
| | - Megan L. Mariani
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Boston University School of Medicine, Boston, MA
| | - Rhoda Au
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Sarah J. Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA
| | - William B. Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Jennifer V. Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Michael J. Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- VA Boston Healthcare System, Boston, MA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Framingham Heart Study, Framingham, MA
| | - Joseph N. Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Kaitlin Hartlage
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA
| | - Alexander P. Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Jeffrey L. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer’s Consortium, Phoenix, AZ
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
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Alosco ML, Barr WB, Banks SJ, Wethe JV, Miller JB, Pulukuri SV, Culhane J, Tripodis Y, Adler CH, Balcer LJ, Bernick C, Mariani ML, Cantu RC, Dodick DW, McClean MD, Au R, Mez J, Turner RW, Palmisano JN, Martin B, Hartlage K, Cummings JL, Reiman EM, Shenton ME, Stern RA. Neuropsychological test performance of former American football players. Alzheimers Res Ther 2023; 15:1. [PMID: 36597138 PMCID: PMC9808953 DOI: 10.1186/s13195-022-01147-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patterns of cognitive impairment in former American football players are uncertain because objective neuropsychological data are lacking. This study characterized the neuropsychological test performance of former college and professional football players. METHODS One hundred seventy male former football players (n=111 professional, n=59 college; 45-74 years) completed a neuropsychological test battery. Raw scores were converted to T-scores using age, sex, and education-adjusted normative data. A T-score ≤ 35 defined impairment. A domain was impaired if 2+ scores fell in the impaired range except for the language and visuospatial domains due to the limited number of tests. RESULTS Most football players had subjective cognitive concerns. On testing, rates of impairments were greatest for memory (21.2% two tests impaired), especially for recall of unstructured (44.7%) versus structured verbal stimuli (18.8%); 51.8% had one test impaired. 7.1% evidenced impaired executive functions; however, 20.6% had impaired Trail Making Test B. 12.1% evidenced impairments in the attention, visual scanning, and psychomotor speed domain with frequent impairments on Trail Making Test A (18.8%). Other common impairments were on measures of language (i.e., Multilingual Naming Test [21.2%], Animal Fluency [17.1%]) and working memory (Number Span Backward [14.7%]). Impairments on our tasks of visuospatial functions were infrequent. CONCLUSIONS In this sample of former football players (most of whom had subjective cognitive concerns), there were diffuse impairments on neuropsychological testing with verbal memory being the most frequently impaired domain.
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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, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
| | - William B Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sarah J Banks
- Department of Neuroscience, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Surya Vamsi Pulukuri
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
| | - Julia Culhane
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Megan L Mariani
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
| | - David W Dodick
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Framingham, MA, USA
- Slone Epidemiology Center, Boston University, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, The George Washington University School of Medicine & Health Sciences, Washington, DC, 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
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - 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
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, 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, Robinson Building, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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7
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Jacob D, Unnsteinsdóttir Kristensen IS, Aubonnet R, Recenti M, Donisi L, Ricciardi C, Svansson HÁR, Agnarsdóttir S, Colacino A, Jónsdóttir MK, Kristjánsdóttir H, Sigurjónsdóttir HÁ, Cesarelli M, Eggertsdóttir Claessen LÓ, Hassan M, Petersen H, Gargiulo P. Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea). Sci Rep 2022; 12:8996. [PMID: 35637235 PMCID: PMC9151646 DOI: 10.1038/s41598-022-12822-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior-posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.
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Affiliation(s)
- Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | | | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Leandro Donisi
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Halldór Á R Svansson
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Sólveig Agnarsdóttir
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Andrea Colacino
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Computer Engineering, Electrical and Applied Mathematics, University of Salerno, Salerno, Italy
| | - María K Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Hafrún Kristjánsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | - Helga Á Sigurjónsdóttir
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Department of Information Technology and Electrical Engineering, University of Naples, Naples, Italy
| | - Lára Ósk Eggertsdóttir Claessen
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mahmoud Hassan
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- MINDig, 35000, Rennes, France
| | - Hannes Petersen
- Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland.
- Department of Science, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland.
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8
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Vike NL, Bari S, Stetsiv K, Walter A, Newman S, Kawata K, Bazarian JJ, Martinovich Z, Nauman EA, Talavage TM, Papa L, Slobounov SM, Breiter HC. A preliminary model of football-related neural stress that integrates metabolomics with transcriptomics and virtual reality. iScience 2022; 25:103483. [PMID: 35106455 PMCID: PMC8786649 DOI: 10.1016/j.isci.2021.103483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/23/2021] [Accepted: 11/19/2021] [Indexed: 12/06/2022] Open
Abstract
Research suggests contact sports affect neurological health. This study used permutation-based mediation statistics to integrate measures of metabolomics, neuroinflammatory miRNAs, and virtual reality (VR)-based motor control to investigate multi-scale relationships across a season of collegiate American football. Fourteen significant mediations (six pre-season, eight across-season) were observed where metabolites always mediated the statistical relationship between miRNAs and VR-based motor control (pSobelperm≤ 0.05; total effect > 50%), suggesting a hypothesis that metabolites sit in the statistical pathway between transcriptome and behavior. Three results further supported a model of chronic neuroinflammation, consistent with mitochondrial dysfunction: (1) Mediating metabolites were consistently medium-to-long chain fatty acids, (2) tricarboxylic acid cycle metabolites decreased across-season, and (3) accumulated head acceleration events statistically moderated pre-season metabolite levels to directionally model post-season metabolite levels. These preliminary findings implicate potential mitochondrial dysfunction and highlight probable peripheral blood biomarkers underlying repetitive head impacts in otherwise healthy collegiate football athletes. Permutation-based mediation statistics can be applied to multi-scale biology problems Fatty acids were a critical link between elevated miRNAs and motor control HAEs interacted with pre-season metabolite levels to model post-season levels Together, our observations point to brain-related mitochondrial dysfunction
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Affiliation(s)
- Nicole L Vike
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sumra Bari
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Khrystyna Stetsiv
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexa Walter
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY 14627, USA
| | - Zoran Martinovich
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL 32806, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Hans C Breiter
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA 02114, USA
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9
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Uretsky M, Bouix S, Killiany RJ, Tripodis Y, Martin B, Palmisano J, Mian AZ, Buch K, Farris C, Daneshvar DH, Dwyer B, Goldstein L, Katz D, Nowinski C, Cantu R, Kowall N, Huber BR, Stern RA, Alvarez VE, Stein TD, McKee A, Mez J, Alosco ML. Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts. Neurology 2022; 98:e27-e39. [PMID: 34819338 PMCID: PMC8726571 DOI: 10.1212/wnl.0000000000013012] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/29/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Late neuropathologies of repetitive head impacts from contact sports can include chronic traumatic encephalopathy (CTE) and white matter degeneration. White matter hyperintensities (WMH) on fluid-attenuated inversion recovery (FLAIR) MRI scans are often viewed as microvascular disease from vascular risk, but might have unique underlying pathologies and risk factors in the setting of repetitive head impacts. We investigated the neuropathologic correlates of antemortem WMH in brain donors exposed to repetitive head impacts. The association between WMH and repetitive head impact exposure and informant-reported cognitive and daily function were tested. METHODS This imaging-pathologic correlation study included symptomatic male decedents exposed to repetitive head impacts. Donors had antemortem FLAIR scans from medical records and were without evidence of CNS neoplasm, large vessel infarcts, hemorrhage, or encephalomalacia. WMH were quantified using log-transformed values for total lesion volume (TLV), calculated using the lesion prediction algorithm from the Lesion Segmentation Toolbox. Neuropathologic assessments included semiquantitative ratings of white matter rarefaction, cerebrovascular disease, hyperphosphorylated tau (p-tau) severity (CTE stage, dorsolateral frontal cortex), and β-amyloid (Aβ). Among football players, years of play was a proxy for repetitive head impact exposure. Retrospective informant-reported cognitive and daily function were assessed using the Cognitive Difficulties Scale (CDS) and Functional Activities Questionnaire (FAQ). Regression models controlled for demographics, diabetes, hypertension, and MRI resolution. Statistical significance was defined as p ≤ 0.05. RESULTS The sample included 75 donors: 67 football players and 8 nonfootball contact sport athletes or military veterans. Dementia was the most common MRI indication (64%). Fifty-three (70.7%) had CTE at autopsy. Log TLV was associated with white matter rarefaction (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.03, 5.24; p = 0.04), arteriolosclerosis (OR 2.38, 95% CI 1.02, 5.52; p = 0.04), CTE stage (OR 2.58, 95% CI 1.17, 5.71; p = 0.02), and dorsolateral frontal p-tau severity (OR 3.03, 95% CI 1.32, 6.97; p = 0.01). There was no association with Aβ. More years of football play was associated with log TLV (unstandardized β 0.04, 95% CI 0.01, 0.06; p = 0.01). Greater log TLV correlated with higher FAQ (unstandardized β 4.94, 95% CI 0.42, 8.57; p = 0.03) and CDS scores (unstandardized β 15.35, 95% CI -0.27, 30.97; p = 0.05). DISCUSSION WMH might capture long-term white matter pathologies from repetitive head impacts, including those from white matter rarefaction and p-tau, in addition to microvascular disease. Prospective imaging-pathologic correlation studies are needed. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence of associations between FLAIR white matter hyperintensities and neuropathologic changes (white matter rarefaction, arteriolosclerosis, p-tau accumulation), years of American football play, and reported cognitive symptoms in symptomatic brain donors exposed to repetitive head impacts.
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Affiliation(s)
- Madeline Uretsky
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Sylvain Bouix
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Ronald J Killiany
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Yorghos Tripodis
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Brett Martin
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Joseph Palmisano
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Asim Z Mian
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Karen Buch
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Chad Farris
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Daniel H Daneshvar
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Brigid Dwyer
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Lee Goldstein
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Douglas Katz
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Christopher Nowinski
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Robert Cantu
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Neil Kowall
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Bertrand Russell Huber
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Robert A Stern
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Victor E Alvarez
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Thor D Stein
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Ann McKee
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Jesse Mez
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA
| | - Michael L Alosco
- From the Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology (M.U., R.J.K., Y.T., D.H.D., B.D., L.G., D.K., C.N., R.C., N.K., B.R.H., R.A.S., V.E.A., T.D.S., A.M., J.M., M.L.A.), Department of Anatomy and Neurobiology (R.J.K., R.A.S.), Center for Biomedical Imaging (R.J.K.), Department of Radiology (A.Z.M., C.F.), Framingham Heart Study (C.F., T.D.S., A.M., J.M.), Department of Pathology and Laboratory Medicine (L.G., N.K., T.D.S., A.M.), Department of Psychiatry (L.G.), Department of Ophthalmology (L.G.), and Department of Neurosurgery (R.C., R.A.S.), Boston University School of Medicine; Department of Psychiatry, Psychiatry Neuroimaging Laboratory (S.B.), Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics (Y.T.) and Biostatistics and Epidemiology Data Analytics Center (B.M., J.P.), Boston University School of Public Health; Departments of Radiology (K.B.) and Physical Medicine & Rehabilitation (D.H.D.), Massachusetts General Hospital, Boston; Braintree Rehabilitation Hospital (B.D., D.K.); Department of Biomedical, Electrical & Computer Engineering (L.G.), Boston University College of Engineering; Concussion Legacy Foundation (C.N., R.C.), Boston; Department of Neurosurgery (R.C.), Emerson Hospital, Concord; VA Boston Healthcare System (B.R.H., V.E.A., T.D.S., A.M.), US Department of Veterans Affairs, Jamaica Plain; National Center for PTSD (B.R.H., V.E.A.), VA Boston Healthcare, Jamaica Plain; and Department of Veterans Affairs Medical Center (V.E.A., T.D.S., A.M.), Bedford, MA.
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James L, Davies M, Mian S, Seghezzo G, Williamson E, Kemp S, Arden N, McElvenny D, Pearce N, Gallo V. The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies. Epidemiol Health 2021; 43:e2021086. [PMID: 34696571 PMCID: PMC8863616 DOI: 10.4178/epih.e2021086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The BRAIN-Q is a tool aimed at maximising the accuracy and minimising measurement error for retrospectively assessing concussions. This paper reports the agreement of the BRAIN-Q tool when compared to extant questionnaire questions, and its reproducibility when compared with its telephonic version (tBRAIN-Q). METHODS The BRAIN-Q entails a 3-stage process: defining a concussion, creating a visual timeline with life events, and establishing detailed characteristics for each reported concussion. It was designed to be administered in-person by trained personnel, and was used in the BRAIN study. Its performance was compared with the MSK study, which previously collected a few questions in a broader self-administered questionnaire, and with the tBRAIN-Q Recall, its telephonic version. RESULTS In total, 101 participants were included, of whom 9 were re-assessed with the tBRAIN-Q. The agreement of the BRAIN-Q with the muscle skeletal-questionnaire for rugby-related concussion was 86.7% (κ=0.6). Rugby-related concussion with loss of consciousness showed lower agreement (82.0%; κ=0.6). The comparison between the BRAIN-Q and the tBRAIN-Q showed good reproducibility. CONCLUSIONS The BRAIN-Q is a relatively easy tool to administer in face-to-face assessments, and it showed optimal reproducibility. It includes a well-established definition of concussion, and is used to collect detailed information on each concussion, allowing for a number of subgroup analyses (e.g., by severity, age, or context). The BRAIN-Q is easily adaptable to other sporting settings.
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Affiliation(s)
- Laura James
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Saba Mian
- London School of Hygiene & Tropical Medicine, London, UK
| | - Giulia Seghezzo
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Simon Kemp
- London School of Hygiene & Tropical Medicine, London, UK.,Rugby Football Union, London, UK
| | | | - Damien McElvenny
- London School of Hygiene & Tropical Medicine, London, UK.,Institute of Occupational edicine, Edinburgh, UK.,Institute of Occupational Medicine and University of Manchester, Manchester, UK
| | - Neil Pearce
- London School of Hygiene & Tropical Medicine, London, UK
| | - Valentina Gallo
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.,London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, Imperial College London, London, UK.,Department of Sustainable Health, Campus Fryslând, University of Groningen, Leeuwarden, Netherlands
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11
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Asken BM, Mantyh WG, La Joie R, Strom A, Casaletto KB, Staffaroni AM, Apple AC, Lindbergh CA, Iaccarino L, You M, Grant H, Fonseca C, Windon C, Younes K, Tanner J, Rabinovici GD, Kramer JH, Gardner RC. Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults. Brain Imaging Behav 2021; 15:2417-2425. [PMID: 33432536 PMCID: PMC8272743 DOI: 10.1007/s11682-020-00440-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/30/2023]
Abstract
We investigated whether clinically normal older adults with remote, mild traumatic brain injury (mTBI) show evidence of higher cortical Aβ burden. Our study included 134 clinically normal older adults (age 74.1 ± 6.8 years, 59.7% female, 85.8% white) who underwent Aβ positron emission tomography (Aβ-PET) and who completed the Ohio State University Traumatic Brain Injury Identification questionnaire. We limited participants to those reporting injuries classified as mTBI. A subset (N = 30) underwent a second Aβ-PET scan (mean 2.7 years later). We examined the effect of remote mTBI on Aβ-PET burden, interactions between remote mTBI and age, sex, and APOE status, longitudinal Aβ accumulation, and the interaction between remote mTBI and Aβ burden on memory and executive functioning. Of 134 participants, 48 (36%) reported remote mTBI (0, N = 86; 1, N = 31, 2+, N = 17; mean 37 ± 23 years since last mTBI). Effect size estimates were small to negligible for the association of remote mTBI with Aβ burden (p = .94, η2 < 0.01), and for all interaction analyses. Longitudinally, we found a non-statistically significant association of those with remote mTBI (N = 11) having a faster rate of Aβ accumulation (B = 0.01, p = .08) than those without (N = 19). There was no significant interaction between remote mTBI and Aβ burden on cognition. In clinically normal older adults, history of mTBI is not associated with greater cortical Aβ burden and does not interact with Aβ burden to impact cognition. Longitudinal analyses suggest remote mTBI may be associated with more rapid cortical Aβ accumulation. This finding warrants further study in larger and more diverse samples with well-characterized lifelong head trauma exposure.
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Affiliation(s)
- Breton M Asken
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
| | - William G Mantyh
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Renaud La Joie
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Amelia Strom
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Kaitlin B Casaletto
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Adam M Staffaroni
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Alexandra C Apple
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Cutter A Lindbergh
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Leonardo Iaccarino
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Michelle You
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Harli Grant
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Corrina Fonseca
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Charles Windon
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Kyan Younes
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Jeremy Tanner
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Departments of Neurology, Radiology & Biomedical Imaging Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, San Francisco, USA
| | - Joel H Kramer
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Raquel C Gardner
- Department of Neurology Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
- San Francisco Veterans Affairs Health , San Francisco, CA, USA
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12
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Self-Reported Lifetime Concussion Among Adults: Comparison of 3 Different Survey Questions. J Head Trauma Rehabil 2021; 35:E136-E143. [PMID: 31479084 DOI: 10.1097/htr.0000000000000534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Because of limitations in current national data sets, respondent self-report may be critical to obtaining concussion prevalence estimates. We examined whether self-report of lifetime concussion among adults varies with the provision of a concussion definition and by the content of that definition. SETTING AND PARTICIPANTS A convenience sample of 6427 American adults who participated in the 2018 Porter Novelli SpringStyles survey. DESIGN Cross-sectional. MAIN MEASURES Frequency of self-reported concussion by variation in concussion definition. RESULTS A quarter of respondents (28.9%) reported experiencing a concussion in their lifetime. While concussion prevalence varied by demographic characteristics, it did not vary significantly by concussion definition. Variation in concussion definition did not result in differences related to recency of last concussion, mechanism of injury, or respondent activity engaged in during which they sustained their most recent concussion. CONCLUSION The current study suggested that in this sample of adults, the percentage reporting a concussion did not significantly vary by whether a concussion definition was provided or by the content of the definition. However, research suggests that prompting about mechanism of injury, listing symptoms individually, and considering only athletic populations may affect estimates and these factors should be included in future question comparisons.
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13
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Alosco ML, Mariani ML, Adler CH, Balcer LJ, Bernick C, Au R, Banks SJ, Barr WB, Bouix S, Cantu RC, Coleman MJ, Dodick DW, Farrer LA, Geda YE, Katz DI, Koerte IK, Kowall NW, Lin AP, Marcus DS, Marek KL, McClean MD, McKee AC, Mez J, Palmisano JN, Peskind ER, Tripodis Y, Turner RW, Wethe JV, Cummings JL, Reiman EM, Shenton ME, Stern RA. Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2021; 13:136. [PMID: 34384490 PMCID: PMC8357968 DOI: 10.1186/s13195-021-00872-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the "Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project." The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project. METHODS The targeted sample and sample size was 240 male participants, ages 45-74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined. RESULTS Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021. CONCLUSIONS Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE. TRIAL REGISTRATION NCT02798185.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Megan L Mariani
- Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, and Slone Epidemiology Center, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 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
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Lindsay A Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, BU Schools of Medicine and Public Health, Boston, MA, USA
| | - Yonas E Geda
- Alzheimer's Disease and Memory Disorders Program, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elaine R Peskind
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - 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
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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14
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Meier TB, España LY, Kirk AJ, Nader AM, Powell JE, Nelson LD, Mayer AR, Brett BL. Association of Previous Concussion with Hippocampal Volume and Symptoms in Collegiate-Aged Athletes. J Neurotrauma 2021; 38:1358-1367. [PMID: 33397203 PMCID: PMC8082726 DOI: 10.1089/neu.2020.7143] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is concern that previous concussion and contact-sport exposure may have negative effects on brain structure and function. Accurately quantifying previous concussion is complicated by the fact that multiple definitions exist, with recent definitions allowing for diagnosis based on the presence of symptoms alone (Concussion in Sport Group criteria; CISG) rather than the presence of acute injury characteristics such as alterations in mental status (American Congress of Rehabilitation Medicine criteria; ACRM). The goals of the current work were to determine the effects of previous concussion and contact-sport exposure on gray matter structure and clinical measures in healthy, young-adult athletes and determine the extent to which these associations are influenced by diagnostic criteria used to retrospectively quantify concussions. One-hundred eight collegiate-aged athletes were enrolled; 106 athletes were included in final analyses (age, 21.37 ± 1.69; 33 female). Participants completed a clinical battery of self-report and neurocognitive measures and magnetic resonance imaging to quantify subcortical volumes and cortical thickness. Semistructured interviews were conducted to measure exposure to contact sports and the number of previous concussions based on CISG and ACRM criteria. There was a significant association of concussion-related and psychological symptoms with previous concussions based on ACRM (ps < 0.05), but not CISG, criteria. Hippocampal volume was inversely associated with the number of previous concussions for both criteria (ps < 0.05). Findings provide evidence that previous concussions are associated with smaller hippocampal volumes and greater subjective clinical symptoms in otherwise healthy athletes and highlight the importance of diagnostic criteria used to quantify previous concussion.
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Affiliation(s)
- Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lezlie Y. España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexander J. Kirk
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy M. Nader
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer E. Powell
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Bedard G, Wyndham Lawrence D. Five-Year Trends in Reported National Football League Injuries. Clin J Sport Med 2021; 31:289-294. [PMID: 33882544 DOI: 10.1097/jsm.0000000000000741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence of all-cause injury and concussion in the National Football League (NFL) over a 5-season time span (2012-2016). DESIGN Prospective descriptive epidemiological study. SETTING National Football League Injury Report data from 2012 to 2016. PARTICIPANTS National Football League players. INTERVENTIONS None (descriptive study). MAIN OUTCOME MEASURES Injury report data were collected prospectively for all NFL injuries from 5 seasons (2012-2016). The incidences of reported concussions, knee injuries, and all-cause injury were compared across the 5 seasons using the Kruskal-Wallis rank-sum test. RESULTS A total of 10 927 injuries were identified across the 5 seasons, including 752 (6.9%) concussions. The top 3 most injured areas included the knee (17.2%), ankle (13.6%), and shoulder (8.8%). Defensive backs consistently had the highest number of all-cause injuries per season. When comparing across years, there was a significant decrease in all-cause injury in 2016 compared with 2015, a significant decrease in knee injuries in 2016 compared with 2015, and a significant increase in concussion in 2015 compared with 2014 (P < 0.05). CONCLUSIONS Reported all-cause injury incidence and knee injury incidence is currently on the decline. However, reported concussion incidence has recently increased, perhaps due to increased awareness and rule changes implemented to aid in the detection and treatment of concussion. Strategies to reduce injury and improve injury awareness should continue to be explored.
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Affiliation(s)
| | - David Wyndham Lawrence
- Faculty of Medicine, University of Toronto, Toronto, ON
- Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, ON
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16
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Baugh CM, Kroshus E, Meehan WP, McGuire TG, Hatfield LA. Accuracy of US College Football Players' Estimates of Their Risk of Concussion or Injury. JAMA Netw Open 2020; 3:e2031509. [PMID: 33372973 PMCID: PMC7772718 DOI: 10.1001/jamanetworkopen.2020.31509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Despite increased concern about the health consequences of contact sports, little is known about athletes' understanding of their own risk of sports-related injury. OBJECTIVE To assess whether college football players accurately estimate their risk of concussion and nonconcussion injury and to identify characteristics of athletes who misestimate their injury risk. DESIGN, SETTING, AND PARTICIPANTS In this survey study, questionnaires were given to 296 current college football players on 4 teams from the 3 of the 5 most competitive conferences of the US National Collegiate Athletic Association. Surveys were conducted between February and May 2017. Data were analyzed from June 2017 through July 2020. MAIN OUTCOMES AND MEASURES Multiple approaches were taken to compare athlete perceptions of their risks of concussion and nonconcussion injury with individual probabilities of these risks, which were modeled using logistic regression. RESULTS Of 296 male college-aged athletes from 4 football teams who participated in the survey, 265 (89%) answered all questions relevant for this study. Participating teams were similar to nonparticipating teams across nearly all measured characteristics. One hundred athletes (34%) had sustained 1 or more concussions, and 197 (68% of the 289 who responded to the question) had sustained 1 or more injuries in the previous football season. Logistic regression models of single-season injury and concussion had reasonably good fit (area under the curve, 0.75 and 0.73, respectively). Of the 265 participants for whom all relevant data were available, 111 (42%) underestimated their risk of concussion (χ2 = 98.6; P = .003). A similar proportion of athletes (113 [43%]) underestimated their risk of injury, although this was not statistically significant (χ2 = 34.0; P = .09). An alternative analytic strategy suggested that 241 athletes (91%) underestimated their risk of injury (Wilcoxon statistic, 7865; P < .001) and 167 (63%) underestimated their risk of concussion (Wilcoxon statistic, 26 768; P < .001). CONCLUSIONS AND RELEVANCE The findings of this survey study suggest that college football players may underestimate their risk of injury and concussion. The implications for informed participation in sport are unclear given that people generally underestimate health risks. It is necessary to consider whether athletes are sufficiently informed and how much risk is acceptable for an athlete to participate in a sport.
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Affiliation(s)
- Christine M. Baugh
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - William P. Meehan
- Sports Concussion Clinic, Department of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Thomas G. McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Laura A. Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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17
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Kristjánsdóttir H, Brynjarsdóttir RM, Kristensen ISU, Sigurjónsdóttir HÁ, Claessen LÓE, Jónsdóttir MK. Self-reported concussion history among Icelandic female athletes with and without a definition of concussion. Clin Neuropsychol 2020; 34:70-82. [PMID: 32990154 DOI: 10.1080/13854046.2020.1814873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examined whether Icelandic female athletes in contact sports, based their self-reported concussion history on adequate medical definitions, by assessing self-reported concussion history with and without a definition of concussion. Another aim was to examine whether currently active athletes were more knowledgeable of concussions than retired athletes. METHODS Participants (age = 26.9, SD = 7.1) were 508 former (34.5%) and current (65.5%) elite female athletes in soccer (41%), handball (30.6%), basketball (19.1%), ice hockey (4.5%) and combat sports (4.7%). An online questionnaire (QuestionPro) was distributed to females in contact sports (snowball sampling). Participants later came for an in-person interview where the authenticity of previous responses was confirmed. In the questionnaire, participants answered background questions and questions about concussion history. First, they reported the total number of sustained concussions without a prompt. They reported the number of sustained concussions again after reading a definition of concussion. Participants could not correct their previous answers. Pearson's Chi-square was used for group comparisons. RESULTS The prevalence of reported concussions increased from 40.2% to 64.8% following a definition. There was no significant difference in how many participants changed their answer when asked about sustaining SRCs before and after reading the definition based on whether the participants were still competitive or retired X 2(1) = 0.69, p = 0.41. CONCLUSIONS Our data suggest that understanding of concussions is inadequate among female athletes. Self-report will continue to be an essential source of clinical information and prompting with a definition can increase the reliability of self-reported concussions.
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Affiliation(s)
- Hafrún Kristjánsdóttir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | | | - Ingunn S U Kristensen
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Helga Á Sigurjónsdóttir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - Lára Ósk Eggertsdóttir Claessen
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - María K Jónsdóttir
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
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18
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Guinn AS, Ports KA, Ford DC, Breiding M, Merrick MT. Associations between adverse childhood experiences and acquired brain injury, including traumatic brain injuries, among adults: 2014 BRFSS North Carolina. Inj Prev 2019; 25:514-520. [PMID: 30317219 PMCID: PMC6462254 DOI: 10.1136/injuryprev-2018-042927] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 01/31/2023]
Abstract
Adverse childhood experiences (ACEs) can negatively affect lifelong health and opportunity. Acquired brain injury (ABI), which includes traumatic brain injury (TBI) as well as other causes of brain injury, is a health condition that affects millions annually. The present study uses data from the 2014 North Carolina Behavioral Risk Factor Surveillance System to examine the relationship between ACEs and ABI. The study sample included 3454 participants who completed questions on both ABI and ACEs. Multivariable logistic regression models were used to determine the relationship between ACEs and ABI as well as ACEs and TBI. Sexual abuse, emotional abuse, physical abuse, household mental illness and household substance abuse were significantly associated with ABI after adjusting for age, race/ethnicity, gender and employment. Compared with those reporting no ACEs, individuals reporting three ACEs had 2.55 times the odds of having experienced an ABI; individuals reporting four or more ACEs had 3.51 times the odds of having experienced an ABI. Examining TBI separately, those who experienced sexual abuse, physical abuse, household mental illness and had incarcerated household members in childhood had greater odds of reported TBI, after adjusting for age, race/ethnicity, gender and income. Respondents reporting three ACEs (AOR=4.16, 95% CI (1.47 to 11.76)) and four or more ACEs (AOR=3.39, 95% CI (1.45 to 7.90)) had significantly greater odds of reporting TBI than respondents with zero ACEs. Prevention of early adversity may reduce the incidence of ABI; however, additional research is required to elucidate the potential pathways from ACEs to ABI, and vice versa.
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Affiliation(s)
- Angie S Guinn
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie A Ports
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Derek C Ford
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matt Breiding
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa T Merrick
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Laker SR, Greiss C, Finnoff JT, Singh JR. Football Participation and Chronic Traumatic Encephalopathy. PM R 2018; 10:655-660. [DOI: 10.1016/j.pmrj.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
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D'Ascanio S, Alosco ML, Stern RA. Chronic traumatic encephalopathy: clinical presentation and in vivo diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:281-296. [PMID: 30482356 DOI: 10.1016/b978-0-444-63954-7.00027-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exposure to repetitive head impacts from contact sport participation (e.g., American football, boxing, soccer) is associated with the neurodegenerative disorder known as chronic traumatic encephalopathy (CTE). The neuropathology of CTE is becoming well defined, and diagnostic criteria have been developed and are being refined. The critical next step in this emerging field is the diagnosis of CTE during life. The objective of this chapter is to describe what is currently known about the clinical presentation and in vivo diagnosis of CTE. This chapter reviews studies in which clinical manifestation of CTE was examined through retrospective telephone interviews with informants of individuals whose brains were donated and were diagnosed with CTE through neuropathologic examination. In vivo research examining the long-term neurobehavioral consequences of repetitive head impacts is also reviewed, followed by a comparison of the existing provisional clinical diagnostic criteria for CTE, as well as preliminary research on possible fluid and neuroimaging biomarkers. An illustrative case study of CTE is presented, and the chapter concludes with a discussion of gaps in knowledge and future directions.
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Affiliation(s)
- Steven D'Ascanio
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, United States.
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21
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Changes in Self-Reported Concussion History after Administration of a Novel Concussion History Questionnaire in Collegiate Recreational Student-Athletes. Sports (Basel) 2017; 5:sports5040095. [PMID: 29910455 PMCID: PMC5969026 DOI: 10.3390/sports5040095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022] Open
Abstract
Research has shown that exposure to a concussion definition (CD) increases self-reported concussion history (SRCH) immediately, however, no research has been performed that examines the effects of exposure to a CD on SRCH over time. Collegiate recreational student-athletes (RSAs) have limited access to monitoring and supervision by medical staff. As such, recognition of concussion symptoms and need for medical management oftentimes falls upon the RSA. The purpose of this study was to assess the effect of a novel questionnaire on the SRCH of RSAs. A two-part questionnaire was sent to RSAs participating is sports with a greater than average risk of concussion at a university in Arizona. Data from 171 RSAs were analyzed to assess the change in RSAs' suspected concussion estimates pre- and post-exposure to a CD and concussion symptom worksheet, as well as over the short-term (2.5 months). Approximately one-third of RSAs reported an increase in suspected concussion estimates immediately following exposure to the questionnaire, but the change was not maintained over the short-term. The results suggest that a single exposure to a CD is ineffective at increasing short-term SRCH estimates.
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22
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Schultz V, Stern RA, Tripodis Y, Stamm J, Wrobel P, Lepage C, Weir I, Guenette JP, Chua A, Alosco ML, Baugh CM, Fritts NG, Martin BM, Chaisson CE, Coleman MJ, Lin AP, Pasternak O, Shenton ME, Koerte IK. Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players. J Neurotrauma 2017; 35:278-285. [PMID: 28990457 DOI: 10.1089/neu.2017.5145] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Thalamic atrophy has been associated with exposure to repetitive head impacts (RHI) in professional fighters. The aim of this study is to investigate whether or not age at first exposure (AFE) to RHI is associated with thalamic volume in symptomatic former National Football League (NFL) players at risk for chronic traumatic encephalopathy (CTE). Eighty-six symptomatic former NFL players (mean age = 54.9 ± 7.9 years) were included. T1-weighted data were acquired on a 3T magnetic resonance imager, and thalamic volumes were derived using FreeSurfer. Mood and behavior, psychomotor speed, and visual and verbal memory were assessed. The association between thalamic volume and AFE to playing football and to number of years playing was calculated. Decreased thalamic volume was associated with more years of play (left: p = 0.03; right: p = 0.03). Younger AFE was associated with decreased right thalamic volume (p = 0.014). This association remained significant after adjusting for total years of play. Decreased left thalamic volume was associated with worse visual memory (p = 0.014), whereas increased right thalamic volume was associated with fewer mood and behavior symptoms (p = 0.003). In our sample of symptomatic former NFL players at risk for CTE, total years of play and AFE were associated with decreased thalamic volume. The effect of AFE on right thalamic volume was almost twice as strong as the effect of total years of play. Our findings confirm previous reports of an association between thalamic volume and exposure to RHI. They suggest further that younger AFE may result in smaller thalamic volume later in life.
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Affiliation(s)
- Vivian Schultz
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Robert A Stern
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,4 Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Yorghos Tripodis
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Julie Stamm
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,6 Department of Kinesiology, University of Wisconsin , Madison, Madison, Wisconsin
| | - Pawel Wrobel
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Christian Lepage
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,7 Department of Psychology, University of Ottawa , Ottawa, Ontario, Canada
| | - Isabelle Weir
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Jeffrey P Guenette
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alicia Chua
- 5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael L Alosco
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Christine M Baugh
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,9 Interfaculty Initiative in Health Policy, Harvard University , Boston, Massachusetts
| | - Nathan G Fritts
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts
| | - Brett M Martin
- 10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine E Chaisson
- 3 BU Alzheimer's Disease and CTE Center, Boston University , Boston, Massachusetts.,10 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Michael J Coleman
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alexander P Lin
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,11 Center for Clinical Spectroscopy , Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ofer Pasternak
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Martha E Shenton
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,8 Department of Radiology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,12 VA Boston Healthcare System, Brockton Division, Brockton, Massachusetts.,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Inga K Koerte
- 1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany .,13 Department of Psychiatry, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
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23
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Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry 2017; 7:e1236. [PMID: 28926003 PMCID: PMC5639242 DOI: 10.1038/tp.2017.197] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/16/2017] [Accepted: 07/30/2017] [Indexed: 12/14/2022] Open
Abstract
Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.
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