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Theadom A, Barker-Collo S, Parag V, Caspi A, Moffitt TE, Hogan S, Ramrakha S, Poulton R. Mild Traumatic Brain Injury Does Not Significantly Affect Midlife Cognitive Functioning Within the General Population: Findings From a Prospective Longitudinal Birth Cohort Study. J Head Trauma Rehabil 2024; 39:E70-E82. [PMID: 37335217 DOI: 10.1097/htr.0000000000000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To determine whether differences exist in mid-adulthood cognitive functioning in people with and without history of mild traumatic brain injury (mTBI). SETTING Community-based study. PARTICIPANTS People born between April 1, 1972, and March 31, 1973, recruited into the Dunedin Multidisciplinary Health and Development Longitudinal Study, who completed neuropsychological assessments in mid-adulthood. Participants who had experienced a moderate or severe TBI or mTBI in the past 12 months were excluded. DESIGN Longitudinal, prospective, observational study. MAIN MEASURES Data were collected on sociodemographic characteristics, medical history, childhood cognition (between 7 and 11 years), and alcohol and substance dependence (from 21 years of age). mTBI history was determined from accident and medical records (from birth to 45 years of age). Participants were classified as having 1 mTBI and more in their lifetime or no mTBI. The Wechsler Adult Intelligence Scale (WAIS-IV) and Trail Making Tests A and B (between 38 and 45 years of age) were used to assess cognitive functioning. T tests and effect sizes were used to identify any differences on cognitive functioning domains between the mTBI and no mTBI groups. Regression models explored the relative contribution of number of mTBIs and age of first mTBI and sociodemographic/lifestyle variables on cognitive functioning. RESULTS Of the 885 participants, 518 (58.5%) had experienced at least 1 mTBI over their lifetime, with a mean number of 2.5 mTBIs. The mTBI group had significantly slower processing speed ( P < .01, d = 0.23) in mid-adulthood than the no TBI controls, with a medium effect size. However, the relationship no longer remained significant after controlling for childhood cognition, sociodemographic and lifestyle factors. No significant differences were observed for overall intelligence, verbal comprehension, perceptual reasoning, working memory, attention, or cognitive flexibility. Childhood cognition was not linked to likelihood of sustaining mTBI later in life. CONCLUSION mTBI histories in the general population were not associated with lower cognitive functioning in mid-adulthood once sociodemographic and lifestyle factors were taken into account.
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Affiliation(s)
- Alice Theadom
- Author Affiliations: Traumatic Brain Injury Network (TBIN), School of Clinical Sciences, Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand (Dr Theadom); School of Psychology, University of Auckland, Auckland, New Zealand (Dr Barker-Collo); National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (Dr Parag); Dunedin Multidisciplinary Health & Development Research Unit, University of Otago, Otago, New Zealand (Mr Hogan and Drs Ramrakha and Poulton); and Department of Psychology and Neuroscience, Duke University, Durham, North Carolina (Drs Caspi and Moffitt)
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Pierre K, Molina V, Shukla S, Avila A, Fong N, Nguyen J, Lucke-Wold B. Chronic traumatic encephalopathy: Diagnostic updates and advances. AIMS Neurosci 2022; 9:519-535. [PMID: 36660076 PMCID: PMC9826753 DOI: 10.3934/neuroscience.2022030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs secondary to repetitive mild traumatic brain injury. Current clinical diagnosis relies on symptomatology and structural imaging findings which often vary widely among those with the disease. The gold standard of diagnosis is post-mortem pathological examination. In this review article, we provide a brief introduction to CTE, current diagnostic workup and the promising research on imaging and fluid biomarker diagnostic techniques. For imaging, we discuss quantitative structural analyses, DTI, fMRI, MRS, SWI and PET CT. For fluid biomarkers, we discuss p-tau, TREM2, CCL11, NfL and GFAP.
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Affiliation(s)
- Kevin Pierre
- University of Florida Department of Radiology, Gainesville 32603, Florida, USA
| | - Vanessa Molina
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Shil Shukla
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Anthony Avila
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Nicholas Fong
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Jessica Nguyen
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Brandon Lucke-Wold
- University of Florida Department of Neurosurgery, Gainesville 32603, Florida, USA,* Correspondence:
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Associations of lifetime concussion history and repetitive head impact exposure with resting-state functional connectivity in former collegiate American football players: An NCAA 15-year follow-up study. PLoS One 2022; 17:e0273918. [PMID: 36084077 PMCID: PMC9462826 DOI: 10.1371/journal.pone.0273918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to examine associations of lifetime concussion history (CHx) and an advanced metric of lifetime repetitive head impact exposure with resting-state functional connectivity (rsFC) across the whole-brain and among large-scale functional networks (Default Mode; Dorsal Attention; and Frontoparietal Control) in former collegiate football players. Individuals who completed at least one year of varsity collegiate football were eligible to participate in this observational cohort study (n = 48; aged 36–41 years; 79.2% white/Caucasian; 12.5±4.4 years of football played; all men). Individuals were excluded if they reported history/suspicion of psychotic disorder with active symptoms, contraindications to participation in study procedures (e.g., MRI safety concern), or inability to travel. Each participant provided concussion and football playing histories. Self-reported concussion history was analyzed in two different ways based on prior research: dichotomous “High” (≥3 concussions; n = 28) versus “Low” (<3 concussions; n = 20); and four ordinal categories (0–1 concussion [n = 19]; 2–4 concussions [n = 8]; 5–7 concussions [n = 9]; and ≥8 concussions [n = 12]). The Head Impact Exposure Estimate (HIEE) was calculated from football playing history captured via structured interview. Resting-state fMRI and T1-weighted MRI were acquired and preprocessed using established pipelines. Next, rsFC was calculated using the Seitzman et al., (2020) 300-ROI functional atlas. Whole-brain, within-network, and between-network rsFC were calculated using all ROIs and network-specific ROIs, respectively. Effects of CHx and HIEE on rsFC values were examined using separate multivariable linear regression models, with a-priori α set to 0.05. We observed no statistically significant associations between rsFC outcomes and either CHx or HIEE (ps ≥ .12). Neither CHx nor HIEE were associated with neural signatures that have been observed in studies of typical and pathological aging. While CHx and repetitive head impacts have been associated with changes in brain health in older former athletes, our preliminary results suggest that associations with rsFC may not be present in early midlife former football players.
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Braga MFM, Juranek J, Eiden LE, Li Z, Figueiredo TH, de Araujo Furtado M, Marini AM. GABAergic circuits of the basolateral amygdala and generation of anxiety after traumatic brain injury. Amino Acids 2022; 54:1229-1249. [PMID: 35798984 DOI: 10.1007/s00726-022-03184-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) has reached epidemic proportions around the world and is a major public health concern in the United States. Approximately 2.8 million individuals sustain a traumatic brain injury and are treated in an Emergency Department yearly in the U.S., and about 50,000 of them die. Persistent symptoms develop in 10-15% of the cases including neuropsychiatric disorders. Anxiety is the second most common neuropsychiatric disorder that develops in those with persistent neuropsychiatric symptoms after TBI. Abnormalities or atrophy in the temporal lobe has been shown in the overwhelming number of TBI cases. The basolateral amygdala (BLA), a temporal lobe structure that consolidates, stores and generates fear and anxiety-based behavioral outputs, is a critical brain region in the anxiety circuitry. In this review, we sought to capture studies that characterized the relationship between human post-traumatic anxiety and structural/functional alterations in the amygdala. We compared the human findings with results obtained with a reproducible mild TBI animal model that demonstrated a direct relationship between the alterations in the BLA and an anxiety-like phenotype. From this analysis, both preliminary insights, and gaps in knowledge, have emerged which may open new directions for the development of rational and more efficacious treatments.
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Affiliation(s)
- Maria F M Braga
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Lee E Eiden
- Section On Molecular Neuroscience, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Zheng Li
- Section On Synapse Development and Plasticity, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Marcio de Araujo Furtado
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Functional, but Minimal Microstructural Brain Changes Present in Aging Canadian Football League Players Years After Retirement. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Iverson GL, Merz ZC, Terry DP. High-School Football and Midlife Brain Health Problems. Clin J Sport Med 2022; 32:86-94. [PMID: 35234740 PMCID: PMC8868212 DOI: 10.1097/jsm.0000000000000898] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine whether middle-aged men who played high-school football experience worse mental health or cognitive functioning than men who did not play high-school football. DESIGN Cross-sectional cohort study. SETTING Online survey completed remotely. PARTICIPANTS A total of 435 men between the ages of 35 and 55 completed the study, of whom 407 were included in the analyses after excluding participants who answered embedded validity items incorrectly (n = 16), played semiprofessional football (n = 2), or experienced a recent concussion (n = 10). ASSESSMENT OF RISK FACTORS Self-reported high school football participation, compared with those who played contact sports, noncontact sports, and no sports. MAIN OUTCOME MEASURES A lifetime history of depression or anxiety; mental health or cognitive problems in the past year; current depression symptoms, and post-concussion-like symptoms. RESULTS Middle-aged men who played high-school football did not have a higher prevalence of being prescribed medication for anxiety or depression or receiving treatment from a mental health professional. Similarly, there were no significant differences between groups on the rates in which they endorsed depression, anxiety, anger, concentration problems, memory problems, headaches, migraines, neck or back pain, or chronic pain over the past year. A greater proportion of those who played football reported sleep problems over the past year and reported being prescribed medication for chronic pain and for headaches. CONCLUSIONS Men who played high-school football did not report worse brain health compared with those who played other contact sports, noncontact sports, or did not participate in sports during high school.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts and
| | - Zachary C. Merz
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, UNC Memorial Hospital, Chapel Hill, North Carolina
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts and
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7
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Walton SR, Kerr ZY, Mannix R, Brett BL, Chandran A, DeFreese JD, McCrea MA, Guskiewicz KM, Meehan WP, Echemendia RJ. Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study. Sports Med 2021; 52:1189-1203. [PMID: 34773581 DOI: 10.1007/s40279-021-01589-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing. OBJECTIVES We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns. METHODS In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1-2 (n = 309); 3-5 (n = 413); 6-9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx. RESULTS More than one-third of participants reported being currently "extremely concerned" about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being "not at all concerned" regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being "not at all" or "slightly" concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently "moderately" or "extremely" concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns. CONCLUSIONS Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player's functioning and well-being.
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Affiliation(s)
- Samuel R Walton
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Mannix
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Jonathan D DeFreese
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M Guskiewicz
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention and Boston Children's Hospital, Waltham, MA, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri, Kansas City, Kansas City, MO, USA.
- University Orthopedics Center Concussion Clinic, 101 Regent Ct., State College, PA, 16801, USA.
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Echlin HV, Rahimi A, Wojtowicz M. Systematic Review of the Long-Term Neuroimaging Correlates of Mild Traumatic Brain Injury and Repetitive Head Injuries. Front Neurol 2021; 12:726425. [PMID: 34659091 PMCID: PMC8514830 DOI: 10.3389/fneur.2021.726425] [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: 06/16/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To systematically review the literature on the long-term neuroimaging findings (≥10 years from exposure) for exposure in adulthood to mild traumatic brain injury (mTBI) and repetitive head impacts (RHIs) using neuroimaging across all available populations. Data sources: Four electronic databases: MEDLINE, SPORTDiscus, PsycINFO, and EMBASE. Study selection: All articles were original research and published in English. Studies examined adults with remote exposure to mTBI and/or RHIs from ten or more years ago in addition to any associated neuroimaging findings. Data extraction: Parameters mainly included participants' population, age, years since head injury, race, sex, education level, and any neuroimaging findings. Scores for the level of evidence and risk of bias were calculated independently by two authors. Results: 5,521 studies were reviewed, of which 34 met inclusion criteria and were included in this study. The majority of adults in these studies showed positive neuroimaging findings one or more decades following mTBI/RHI exposure. This was consistent across study populations (i.e., veterans, athletes, and the general population). There was evidence for altered protein deposition patterns, micro- and macro-structural, functional, neurochemical, and blood flow-related differences in the brain for those with remote mTBI/RHI exposure. Conclusion: Findings from these studies suggest that past mTBI/RHI exposure may be associated with neuroimaging findings. However, given the methodological constraints related to relatively small sample sizes and the heterogeneity in injury types/exposure and imaging techniques used, conclusions drawn from this review are limited. Well-designed longitudinal studies with multimodal imaging and in-depth health and demographic information will be required to better understand the potential for having positive neuroimaging findings following remote mTBI/RHI.
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Iverson GL, Büttner F, Caccese JB. Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review. Front Neurol 2021; 12:727089. [PMID: 34659092 PMCID: PMC8511696 DOI: 10.3389/fneur.2021.727089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
A controversial theory proposes that playing tackle football before the age of 12 causes later in life brain health problems. This theory arose from a small study of 42 retired National Football League (NFL) players, which reported that those who started playing tackle football at a younger age performed worse on selected neuropsychological tests and a word reading test. The authors concluded that these differences were likely due to greater exposure to repetitive neurotrauma during a developmentally sensitive maturational period in their lives. Several subsequent studies of current high school and collegiate contact/collision sports athletes, and former high school, collegiate, and professional tackle football players have not replicated these findings. This narrative review aims to (i) discuss the fundamental concepts, issues, and controversies surrounding existing research on age of first exposure (AFE) to contact/collision sport, and (ii) provide a balanced interpretation, including risk of bias assessment findings, of this body of evidence. Among 21 studies, 11 studies examined former athletes, 8 studies examined current athletes, and 2 studies examined both former and current athletes. Although the literature on whether younger AFE to tackle football is associated with later in life cognitive, neurobehavioral, or mental health problems in former NFL players is mixed, the largest study of retired NFL players (N = 3,506) suggested there was not a significant association between earlier AFE to organized tackle football and worse subjectively experienced cognitive functioning, depression, or anxiety. Furthermore, no published studies of current athletes show a significant association between playing tackle football (or other contact/collision sports) before the age of 12 and cognitive, neurobehavioral, or mental health problems. It is important to note that all studies were judged to be at high overall risk of bias, indicating that more methodologically rigorous research is needed to understand whether there is an association between AFE to contact/collision sports and later in life brain health. The accumulated research to date suggests that earlier AFE to contact/collision sports is not associated with worse cognitive functioning or mental health in (i) current high school athletes, (ii) current collegiate athletes, or (iii) middle-aged men who played high school football. The literature on former NFL players is mixed and does not, at present, clearly support the theory that exposure to tackle football before age 12 is associated with later in life cognitive impairment or mental health problems.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jaclyn B. Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, United States
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Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, Meehan WP, McCrea M, Guskiewicz KM, Kerr ZY. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study. Med Sci Sports Exerc 2021; 54:424-431. [PMID: 34593716 DOI: 10.1249/mss.0000000000002802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate prevalences of MCI and dementia diagnoses in former National Football League (NFL) players ≥50 years old and examine the relationships among these diagnoses and an array of predictors of long-term brain health. METHODS A cross-section of former NFL players (n = 922; aged [mean ± SD] 64.8 ± 8.9 years) completed a questionnaire. Prevalences of self-reported medical diagnoses of MCI and dementia were reported alongside U.S. population estimates across 5-year age intervals (e.g., 60-64 years). Prevalence ratios (PRs) were calculated for multiple predictors of long-term brain health. RESULTS Overall, MCI and dementia prevalences were n = 219(23.8%) and n = 82(8.9%), respectively. Each diagnosis was more prevalent in former NFL players across age groups than U.S. norms, with greater disparities at relatively younger ages (e.g., 65-69) compared with older ages. Greater prevalences of MCI and dementia were associated with: self-reported concussion history (10+ vs. 0; PRadjusted[95%CI] = 1.66[1.02-2.71] and 2.61[1.01-6.71], respectively); recent pain intensity (PRadjusted[95%CI] = 1.13[1.07-1.20] and 1.15[1.03-1.28]); and diagnoses of depression (PRadjusted[95%CI] = 2.70[1.92-3.81] and 3.22[1.69-6.14]), anxiety (PRadjusted[95%CI] = 1.96[1.26-3.07] and 3.14[1.47-6.74]), or both (PRadjusted[95%CI] = 3.11[2.38-4.08] and 4.43[2.71-7.25]). Higher MCI prevalence was related to sleep apnea (PRadjusted[95%CI] = 1.30[1.06-1.60]); higher dementia prevalence was associated with age (5-year interval, PRadjusted[95%CI] = 1.42[1.26-1.60]) and race (non-White vs. White, PRadjusted[95%CI] = 1.64[1.07-2.53]). CONCLUSIONS Self-reported MCI and dementia prevalences were higher in former NFL players than national estimates and were associated with numerous personal factors, including mood-related disorders and a high number of self-reported concussions. Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.
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Affiliation(s)
- Samuel R Walton
- Department of Exercise and Sport Science and Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN Division of Emergency Medicine, Boston Children's Hospital, Boston, MA Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA Department of Psychology, University of Missouri - Kansas City, Kansas City, MO University Orthopedics Center Concussion Care Clinic, State College, PA Sports Medicine Division, Boston Children's Hospital, Boston, MA The Micheli Center for Sports Injury Prevention, Boston, MA Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
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Symons GF, Clough M, Fielding J, O'Brien WT, Shepherd CE, Wright DK, Shultz SR. The Neurological Consequences of Engaging in Australian Collision Sports. J Neurotrauma 2021; 37:792-809. [PMID: 32056505 DOI: 10.1089/neu.2019.6884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Collision sports are an integral part of Australian culture. The most common collision sports in Australia are Australian rules football, rugby union, and rugby league. Each of these sports often results in participants sustaining mild brain traumas, such as concussive and subconcussive injuries. However, the majority of previous studies and reviews pertaining to the neurological implications of sustaining mild brain traumas, while engaging in collision sports, have focused on those popular in North America and Europe. As part of this 2020 International Neurotrauma Symposium special issue, which highlights Australian neurotrauma research, this article will therefore review the burden of mild brain traumas in Australian collision sports athletes. Specifically, this review will first provide an overview of the consequences of mild brain trauma in Australian collision sports, followed by a summary of the previous studies that have investigated neurocognition, ocular motor function, neuroimaging, and fluid biomarkers, as well as neuropathological outcomes in Australian collision sports athletes. A review of the literature indicates that although Australians have contributed to the field, several knowledge gaps and limitations currently exist. These include important questions related to sex differences, the identification and implementation of blood and imaging biomarkers, the need for consistent study designs and common data elements, as well as more multi-modal studies. We conclude that although Australia has had an active history of investigating the neurological impact of collision sports participation, further research is clearly needed to better understand these consequences in Australian athletes and how they can be mitigated.
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Affiliation(s)
- Georgia F Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claire E Shepherd
- Neuroscience Research Australia, The University of New South Wales, Sydney, New South Wales, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Esopenko C, Meyer J, Wilde EA, Marshall AD, Tate DF, Lin AP, Koerte IK, Werner KB, Dennis EL, Ware AL, de Souza NL, Menefee DS, Dams-O'Connor K, Stein DJ, Bigler ED, Shenton ME, Chiou KS, Postmus JL, Monahan K, Eagan-Johnson B, van Donkelaar P, Merkley TL, Velez C, Hodges CB, Lindsey HM, Johnson P, Irimia A, Spruiell M, Bennett ER, Bridwell A, Zieman G, Hillary FG. A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group. Brain Imaging Behav 2021; 15:475-503. [PMID: 33405096 PMCID: PMC8785101 DOI: 10.1007/s11682-020-00417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
- Department of Health Informatics, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
| | - Jessica Meyer
- Department of Psychiatry, Summa Health System, Akron, OH, 44304, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Amy D Marshall
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Alexander P Lin
- Department of Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 80336, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
| | - Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Ashley L Ware
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, 07103, USA
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, 7501, South Africa
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Martha E Shenton
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
- Departments of Psychiatry and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Veterans Affairs, Boston Healthcare System, Boston, MA, 02130, USA
| | - Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Judy L Postmus
- School of Social Work, University of Maryland, Baltimore, USA
| | - Kathleen Monahan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, 11794-8231, USA
| | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carmen Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Cooper B Hodges
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Paula Johnson
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
- Denney Research Center Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Matthew Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Esther R Bennett
- Rutgers University School of Social Work, New Brunswick, NJ, 08901, USA
| | - Ashley Bridwell
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Glynnis Zieman
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
- Social Life and Engineering Sciences Imaging Center, University Park, PA, 16802, USA
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13
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Alosco ML, Culhane J, Mez J. Neuroimaging Biomarkers of Chronic Traumatic Encephalopathy: Targets for the Academic Memory Disorders Clinic. Neurotherapeutics 2021; 18:772-791. [PMID: 33847906 PMCID: PMC8423967 DOI: 10.1007/s13311-021-01028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts, such as those from contact sports. The pathognomonic lesion for CTE is the perivascular accumulation of hyper-phosphorylated tau in neurons and other cell process at the depths of sulci. CTE cannot be diagnosed during life at this time, limiting research on risk factors, mechanisms, epidemiology, and treatment. There is an urgent need for in vivo biomarkers that can accurately detect CTE and differentiate it from other neurological disorders. Neuroimaging is an integral component of the clinical evaluation of neurodegenerative diseases and will likely aid in diagnosing CTE during life. In this qualitative review, we present the current evidence on neuroimaging biomarkers for CTE with a focus on molecular, structural, and functional modalities routinely used as part of a dementia evaluation. Supporting imaging-pathological correlation studies are also presented. We targeted neuroimaging studies of living participants at high risk for CTE (e.g., aging former elite American football players, fighters). We conclude that an optimal tau PET radiotracer with high affinity for the 3R/4R neurofibrillary tangles in CTE has not yet been identified. Amyloid PET scans have tended to be negative. Converging structural and functional imaging evidence together with neuropathological evidence show frontotemporal and medial temporal lobe neurodegeneration, and increased likelihood for a cavum septum pellucidum. The literature offers promising neuroimaging biomarker targets of CTE, but it is limited by cross-sectional studies of small samples where the presence of underlying CTE is unknown. Imaging-pathological correlation studies will be important for the development and validation of neuroimaging biomarkers of CTE.
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Affiliation(s)
- Michael L Alosco
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA.
| | - Julia Culhane
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
| | - Jesse Mez
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
- Framingham Heart Study, Boston University School of Medicine, MA, Boston, USA
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14
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Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan Iii WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med 2021; 55:683-690. [PMID: 33397673 DOI: 10.1136/bjsports-2020-103400] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players. METHODS In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates. RESULTS Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol. CONCLUSION Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D DeFreese
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
| | - Michael McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan Iii
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Prien A, Feddermann-Demont N, Verhagen E, Twisk J, Junge A. Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes. BMJ Open Sport Exerc Med 2020; 6:e000952. [PMID: 33312682 PMCID: PMC7716672 DOI: 10.1136/bmjsem-2020-000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women. Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB. Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB. Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.
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Affiliation(s)
- Annika Prien
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Human Biology, Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jos Twisk
- Epidemiology and Biostatistics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Astrid Junge
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
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16
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Alosco ML, Tripodis Y, Rowland B, Chua AS, Liao H, Martin B, Jarnagin J, Chaisson CE, Pasternak O, Karmacharya S, Koerte IK, Cantu RC, Kowall NW, McKee AC, Shenton ME, Greenwald R, McClean M, Stern RA, Lin A. A magnetic resonance spectroscopy investigation in symptomatic former NFL players. Brain Imaging Behav 2020; 14:1419-1429. [PMID: 30848432 PMCID: PMC6994233 DOI: 10.1007/s11682-019-00060-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The long-term neurologic consequences of exposure to repetitive head impacts (RHI) are not well understood. This study used magnetic resonance spectroscopy (MRS) to examine later-life neurochemistry and its association with RHI and clinical function in former National Football League (NFL) players. The sample included 77 symptomatic former NFL players and 23 asymptomatic individuals without a head trauma history. Participants completed cognitive, behavior, and mood measures. N-acetyl aspartate, glutamate/glutamine, choline, myo-inositol, creatine, and glutathione were measured in the posterior (PCG) and anterior (ACG) cingulate gyrus, and parietal white matter (PWM). A cumulative head impact index (CHII) estimated RHI. In former NFL players, a higher CHII correlated with lower PWM creatine (r = -0.23, p = 0.02). Multivariate mixed-effect models examined neurochemical differences between the former NFL players and asymptomatic individuals without a history of head trauma. PWM N-acetyl aspartate was lower among the former NFL players (mean diff. = 1.02, p = 0.03). Between-group analyses are preliminary as groups were recruited based on symptomatic status. The ACG was the only region associated with clinical function, including positive correlations between glutamate (r = 0.32, p = 0.004), glutathione (r = 0.29, p = 0.02), and myo-inositol (r = 0.26, p = 0.01) with behavioral/mood symptoms. Other positive correlations between ACG neurochemistry and clinical function emerged (i.e., behavioral/mood symptoms, cognition), but the positive directionality was unexpected. All analyses controlled for age, body mass index, and education (for analyses examining clinical function). In this sample of symptomatic former NFL players, there was a direct effect between RHI and reduced cellular energy metabolism (i.e., lower creatine). MRS neurochemicals associated with neuroinflammation also correlated with behavioral/mood symptoms.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin Rowland
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Alicia S Chua
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Huijun Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Johnny Jarnagin
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K Koerte
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Neurology Service, VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Martha E Shenton
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Richard Greenwald
- Simbex, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA.
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17
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McDonough IM, Festini SB, Wood MM. Risk for Alzheimer's disease: A review of long-term episodic memory encoding and retrieval fMRI studies. Ageing Res Rev 2020; 62:101133. [PMID: 32717407 DOI: 10.1016/j.arr.2020.101133] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/21/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
Many risk factors have been identified that predict future progression to Alzheimer's disease (AD). However, clear links have yet to be made between these risk factors and how they affect brain functioning in early stages of AD. We conducted a narrative review and a quantitative analysis to better understand the relationship between nine categories of AD risk (i.e., brain pathology, genetics/family history, vascular health, head trauma, cognitive decline, engagement in daily life, late-life depression, sex/gender, and ethnoracial group) and task-evoked fMRI activity during episodic memory in cognitively-normal older adults. Our narrative review revealed widespread regional alterations of both greater and lower brain activity with AD risk. Nevertheless, our quantitative analysis revealed that a subset of studies converged on two patterns: AD risk was associated with (1) greater brain activity in frontal and parietal regions, but (2) reduced brain activity in hippocampal and occipital regions. The brain regions affected depended on the assessed memory stage (encoding or retrieval). Although the results clearly indicate that AD risks impact brain activity, we caution against using fMRI as a diagnostic tool for AD at the current time because the above consistencies were present among much variability, even among the same risk factor.
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Affiliation(s)
- Ian M McDonough
- Department of Psychology, The University of Alabama, BOX 870348, Tuscaloosa, AL 35487, USA.
| | - Sara B Festini
- Department of Psychology, University of Tampa, 401 W Kennedy Blvd. Tampa, FL 33606, USA
| | - Meagan M Wood
- Department of Psychology, Valdosta State University, 1500 N. Patterson Street, Valdosta, GA 31698, USA
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18
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Cunningham J, Broglio SP, O'Grady M, Wilson F. History of Sport-Related Concussion and Long-Term Clinical Cognitive Health Outcomes in Retired Athletes: A Systematic Review. J Athl Train 2020; 55:132-158. [PMID: 31935139 DOI: 10.4085/1062-6050-297-18] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sport-related concussions (SRCs) are known to have short-term effects on cognitive processes, which can result in diverse clinical presentations. The long-term effects of SRC and repeated exposure to head impacts that do not result in SRC on specific cognitive health outcomes remain unclear. OBJECTIVES To synthesize and appraise the evidence base regarding cognitive health in living retired athletes with a history of head-impact exposure or SRC. DATA SOURCES A systematic search of the EMBASE, PsycINFO, MEDLINE/PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted from inception to April 2018 using common key words and medical subject headings related to 3 components: (1) the participant (eg, retired athlete), (2) the primary outcome measure (eg, cognitive test used), and (3) the secondary outcome measure (eg, history of sport concussion). STUDY SELECTION Cross-sectional studies of living retired male or female athletes in which at least 1 cognitive test was used as an outcome measure were included. Two reviewers independently screened studies. DATA EXTRACTION Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodologic quality was assessed independently by 2 reviewers using the Downs and Black tool. DATA SYNTHESIS The search yielded 46 cross-sectional observational studies that were included in a qualitative synthesis. Most included studies (80%, n = 37) were published in the 5 years before our review. A large proportion of these studies (n = 20) included retired American National Football League players. The other research investigated professional, university, high school, and amateur retired athletes participating in sports such as American and Australian football, boxing, field and ice hockey, rugby, and soccer. The total sample consisted of 13 975 participants: 7387 collision-sport athletes, 662 contact-sport athletes, 3346 noncontact-sport athletes, and 2580 participants classified as controls. Compared with control participants or normative data, retired athletes displayed worse performance in 17 of 31 studies (55%) of memory, 6 of 11 studies (55%) of executive function, and 4 of 6 studies (67%) of psychomotor function and increased subjective concerns about cognitive function in 11 of 14 studies (79%). The authors of 13 of 46 investigations (28%) reported a frequency-response relationship, with poorer cognitive outcomes in athletes who had greater levels of exposure to head impacts or concussions. However, these results must be interpreted in light of the lack of methodologic rigor and moderate quality assessment of the included studies. CONCLUSIONS Evidence of poorer cognitive health among retired athletes with a history of concussion and head-impact exposure is evolving. Our results suggest that a history of SRC may more greatly affect the cognitive domains of memory, executive function, and psychomotor function. Retired athletes appeared to have increased self-reported cognitive difficulties, but the paucity of high-quality, prospective studies limited the conclusions that could be drawn regarding a cause-and-effect relationship between concussion and long-term health outcomes. Future researchers should consider a range of cognitive health outcomes, as well as premorbid ability, in diverse samples of athletes with or without a history of concussion or head-impact exposure to delineate the long-term effects of sport participation on cognitive functioning.
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Affiliation(s)
- Joice Cunningham
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | | | - Megan O'Grady
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | - Fiona Wilson
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
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Terpstra AR, Vasquez BP, Colella B, Tartaglia MC, Tator CH, Mikulis D, Davis KD, Wennberg R, Green REA. Comprehensive Neuropsychiatric and Cognitive Characterization of Former Professional Football Players: Implications for Neurorehabilitation. Front Neurol 2019; 10:712. [PMID: 31447753 PMCID: PMC6696977 DOI: 10.3389/fneur.2019.00712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms. Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports. Design: Between-groups analyses. Main measures: Neuropsychiatric. Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive. Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task). Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions (x ¯ = 6 . 1 ), but not former players with ≤ 3 concussions (x ¯ = 2 . 0 ), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task. Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.
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Affiliation(s)
- Alex R. Terpstra
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Brandon P. Vasquez
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Neuropsychology & Cognitive Health, Baycrest, Toronto, ON, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - Charles H. Tator
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - David Mikulis
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Karen D. Davis
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robin E. A. Green
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Elliott J, Anderson R, Collins S, Heron N. Sports-related concussion (SRC) assessment in road cycling: a systematic review and call to action. BMJ Open Sport Exerc Med 2019; 5:e000525. [PMID: 31205745 PMCID: PMC6540321 DOI: 10.1136/bmjsem-2019-000525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background Sports-related concussion (SRC) is a recognised risk in road cycling and can have serious health consequences. Recent high-profile cases of professional road cyclists continuing to participate in races despite suffering obvious SRC have highlighted the difficulties in assessing SRC within road cycling. Purpose To undertake a systematic review of the literature on SRC assessment in road cycling. Study design Systematic review. Methods Literature describing SRC assessment in road cycling was identified by searching MEDLINE, EMBASE, PsycINFO and Web of Science. Two reviewers independently screened titles and abstracts for eligibility and a qualitative analysis was undertaken of included studies. Results From 94 studies identified, two were included for review. Gordon et al describe the presentation of a single case of paediatric concussion following a cycling crash. They highlight the utility of SRC evaluation using the Sport Concussion Assessment Tool (SCAT) as well as the importance of a stepwise return-to-play protocol. Greve and Modabber discuss a number of traumatic brain injuries that occurred during the 2011 road cycling season and, as a minimum, call for riders to be withdrawn from competition following loss of consciousness or amnesia. Both studies are at high risk of bias and of low quality. Conclusion Road cycling poses unique challenges for the assessment of SRC. This review illustrates the lack of published evidence to advise effective means of SRC assessment within road cycling. The Union Cycliste Internationale (UCI) regulations advise the use of SCAT-5 for concussion assessment but this tool is impractical, requiring modification for use in road cycling. We would like to call on the UCI to hold a consensus meeting to establish an evidence-based SRC assessment protocol and return-to-riding protocol for road cycling.
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Affiliation(s)
- Jonathan Elliott
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Richard Anderson
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Collins
- Department of Medicine and Surgery, Northern Health and Social Care Trust, Coleraine, United Kingdom
| | - Neil Heron
- General Practice/Centre for Public Health, Queen's University Belfast, Belfast, UK.,Department of General Practice, Keele University, Keele, Staffordshire, United Kingdom
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21
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McKeithan L, Hibshman N, Yengo-Kahn AM, Solomon GS, Zuckerman SL. Sport-Related Concussion: Evaluation, Treatment, and Future Directions. Med Sci (Basel) 2019; 7:medsci7030044. [PMID: 30884753 PMCID: PMC6473667 DOI: 10.3390/medsci7030044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 01/16/2023] Open
Abstract
Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility of prolonged recovery account for the vast majority of morbidity from SRC. Modifying factors have been identified and may allow for improved prediction of a protracted course. Potential novel modifying factors may include genetic determinants of recovery, as well as radiographic biomarkers, which represent burgeoning subfields in SRC research. Helmet design and understanding the biomechanical stressors on the brain that lead to concussion also represent active areas of research. This narrative review provides a general synopsis of SRC, including relevant definitions, current treatment paradigms, and modifying factors for recovery, in addition to novel areas of research and future directions for SRC research.
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Affiliation(s)
- Lydia McKeithan
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Natalie Hibshman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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22
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Alosco ML, Stern RA. The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:337-355. [PMID: 31753141 DOI: 10.1016/b978-0-12-804766-8.00018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). Although described in boxers for almost a century, scientific and public interest in CTE grew tremendously following a report of postmortem evidence of CTE in the first former professional American football player in 2005. Neuropathologic diagnostic criteria for CTE have been defined, with abnormal perivascular deposition of hyperphosphorylated tau at the sulcal depths as the pathognomonic feature. CTE can currently only be diagnosed postmortem, but clinical research criteria for the in vivo diagnosis of CTE have been proposed. The clinical phenotype of CTE is still ill-defined and there are currently no validated biomarkers to support an in-life diagnosis of "Probable CTE." Many knowledge gaps remain regarding the neuropathologic and clinical make-up of CTE. An increased understanding of CTE is critical given the millions that could potentially be impacted by this disease. This chapter describes the state of the literature on CTE. The historical origins of CTE are first presented, followed by a comprehensive description of the neuropathologic and clinical features. The chapter concludes with discussion on future research directions, emphasizing the importance of diagnosing CTE during life to facilitate development of preventative and intervention strategies.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States; Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States.
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23
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Long-Term Neuroimaging Findings in American Football Players: Systematic Review. World Neurosurg 2018; 120:e365-e379. [DOI: 10.1016/j.wneu.2018.08.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/11/2018] [Indexed: 01/08/2023]
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24
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Esopenko C, Simonds AH, Anderson EZ. The synergistic effect of concussions and aging in women? Disparities and perspectives on moving forward. Concussion 2018; 3:CNC55. [PMID: 30364380 PMCID: PMC6195093 DOI: 10.2217/cnc-2018-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Adrienne H Simonds
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Ellen Z Anderson
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
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25
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La Fountaine MF. An anatomical and physiological basis for the cardiovascular autonomic nervous system consequences of sport-related brain injury. Int J Psychophysiol 2018; 132:155-166. [DOI: 10.1016/j.ijpsycho.2017.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 01/11/2023]
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26
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Zhang H, Zhang Z, Wang Z, Zhen Y, Yu J, Song H. Research on the changes in balance motion behavior and learning, as well as memory abilities of rats with multiple cerebral concussion-induced chronic traumatic encephalopathy and the underlying mechanism. Exp Ther Med 2018; 16:2295-2302. [PMID: 30186470 PMCID: PMC6122478 DOI: 10.3892/etm.2018.6474] [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: 12/01/2017] [Accepted: 06/14/2018] [Indexed: 11/18/2022] Open
Abstract
To study the effects of multiple cerebral concussion (MCC)-induced chronic traumatic encephalopathy on balance motion behavior learning and memory abilities of rats and its possible mechanism. 4MCC rat models were established by means of striking the head (4MCC group, n=15), while normal Sprague-Dawley (SD) rats were used as controls (C group, n=15). At 2 weeks after injury, balance beam (BB) test, beam walking (BW) test and Morris water maze (MWM) test were performed, respectively. The metabolites in brain tissues of rats, the number of glial fibrillary acidic protein (GFAP)-positive cells and apoptotic cells in brain slices of rats, and the expression levels of phosphorylated tau (p-tau) and Aβ1-40 proteins were detected. The score of rats in 4MCC group was significantly lower than that in C group (p<0.01). The escape latencies of rats in 4MCC group on the 4th-7th days during training and the time reaching the platform were significantly longer (p<0.05), but the residence time in the target quadrant was obviously shorter (p<0.01). Naphthalene acetic acid (NAA) and creatinine (Cr) values in septal coronal section in 4MCC group were significantly lower, but choline (Cho) and myo-inositol (MI) values were obviously higher (p<0.01). The number of GFAP-positive cells in the hippocampal and septal areas in 4MCC group were significantly larger (p<0.01). In the hippocampal and septal areas of 4MCC group, the number of apoptotic cells was obviously larger (p<0.01), and the expression levels of p-tau and Aβ1-40 proteins were significantly higher (p<0.01). Thus, MCC-induced chronic traumatic encephalopathy can increase the expressions of p-tau and Aβ1-40 proteins in the hippocampal and septal areas, leading to damage of hippocampal and septal neurons and increasing the number of astrocytes in the hippocampal and septal areas, ultimately damaging the balance motion behavior and learning, as well as memory abilities of rats.
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Affiliation(s)
- Huan Zhang
- College of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Zhenguang Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Zhen Wang
- College of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yongjiang Zhen
- College of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Jiangyun Yu
- College of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Hai Song
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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27
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Mannes ZL, Waxenberg LB, Cottler LB, Perlstein WM, Burrell LE, Ferguson EG, Edwards ME, Ennis N. Prevalence and Correlates of Psychological Distress among Retired Elite Athletes: A Systematic Review. INTERNATIONAL REVIEW OF SPORT AND EXERCISE PSYCHOLOGY 2018; 12:265-294. [PMID: 31217807 PMCID: PMC6583001 DOI: 10.1080/1750984x.2018.1469162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/20/2018] [Indexed: 06/09/2023]
Abstract
This article presents results of a systematic review of the literature (2000-2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.
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Affiliation(s)
- Zachary L. Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Lori B. Waxenberg
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL
| | - William M. Perlstein
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Erin G. Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Mary E. Edwards
- Health Science Center, University of Florida, Gainesville, FL
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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28
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Abstract
BACKGROUND Individuals who sustain their first concussion during childhood may be at greater risk of sustaining multiple concussions throughout their lifetime because of a longer window of vulnerability. This article aims to estimate the association between age at first concussion and number of subsequent concussions. PATIENTS AND METHODS A total of 23,582 collegiate athletes from 26 universities and military cadets from three military academies completed a concussion history questionnaire (65% males, age 19.9 ± 1.4 years). Participants self-reported concussions and age at time of each injury. Participants with a history of concussion (n = 3,647, 15.5%) were categorized as having sustained their first concussion during childhood (less than ten years old) or adolescence (≥10 and ≤18 years old). Poisson regression was used to model age group (childhood, adolescence) predicting the number of subsequent concussions (0, 1, 2+). A second Poisson regression was developed to determine whether age at first concussion predicted the number of subsequent concussions. RESULTS Participants self-reporting their first concussion during childhood had an increased risk of subsequent concussions (rate ratio = 2.19, 95% confidence interval: 1.82, 2.64) compared with participants self-reporting their first concussion during adolescence. For every one-year increase in age at first concussion, we observed a 16% reduction in the risk of subsequent concussion (rate ratio = 0.84, 95% confidence interval: 0.82, 0.86). CONCLUSIONS Individuals self-reporting a concussion at a young age sustained a higher number of concussions before age 18. Concussion prevention, recognition, and reporting strategies are of particular need at the youth level.
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29
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Clark MD, Varangis EML, Champagne AA, Giovanello KS, Shi F, Kerr ZY, Smith JK, Guskiewicz KM. Effects of Career Duration, Concussion History, and Playing Position on White Matter Microstructure and Functional Neural Recruitment in Former College and Professional Football Athletes. Radiology 2018; 286:967-977. [PMID: 29087238 PMCID: PMC5834225 DOI: 10.1148/radiol.2017170539] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To better understand the relationship between exposure to concussive and subconcussive head impacts, white matter integrity, and functional task-related neural activity in former U.S. football athletes. Materials and Methods Between 2011 and 2013, 61 cognitively unimpaired former collegiate and professional football players (age range, 52-65 years) provided informed consent to participate in this cross-sectional study. Participants were stratified across three crossed factors: career duration, concussion history, and primary playing position. Fractional anisotropy (FA) and blood oxygen level-dependent (BOLD) percent signal change (PSC) were measured with diffusion-weighted and task-related functional magnetic resonance imaging, respectively. Analyses of variance of FA and BOLD PSC were used to determine main or interaction effects of the three factors. Results A significant interaction between career duration and concussion history was observed; former college players with more than three concussions had lower FA in a broadly distributed area of white matter compared with those with zero to one concussion (t29 = 2.774; adjusted P = .037), and the opposite was observed for former professional players (t29 = 3.883; adjusted P = .001). A separate interaction between concussion history and position was observed: Nonspeed players with more than three concussions had lower FA in frontal white matter compared with those with zero to one concussion (t25 = 3.861; adjusted P = .002). Analysis of working memory-task BOLD PSC revealed a similar interaction between concussion history and position (all adjusted P < .004). Overall, former players with lower FA tended to have lower BOLD PSC across three levels of a working memory task. Conclusion Career duration and primary playing position seem to modify the effects of concussion history on white matter structure and neural recruitment. The differences in brain structure and function were observed in the absence of clinical impairment, which suggested that multimodal imaging may provide early markers of onset of traumatic neurodegenerative disease. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Michael D. Clark
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Eleanna M. L. Varangis
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Allen A. Champagne
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Kelly S. Giovanello
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Feng Shi
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Zachary Y. Kerr
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - J. Keith Smith
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
| | - Kevin M. Guskiewicz
- From the Departments of Exercise and Sport Science (M.D.C., Z.Y.K.,
K.M.G.), Psychology and Neuroscience (E.M.L.V., K.S.G.), and Radiology (J.K.S.),
University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB 8700, Chapel Hill,
NC 27599; Centre for Neuroscience Studies, Queen’s University, Kingston, Ont,
Canada (A.A.C.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (F.S.)
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30
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Consequences of Traumatic Brain Injury in Professional American Football Players: A Systematic Review of the Literature. Clin J Sport Med 2018; 28:91-99. [PMID: 28489656 DOI: 10.1097/jsm.0000000000000432] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature for the consequences Traumatic brain injury (TBI) has on cognitive, psychological, physical, and sports-related functioning in professional American Football players. DATA SOURCES We performed a systematic search in 2 databases, PubMed and SPORTDiscus, to obtain literature from January 1990 to January 2015. To be eligible for inclusion, a study had to examine the relationship between TBI and the consequences for several aspects of functioning in professional American football players older than 18 years. Methodological quality was assessed using a 5-item checklist which assessed selection bias, information bias, and correct reporting of the population and exposure characteristics. MAIN RESULTS The search yielded 21 studies that met our inclusion criteria. An evidence synthesis was performed on the extracted data and resulted in 5 levels of evidence. The evidence synthesis revealed that there is strong evidence that concussions are associated with late-life depression and short-term physical dysfunctions. Evidence for the relationship between concussion and impaired sports-related function, prolonged reaction time, memory impairment, and visual-motor speed was inconclusive. Moderate evidence was found for the association between TBI and mild cognitive impairment (MCI), and limited evidence was found for the association between TBI and executive dysfunction. CONCLUSIONS There is strong evidence that a history of concussion in American football players is associated with depression later in life and short-term physical dysfunctions. Also cognitive dysfunctions such as MCI are seen in older players with a history of TBI. These results provide input for actions to prevent TBI and their consequences in (retired) American football players.
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Abstract
Research into sports-related concussion (SRC) or brain injury has vastly expanded our knowledge of the connection between brain activity and behavioral outcomes. Historical examination of concussion reveals components of structural changes in the brain resulting from injury. A constellation of clinical symptoms is typically present following concussion for several days and weeks. However, the intersection of structural changes and clinical examination still remains elusive to medical professionals. With emerging technologies and modalities such as quantitative electroencephalography (EEG), functional magnetic resonance imaging (fMRI), virtual reality (VR), and the study of movement, we can better understand the brain–behavior relationship on clinical findings post-injury. Our advancement in SRC study using athletics provides a unique window into the advances in our ability to study this public health crisis. SRC also allows us to understand how athletics and exercise influence brain health. The evolution of SRC diagnosis, treatment, and management informs our current abilities in the study of the brain.
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Lucke-Wold BP, Logsdon AF, Nguyen L, Eltanahay A, Turner RC, Bonasso P, Knotts C, Moeck A, Maroon JC, Bailes JE, Rosen CL. Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutr Neurosci 2018; 21:79-91. [PMID: 27705610 PMCID: PMC5491366 DOI: 10.1080/1028415x.2016.1236174] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Studies using traditional treatment strategies for mild traumatic brain injury (TBI) have produced limited clinical success. Interest in treatment for mild TBI is at an all time high due to its association with the development of chronic traumatic encephalopathy and other neurodegenerative diseases, yet therapeutic options remain limited. Traditional pharmaceutical interventions have failed to transition to the clinic for the treatment of mild TBI. As such, many pre-clinical studies are now implementing non-pharmaceutical therapies for TBI. These studies have demonstrated promise, particularly those that modulate secondary injury cascades activated after injury. Because no TBI therapy has been discovered for mild injury, researchers now look to pharmaceutical supplementation in an attempt to foster success in human clinical trials. Non-traditional therapies, such as acupuncture and even music therapy are being considered to combat the neuropsychiatric symptoms of TBI. In this review, we highlight alternative approaches that have been studied in clinical and pre-clinical studies of TBI, and other related forms of neural injury. The purpose of this review is to stimulate further investigation into novel and innovative approaches that can be used to treat the mechanisms and symptoms of mild TBI.
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Affiliation(s)
- Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Aric F. Logsdon
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Linda Nguyen
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Ahmed Eltanahay
- Department of Neurosurgery, Oregon Health Sciences University, Portland, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Patrick Bonasso
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Chelsea Knotts
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Adam Moeck
- Department of Surgery, Matigan Army Medical Center, Tacoma, WA, USA
| | - Joseph C. Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, PA, USA
| | - Julian E. Bailes
- Department of Neurosurgery, Northshore Healthcare System, Evanston, IL, USA
| | - Charles L. Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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Kroshus E, Sonnen AJ, Chrisman SP, Rivara FP. Association between community socioeconomic characteristics and access to youth flag football. Inj Prev 2018; 25:278-282. [PMID: 29330199 DOI: 10.1136/injuryprev-2017-042677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents. METHODS In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics. RESULTS In both states, communities with more educated residents were more likely to offer flag football for youth aged 6-12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001). CONCLUSION These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Aly J Sonnen
- University of Notre Dame, South Bend, Indiana, USA
| | - Sara Pd Chrisman
- Division of Adolescent Medicine, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
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Lin A, Charney M, Shenton ME, Koerte IK. Chronic traumatic encephalopathy: neuroimaging biomarkers. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:309-322. [PMID: 30482359 DOI: 10.1016/b978-0-444-63954-7.00029-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury. To describe the use of neuroimaging as presumed biomarkers of CTE, this chapter focuses on only those studies that report the chronic stages of sports-related brain injury, as opposed to previous chapters that described neuroimaging in the context of acute and subacute injury. Studies using positron emission tomography and magnetic resonance imaging and spectroscopy will be discussed for contact/collision sports such as American football, boxing, mixed martial arts, rugby, and soccer, in which repetitive head impacts are common.
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Affiliation(s)
- Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Molly Charney
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; VA Boston Healthcare System, Boston, MA, United States
| | - Inga Katharina Koerte
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
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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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Wright AD, Smirl JD, Bryk K, van Donkelaar P. A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Acute and Cumulative Effects of Sport-Related Concussion on Neurovascular Coupling Response Dynamics. J Neurotrauma 2017. [DOI: 10.1089/neu.2017.5020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alexander D. Wright
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kelsey Bryk
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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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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Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, Castellani RJ, Turner M, Jordan BD, Randolph C, Dvořák J, Hayden KA, Tator CH, McCrory P, Iverson GL. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017; 51:969-977. [PMID: 28455362 PMCID: PMC5466926 DOI: 10.1136/bjsports-2017-097791] [Citation(s) in RCA: 389] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/14/2022]
Abstract
Objective Systematic review of possible long-term effects of sports-related concussion in retired athletes. Data sources Ten electronic databases. Study selection Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury. Data extraction Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors. Results Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes. Conclusion Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
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Affiliation(s)
- Geoff Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina, Chapel Hill, USA
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Co-Director, NorthShore Neurological Institute; University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Robert C Cantu
- Department of Neurosurgery, Emerson Hospital, Concord, MA, and Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, USA
| | - Rudolph J Castellani
- Center for Neuropathology, Western Michigan University, and Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Michael Turner
- The International Concussion and Head Injury Research Foundation, Marylebone, UK
| | | | | | - Jiří Dvořák
- Department of Nerology, University of Zurich, Schulthess Clinic, Swiss Concussion Center, Zurich, Switzerland
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Charles H Tator
- Canadian Concussion Centre, Toronto Western Hospital, University of Toronto, Krembil Neuroscience Centre, Toronto, Canada
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA
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Abstract
OBJECTIVE This study looks at the changes in injuries after the implementation of a new rule by the International Boxing Association (AIBA) to remove head guards from its competitions. DESIGN A cross-sectional observational study performed prospectively. This brief report examines the removal of head guards in 2 different ways. The first was to examine the stoppages due to blows to the head by comparing World Series Boxing (WSB), without head guards, to other AIBA competitions with head guards. Secondly, we examined the last 3 world championships: 2009 and 2011 (with head guards) and 2013 (without head guards). SETTING World Series Boxing and AIBA world championship boxing. PARTICIPANTS Boxers from WSB and AIBA world championships. INTERVENTIONS The information was recorded by ringside medical physicians. MAIN OUTCOME MEASURES Stoppages per 10 000 rounds; stoppages per 1000 hours. RESULTS Both studies show that the number of stoppages due to head blows was significantly decreased without head guards. The studies also showed that there was a notable increase in cuts. CONCLUSIONS Removing head guards may reduce the already small risk of acute brain injury in amateur boxing.
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Butterfield DA, Reed TT. Lipid peroxidation and tyrosine nitration in traumatic brain injury: Insights into secondary injury from redox proteomics. Proteomics Clin Appl 2016; 10:1191-1204. [PMID: 27588567 DOI: 10.1002/prca.201600003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/17/2022]
Abstract
Traumatic brain injury (TBI) is a spontaneous event in which sudden trauma and secondary injury cause brain damage. Symptoms of TBI can range from mild to severe depending on extent of injury. The outcome can span from complete patient recovery to permanent memory loss and neurological decline. Currently, there is no known cure for TBI; however, immediate medical attention after injury is most beneficial for patient recovery. It is a well-established concept that imbalances in the production of reactive oxygen species (ROS), reactive nitrogen species (RNS), and native antioxidant mechanisms have been shown to increase oxidative stress. Over the years, proteomics has been used to identify specific biomarkers in diseases such as cancers and neurological disorders such as Alzheimer disease and Parkinson disease. As TBI is a risk factor for a multitude of neurological diseases, biomarkers for this phenomenon are a likely field of study in order to confirm diagnosis. This review highlights the current proteomics studies that investigated excessively nitrated proteins and those altered by lipid peroxidation in TBI. This review also highlights possible diagnostic measures and provides insights for future treatment strategies.
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Affiliation(s)
- D Allan Butterfield
- Department of Chemistry, University of Kentucky, Lexington, KY, USA.,Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Tanea T Reed
- Department of Chemistry, Eastern Kentucky University, Richmond, KY, USA
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Albrecht MA, Masters CL, Ames D, Foster JK. Impact of Mild Head Injury on Neuropsychological Performance in Healthy Older Adults: Longitudinal Assessment in the AIBL Cohort. Front Aging Neurosci 2016; 8:105. [PMID: 27242516 PMCID: PMC4863889 DOI: 10.3389/fnagi.2016.00105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/25/2016] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is suggested to be a significant risk factor for dementia. However, little research has been conducted into long-term neuropsychological outcomes after head trauma. Participants from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL) who had recovered after sustaining a mild TBI involving loss of consciousness more than 5 years previously were compared with matched controls across a 3-year period. Bayesian nested-domain modeling was used to estimate the effect of TBI on neuropsychological performance. There was no evidence for a chronic effect of mild TBI on any neuropsychological domain compared to controls. Within the TBI group, there was some evidence suggesting that the age that the head trauma occurred and the duration of unconsciousness were modulators of episodic memory. However, these findings were not robust. Taken together, these findings indicate that adults who have sustained a TBI resulting in loss of consciousness, but who recover to a healthy level of cognitive functioning, do not experience frank deficits in cognitive ability.
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Affiliation(s)
- Matthew A Albrecht
- School of Public Health, Curtin UniversityPerth, WA, Australia; Curtin Health Innovation Research Institute - BiosciencesPerth, WA, Australia; Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of MedicineBaltimore, MD, USA
| | - Colin L Masters
- Mental Health Research Institute, The University of Melbourne Parkville, VIC, Australia
| | - David Ames
- Department of Psychiatry, Academic Unit for Psychiatry of Old Age, The University of Melbourne, St. Vincent's Aged Psychiatry Service, St. George's HospitalParkville, VIC, Australia; National Ageing Research Institute, Royal Melbourne HospitalParkville, VIC, Australia
| | - Jonathan K Foster
- School of Psychology and Speech Pathology, Curtin UniversityPerth, WA, Australia; Health Department of WA, Neurosciences UnitPerth, WA, Australia
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Ozolins B, Aimers N, Parrington L, Pearce AJ. Movement disorders and motor impairments following repeated head trauma: A systematic review of the literature 1990-2015. Brain Inj 2016; 30:937-47. [PMID: 27120772 DOI: 10.3109/02699052.2016.1147080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing attention on the long-term sequelae following multiple concussions and traumatic brain injury (TBI) in later life. The majority of the research has focused on long-term cognitive impairments and behavioural changes. Despite being researched and reported, long-term motor dysfunction and movement disorders as a consequence of concussions and TBI have not received due consideration. REVIEW This study used a systematic review and qualitative analysis that focused on two key areas: (1) identified movement disorders in individuals with a reported history of repeated concussions or repeated mild-to-moderate TBIs; and (2) identified motor impairments in individuals with a history of repeated concussions or repeated mild-to-moderate TBIs. Fourteen studies investigating long-term movement disorders or motor impairments as a result of repeated concussions or TBI met the selection criteria. Study ratings were moderate-to-high; therefore, evidence was strong enough to conclude that repeated concussions or repeated mild/moderate TBIs did affect the motor system. CONCLUSION The evidence in this systematic review highlights the need for future studies to include motor outcomes along with cognitive and behavioural outcomes when assessing the long-term effects of repeated concussions or repeated mild/moderate TBIs.
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Affiliation(s)
- Bede Ozolins
- a Faculty of Health , Deakin University , Melbourne , Australia
| | - Nicole Aimers
- b Centre for Design Innovation (CDI) , Swinburne University of Technology , Melbourne , Australia
| | - Lucy Parrington
- c Department of Biomedical and Health Sciences , Swinburne University of Technology , Melbourne , Australia
| | - Alan J Pearce
- b Centre for Design Innovation (CDI) , Swinburne University of Technology , Melbourne , Australia.,d Melbourne School of Health Sciences , The University of Melbourne , Australia
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Yengo-Kahn AM, Johnson DJ, Zuckerman SL, Solomon GS. Concussions in the National Football League: A Current Concepts Review. Am J Sports Med 2016; 44:801-11. [PMID: 25899432 DOI: 10.1177/0363546515580313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. PURPOSE To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. STUDY DESIGN Systematic review of literature. METHODS English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. RESULTS Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). CONCLUSION The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community as well as the public should be cautious in interpreting the current literature surrounding concussion.
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Affiliation(s)
- Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Daniel J Johnson
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Clark M, Guskiewicz K. Sport-Related Traumatic Brain Injury. TRANSLATIONAL RESEARCH IN TRAUMATIC BRAIN INJURY 2015. [DOI: 10.1201/b18959-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Koerte IK, Lin AP, Willems A, Muehlmann M, Hufschmidt J, Coleman MJ, Green I, Liao H, Tate DF, Wilde EA, Pasternak O, Bouix S, Rathi Y, Bigler ED, Stern RA, Shenton ME. A review of neuroimaging findings in repetitive brain trauma. Brain Pathol 2015; 25:318-49. [PMID: 25904047 PMCID: PMC5699448 DOI: 10.1111/bpa.12249] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease confirmed at postmortem. Those at highest risk are professional athletes who participate in contact sports and military personnel who are exposed to repetitive blast events. All neuropathologically confirmed CTE cases, to date, have had a history of repetitive head impacts. This suggests that repetitive head impacts may be necessary for the initiation of the pathogenetic cascade that, in some cases, leads to CTE. Importantly, while all CTE appears to result from repetitive brain trauma, not all repetitive brain trauma results in CTE. Magnetic resonance imaging has great potential for understanding better the underlying mechanisms of repetitive brain trauma. In this review, we provide an overview of advanced imaging techniques currently used to investigate brain anomalies. We also provide an overview of neuroimaging findings in those exposed to repetitive head impacts in the acute/subacute and chronic phase of injury and in more neurodegenerative phases of injury, as well as in military personnel exposed to repetitive head impacts. Finally, we discuss future directions for research that will likely lead to a better understanding of the underlying mechanisms separating those who recover from repetitive brain trauma vs. those who go on to develop CTE.
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Affiliation(s)
- Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Alexander P. Lin
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Anna Willems
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Marc Muehlmann
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Jakob Hufschmidt
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Pediatric NeurologyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Michael J. Coleman
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Isobel Green
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Huijun Liao
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - David F. Tate
- General Dynamic Information Technologies ContractorDefense and Veterans Brain Injury CentersSan Antonio Military Medical CenterSan AntonioTX
| | - Elisabeth A. Wilde
- Departments of Physical Medicine and RehabilitationNeurology and RadiologyBaylor College of MedicineSan AntonioTX
- Michael E. DeBakey VA Medical CenterSan AntonioTX
| | - Ofer Pasternak
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Sylvain Bouix
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Yogesh Rathi
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Erin D. Bigler
- Neuroscience Center and Department of PsychologyBrigham Young UniversityProvoUT
| | - Robert A. Stern
- Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease CenterBoston University School of MedicineBostonMA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- VA Boston Healthcare SystemBostonMA
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Terry DP, Adams TE, Ferrara MS, Miller LS. FMRI hypoactivation during verbal learning and memory in former high school football players with multiple concussions. Arch Clin Neuropsychol 2015; 30:341-55. [PMID: 25903375 DOI: 10.1093/arclin/acv020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 01/05/2023] Open
Abstract
Multiple concussions before the age of 18 may be associated with late-life memory deficits. This study examined neural activation associated with verbal encoding and memory retrieval in former athletes ages 40-65 who received at least two concussions (median = 3; range = 2-15) playing high school football and a group of former high school football players with no reported history of concussions matched on age, education, and pre-morbid IQ. Functional magnetic resonance imaging data collected during a modified verbal paired associates paradigm indicated that those with concussive histories had hypoactivation in left hemispheric language regions, including the inferior/middle frontal gyri and angular gyrus compared with controls. However, concussive history was not associated with worse memory functioning on neuropsychological tests or worse behavioral performance during the paradigm, suggesting that multiple early-life concussions may be associated with subtle changes in the verbal encoding system that limits one from accessing higher-order semantic networks, but this difference does not translate into measurable cognitive performance deficits.
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Affiliation(s)
- Douglas P Terry
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - T Eric Adams
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Michael S Ferrara
- College of Health & Human Services, University of New Hampshire, Durham, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, GA, USA BioImaging Research Center, Biomedical & Health Science Institute, University of Georgia, Athens, GA, USA
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Daneshvar DH, Goldstein LE, Kiernan PT, Stein TD, McKee AC. Post-traumatic neurodegeneration and chronic traumatic encephalopathy. Mol Cell Neurosci 2015; 66:81-90. [PMID: 25758552 DOI: 10.1016/j.mcn.2015.03.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/05/2015] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease. However, the pathologic phenotype of these post-traumatic neurodegenerations is largely unknown and there may be pathobiological differences between post-traumatic disease and the corresponding sporadic disorder. By contrast, the pathology of CTE is increasingly well known and is characterized by a distinctive pattern of progressive brain atrophy and accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, 43 kDa TAR DNA-binding protein (TDP-43) neuronal and glial aggregates, microvasculopathy, myelinated axonopathy, neuroinflammation, and white matter degeneration. Clinically, CTE is associated with behavioral changes, executive dysfunction, memory deficits, and cognitive impairments that begin insidiously and most often progress slowly over decades. Although research on the long-term effects of TBI is advancing quickly, the incidence and prevalence of post-traumatic neurodegeneration and CTE are unknown. Critical knowledge gaps include elucidation of pathogenic mechanisms, identification of genetic risk factors, and clarification of relevant variables-including age at exposure to trauma, history of prior and subsequent head trauma, substance use, gender, stress, and comorbidities-all of which may contribute to risk profiles and the development of post-traumatic neurodegeneration and CTE. This article is part of a Special Issue entitled 'Traumatic Brain Injury'.
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Affiliation(s)
- Daniel H Daneshvar
- Boston University Chronic Traumatic Encephalopathy Program, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Neurology, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Lee E Goldstein
- Boston University Chronic Traumatic Encephalopathy Program, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Neurology, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Neurosurgery, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Photonics Center, Boston University, 1 Silber Way, Boston, MA 02115, USA; Department of Biomedical Engineering, Boston University, 1 Silber Way, Boston, MA 02115, USA; Department of Electrical and Computer Engineering, Boston University, 1 Silber Way, Boston, MA 02115, USA; Department of Mechanical Engineering, Boston University, 1 Silber Way, Boston, MA 02115, USA
| | - Patrick T Kiernan
- Boston University Chronic Traumatic Encephalopathy Program, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Neurology, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Thor D Stein
- Boston University Chronic Traumatic Encephalopathy Program, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA
| | - Ann C McKee
- Boston University Chronic Traumatic Encephalopathy Program, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Neurology, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA; VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130, USA
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Esopenko C, Levine B. Aging, neurodegenerative disease, and traumatic brain injury: the role of neuroimaging. J Neurotrauma 2015; 32:209-20. [PMID: 25192426 PMCID: PMC4321975 DOI: 10.1089/neu.2014.3506] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is a highly prevalent condition with significant effects on cognition and behavior. While the acute and sub-acute effects of TBI recover over time, relatively little is known about the long-term effects of TBI in relation to neurodegenerative disease. This issue has recently garnered a great deal of attention due to publicity surrounding chronic traumatic encephalopathy (CTE) in professional athletes, although CTE is but one of several neurodegenerative disorders associated with a history of TBI. Here, we review the literative on neurodegenerative disorders linked to remote TBI. We also review the evidence for neuroimaging changes associated with unhealthy brain aging in the context of remote TBI. We conclude that neuroimaging biomarkers have significant potential to increase understanding of the mechanisms of unhealthy brain aging and neurodegeneration following TBI, with potential for identifying those at risk for unhealthy brain aging prior to the clinical manifestation of neurodegenerative disease.
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Affiliation(s)
- Carrie Esopenko
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Brian Levine
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Departments of Psychology and Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
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Solomon GS, Lovell MR, Casson IR, Viano DC. Normative Neurocognitive Data for National Football League Players: An Initial Compendium. Arch Clin Neuropsychol 2015; 30:161-73. [DOI: 10.1093/arclin/acv003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Montenigro PH, Corp DT, Stein TD, Cantu RC, Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol 2015; 11:309-30. [PMID: 25581233 DOI: 10.1146/annurev-clinpsy-032814-112814] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is most often identified in postmortem autopsies of individuals exposed to repetitive head impacts, such as boxers and football players. The neuropathology of CTE is characterized by the accumulation of hyperphosphorylated tau protein in a pattern that is unique from that of other neurodegenerative diseases, including Alzheimer's disease. The clinical features of CTE are often progressive, leading to dramatic changes in mood, behavior, and cognition, frequently resulting in debilitating dementia. In some cases, motor features, including parkinsonism, can also be present. In this review, the historical origins of CTE are revealed and an overview of the current state of knowledge of CTE is provided, including the neuropathology, clinical features, proposed clinical and pathological diagnostic criteria, potential in vivo biomarkers, known risk factors, and treatment options.
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Affiliation(s)
- Philip H Montenigro
- Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, Massachusetts 02118; , ,
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