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Brett BL, Klein AP, Vazirnia P, Omidfar S, Guskiewicz KK, McCrea M, Meier T. White Matter Hyperintensities and Microstructural Alterations in Contact Sport Athletes from Adolescence to Early Midlife. J Neurotrauma 2024. [PMID: 38661548 DOI: 10.1089/neu.2023.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Studies have demonstrated associations between cumulative concussion and repetitive head impact exposure (RHI) via contact sports with white matter (WM) alterations later in life. The course of WM changes associated with exposure earlier in the lifespan are unclear. This study investigated alterations in white matter (WM hyperintensity [WMH] volume and microstructural changes) associated with concussion and RHI exposure from adolescence to early midlife, as well as the interaction between exposure and age-cohort (i.e., adolescent/young adult compared to early midlife athlete cohorts) on WM outcomes. Participating football players included an adolescent/young adulthood cohort (n=82; Mage=18.41.7) and an early midlife cohort (37 former collegiate players approximately 15-years removed from sport; Mage=37.71.4). Years of football participation and number of prior concussions were exposures of interest. White matter outcomes included log-transformed manually segmented total WMH volume and neurite orientation dispersion and density imaging metrics of microstructure/organization (isotropic volume fraction[Viso], intra-cellular volume fraction[Vic], and orientation dispersion[OD]). Regression models were fit to test effects of concussion history, years of football participation, and age-cohort by years of football participation with WM outcomes. Spearman's correlations assessed associations between significant WM metrics and measures of cognitive and psychological function. A significant age-cohort by years of participation effect was observed for whole brain white matter OD, B=-0.002, SE=0.001, p=0.001. The interaction was driven by a negative association between years of participation and OD within the younger cohort, B=-0.001, SE=0.0004, p=0.008, whereas a positive association between participation and OD in the early midlife cohort, B=0.001, SE=0.0003, p=0.039, was observed. Follow-up ROI analyses showed significant interaction effects for OD in the body of the corpus callosum, genu of the corpus callosum, cingulum, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, posterior thalamic radiation (ps<0.05). Greater concussion history was significantly associated with greater Viso in the early midlife cohort, B=0.001, SE= 0.0002, p=0.010. Years of participation and concussion history were not associated with WMH volume, ps>0.05. Performance on a measure of executive function was significantly associated with years of participation, =.34, p=.04, and a trend was observed for OD, =.28, p=.09 in the early midlife cohort only. The global characterization of white matter changes associated with years of football participation were broadly similar and stable from adolescence through early midlife (i.e., microstructural alterations, but not macroscopic lesions). An inverse association between years of participation and orientation dispersion across age-cohorts may represent a process of initial recovery/reorganization proximal to sport, followed by later reduction of white matter coherence.
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Affiliation(s)
- Benjamin L Brett
- Medical College of Wisconsin, 5506, Neurosurgery and Neurology, 8701 W Watertown Plank Rd, Milwaukee, Wisconsin, United States, 53226;
| | - Andrew P Klein
- Medical College of Wisconsin, 5506, Radiology, 9200 West Wisconsin Ave, Milwaukee, Wisconsin, United States, 53226;
| | - Parsia Vazirnia
- Medical College of Wisconsin, 5506, Milwaukee, Wisconsin, United States;
| | - Samantha Omidfar
- Medical College of Wisconsin, 5506, Milwaukee, Wisconsin, United States;
| | - Kevin K Guskiewicz
- University of North Carolina, Exercise and Sport Science, CB#8700, Chapel Hill, North Carolina, United States, 27599-8700;
| | - Michael McCrea
- Medical College of Wisconsin, Neurosurgery, Hub for Collaborative Medicine, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
| | - Timothy Meier
- Medical College of Wisconsin, Neurosurgery, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
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2
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Strain JF, Rahmani M, Dierker D, Owen C, Jafri H, Vlassenko AG, Womack K, Fripp J, Tosun D, Benzinger TLS, Weiner M, Masters C, Lee JM, Morris JC, Goyal MS. Accuracy of TrUE-Net in comparison to established white matter hyperintensity segmentation methods: An independent validation study. Neuroimage 2024; 285:120494. [PMID: 38086495 DOI: 10.1016/j.neuroimage.2023.120494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023] Open
Abstract
White matter hyperintensities (WMH) are nearly ubiquitous in the aging brain, and their topography and overall burden are associated with cognitive decline. Given their numerosity, accurate methods to automatically segment WMH are needed. Recent developments, including the availability of challenge data sets and improved deep learning algorithms, have led to a new promising deep-learning based automated segmentation model called TrUE-Net, which has yet to undergo rigorous independent validation. Here, we compare TrUE-Net to six established automated WMH segmentation tools, including a semi-manual method. We evaluated the techniques at both global and regional level to compare their ability to detect the established relationship between WMH burden and age. We found that TrUE-Net was highly reliable at identifying WMH regions with low false positive rates, when compared to semi-manual segmentation as the reference standard. TrUE-Net performed similarly or favorably when compared to the other automated techniques. Moreover, TrUE-Net was able to detect relationships between WMH and age to a similar degree as the reference standard semi-manual segmentation at both the global and regional level. These results support the use of TrUE-Net for identifying WMH at the global or regional level, including in large, combined datasets.
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Affiliation(s)
- Jeremy F Strain
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis MO, USA.
| | - Maryam Rahmani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis MO, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis MO, USA
| | - Christopher Owen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hussain Jafri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrei G Vlassenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis MO, USA
| | - Kyle Womack
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, QLD, Australia
| | - Duygu Tosun
- Division of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer Disease Research Center, St. Louis, MO, USA
| | - Michael Weiner
- Division of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - Colin Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Knight Alzheimer Disease Research Center, St. Louis, MO, USA
| | - Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Neuroimaging Labs Research Center, Washington University School of Medicine, St. Louis MO, USA
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3
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Gangolli M, Pajevic S, Kim JH, Hutchinson EB, Benjamini D, Basser PJ. Correspondence of mean apparent propagator MRI metrics with phosphorylated tau and astrogliosis in chronic traumatic encephalopathy. Brain Commun 2023; 5:fcad253. [PMID: 37901038 PMCID: PMC10600571 DOI: 10.1093/braincomms/fcad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Chronic traumatic encephalopathy is a neurodegenerative disease that is diagnosed and staged based on the localization and extent of phosphorylated tau pathology. Although its identification remains the primary diagnostic criteria to distinguish chronic traumatic encephalopathy from other tauopathies, the hyperphosphorylated tau that accumulates in neurofibrillary tangles in cortical grey matter and perivascular regions is often accompanied by concomitant pathology such as astrogliosis. Mean apparent propagator MRI is a clinically feasible diffusion MRI method that is suitable to characterize microstructure of complex biological media efficiently and comprehensively. We performed quantitative correlations between propagator metrics and underlying phosphorylated tau and astroglial pathology in a cross-sectional study of 10 ex vivo human tissue specimens with 'high chronic traumatic encephalopathy' at 0.25 mm isotropic voxels. Linear mixed effects analysis of regions of interest showed significant relationships of phosphorylated tau with propagator-estimated non-Gaussianity in cortical grey matter (P = 0.002) and of astrogliosis with propagator anisotropy in superficial cortical white matter (P = 0.0009). The positive correlation between phosphorylated tau and non-Gaussianity was found to be modest but significant (R2 = 0.44, P = 6.0 × 10-5) using linear regression. We developed an unsupervised clustering algorithm with non-Gaussianity and propagator anisotropy as inputs, which was able to identify voxels in superficial cortical white matter that corresponded to astrocytes that were accumulated at the grey-white matter interface. Our results suggest that mean apparent propagator MRI at high spatial resolution provides a means to not only identify phosphorylated tau pathology but also detect regions with astrocytic pathology and may therefore prove diagnostically valuable in the evaluation of concomitant pathology in cortical tissue with complex microstructure.
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Affiliation(s)
- Mihika Gangolli
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sinisa Pajevic
- Section on Critical Brain Dynamics, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joong Hee Kim
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Elizabeth B Hutchinson
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 20892, USA
| | - Dan Benjamini
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20817, USA
- Multiscale Imaging and Integrative Biophysics Unit, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter J Basser
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD 20817, USA
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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4
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Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
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Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
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5
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Alosco ML, Ly M, Mosaheb S, Saltiel N, Uretsky M, Tripodis Y, Martin B, Palmisano J, Delano-Wood L, Bondi MW, Meng G, Xia W, Daley S, Goldstein LE, Katz DI, Dwyer B, Daneshvar DH, Nowinski C, Cantu RC, Kowall NW, Stern RA, Alvarez VE, Mez J, Huber BR, McKee AC, Stein TD. Decreased myelin proteins in brain donors exposed to football-related repetitive head impacts. Brain Commun 2023; 5:fcad019. [PMID: 36895961 PMCID: PMC9990992 DOI: 10.1093/braincomms/fcad019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 03/09/2023] Open
Abstract
American football players and other individuals exposed to repetitive head impacts can exhibit a constellation of later-life cognitive and neuropsychiatric symptoms. While tau-based diseases such as chronic traumatic encephalopathy can underpin certain symptoms, contributions from non-tau pathologies from repetitive head impacts are increasingly recognized. We examined cross-sectional associations between myelin integrity using immunoassays for myelin-associated glycoprotein and proteolipid protein 1 with risk factors and clinical outcomes in brain donors exposed to repetitive head impacts from American football. Immunoassays for myelin-associated glycoprotein and proteolipid protein 1 were conducted on dorsolateral frontal white matter tissue samples of 205 male brain donors. Proxies of exposure to repetitive head impacts included years of exposure and age of first exposure to American football play. Informants completed the Functional Activities Questionnaire, Behavior Rating Inventory of Executive Function-Adult Version (Behavioral Regulation Index), and Barratt Impulsiveness Scale-11. Associations between myelin-associated glycoprotein and proteolipid protein 1 with exposure proxies and clinical scales were tested. Of the 205 male brain donors who played amateur and professional football, the mean age was 67.17 (SD = 16.78), and 75.9% (n = 126) were reported by informants to be functionally impaired prior to death. Myelin-associated glycoprotein and proteolipid protein 1 correlated with the ischaemic injury scale score, a global indicator of cerebrovascular disease (r = -0.23 and -0.20, respectively, Ps < 0.01). Chronic traumatic encephalopathy was the most common neurodegenerative disease (n = 151, 73.7%). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with chronic traumatic encephalopathy status, but lower proteolipid protein 1 was associated with more severe chronic traumatic encephalopathy (P = 0.03). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with other neurodegenerative disease pathologies. More years of football play was associated with lower proteolipid protein 1 [beta = -2.45, 95% confidence interval (CI) [-4.52, -0.38]] and compared with those who played <11 years of football (n = 78), those who played 11 or more years (n = 128) had lower myelin-associated glycoprotein (mean difference = 46.00, 95% CI [5.32, 86.69]) and proteolipid protein 1 (mean difference = 24.72, 95% CI [2.40, 47.05]). Younger age of first exposure corresponded to lower proteolipid protein 1 (beta = 4.35, 95% CI [0.25, 8.45]). Among brain donors who were aged 50 or older (n = 144), lower proteolipid protein 1 (beta = -0.02, 95% CI [-0.047, -0.001]) and myelin-associated glycoprotein (beta = -0.01, 95% CI [-0.03, -0.002]) were associated with higher Functional Activities Questionnaire scores. Lower myelin-associated glycoprotein correlated with higher Barratt Impulsiveness Scale-11 scores (beta = -0.02, 95% CI [-0.04, -0.0003]). Results suggest that decreased myelin may represent a late effect of repetitive head impacts that contributes to the manifestation of cognitive symptoms and impulsivity. Clinical-pathological correlation studies with prospective objective clinical assessments are needed to confirm our findings.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Monica Ly
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Sydney Mosaheb
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nicole Saltiel
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | | | - Weiming Xia
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah Daley
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - Douglas I Katz
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Robert C Cantu
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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6
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Raukola-Lindblom M, Kurki T, Ljungqvist L, Laasonen M, Hämäläinen H, Tenovuo O. Association of cognitive-linguistic deficits to diffusion tensor imaging parameters in moderate to severe traumatic diffuse axonal injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36688868 DOI: 10.1080/23279095.2023.2169885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cognitive-linguistic functions are an essential part of adequate communication competence. Cognitive-linguistic deficits are common after traumatic diffuse axonal injury (DAI). We aimed to examine the integrity of perisylvian white matter tracts known to be associated with linguistic functions in individuals with DAI and their eventual association with poor cognitive-linguistic outcomes. Diffusion tensor imaging (DTI) results of 44 adults with moderate-to-severe DAI were compared with those of 67 controls. Fractional anisotropy (FA) values of the superior longitudinal fasciculus (SLF), arcuate fasciculus (AF), SLF with frontal connections to the lower parietal cortex, and AF with temporal connections to the lower parietal cortex were measured using tractography. The associations between white matter integrity FA values and cognitive-linguistic deficits were studied in the DAI group. Cognitive-linguistic deficits were determined based on our earlier study using the novel KAT test. No previous studies have examined the associations between white matter integrity and cognitive-linguistic deficits determined using the KAT test. Patients with DAI showed lower FA values in all left-side tracts than the controls. Unexpectedly, the poor cognitive-linguistic outcome in the language comprehension and production domains was associated with high FA values of several tracts. After excluding five cases with the poorest cognitive-linguistic performance, but with the highest values in the DTI variables, no significant associations with DTI metrics were found. The association between white matter integrity and cognitive-linguistic functioning is complex in patients with DAI of traumatic origin, probably reflecting the heterogeneity of TBI.
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Affiliation(s)
| | - Timo Kurki
- Department of Radiology, University of Turku, Turku, Finland.,Terveystalo Medical Center, Turku, Finland
| | - Linda Ljungqvist
- City of Turku, Welfare Division, Psychosocial Services, Turku, Finland
| | - Marja Laasonen
- Department of Logopedics, School of Humanities, University of Eastern Finland, Joensuu, Finland
| | - Heikki Hämäläinen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Turku Brain Injury Center, Neurocenter, Turku University Hospital, Turku, Finland
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7
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Strain JF, Cooley S, Kilgore C, Nelson B, Doyle J, Thompson R, Westerhaus E, Petersen KJ, Wisch J, Ances BM. The Structural and Functional Correlates of Frailty in Persons With Human Immunodeficiency Virus. Clin Infect Dis 2022; 75:1740-1746. [PMID: 35404408 PMCID: PMC10200329 DOI: 10.1093/cid/ciac271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons with HIV (PWH) are at increased risk of frailty, a clinically recognizable state of increased vulnerability resulting from aging-associated decline in multiple physiologic systems. Frailty is often defined by the Fried criteria, which includes subjective and objective standards concerning health resiliency. However, these frailty metrics do not incorporate cognitive performance or neuroimaging measures. METHODS We compared structural (diffusion tensor imaging [DTI]) and functional (cerebral blood flow [CBF]) neuroimaging markers in PWH with frailty and cognitive performance. Virologically controlled PWH were dichotomized as either frail (≥3) or nonfrail (<3) using the Fried criteria. Cognitive Z-scores, both domain (executive, psychomotor speed, language, and memory) and global, were derived from a battery of tests. We identified three regions of reduced CBF, based on a voxel-wise comparison of frail PWH compared with nonfrail PWH. These clusters (bilateral frontal and posterior cingulate) were subsequently used as seed regions of interest (ROIs) for DTI probabilistic white matter tractography. RESULTS White matter integrity connecting the ROIs was significantly decreased in frail compared with nonfrail PWH. No differences in cognition were observed between frail and nonfrail PWH. However, reductions in white matter integrity among these ROIs was significantly associated with worse psychomotor speed and executive function across the entire cohort. CONCLUSIONS We conclude that frailty in PWH can lead to structural and functional brain changes, including subtle changes that are not detectable by standard neuropsychological tests. Multimodal neuroimaging in conjunction with frailty assessment could identify pathological brain changes observed in PWH.
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Affiliation(s)
- Jeremy F Strain
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sarah Cooley
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Collin Kilgore
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Brittany Nelson
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - John Doyle
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Regina Thompson
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | | | - Kalen J Petersen
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Julie Wisch
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Beau M Ances
- Department of Neurology, Washington University, St. Louis, Missouri, USA
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8
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Strain JF, Barthelemy N, Horie K, Gordon BA, Kilgore C, Aschenbrenner A, Cruchaga C, Xiong C, Joseph-Mathurin N, Hassenstab J, Fagan AM, Li Y, Karch CM, Perrin RJ, Berman SB, Chhatwal JP, Graff-Radford NR, Mori H, Levin J, Noble JM, Allegri R, Schofield PR, Marcus DS, Holtzman DM, Morris JC, Benzinger TLS, McDade EM, Bateman RJ, Ances BM. CSF Tau phosphorylation at Thr205 is associated with loss of white matter integrity in autosomal dominant Alzheimer disease. Neurobiol Dis 2022; 168:105714. [PMID: 35358703 PMCID: PMC9701560 DOI: 10.1016/j.nbd.2022.105714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hyperphosphorylation of tau leads to conformational changes that destabilize microtubules and hinder axonal transport in Alzheimer's disease (AD). However, it remains unknown whether white matter (WM) decline due to AD is associated with specific Tau phosphorylation site(s). METHODS In autosomal dominant AD (ADAD) mutation carriers (MC) and non-carriers (NC) we compared cerebrospinal fluid (CSF) phosphorylation at tau sites (pT217, pT181, pS202, and pT205) and total tau with WM measures, as derived from diffusion tensor imaging (DTI), and cognition. A WM composite metric, derived from a principal component analysis, was used to identify spatial decline seen in ADAD. RESULTS The WM composite explained over 70% of the variance in MC. WM regions that strongly contributed to the spatial topography were located in callosal and cingulate regions. Loss of integrity within the WM composite was strongly associated with AD progression in MC as defined by the estimated years to onset (EYO) and cognitive decline. A linear regression demonstrated that amyloid, gray matter atrophy and phosphorylation at CSF tau site pT205 each uniquely explained a reduction in the WM composite within MC that was independent of vascular changes (white matter hyperintensities), and age. Hyperphosphorylation of CSF tau at other sites and total tau did not significantly predict WM composite loss. CONCLUSIONS We identified a site-specific relationship between CSF phosphorylated tau and WM decline within MC. The presence of both amyloid deposition and Tau phosphorylation at pT205 were associated with WM composite loss. These findings highlight a primary AD-specific mechanism for WM dysfunction that is tightly coupled to symptom manifestation and cognitive decline.
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Affiliation(s)
- Jeremy F Strain
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Nicolas Barthelemy
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Kanta Horie
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Brian A Gordon
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Department of Psychological & Brain Sciences, Washington University, St. Louis, MO 63110, USA
| | - Collin Kilgore
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | | | - Carlos Cruchaga
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Chengjie Xiong
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Nelly Joseph-Mathurin
- Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Anne M Fagan
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Yan Li
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Celeste M Karch
- Department of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Richard J Perrin
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Hiroshi Mori
- Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Johannes Levin
- German Center for Neurodegenerative Disease (DZNE) Munich, Munich, Germany
| | - James M Noble
- Department of Neurology, Columbia University, New York, NY 100310, USA
| | - Ricardo Allegri
- School of Medicine, Universidad de Buenos Aires, Viamonte 430, C1053 CABA, Argentina
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia; Hope Center for Neurological Disorders, Washington University, St. Louis, MO 63100, USA
| | - Daniel S Marcus
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - David M Holtzman
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - John C Morris
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Tammie L S Benzinger
- Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Eric M McDade
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Randall J Bateman
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA.
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Li Y, Qiao Y, Wang F, Wei C, Wang R, Jin H, Xie B, You J, Jia J, Zhou A. Culture Effects on the Chinese Version Boston Naming Test Performance and the Normative Data in the Native Chinese-Speaking Elders in Mainland China. Front Neurol 2022; 13:866261. [PMID: 35645954 PMCID: PMC9139106 DOI: 10.3389/fneur.2022.866261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Chinese version of Boston Naming Test (BNT-C) is administered in China widely. However, the neuropsychological parameter of BNT-C in native Chinese-speaking elders in mainland China has not been explored systematically. The aim of this study was to explore cultural influences on BNT-C performance and establish norms among native Chinese-speaking elders in Beijing. Methods A total of 161 native, Chinese-speaking, cognitively normal elders aged ≥55 years were enrolled from various communities in Beijing. The BNT-C was conducted on all the participants. The internal consistency, participants' familiarity, and naming accuracy were analyzed and compared with data from Chinese areas outside the mainland and from American published previously. The influencing factors and stratified norms for BNT-C were established. Results The BNT-C showed good internal consistency (α = 0.738). Strong correlation between naming accuracy and object familiarity was found (r = 0.962, P < 0.001). Participants' familiarity and correct naming rate for many items were notably different between the Chinese-speaking elders and English-speaking elders in America. The difference in some items' correct naming rate also existed between Beijing, Taiwan, and Hongkong. Higher education was associated with higher scores, whereas age and gender had no effect on BNT-C performance. The recommended norms of total naming scores for elders with education ≤ 9 and >9 years were 16 and 23, respectively. Conclusion The participants' familiarity with BNT items differed between different cultures, which further affected the naming accuracy and total scores. The education stratified norms established here are helpful for the better application of BNT-C in mainland China.
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Yuan W, Diekfuss JA, Barber Foss KD, Dudley JA, Leach JL, Narad ME, DiCesare CA, Bonnette S, Epstein JN, Logan K, Altaye M, Myer GD. High School Sports-Related Concussion and the Effect of a Jugular Vein Compression Collar: A Prospective Longitudinal Investigation of Neuroimaging and Neurofunctional Outcomes. J Neurotrauma 2021; 38:2811-2821. [PMID: 34375130 DOI: 10.1089/neu.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes. We aimed to quantify the alterations in white matter (WM) microstructure and global network organization, and the decrements in behavioral and cognitive outcomes from pre-season to post-concussion in youth athletes who experienced SRC. We also aimed to evaluate whether wearing a jugular compression neck collar, a device designed to mitigate brain "slosh" injury, would mitigate the pre-season to post-concussion alterations in neuroimaging, behavioral, and cognitive outcomes. A total of 488 high school football and soccer athletes (14-18 years old) were prospectively enrolled and assigned to the non-collar group (n = 237) or the collar group (n = 251). The outcomes of the study were the pre-season to post-concussion neuroimaging, behavioral, and cognitive alterations. Forty-six participants (non-collar: n = 24; collar: n = 22) were diagnosed with a SRC during the season. Forty of these 46 athletes (non-collar: n = 20; collar: n = 20) completed neuroimaging assessment. Significant pre-season to post-concussion alterations in WM microstructural integrity and brain network organization were found in these athletes (corrected p < 0.05). The alterations were significantly reduced in collar-wearing athletes compared to non-collar-wearing athletes (corrected p < 0.05). Concussion and collar main effects were identified for some of the behavioral and cognitive outcomes, but no collar by SRC interaction effects were observed in any outcomes. In summary, young athletes exhibited significant WM microstructural and network organizational, and cognitive alterations following SRC. The use of the jugular vein compression collar showed promising evidence to reduce these alterations in high school contact sport athletes.
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Affiliation(s)
- Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Megan E Narad
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher A DiCesare
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffery N Epstein
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelsey Logan
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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11
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Alosco ML, Mariani ML, Adler CH, Balcer LJ, Bernick C, Au R, Banks SJ, Barr WB, Bouix S, Cantu RC, Coleman MJ, Dodick DW, Farrer LA, Geda YE, Katz DI, Koerte IK, Kowall NW, Lin AP, Marcus DS, Marek KL, McClean MD, McKee AC, Mez J, Palmisano JN, Peskind ER, Tripodis Y, Turner RW, Wethe JV, Cummings JL, Reiman EM, Shenton ME, Stern RA. Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2021; 13:136. [PMID: 34384490 PMCID: PMC8357968 DOI: 10.1186/s13195-021-00872-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the "Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project." The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project. METHODS The targeted sample and sample size was 240 male participants, ages 45-74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined. RESULTS Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021. CONCLUSIONS Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE. TRIAL REGISTRATION NCT02798185.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Megan L Mariani
- Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, and Slone Epidemiology Center, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sarah J Banks
- Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA
| | - William B Barr
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Lindsay A Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, BU Schools of Medicine and Public Health, Boston, MA, USA
| | - Yonas E Geda
- Alzheimer's Disease and Memory Disorders Program, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Framingham Heart Study, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elaine R Peskind
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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Hellewell SC, Welton T, Pearce AJ, Maller JJ, Grieve SM. Diffusion MRI as a complementary assessment to cognition, emotion, and motor dysfunction after sports-related concussion: a systematic review and critical appraisal of the literature. Brain Imaging Behav 2021; 15:1685-1704. [PMID: 32720180 DOI: 10.1007/s11682-020-00336-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sports-related concussion (SRC) is a complex and heterogeneous injury with psychological, cognitive and functional consequences. Advances in diffusion magnetic resonance imaging (dMRI) allow sensitive measurement of white matter pathology post-SRC and may provide insight into injury and recovery. We systematically reviewed and meta-analyzed the literature examining dMRI alongside cognitive, emotional or motor assessments to determine relationships between these analyses. Sixteen studies examining young athletes (n = 6) or retired professionals (n = 10) met the inclusion criteria, with 12 emotional, 10 cognitive and four motor assessments. Studies had heterogeneous methodology, moderate quality and modest sample sizes. Fractional anisotropy (FA) was the most frequent dMRI metric, with SRC-induced changes described most commonly in the frontal lobe and least in the cerebellum and brainstem. There is an emerging complementary role for dMRI as part of a comprehensive assessment battery for SRC. However, larger-scale studies with broader subject populations (specifically, in females and in the 30-45 year age range) are needed to corroborate findings and determine the true diagnostic utility of dMRI post-SRC.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Alan J Pearce
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jerome J Maller
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.,General Electric Healthcare, Richmond, VIC, 3181, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia. .,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2006, Australia.
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13
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Chen H, Kevala K, Aflaki E, Marugan J, Kim HY. GPR110 ligands reduce chronic optic tract gliosis and visual deficit following repetitive mild traumatic brain injury in mice. J Neuroinflammation 2021; 18:157. [PMID: 34273979 PMCID: PMC8286622 DOI: 10.1186/s12974-021-02195-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Repetitive mild traumatic brain injury (mTBI) can result in chronic visual dysfunction. G-protein receptor 110 (GPR110, ADGRF1) is the target receptor of N-docosahexaenoylethanolamine (synaptamide) mediating the anti-neuroinflammatory function of synaptamide. In this study, we evaluated the effect of an endogenous and a synthetic ligand of GPR110, synaptamide and (4Z,7Z,10Z,13Z,16Z,19Z)-N-(2-hydroxy-2-methylpropyl) docosa-4,7,10,13,16,19-hexaenamide (dimethylsynaptamide, A8), on the mTBI-induced long-term optic tract histopathology and visual dysfunction using Closed-Head Impact Model of Engineered Rotational Acceleration (CHIMERA), a clinically relevant model of mTBI. METHODS The brain injury in wild-type (WT) and GPR110 knockout (KO) mice was induced by CHIMERA applied daily for 3 days, and GPR110 ligands were intraperitoneally injected immediately following each impact. The expression of GPR110 and proinflammatory mediator tumor necrosis factor (TNF) in the brain was measured by using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) in an acute phase. Chronic inflammatory responses in the optic tract and visual dysfunction were assessed by immunostaining for Iba-1 and GFAP and visual evoked potential (VEP), respectively. The effect of GPR110 ligands in vitro was evaluated by the cyclic adenosine monophosphate (cAMP) production in primary microglia isolated from adult WT or KO mouse brains. RESULTS CHIMERA injury acutely upregulated the GPR110 and TNF gene level in mouse brain. Repetitive CHIMERA (rCHIMERA) increased the GFAP and Iba-1 immunostaining of glia cells and silver staining of degenerating axons in the optic tract with significant reduction of N1 amplitude of visual evoked potential at up to 3.5 months after injury. Both GPR110 ligands dose- and GPR110-dependently increased cAMP in cultured primary microglia with A8, a ligand with improved stability, being more effective than synaptamide. Intraperitoneal injection of A8 at 1 mg/kg or synaptamide at 5 mg/kg significantly reduced the acute expression of TNF mRNA in the brain and ameliorated chronic optic tract microgliosis, astrogliosis, and axonal degeneration as well as visual deficit caused by injury in WT but not in GPR110 KO mice. CONCLUSION Our data demonstrate that ligand-induced activation of the GPR110/cAMP system upregulated after injury ameliorates the long-term optic tract histopathology and visual impairment caused by rCHIMERA. Based on the anti-inflammatory nature of GPR110 activation, we suggest that GPR110 ligands may have therapeutic potential for chronic visual dysfunction associated with mTBI.
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Key Words
- A8 (4Z,7Z,10Z,13Z,16Z,19Z)-N-(2-hydroxy-2-methylpropyl) docosa-4,7,10,13,16,19-hexaenamide (dimethylsynaptamide)
- GPR110
- Histopathology
- Optic tract
- Synaptamide
- VEP
- Visual deficit
- mTBI
- repetitive CHIMERA
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Affiliation(s)
- Huazhen Chen
- Laboratory of Molecular Signaling, NIAAA, NIH, 5625 Fishers Lane, Rockville, MD, 20852, USA.,Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, 20817, USA
| | - Karl Kevala
- Laboratory of Molecular Signaling, NIAAA, NIH, 5625 Fishers Lane, Rockville, MD, 20852, USA
| | - Elma Aflaki
- Laboratory of Molecular Signaling, NIAAA, NIH, 5625 Fishers Lane, Rockville, MD, 20852, USA
| | - Juan Marugan
- Division of Pre-Clinical Innovation, NCATS, NIH, Rockville, MD, 20817, USA
| | - Hee-Yong Kim
- Laboratory of Molecular Signaling, NIAAA, NIH, 5625 Fishers Lane, Rockville, MD, 20852, USA. .,Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD, 20817, USA.
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14
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Tayebi M, Holdsworth SJ, Champagne AA, Cook DJ, Nielsen P, Lee TR, Wang A, Fernandez J, Shim V. The role of diffusion tensor imaging in characterizing injury patterns on athletes with concussion and subconcussive injury: a systematic review. Brain Inj 2021; 35:621-644. [PMID: 33843389 DOI: 10.1080/02699052.2021.1895313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem. The majority of TBIs are in the form of mild TBI (also known as concussion) with sports-related concussion (SRC) receiving public attention in recent years.Here we have performed a systematic review of the literature on the use of Diffusion Tensor Imaging (DTI) on sports-related concussion and subconcussive injuries. Our review found different patterns of change in DTI parameters between concussed and subconcussed groups. The Fractional Anisotropy (FA) was either unchanged or increased for the concussion group, while the subconcussed group generally experienced a decrease in FA. A reverse pattern was observed for Mean Diffusivity (MD) - where the concussed group experienced a decrease in MD while the subconcussed group showed an increase in MD. However, in general, discrepancies were observed in the results reported in the literature - likely due to the huge variations in DTI acquisition parameters, and image processing and analysis methods used in these studies. This calls for more comprehensive and well-controlled studies in this field, including those that combine the advanced brain imaging with biomechancial modeling and kinematic sensors - to shed light on the underlying mechanisms behind the structural changes observed from the imaging studies.
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Affiliation(s)
- Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Insitute, Gisborne, New Zealand
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Poul Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tae-Rin Lee
- Advanced Institute of Convergence Technology, Seoul National University, Seoul, Republic of Korea
| | - Alan Wang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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15
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Veksler R, Vazana U, Serlin Y, Prager O, Ofer J, Shemen N, Fisher AM, Minaeva O, Hua N, Saar-Ashkenazy R, Benou I, Riklin-Raviv T, Parker E, Mumby G, Kamintsky L, Beyea S, Bowen CV, Shelef I, O'Keeffe E, Campbell M, Kaufer D, Goldstein LE, Friedman A. Slow blood-to-brain transport underlies enduring barrier dysfunction in American football players. Brain 2021; 143:1826-1842. [PMID: 32464655 PMCID: PMC7297017 DOI: 10.1093/brain/awaa140] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
Repetitive mild traumatic brain injury in American football players has garnered increasing public attention following reports of chronic traumatic encephalopathy, a progressive tauopathy. While the mechanisms underlying repetitive mild traumatic brain injury-induced neurodegeneration are unknown and antemortem diagnostic tests are not available, neuropathology studies suggest a pathogenic role for microvascular injury, specifically blood–brain barrier dysfunction. Thus, our main objective was to demonstrate the effectiveness of a modified dynamic contrast-enhanced MRI approach we have developed to detect impairments in brain microvascular function. To this end, we scanned 42 adult male amateur American football players and a control group comprising 27 athletes practicing a non-contact sport and 26 non-athletes. MRI scans were also performed in 51 patients with brain pathologies involving the blood–brain barrier, namely malignant brain tumours, ischaemic stroke and haemorrhagic traumatic contusion. Based on data from prolonged scans, we generated maps that visualized the permeability value for each brain voxel. Our permeability maps revealed an increase in slow blood-to-brain transport in a subset of amateur American football players, but not in sex- and age-matched controls. The increase in permeability was region specific (white matter, midbrain peduncles, red nucleus, temporal cortex) and correlated with changes in white matter, which were confirmed by diffusion tensor imaging. Additionally, increased permeability persisted for months, as seen in players who were scanned both on- and off-season. Examination of patients with brain pathologies revealed that slow tracer accumulation characterizes areas surrounding the core of injury, which frequently shows fast blood-to-brain transport. Next, we verified our method in two rodent models: rats and mice subjected to repeated mild closed-head impact injury, and rats with vascular injury inflicted by photothrombosis. In both models, slow blood-to-brain transport was observed, which correlated with neuropathological changes. Lastly, computational simulations and direct imaging of the transport of Evans blue-albumin complex in brains of rats subjected to recurrent seizures or focal cerebrovascular injury suggest that increased cellular transport underlies the observed slow blood-to-brain transport. Taken together, our findings suggest dynamic contrast-enhanced-MRI can be used to diagnose specific microvascular pathology after traumatic brain injury and other brain pathologies.
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Affiliation(s)
- Ronel Veksler
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Udi Vazana
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yonatan Serlin
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Neurology Residency Training Program, McGill University, Montreal, QC, Canada
| | - Ofer Prager
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonathan Ofer
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nofar Shemen
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Andrew M Fisher
- Molecular Aging and Development Laboratory, Boston University School of Medicine, College of Engineering, Alzheimer's Disease and CTE Center, and Photonics Center, Boston University, Boston, MA, USA
| | - Olga Minaeva
- Molecular Aging and Development Laboratory, Boston University School of Medicine, College of Engineering, Alzheimer's Disease and CTE Center, and Photonics Center, Boston University, Boston, MA, USA
| | - Ning Hua
- Molecular Aging and Development Laboratory, Boston University School of Medicine, College of Engineering, Alzheimer's Disease and CTE Center, and Photonics Center, Boston University, Boston, MA, USA
| | - Rotem Saar-Ashkenazy
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Psychology and the School of Social-work, Ashkelon Academic College, Israel
| | - Itay Benou
- Department of Electrical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tammy Riklin-Raviv
- Department of Electrical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ellen Parker
- Department of Medical Neuroscience, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Griffin Mumby
- Department of Medical Neuroscience, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Steven Beyea
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre and QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Chris V Bowen
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre and QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ilan Shelef
- Department of Medical Imaging, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eoin O'Keeffe
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Matthew Campbell
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Daniela Kaufer
- Department of Integrative Biology and the Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Lee E Goldstein
- Molecular Aging and Development Laboratory, Boston University School of Medicine, College of Engineering, Alzheimer's Disease and CTE Center, and Photonics Center, Boston University, Boston, MA, USA
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Medical Neuroscience, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
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16
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Yao ZF, Sligte IG, Moreau D, Hsieh S, Yang CT, Ridderinkhof KR, Muggleton NG, Wang CH. The brains of elite soccer players are subject to experience-dependent alterations in white matter connectivity. Cortex 2020; 132:79-91. [PMID: 32956909 DOI: 10.1016/j.cortex.2020.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/26/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
Soccer is the only major sport with voluntary unprotected head-to-ball contact. It is crucial to determine if head impact through long-term soccer training is manifested in brain structure and connectivity, and whether such alterations are due to sustained training per se. Using diffusion tensor imaging, we documented a comprehensive view of soccer players' brains in a sample of twenty-five right-handed male elite soccer players aged from 18 to 22 years and twenty-five non-athletic controls aged 19-24 years. Importantly, none had recalled a history of concussion. We performed a whole-brain tract-based spatial statistical analysis, and a tract-specific probabilistic tractography method to measure the differences of white matter properties between groups. Whole-brain integrity analysis showed stronger microstructural integrity within the corpus callosum tract in soccer players compared to controls. Further, tract-specific probabilistic tractography revealed that the anterior part of corpus callosum may be the brain structure most relevant to training experience, which may put into perspective prior evidence showing corpus callosum alteration in retired or concussed athletes practicing contact sports. Intriguingly, experience-related alterations showed left hemispheric lateralization of potential early signs of concussion-like effects. In sum, we concluded that the observed gains and losses may be due to a consequence of engagement in protracted soccer training that incurs prognostic hallmarks associated with minor injury-induced neural inflammation.
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Affiliation(s)
- Zai-Fu Yao
- Brain and Cognition, Department of Psychology, University of Amsterdam, the Netherlands
| | - Ilja G Sligte
- Brain and Cognition, Department of Psychology, University of Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, the Netherlands
| | - David Moreau
- Centre for Brain Research, School of Psychology, The University of Auckland, New Zealand
| | - Shulan Hsieh
- Cognitive Electrophysiology Laboratory: Control, Aging, Sleep, and Emotion (CASE), Department of Psychology, National Cheng Kung University, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Taiwan; Department and Institute of Public Health, National Cheng Kung University, Taiwan; Department of Psychology, National Cheng Kung University, Taiwan
| | - Cheng-Ta Yang
- Institute of Allied Health Sciences, National Cheng Kung University, Taiwan; Department of Psychology, National Cheng Kung University, Taiwan
| | - K Richard Ridderinkhof
- Brain and Cognition, Department of Psychology, University of Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, the Netherlands
| | - Neil G Muggleton
- Institute of Cognitive Neuroscience, National Central University, Taoyuan City, Taiwan; Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Chun-Hao Wang
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Taiwan.
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17
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Fields L, Didehbani N, Hart J, Cullum CM. No Linear Association Between Number of Concussions or Years Played and Cognitive Outcomes in Retired NFL Players. Arch Clin Neuropsychol 2020; 35:233-239. [PMID: 30844072 DOI: 10.1093/arclin/acz008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/17/2018] [Accepted: 02/05/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of the current study is to examine whether concussion history and years played are linearly associated with cognitive outcomes in retired National Football League (NFL) players. METHOD Thirty-five retired NFL players over the age of 50 who had sustained at least one concussion completed a clinical interview and brief neuropsychological battery. Correlational analyses were conducted between exposure variables [number of total concussions, concussions with loss of consciousness (LOC), and years played] and cognitive performance as characterized by cognitive composite scores based on performance on neuropsychological measures (attention/processing speed, language, memory, and overall composite scores). RESULTS Correlational analyses corrected for multiple comparisons did not reveal any statistically significant correlations between exposure variables and cognitive outcomes. CONCLUSIONS We did not find a significant linear association between cognitive outcomes and either number of total concussions, concussions with LOC, or years played in the NFL. These findings do not support a dose-response relationship between sports-related exposure to head impacts and cognitive outcomes later in life. Rather, the findings suggest that cognitive difficulties experienced by some retired players later in life are not directly linearly associated with quantified exposure to head impacts sustained throughout a football career, but related to factors or combinations of factors that have yet to be elucidated.
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Affiliation(s)
- Lindy Fields
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,University of Texas at Dallas, Dallas, TX, USA
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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18
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Mild Cognitive Impairment in Retired Professional Football Players With a History of Mild Traumatic Brain Injury: A Pilot Investigation. Cogn Behav Neurol 2020; 33:208-217. [PMID: 32889953 DOI: 10.1097/wnn.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a known risk factor for neurodegenerative dementias such as Alzheimer disease (AD); however, the potential risk of mild cases of TBI, such as concussions, remains unclear. OBJECTIVE To explore whether a small sample of retired professional athletes with a diagnosis of mild cognitive impairment (MCI)-the prodromal stage of AD-and a history of multiple mild TBIs exhibit greater neuropsychological impairment than age-matched nonathletes with MCI and no history of TBI. METHOD Ten retired National Football League players diagnosed with MCI and reporting multiple mild TBIs, and 10 nonathletes, also diagnosed with MCI but with no history of TBI, completed a standard neurologic examination and neuropsychological testing. Independent samples t tests were conducted to examine differences in neuropsychological performance between the two groups. RESULTS The retired athletes with a history of mild TBI obtained generally similar scores to the nonathlete controls on measures of verbal learning and memory, verbal fluency, and processing speed. However, the retired athletes scored lower than the controls on tests of confrontation naming and speeded visual attention. CONCLUSION Retired athletes with MCI and a history of mild TBI demonstrated similar neuropsychological profiles as nonathlete controls despite lower scores on measures of confrontation naming and speeded visual attention. These findings suggest that a history of multiple mild TBIs does not significantly alter the overall neuropsychological profile of individuals with MCI; confirmation of this will require longitudinal research with larger sample sizes.
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19
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Phelps A, Mez J, Stern RA, Alosco ML. Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework. Semin Neurol 2020; 40:439-449. [PMID: 32674182 DOI: 10.1055/s-0040-1713633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.
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Affiliation(s)
- Alyssa Phelps
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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20
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Schaffert J, LoBue C, Fields L, Wilmoth K, Didehbani N, Hart J, Cullum CM. Neuropsychological functioning in ageing retired NFL players: a critical review. Int Rev Psychiatry 2020; 32:71-88. [PMID: 31592681 DOI: 10.1080/09540261.2019.1658572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent discovery of chronic traumatic encephalopathy in former National Football League (NFL) players has led to a surge of papers investigating cognitive functioning in these former athletes. This critical review of the literature focused on the neuropsychological functioning in these ageing athletes, and included 22 articles published between 2013 and 2019, of which 13 reported on neuroradiological imaging and four focused on dose-response relationships of repetitive head injury on cognitive outcomes. Four studies suggest higher prevalence of MCI and neurodegenerative disease among NFL retirees, although a quantifiable risk and prevalence of cognitive impairment and dementia in these players remains unknown. Decreased verbal memory has been found in some players across multiple studies, though with unknown clinical significance due to small sample sizes, unreported effect sizes, and absence of longitudinal data. Studies investigating a dose-response relationship between cognitive decline and head injury have generated mixed findings utilizing various measures of head injury exposure. Neuroradiological findings are inconsistent, but suggest that some NFL players may be at greater risk for reduced white matter integrity. Future research is needed to understand the relationship between sports-related concussions and the risk of long-term cognitive decline and neurodegenerative disease in ageing NFL players.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Departments of Psychiatry and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindy Fields
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristin Wilmoth
- Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Callier Center, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Departments of Neurology and Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology and Neurotherapeutics, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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A novel repetitive head impact exposure measurement tool differentiates player position in National Football League. Sci Rep 2020; 10:1200. [PMID: 31992719 PMCID: PMC6987098 DOI: 10.1038/s41598-019-54874-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/18/2019] [Indexed: 01/05/2023] Open
Abstract
American-style football participation poses a high risk of repetitive head impact (RHI) exposure leading to acute and chronic brain injury. The complex nature of symptom expression, human predisposition, and neurological consequences of RHI limits our understanding of what constitutes as an injurious impact affecting the integrity of brain tissue. Video footage of professional football games was reviewed and documentation made of all head contact. Frequency of impact, tissue strain magnitude, and time interval between impacts was used to quantify RHI exposure, specific to player field position. Differences in exposure characteristics were found between eight different positions; where three unique profiles can be observed. Exposure profiles provide interpretation of the relationship between the traumatic event(s) and how tissue injury is manifested and expressed. This study illustrates and captures an objective measurement of RHI on the field, a critical component in guiding public policy and guidelines for managing exposure.
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22
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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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23
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Plessow F, Pascual-Leone A, McCracken CM, Baker J, Krishnan S, Baggish A, Connor A, Courtney TK, Nadler LM, Speizer FE, Taylor HA, Weisskopf MG, Zafonte RD, Meehan WP. Self-Reported Cognitive Function and Mental Health Diagnoses among Former Professional American-Style Football Players. J Neurotrauma 2019; 37:1021-1028. [PMID: 31672091 PMCID: PMC7185350 DOI: 10.1089/neu.2019.6661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Clinical practice strongly relies on patients' self-report. Former professional American-style football players are hesitant to seek help for mental health problems, but may be more willing to report cognitive symptoms. We sought to assess the association between cognitive symptoms and diagnosed mental health problems and quality of life among a cohort of former professional players. In a cross-sectional design, we assessed self-reported cognitive function using items from the Quality of Life in Neurological Disorders (Neuro-QOL) Item Bank. We then compared mental health diagnoses and quality of life, assessed by items from the Patient-Reported Outcome Measurement Information System (PROMIS®), between former professional players reporting daily problems in cognitive function and former players not reporting daily cognitive problems. Of the 3758 former professional players included in the analysis, 40.0% reported daily problems due to cognitive dysfunction. Former players who reported daily cognitive problems were more likely to also report depression (18.0% vs. 3.3%, odds ratio [OR] = 6.42, 95% confidence interval [CI] [4.90–8.40]) and anxiety (19.1% vs. 4.3%, OR = 5.29, 95% CI [4.14–6.75]) than those without daily cognitive problems. Further, former players reporting daily cognitive problems were more likely to report memory loss and attention deficit(/hyperactivity) disorder and poorer general mental health, lower quality of life, less satisfaction with social activities and relationships, and more emotional problems. These findings highlight the potential of an assessment of cognitive symptoms for identifying former players with mental health, social, and emotional problems.
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Affiliation(s)
- Franziska Plessow
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Department of Neurology, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts.,Guttmann Brain Health Institut, Institut Guttmann, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Caitlin M McCracken
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,College of Pharmacy, Oregon State University/Oregon Health Science University, Portland, Oregon
| | - Jillian Baker
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Supriya Krishnan
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Aaron Baggish
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Connor
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lee M Nadler
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Frank E Speizer
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Herman A Taylor
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Cardiovascular Research Institute, Morehouse Medical School, Atlanta, Georgia
| | - Marc G Weisskopf
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ross D Zafonte
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William P Meehan
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics and Orthopedics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Satarasinghe P, Hamilton DK, Buchanan RJ, Koltz MT. Unifying Pathophysiological Explanations for Sports-Related Concussion and Concussion Protocol Management: Literature Review. J Exp Neurosci 2019; 13:1179069518824125. [PMID: 30675103 PMCID: PMC6330734 DOI: 10.1177/1179069518824125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022] Open
Abstract
Objective There is a plethora of theories about the pathophysiology behind a sport-related concussion. In this review of the literature, the authors evaluated studies on the pathophysiology of sport-related concussion and professional athlete return-to-play guidelines. The goal of this article is to summarize the most common hypotheses for sport-related concussion, evaluate if there are common underlying mechanisms, and determine if correlations are seen between published mechanisms and the most current return-to-play recommendations. Methods Two authors selected papers from the past 5 years for literature review involving discussion of sport-related concussion and pathophysiology, pathology, or physiology of concussion using mutually agreed-upon search criteria. After the articles were filtered based on search criteria, pathophysiological explanations for concussion were organized into tables. Following analysis of pathophysiology, concussion protocols and return-to-play guidelines were obtained via a Google search for the major professional sports leagues and synthesized into a summary table. Results Out of 1112 initially identified publications, 53 met our criteria for qualitative analysis. The 53 studies revealed 5 primary neuropathological explanations for sport-related concussion, regardless of the many theories talked about in the different papers. These 5 explanations, in order of predominance in the articles analyzed, were (1) tauopathy, (2) white matter changes, (3) neural connectivity alterations, (4) reduction in cerebral perfusion, and (5) gray matter atrophy. Pathology may be sport specific: white matter changes are seen in 47% of football reports, tauopathy is seen in 50% of hockey reports, and soccer reports 50% tauopathy as well as 50% neural connectivity alterations. Analysis of the return-to-play guidelines across professional sports indicated commonalities in concussion management despite individual policies. Conclusions Current evidence on pathophysiology for sport-related concussion does not yet support one unifying mechanism, but published hypotheses may potentially be simplified into 5 primary groups. The unification of the complex, likely multifactorial mechanisms for sport-related concussion to a few common explanations, combined with unique findings within individual sports presented in this report, may help filter and link concussion pathophysiology in sport. By doing so, the authors hope that this review will help guide future concussion research, treatment, and management.
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Affiliation(s)
- Praveen Satarasinghe
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert J Buchanan
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA
| | - Michael T Koltz
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA
- Michael T Koltz, Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA.
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25
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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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26
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Myer GD, Barber Foss K, Thomas S, Galloway R, DiCesare CA, Dudley J, Gadd B, Leach J, Smith D, Gubanich P, Meehan Iii WP, Altaye M, Lavin P, Yuan W. Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes. Br J Sports Med 2018; 53:1539-1551. [PMID: 30323056 DOI: 10.1136/bjsports-2018-099571] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To (1) quantify white matter (WM) alterations in female high school athletes during a soccer season and characterise the potential for normalisation during the off-season rest period, (2) determine the association between WM alterations and exposure to repetitive subconcussive head impacts, and (3) evaluate the efficacy of a jugular vein compression collar to prevent WM alterations associated with head impact exposure. METHODS Diffusion tensor imaging (DTI) data were prospectively collected from high school female soccer participants (14-18 years) at up to three time points over 9 months. Head impacts were monitored using accelerometers during all practices and games. Participants were assigned to a collar (n=24) or non-collar group (n=22). The Tract-Based Spatial Statistics approach was used in the analysis of within-group longitudinal change and between-group comparisons. RESULTS DTI analyses revealed significant pre-season to post-season WM changes in the non-collar group in mean diffusivity (2.83%±2.46%), axial diffusivity (2.58%±2.34%) and radial diffusivity (3.52%±2.60%), but there was no significant change in the collar group despite similar head impact exposure. Significant correlation was found between head impact exposure and pre-season to post-season DTI changes in the non-collar group. WM changes in the non-collar group partially resolved at 3 months off-season follow-up. DISCUSSION Microstructural changes in WM occurred during a season of female high school soccer among athletes who did not wear the collar device. In comparison, there were no changes in players who wore the collar, suggesting a potential prophylactic effect of the collar device in preventing changes associated with repetitive head impacts. In those without collar use, the microstructural changes showed a reversal towards normal over time in the off-season follow-up period.
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Affiliation(s)
- Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Kim Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Staci Thomas
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan Galloway
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brooke Gadd
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David Smith
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul Gubanich
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip Lavin
- Boston Biostatistics Research Foundation, Framingham, Massachusetts, USA
| | - Weihong Yuan
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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27
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Strain JF, Smith RX, Beaumont H, Roe CM, Gordon BA, Mishra S, Adeyemo B, Christensen JJ, Su Y, Morris JC, Benzinger TLS, Ances BM. Loss of white matter integrity reflects tau accumulation in Alzheimer disease defined regions. Neurology 2018; 91:e313-e318. [PMID: 29959265 DOI: 10.1212/wnl.0000000000005864] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/18/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE White matter (WM) projections were assessed from Alzheimer disease (AD) gray matter regions associated with β-amyloid (Aβ), tau, or neurodegeneration to ascertain relationship between WM structural integrity with Aβ and/or tau deposition. METHODS Participants underwent diffusion tensor imaging (DTI), PET Aβ ([18F]AV-45 [florbetapir]), and PET tau ([18F]AV-1451 [flortaucipir]) imaging. Probabilistic WM summary and individual tracts were created from either a composite or individual gray matter seed regions derived from Aβ, tau, and neurodegeneration. Linear regressions were performed for Aβ, age, tau and WM hyperintensities (WMH) to predict mean diffusivity (MD) or fractional anisotropy (FA) from the corresponding WM summaries or tracts. RESULTS Our cohort was composed of 59 cognitively normal participants and 10 cognitively impaired individuals. Aβ was not associated with DTI metrics in WM summary or individual tracts. Age and WMH strongly predicted MD and FA in several WM regions, with tau a significant predictor of MD only in the anterior temporal WM. CONCLUSION Tau, not Aβ, was associated with changes in anterior temporal WM integrity. WMH, a proxy for vascular damage, was strongly associated with axonal damage, but tau independently contributed to the model, suggesting an additional degenerative mechanism within tracts projecting from regions vulnerable to AD pathology. WM decline was associated with early tau accumulation, and further decline may reflect tau propagation in more advanced stages of AD.
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Affiliation(s)
- Jeremy F Strain
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Robert X Smith
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Helen Beaumont
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Catherine M Roe
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Brian A Gordon
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Shruti Mishra
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Babatunde Adeyemo
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Jon J Christensen
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Yi Su
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - John C Morris
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Tammie L S Benzinger
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO
| | - Beau M Ances
- From the Department of Neurology (J.F.S., R.X.S., H.B., C.M.R., S.M., B.A., J.C.M., B.M.A.), Department of Radiology (B.A.G., J.J.C., Y.S., T.L.S.B., B.M.A.), Knight Alzheimer's Disease Research Center (B.A.G., J.C.M., T.L.S.B., B.M.A.), Department of Pathology (J.C.M.), and Hope Center for Neurological Disorders (J.C.M., B.M.A.), Washington University in St. Louis, MO.
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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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Mouzon BC, Bachmeier C, Ojo JO, Acker CM, Ferguson S, Paris D, Ait-Ghezala G, Crynen G, Davies P, Mullan M, Stewart W, Crawford F. Lifelong behavioral and neuropathological consequences of repetitive mild traumatic brain injury. Ann Clin Transl Neurol 2017; 5:64-80. [PMID: 29376093 PMCID: PMC5771321 DOI: 10.1002/acn3.510] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022] Open
Abstract
Objective Exposure to repetitive concussion, or mild traumatic brain injury (mTBI), has been linked with increased risk of long‐term neurodegenerative changes, specifically chronic traumatic encephalopathy (CTE). To date, preclinical studies largely have focused on the immediate aftermath of mTBI, with no literature on the lifelong consequences of mTBI in these models. This study provides the first account of lifelong neurobehavioral and histological consequences of repetitive mTBI providing unique insight into the constellation of evolving and ongoing pathologies with late survival. Methods Male C57BL/6J mice (aged 2–3 months) were exposed to either single or repetitive mild TBI or sham procedure. Thereafter, animals were monitored and assessed at 24 months post last injury for measures of motor coordination, learning deficits, cognitive function, and anxiety‐like behavior prior to euthanasia and preparation of the brains for detailed neuropathological and protein biochemical studies. Results At 24 months survival animals exposed to r‐mTBI showed clear evidence of learning and working memory impairment with a lack of spatial memory and vestibule‐motor vestibulomotor deficits compared to sham animals. Associated with these late behavioral deficits there was evidence of ongoing axonal degeneration and neuroinflammation in subcortical white matter tracts. Notably, these changes were also observed after a single mTBI, albeit to a lesser degree than repetitive mTBI. Interpretation In this context, our current data demonstrate, for the first time, that rather than an acute, time limited event, mild TBI can precipitate a lifelong degenerative process. These data therefore suggest that successful treatment strategies should consider both the acute and chronic nature of mTBI.
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Affiliation(s)
- Benoit C Mouzon
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
| | - Corbin Bachmeier
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
| | - Joseph O Ojo
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida
| | | | - Scott Ferguson
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida
| | - Daniel Paris
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
| | - Ghania Ait-Ghezala
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
| | - Gogce Crynen
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
| | - Peter Davies
- Feinstein Institute for Medical Research Manhasset New York
| | | | - William Stewart
- Queen Elizabeth Glasgow University Hospital Glasgow United Kingdom.,University of Glasgow Glasgow United Kingdom
| | - Fiona Crawford
- Roskamp Institute Sarasota Florida.,James A. Haley Veterans' Hospital Tampa Florida.,The Open University Milton Keynes United Kingdom
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30
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Concussions in NCAA Varsity Football Athletes: A Qualitative Investigation of Player Perception and Return to Sport. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2017; 1:e070. [PMID: 30211371 PMCID: PMC6132341 DOI: 10.5435/jaaosglobal-d-17-00070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/24/2016] [Indexed: 01/01/2023]
Abstract
Background The objective of this study was to understand the experiences and perspectives of varsity football athletes on return to play following a concussion injury. Methods Two experienced interviewers conducted qualitative, semistructured interviews of college-level football players who had sustained at least one concussion during their varsity careers. Results Twenty varsity football players who averaged 2.3 concussions each (range, 1-5) were interviewed regarding peer pressure, the culture of football, and player awareness as factors affecting return to sport following a concussion. Less common secondary factors included risk management, severity and timing of the injury, and team support. Conclusions Psychological stressors, the culture of football, and increased awareness were the most influential factors affecting collegiate football players' deciding to return to sport following a concussion. Level of Evidence Level III.
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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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32
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Alosco ML, Tripodis Y, Jarnagin J, Baugh CM, Martin B, Chaisson CE, Estochen N, Song L, Cantu RC, Jeromin A, Stern RA. Repetitive head impact exposure and later-life plasma total tau in former National Football League players. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 7:33-40. [PMID: 28229128 PMCID: PMC5312499 DOI: 10.1016/j.dadm.2016.11.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction Blood protein analysis of total tau (t-tau) may be a practical screening biomarker for chronic traumatic encephalopathy (CTE), a neurodegenerative tauopathy associated with repetitive head impact (RHI) exposure. We examined plasma t-tau in symptomatic former National Football League (NFL) players compared with controls and the relationship between RHI exposure and later-life plasma t-tau. Methods Ninety-six former NFL players (age 40–69) and 25 same-age controls underwent blood draw to determine plasma t-tau levels. The cumulative head impact index (CHII) quantified RHI exposure. Subjects completed measures of clinical function. Results A higher CHII predicted greater plasma t-tau in the former NFL players (P = .0137). No group differences in plasma t-tau emerged, but a concentration ≥3.56 pg/mL was 100% specific to former NFL players. Plasma t-tau did not predict clinical function. Discussion Greater RHI exposure predicted higher later-life plasma t-tau concentrations, and further study on plasma t-tau as a candidate screening biomarker for CTE is warranted.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Johnny Jarnagin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Baugh
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Interfaculty Initiative in Health Policy, Harvard University Boston, MA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | | | - Linan Song
- Quanterix Corporation, Lexington, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | | | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
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