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Esagoff AI, Gifford MK, Narapareddy BR, Sair HI, Luna LP, Raj D, Shan G, Peters M, Bernick C. Prior football or rugby exposure and white matter signal abnormalities in professional male mixed martial arts fighters. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 39022864 DOI: 10.1080/00913847.2024.2382085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND White matter signal abnormalities have been associated with traumatic brain injury (TBI) and repetitive head impacts (RHI) in contact sports (e.g. American football, rugby). However, previous studies of mixed martial arts (MMA) fighters from the Professional Fighters Brain Health Study have not found greater white matter signal abnormalities in fighters versus controls. OBJECTIVE This study aims to explore the varying white matter effects of football/rugby and MMA by analyzing how football/rugby history in mixed martial arts fighters may relate to white matter signal abnormalities, helping to further our understanding of sport-specific brain health risks. METHODS Baseline visits for 90 active, professional, male mixed martial arts fighters and 27 unexposed male controls were cross-sectionally analyzed. Wilcoxon and Kruskal-Wallis tests compared demographics and white matter signal abnormalities, and multivariable regression models examined the associations between football/rugby history and white matter signal abnormality burden in fighters, adjusting for age, education, race, fights, MRI scanner, and supratentorial volume. RESULTS 37/90 fighters had football/rugby history (mean: 4 years; range: 1-12 years). White matter signal abnormalities were significantly greater in fighters with football/rugby history compared to fighters without football/rugby history (Wilcoxon, p = 0.0190). Football/rugby history was significantly associated with white matter signal abnormality burden >75th percentile (OR: 12, CI: 3.3-61, p < 0.001) and >50th percentile (OR: 3.2, CI: 1.2-9.4, p = 0.024) in fighters. Years of football/rugby were also significantly associated with white matter signal abnormalities. CONCLUSION Our findings expand on previous literature by demonstrating a significant relationship between white matter signal abnormalities (WMSAs) and football/rugby history but not MMA. Furthermore, our study suggests an added risk for WMSAs in MMA fighters with a history of football/rugby. Future research should further evaluate WMSAs in contact sports, helping to inform athletes, regulatory bodies, and healthcare providers of the potential brain health risks of contact sports.
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Affiliation(s)
- Aaron I Esagoff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mia K Gifford
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Haris I Sair
- Department of Radiology and Radiological Science - Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Licia P Luna
- Department of Radiology and Radiological Science - Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divyaansh Raj
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guogen Shan
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew Peters
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Huang W, Ma L, Yan J, Hu W, Liu G, Wang R, Zhang J. Neurite orientation dispersion and density imaging reveals abnormal white matter and glymphatic function in active young boxers. Eur J Sport Sci 2024; 24:975-986. [PMID: 38956796 PMCID: PMC11235717 DOI: 10.1002/ejsc.12113] [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: 11/02/2023] [Revised: 02/23/2024] [Accepted: 04/08/2024] [Indexed: 07/04/2024]
Abstract
The neurological effects and underlying pathophysiological mechanisms of sports-related concussion (SRC) in active young boxers remain poorly understood. This study aims to investigate the impairment of white matter microstructure and assess changes in glymphatic function following SRC by utilizing neurite orientation dispersion and density imaging (NODDI) on young boxers who have sustained SRC. A total of 60 young participants were recruited, including 30 boxers diagnosed with SRC and 30 healthy individuals engaging in regular exercise. The assessment of whole-brain white matter damage was conducted using diffusion metrics, while the evaluation of glymphatic function was performed through diffusion tensor imaging (DTI) analysis along the perivascular space (DTI-ALPS) index. A two-sample t-test was utilized to examine group differences in DTI and NODDI metrics. Spearman correlation and generalized linear mixed models were employed to investigate the relationship between clinical assessments of SRC and NODDI measurements. Significant alterations were observed in DTI and NODDI metrics among young boxers with SRC. Additionally, the DTI-ALPS index in the SRC group exhibited a significantly higher value than that of the control group (left side: 1.58 vs. 1.48, PFDR = 0.009; right side: 1.61 vs. 1.51, PFDR = 0.02). Moreover, it was observed that the DTI-ALPS index correlated with poorer cognitive test results among boxers in this study population. Repetitive SRC in active young boxers is associated with diffuse white matter injury and glymphatic dysfunction, highlighting the detrimental impact on brain health. These findings highlight the importance of long-term monitoring of the neurological health of boxers.
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Affiliation(s)
- Wenjing Huang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Laiyang Ma
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Jiahao Yan
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Wanjun Hu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
| | - Guangyao Liu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| | - Rui Wang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
| | - Jing Zhang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
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3
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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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Goeckner BD, Brett BL, Mayer AR, España LY, Banerjee A, Muftuler LT, Meier TB. Associations of prior concussion severity with brain microstructure using mean apparent propagator magnetic resonance imaging. Hum Brain Mapp 2024; 45:e26556. [PMID: 38158641 PMCID: PMC10789198 DOI: 10.1002/hbm.26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/16/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Magnetic resonance imaging (MRI) diffusion studies have shown chronic microstructural tissue abnormalities in athletes with history of concussion, but with inconsistent findings. Concussions with post-traumatic amnesia (PTA) and/or loss of consciousness (LOC) have been connected to greater physiological injury. The novel mean apparent propagator (MAP) MRI is expected to be more sensitive to such tissue injury than the conventional diffusion tensor imaging. This study examined effects of prior concussion severity on microstructure with MAP-MRI. Collegiate-aged athletes (N = 111, 38 females; ≥6 months since most recent concussion, if present) completed semistructured interviews to determine the presence of prior concussion and associated injury characteristics, including PTA and LOC. MAP-MRI metrics (mean non-Gaussian diffusion [NG Mean], return-to-origin probability [RTOP], and mean square displacement [MSD]) were calculated from multi-shell diffusion data, then evaluated for associations with concussion severity through group comparisons in a primary model (athletes with/without prior concussion) and two secondary models (athletes with/without prior concussion with PTA and/or LOC, and athletes with/without prior concussion with LOC only). Bayesian multilevel modeling estimated models in regions of interest (ROI) in white matter and subcortical gray matter, separately. In gray matter, the primary model showed decreased NG Mean and RTOP in the bilateral pallidum and decreased NG Mean in the left putamen with prior concussion. In white matter, lower NG Mean with prior concussion was present in all ROI across all models and was further decreased with LOC. However, only prior concussion with LOC was associated with decreased RTOP and increased MSD across ROI. Exploratory analyses conducted separately in male and female athletes indicate associations in the primary model may differ by sex. Results suggest microstructural measures in gray matter are associated with a general history of concussion, while a severity-dependent association of prior concussion may exist in white matter.
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Affiliation(s)
- Bryna D. Goeckner
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Benjamin L. Brett
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of NeurologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research InstituteAlbuquerqueNew MexicoUSA
- Departments of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Lezlie Y. España
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Anjishnu Banerjee
- Department of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - L. Tugan Muftuler
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Timothy B. Meier
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of Biomedical EngineeringMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of Cell Biology, Neurobiology and AnatomyMedical College of WisconsinMilwaukeeWisconsinUSA
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Morgan AT, Scerri TS, Vogel AP, Reid CA, Quach M, Jackson VE, McKenzie C, Burrows EL, Bennett MF, Turner SJ, Reilly S, Horton SE, Block S, Kefalianos E, Frigerio-Domingues C, Sainz E, Rigbye KA, Featherby TJ, Richards KL, Kueh A, Herold MJ, Corbett MA, Gecz J, Helbig I, Thompson-Lake DGY, Liégeois FJ, Morell RJ, Hung A, Drayna D, Scheffer IE, Wright DK, Bahlo M, Hildebrand MS. Stuttering associated with a pathogenic variant in the chaperone protein cyclophilin 40. Brain 2023; 146:5086-5097. [PMID: 37977818 PMCID: PMC10689913 DOI: 10.1093/brain/awad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 11/19/2023] Open
Abstract
Stuttering is a common speech disorder that interrupts speech fluency and tends to cluster in families. Typically, stuttering is characterized by speech sounds, words or syllables which may be repeated or prolonged and speech that may be further interrupted by hesitations or 'blocks'. Rare variants in a small number of genes encoding lysosomal pathway proteins have been linked to stuttering. We studied a large four-generation family in which persistent stuttering was inherited in an autosomal dominant manner with disruption of the cortico-basal-ganglia-thalamo-cortical network found on imaging. Exome sequencing of three affected family members revealed the PPID c.808C>T (p.Pro270Ser) variant that segregated with stuttering in the family. We generated a Ppid p.Pro270Ser knock-in mouse model and performed ex vivo imaging to assess for brain changes. Diffusion-weighted MRI in the mouse revealed significant microstructural changes in the left corticospinal tract, as previously implicated in stuttering. Quantitative susceptibility mapping also detected changes in cortico-striatal-thalamo-cortical loop tissue composition, consistent with findings in affected family members. This is the first report to implicate a chaperone protein in the pathogenesis of stuttering. The humanized Ppid murine model recapitulates network findings observed in affected family members.
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Affiliation(s)
- Angela T Morgan
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Thomas S Scerri
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Adam P Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville 3053, Australia
- Clinical Trials, Redenlab Inc., Melbourne 3000, Australia
| | - Christopher A Reid
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Mara Quach
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Victoria E Jackson
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Chaseley McKenzie
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Emma L Burrows
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Mark F Bennett
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | | | - Sheena Reilly
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Menzies Health Institute Queensland, Griffith University, 4215 Southport, Australia
| | - Sarah E Horton
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Susan Block
- Discipline of Speech Pathology, School of Allied Health, La Trobe University, Bundoora 3086, Australia
| | - Elaina Kefalianos
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Carlos Frigerio-Domingues
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Eduardo Sainz
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Kristin A Rigbye
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Travis J Featherby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Kay L Richards
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Andrew Kueh
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Marco J Herold
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Mark A Corbett
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Ingo Helbig
- Department of Neurology, Children’s Hospital, Philadelphia, PA 19104, USA
| | - Daisy G Y Thompson-Lake
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frédérique J Liégeois
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert J Morell
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
- Genomics and Computational Biology Core, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Hung
- School of Science, STEM College, RMIT University, Melbourne 3001, Australia
| | - Dennis Drayna
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Ingrid E Scheffer
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Melanie Bahlo
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- School of Mathematics and Statistics, University of Melbourne, 3010 Parkville, Australia
| | - Michael S Hildebrand
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
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Le Roux J, Anema F, Janse van Rensburg DC, Kerkhoffs G, Gouttebarge V. Health conditions among retired elite rugby players: a scoping review. BMJ Open Sport Exerc Med 2023; 9:e001573. [PMID: 37547127 PMCID: PMC10401243 DOI: 10.1136/bmjsem-2023-001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
The aim of this scoping review was to present an overview of the existing epidemiological evidence in retired male and female elite rugby players regarding the prevalence rates of musculoskeletal, cardiovascular, neurocognitive, psychological and gynaecological health conditions. A systematic search was carried out across MEDLINE (via PubMed), SPORTDiscus (via EBSCOhost), PsycINFO (via EBSCOhost) and EMBASE for musculoskeletal (eg, osteoarthritis), cardiovascular (eg, hypertension), neurocognitive (eg, dementia) and psychological health (eg, disordered eating, alcohol misuse) conditions in retired elite male and female rugby players and gynaecological health conditions (menorrhagia) in retired female rugby players. Primary research studies describing the prevalence rates of health conditions in retired elite male and female rugby players written in English, Dutch or French and with full text available online were included. Five hundred and seventy-three citations were originally identified and 16 studies were ultimately included in our review. No studies on health conditions in retired elite female rugby players were found. Four individual studies showed there was a significant higher prevalence rate of osteoarthritis in retired elite male rugby players compared with control groups. Various neurocognitive health conditions were investigated and showed, among others, a prevalence rate of 57% for mild cognitive disorder. The prevalence of self-reported depression and hazardous alcohol use in retired elite male rugby players was significantly higher than in control groups matched for age and education. Our review found relatively high prevalence rates of musculoskeletal health conditions such as osteoarthritis and psychological health conditions such as depression and hazardous alcohol use in retired elite male rugby players. More research needs to be conducted to understand better the health conditions of retired elite rugby players, especially among retired elite female players.
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Affiliation(s)
- Johan Le Roux
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
| | - Flo Anema
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
| | | | - Gino Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, Amsterdam, Netherlands
| | - Vincent Gouttebarge
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center of Excellence, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Ageing & Vitality, Amsterdam, Netherlands
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Sub-acute Changes on MRI Measures of Cerebral Blood Flow and Venous Oxygen Saturation in Concussed Australian Rules Footballers. SPORTS MEDICINE - OPEN 2022; 8:45. [PMID: 35362855 PMCID: PMC8975948 DOI: 10.1186/s40798-022-00435-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022]
Abstract
Background Sports-related concussion (SRC) is common in collision sport athletes. There is growing evidence that repetitive SRC can have serious neurological consequences, particularly when the repetitive injuries occur when the brain has yet to fully recover from the initial injury. Hence, there is a need to identify biomarkers that are capable of determining SRC recovery so that they can guide clinical decisions pertaining to return-to-play. Cerebral venous oxygen saturation (SvO2) and cerebral blood flow (CBF) can be measured using magnetic resonance imaging (MRI) and may provide insights into changing energy demands and recovery following SRC. Results In this study we therefore investigated SvO2 and CBF in a cohort of concussed amateur Australian Football athletes (i.e., Australia’s most participated collision sport). Male and female Australian footballers (n = 13) underwent MRI after being cleared to return to play following a mandatory 13-day recovery period and were compared to a group of control Australian footballers (n = 16) with no recent history of SRC (i.e., > 3 months since last SRC). Despite the concussed Australian footballers being cleared to return to play at the time of MRI, we found evidence of significantly increased susceptibility in the global white matter (p = 0.020) and a trend (F5,21 = 2.404, p = 0.071) for reduced relative CBF (relCBF) compared to the control group. Further, there was evidence of an interaction between sex and injury in straight sinus susceptibility values (F1,25 = 3.858, p = 0.061) which were decreased in female SRC athletes (p = 0.053). Of note, there were significant negative correlations between straight sinus susceptibility and relCBF suggesting impaired metabolic function after SRC. Conclusions These findings support the use of quantitative susceptibility mapping (QSM) and relCBF as sensitive indicators of SRC, and raise further concerns related to SRC guidelines that allow for return-to-play in less than two weeks.
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Zamani A, Walker AK, Rollo B, Ayers KL, Farah R, O'Brien TJ, Wright DK. Early and progressive dysfunction revealed by in vivo neurite imaging in the rNLS8 TDP-43 mouse model of ALS. Neuroimage Clin 2022; 34:103016. [PMID: 35483133 PMCID: PMC9125783 DOI: 10.1016/j.nicl.2022.103016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Are neurite density and dispersion altered in amyotropic lateral sclerosis (ALS)? Both measures are affected in the rNLS8 TDP-43 mouse model of ALS. Diffusion tensor imaging metrics were also affected. Group-wise changes were observed early in the disease course. Together these diffusion imaging metrics may aid in the timelier diagnosis of ALS.
Amyotrophic lateral sclerosis (ALS) is characterized by transactive response DNA-binding protein 43 (TDP-43) pathology, progressive loss of motor neurons and muscle dysfunction. Symptom onset can be insidious and diagnosis challenging. Conventional neuroimaging is used to exclude ALS mimics, however more advanced neuroimaging techniques may facilitate an earlier diagnosis. Here, we investigate the potential for neurite orientation dispersion and density imaging and diffusion tensor imaging (DTI) to detect microstructural changes in an experimental model of ALS with neuronal doxycycline (Dox)-suppressible overexpression of human TDP-43 (hTDP-43). In vivo diffusion-weighted imaging (DWI) was acquired 1- and 3- weeks following the initiation of hTDP-43 expression (post-Dox) to investigate whether neurite density imaging (NDI) and orientation dispersion imaging (ODI) are affected early in this preclinical model of ALS and if so, how these metrics compare to those derived from the diffusion tensor. Tract-based spatial statistics at 1-week post-Dox, i.e. very early in the disease stage, demonstrated increased NDI in TDP-43 mice but no change in ODI or DTI metrics. At 3-weeks post-Dox, a reduced pattern of increased NDI was observed along with widespread increases in ODI, and decreased fractional anisotropy (FA), apparent diffusion coefficient (ADC) and axial diffusivity (AD). A hypothesis driven analysis of the bilateral corticospinal tracts demonstrated that at 1-week post-Dox, ODI was significantly increased caudally but decreased in the motor cortex of TDP-43 mice. Decreased cortical ODI had normalized by 3-weeks post-Dox and only significant increases were observed. A similar, but inverse pattern in FA was also observed. Together, these results suggest a non-monotonic relationship between DWI metrics and pathophysiological progression with TDP-43 mice exhibiting significantly altered diffusion metrics consistent with early inflammation followed by progressive axonal degeneration. Importantly, significant group-wise changes were observed in the earliest stages of disease when subtle pathology may be more elusive to traditional structural imaging techniques.
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Affiliation(s)
- Akram Zamani
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Adam K Walker
- Queensland Brain Institute, The University of Queensland, QLD 4072, Australia
| | - Ben Rollo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Katie L Ayers
- The Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Pediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Raysha Farah
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3052, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
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9
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Functional, but Minimal Microstructural Brain Changes Present in Aging Canadian Football League Players Years After Retirement. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Stanwell P, Iverson GL, Van Patten R, Castellani RJ, McCrory P, Gardner AJ. Examining for Cavum Septum Pellucidum and Ventricular Enlargement in Retired Elite-Level Rugby League Players. Front Neurol 2022; 13:817709. [PMID: 35493804 PMCID: PMC9044485 DOI: 10.3389/fneur.2022.817709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveA cavum septum pellucidum (CSP) has been reported as a visible brain anomaly in normal individuals as well in some former combat and collision sport athletes. The appearance of CSP with fenestrations and ventricular enlargement are considered associated features of the neuropathological diagnosis of chronic traumatic encephalopathy. The current study examined CSP anatomic features and lateral ventricle size in retired elite rugby league players and controls.MethodsForty-one retired rugby league players and 41 healthy community controls, similar in age and education, underwent structural MRI scans. CSP grade, CSP length, corpus callosum septal length, and Evans' ratio (for lateral ventricle size) were rated by two of the current study authors. All participants also self-reported concussion exposure histories, depressive symptoms, daytime sleepiness, and impulsivity. They completed a neuropsychological test battery assessing premorbid intellectual functioning, attention, processing speed, language, visuospatial skills, memory, and aspects of executive functioning.ResultsThe two raters had high agreement for CSP grade (Cohen's κ = 0.80), CSP length [intraclass correlation (ICC) = 0.99], corpus callosum septal length (ICC = 0.73), the CSP/septal ratio (ICC = 0.99), and the Evans' ratio (ICC = 0.75). Twenty-five retired players (61.0%) had an abnormal CSP compared to 17 controls [41.5%; χ(1, 82)2 = 3.12, p = 0.08, odds ratio = 2.21]. The CSP/septal ratio was larger for retired players than for the controls. The Evans' ratio did not differ between the two groups. In the retired rugby league players (n = 41), those with normal (n = 16) and abnormal (n = 25) CSP grades did not differ across age, age of first exposure to collision sport, years of sport exposure, concussion history, or 23 clinical and cognitive variables.ConclusionThis study revealed a difference in the size of the CSP between retired professional rugby league players and controls. There was no significant difference in the size of the ventricles between the two groups. There were no significant differences between those with vs. without an abnormal CSP on age of first exposure to rugby league, years of exposure to repetitive neurotrauma, number of lifetime concussions, depression, impulsivity, perceived cognitive decline, or on any neuropsychological test.
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Affiliation(s)
- Peter Stanwell
- Priority Research Centre for Stroke and Brain Injury, School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- *Correspondence: Peter Stanwell
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Providence Veterans Administration Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Andrew J. Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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11
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Zhang L, Levenson CW, Salazar VC, Biederman J, Zafonte R, Bhide PG. Repetitive Mild Traumatic Brain Injury in an Awake, Unanesthetized Mouse Model of Perinatal Nicotine Exposure Produces Transient Novelty-Seeking and Depression-Like Behaviors. J Neurotrauma 2022; 39:954-963. [PMID: 34913733 DOI: 10.1089/neu.2021.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) can be a risk factor for repetitive mild traumatic brain injury (mTBI) or concussions such as those that can occur in contact sports. Individuals with ADHD also appear to have a higher risk of poor neurocognitive outcomes after repetitive mTBI. Findings from clinical studies examining the interactions between ADHD and repetitive mTBI vary, likely because of variabilities in experimental design and outcome measures. We used a mouse model of perinatal nicotine exposure (PNE), which displays behavioral, neuroanatomical, and neurotransmitter features consistent with ADHD and subjected the mice to repetitive mTBI. We used a closed head model of mTBI in awake, unanesthetized mice to mimic concussions in humans. The mTBI was repeated three times daily for seven days. The mice in the PNE-mTBI group took longer to regain consciousness after the mTBI and showed transient novelty-seeking and depression-like behaviors. Before the repetitive mTBI, the mice in the PNE group showed attention deficit, which persisted after the mTBI. The mice in the control (non-PNE) group showed a transient attention deficit after the repetitive mTBI but not any of the other behavioral changes seen in the PNE-mTBI group. These findings from an unanesthetized mouse model with a pre-existing condition show that ADHD and repetitive mTBI together contribute to transient novelty-seeking and depression-like behavior supporting the notion that untreated ADHD may be a risk factor for poor neurocognitive outcomes after concussions.
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Affiliation(s)
- Lin Zhang
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Cathy W Levenson
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Valentina Cea Salazar
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Joseph Biederman
- Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Pradeep G Bhide
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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12
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Kim MS, Cho MJ, Kim JW, Jang SH. White Matter Abnormalities in Traumatic Subarachnoid Hemorrhage: A Tract-Based Spatial Statistics Study. Med Sci Monit 2021; 27:e933959. [PMID: 34657118 PMCID: PMC8529937 DOI: 10.12659/msm.933959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The pathophysiology of traumatic subarachnoid hemorrhage and brain injury has not been fully elucidated. In this study, we examined abnormalities of white matter in isolated traumatic subarachnoid hemorrhage patients by applying tract-based spatial statistics. Material/Methods For this study, 10 isolated traumatic subarachnoid hemorrhage patients and 10 age- and sex-matched healthy control subjects were recruited. Fractional anisotropy data voxel-wise statistical analyses were conducted through the tract-based spatial statistics as implemented in the FMRIB Software Library. Depending on the intersection between the fractional anisotropy skeleton and the probabilistic white matter atlases of Johns Hopkins University, we calculated mean fractional anisotropy values within the entire tract skeleton and 48 regions of interest. Results The fractional anisotropy values for 19 of 48 regions of interest showed significant divergences (P<0.05) between the patient group and control group. The regions showing significant differences included the corpus callosum and its adjacent neural structures, the brainstem and its adjacent neural structures, and the subcortical white matter that passes the long neural tract. Conclusions The results demonstrated abnormalities of white matter in traumatic subarachnoid hemorrhage patients, and the abnormality locations are compatible with areas that are vulnerable to diffuse axonal injury. Based on these results, traumatic subarachnoid hemorrhage patients also exhibit diffuse axonal injuries; thus, traumatic subarachnoid hemorrhage could be an indicator of the presence of severe brain injuries associated with acute or excessive mechanical forces.
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Affiliation(s)
- Min Son Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, South Korea
| | - Min Jye Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, South Korea
| | - Jae Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Namku, Taegu, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, South Korea
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13
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Symons GF, Clough M, Mutimer S, Major BP, O'Brien WT, Costello D, McDonald SJ, Chen Z, White O, Mychasiuk R, Law M, Wright DK, O'Brien TJ, Fielding J, Kolbe SC, Shultz SR. Cognitive ocular motor deficits and white matter damage chronically after sports-related concussion. Brain Commun 2021; 3:fcab213. [PMID: 34595476 PMCID: PMC8477916 DOI: 10.1093/braincomms/fcab213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/11/2021] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
A history of concussion has been linked to long-term cognitive deficits; however, the neural underpinnings of these abnormalities are poorly understood. This study recruited 26 asymptomatic male Australian footballers with a remote history of concussion (i.e. at least six months since last concussion), and 23 non-collision sport athlete controls with no history of concussion. Participants completed three ocular motor tasks (prosaccade, antisaccade and a cognitively complex switch task) to assess processing speed, inhibitory control and cognitive flexibility, respectively. Diffusion tensor imaging data were acquired using a 3 T MRI scanner, and analysed using tract-based spatial statistics, to investigate white matter abnormalities and how they relate to ocular motor performance. Australian footballers had significantly slower adjusted antisaccade latencies compared to controls (P = 0.035). A significant switch cost (i.e. switch trial error > repeat trial error) was also found on the switch task, with Australian footballers performing increased magnitude of errors on prosaccade switch trials relative to prosaccade repeat trials (P = 0.023). Diffusion tensor imaging analysis found decreased fractional anisotropy, a marker of white matter damage, in major white matter tracts (i.e. corpus callosum, corticospinal tract) in Australian footballers relative to controls. Notably, a larger prosaccade switch cost was significantly related to reduced fractional anisotropy in anterior white matter regions found to connect to the prefrontal cortex (i.e. a key cortical ocular motor centre involved in executive functioning and task switching). Taken together, Australian footballers with a history of concussion have ocular motor deficits indicative of poorer cognitive processing speed and cognitive flexibility, which are related to reduce white matter integrity in regions projecting to important cognitive ocular motor structures. These findings provide novel insights into the neural mechanisms that may underly chronic cognitive impairments in individuals with a history of concussion.
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Affiliation(s)
- Georgia F Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Steven Mutimer
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Brendan P Major
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Daniel Costello
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Scott C Kolbe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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14
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Zimmerman KA, Laverse E, Samra R, Yanez Lopez M, Jolly AE, Bourke NJ, Graham NSN, Patel MC, Hardy J, Kemp S, Morris HR, Sharp DJ. White matter abnormalities in active elite adult rugby players. Brain Commun 2021; 3:fcab133. [PMID: 34435188 PMCID: PMC8381344 DOI: 10.1093/braincomms/fcab133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
The recognition, diagnosis and management of mild traumatic brain injuries are difficult and confusing. It is unclear how the severity and number of injuries sustained relate to brain injuries, such as diffuse axonal injury, diffuse vascular injury and progressive neurodegeneration. Advances in neuroimaging techniques enable the investigation of neuropathologies associated with acute and long-term effects of injury. Head injuries are the most commonly reported injury seen during professional rugby. There is increased vigilance for the immediate effects of these injuries in matches, but there has been surprisingly little research investigating the longer-term effects of rugby participation. Here, we present a longitudinal observational study investigating the relationship of exposure to rugby participation and sub-acute head injuries in professional adult male and female rugby union and league players using advanced MRI. Diffusion tensor imaging and susceptibility weighted imaging was used to assess white matter structure and evidence of axonal and diffuse vascular injury. We also studied changes in brain structure over time using Jacobian Determinant statistics extracted from serial volumetric imaging. We tested 41 male and 3 female adult elite rugby players, of whom 21 attended study visits after a head injury, alongside 32 non-sporting controls, 15 non-collision-sport athletic controls and 16 longitudinally assessed controls. Eighteen rugby players participated in the longitudinal arm of the study, with a second visit at least 6 months after their first scan. Neuroimaging evidence of either axonal injury or diffuse vascular injury was present in 23% (10/44) of players. In the non-acutely injured group of rugby players, abnormalities of fractional anisotropy and other diffusion measures were seen. In contrast, non-collision-sport athletic controls were not classified as showing abnormalities. A group level contrast also showed evidence of sub-acute injury using diffusion tensor imaging in rugby players. Examination of longitudinal imaging revealed unexpected reductions in white matter volume in the elite rugby players studied. These changes were not related to self-reported head injury history or neuropsychological test scores and might indicate excess neurodegeneration in white matter tracts affected by injury. Taken together, our findings suggest an association of participation in elite adult rugby with changes in brain structure. Further well-designed large-scale studies are needed to understand the impact of both repeated sports-related head impacts and head injuries on brain structure, and to clarify whether the abnormalities we have observed are related to an increased risk of neurodegenerative disease and impaired neurocognitive function following elite rugby participation.
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Affiliation(s)
- Karl A Zimmerman
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Etienne Laverse
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - Ravjeet Samra
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK
| | - Maria Yanez Lopez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Amy E Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Neil S N Graham
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Maneesh C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - John Hardy
- Department of Neurodegenerative Disease, Reta Lila Weston Laboratories, Queen Square Genomics, UCL Dementia Research Institute, London WC1N 3BG, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, London TW2 7BA, UK.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK.,The Royal British Legion Centre for Blast Injury Studies, Imperial College London SW7 2AZ, UK
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15
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Major B, Symons GF, Sinclair B, O'Brien WT, Costello D, Wright DK, Clough M, Mutimer S, Sun M, Yamakawa GR, Brady RD, O'Sullivan MJ, Mychasiuk R, McDonald SJ, O'Brien TJ, Law M, Kolbe S, Shultz SR. White and Gray Matter Abnormalities in Australian Footballers With a History of Sports-Related Concussion: An MRI Study. Cereb Cortex 2021; 31:5331-5338. [PMID: 34148076 DOI: 10.1093/cercor/bhab161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sports-related concussion (SRC) is a form of mild traumatic brain injury that has been linked to long-term neurological abnormalities. Australian rules football is a collision sport with wide national participation and is growing in popularity worldwide. However, the chronic neurological consequences of SRC in Australian footballers remain poorly understood. This study investigated the presence of brain abnormalities in Australian footballers with a history of sports-related concussion (HoC) using multimodal MRI. Male Australian footballers with HoC (n = 26), as well as noncollision sport athletes with no HoC (n = 27), were recruited to the study. None of the footballers had sustained a concussion in the preceding 6 months, and all players were asymptomatic. Data were acquired using a 3T MRI scanner. White matter integrity was assessed using diffusion tensor imaging. Cortical thickness, subcortical volumes, and cavum septum pellucidum (CSP) were analyzed using structural MRI. Australian footballers had evidence of widespread microstructural white matter damage and cortical thinning. No significant differences were found regarding subcortical volumes or CSP. These novel findings provide evidence of persisting white and gray matter abnormalities in Australian footballers with HoC, and raise concerns related to the long-term neurological health of these athletes.
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Affiliation(s)
- Brendan Major
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Ben Sinclair
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia
| | - William T O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Steven Mutimer
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Michael J O'Sullivan
- Department of Faculty of Medicine, UQ Centre for Clinical Research and Institute of Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Meng Law
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Radiology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC 3800, Australia
| | - Scott Kolbe
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
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16
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Iverson GL, Van Patten R, Terry DP, Levi CR, Gardner AJ. Predictors and Correlates of Depression in Retired Elite Level Rugby League Players. Front Neurol 2021; 12:655746. [PMID: 33868156 PMCID: PMC8047059 DOI: 10.3389/fneur.2021.655746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background: There is considerable interest in determining whether later-in-life depression is associated with lifetime history of concussions or the duration of a career in professional contact and collision sports. Rugby league is a high-intensity collision sport involving a large number of tackles per game and a high rate of concussions. We examined predictors and correlates of depression in retired elite level rugby league players in Australia. Methods: Retired elite level rugby league players (N = 141, age: M = 52.6, SD = 13.8; Range = 30-89 years) completed the Depression, Anxiety, and Stress Scale (DASS), Brief Pain Inventory, Connor-Davidson Resilience Scale (CD-RISC), and Epworth Sleepiness Scale; they also reported on lifetime history of concussions. The DASS depression score was regressed on age, total number of self-reported concussions, years played professionally, CD-RISC score, BPI pain interference score, and ESS score. Results: The retired players reported a median of 15 total lifetime concussions [interquartile range (IQR) = 6-30], and a median of 8 years playing professional sports (IQR = 3.5-11). The proportion of the sample endorsing at least mild current depression was 29%. The DASS depression score was positively correlated with the DASS anxiety (r = 0.54) and DASS stress scores (r = 0.58). The CD-RISC score was negatively correlated with the depression score (r = -0.53). Depression scores were not significantly correlated with pain severity (r = 0.14), and were weakly correlated with life interference due to pain (r = 0.20) and years playing professional sports (r = -0.17). Depression scores were not significantly correlated with lifetime history of concussions (r = 0.14). A multiple regression model, with age, total number of self-reported concussions, years played professionally, the CD-RISC, Brief Pain Inventory-pain interference score, and Epworth Sleepiness Scale score as predictors was significant, with 35% of the variance in DASS depression accounted for. The two significant independent predictors of depression were lower resilience and greater life interference due to pain. Conclusions: This is the first large study of depression in retired rugby league players. Depression in these retired players was not meaningfully associated with lifetime history of concussions or number of years playing elite level collision sport. Depression was associated with current anxiety, stress, resilience, and life interference due to chronic pain.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Christopher R. Levi
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
| | - Andrew J. Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
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17
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Wang Y, Wang Q, Xie J, Zhu Y, Zhang D, Li G, Zhu X, Li Y. Mediation on the Association Between Stressful Life Events and Depression by Abnormal White Matter Microstructures. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:162-170. [PMID: 33775928 DOI: 10.1016/j.bpsc.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stressful life events (SLEs) are an important causal factor in depression; however, the mechanism by which SLEs cause depression remains unclear. Recent studies suggested that white matter (WM) microstructures might be a potential mediator between SLEs and depression. Hence, we aimed to investigate the concrete correspondence among them using mediation effect models. METHODS In participants (N = 194) with SLEs experience prospectively recruited from six residential communities, WM microstructures were detected with diffusion tensor imaging. The interrelationship among SLEs, WM microstructures, and depression was explored with multiple linear regression models and logistic regression models. Furthermore, the influence of WM microstructures on the association between SLEs and depression was tested with mediation effect models. RESULTS Successfully established mediation effect models showed the specific influence of fractional anisotropy of the corpus callosum and left uncinate fasciculus on the association between SLEs and depression onset (ab path = 0.032; ab path = 0.026, respectively) and between SLEs and depressive severity (ab path = 0.052; ab path = 0.067, respectively). In addition, significant total mediation effects on the association between SLEs and depression onset (ab path = 0.031) and severity (ab path = 0.075) through fractional anisotropy of the corpus callosum and left uncinate fasciculus were noted. CONCLUSIONS WM microstructure alterations impose a substantial mediation effect on the association between SLEs and depression, which suggest that changes in WM microstructure integrity might increase the risk of depression onset and unfavorable disease courses induced by the SLEs.
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Affiliation(s)
- Yun Wang
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China; Department of Clinical Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Qi Wang
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jie Xie
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yan Zhu
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Danwei Zhang
- Department of Clinical Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Guohai Li
- Department of Clinical Psychology, Zhenjiang Mental Health Center, Zhenjiang, China.
| | - Xiaolan Zhu
- Department of Central Laboratory, the Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuefeng Li
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China; Department of Clinical Psychology, Zhenjiang Mental Health Center, Zhenjiang, China.
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Pearce AJ, Kidgell DJ, Tommerdahl MA, Frazer AK, Rist B, Mobbs R, Batchelor J, Buckland ME. Chronic Neurophysiological Effects of Repeated Head Trauma in Retired Australian Male Sport Athletes. Front Neurol 2021; 12:633320. [PMID: 33767661 PMCID: PMC7985524 DOI: 10.3389/fneur.2021.633320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Aim: This study investigated the somatosensory and corticomotor physiology of retired contact sport athletes with a history of repeated concussion/subconcussion head trauma. Methods: Retired male athletes with a history of playing contact sports and repeated head trauma (n = 122) were divided into two groups: those who expressed concerns regarding their mental and cognitive health ("symptomatic": n = 83), and those who did not express any ongoing concerns ("asymptomatic": n = 39). Both groups were compared to age-matched male controls (n = 50) with no history of concussions or participation in contact sports, an absence of self-reported cognitive, or mood impairments. Transcranial magnetic stimulation (TMS) and vibrotactile stimulation were used to assess corticomotor and somatosensory pathways respectively. TMS and vibrotactile stimulation were correlated to self-reported responses using the Fatigue and Related Symptom Survey. Linear regression was used to associate concussion history with TMS, somatosensory variables. Results: Significant differences were found in symptom survey scores between all groups (p < 0.001). TMS showed significant differences between the "symptomatic" and control groups for intracortical inhibition and paired pulse TMS measures. Somatosensory measures showed significant differences for reaction time (p < 0.01) and reaction time variability (p < 0.01) between the "symptomatic" group to the "asymptomatic" and control groups. For other somatosensory measures, the "symptomatic" measures showed differences to the "control" group. Correlations showed significant associations between severity of symptom reporting with TMS and somatosensory measure, and regression revealed the number of concussions reported was shown to have significant relationships to increased intracortical inhibition and poorer somatosensory performance. Conclusion: This study shows that retired contact sport athletes expressing chronic symptoms showed significant pathophysiology compared to those with no ongoing concerns and non-concussed controls. Further, there is a linear dose-response relationship between number of reported concussions and abnormal neurophysiology. Neurophysiological assessments such as TMS and somatosensory measures represent useful and objective biomarkers to assess cortical impairments and progression of neuropsychological impairment in individuals with a history of repeated head trauma.
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Affiliation(s)
- Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Dawson J. Kidgell
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Mark A. Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chappell Hill, NC, United States
- Cortical Metrics, Carrboro, NC, United States
| | - Ashlyn K. Frazer
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Billymo Rist
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Rowena Mobbs
- Department of Neurology, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
| | | | - Michael E. Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Brain and Mind Centre, University Sydney, Camperdown, NSW, Australia
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19
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Pham L, Wright DK, O'Brien WT, Bain J, Huang C, Sun M, Casillas-Espinosa PM, Shah AD, Schittenhelm RB, Sobey CG, Brady RD, O'Brien TJ, Mychasiuk R, Shultz SR, McDonald SJ. Behavioral, axonal, and proteomic alterations following repeated mild traumatic brain injury: Novel insights using a clinically relevant rat model. Neurobiol Dis 2020; 148:105151. [PMID: 33127468 DOI: 10.1016/j.nbd.2020.105151] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
A history of mild traumatic brain injury (mTBI) is linked to a number of chronic neurological conditions, however there is still much unknown about the underlying mechanisms. To provide new insights, this study used a clinically relevant model of repeated mTBI in rats to characterize the acute and chronic neuropathological and neurobehavioral consequences of these injuries. Rats were given four sham-injuries or four mTBIs and allocated to 7-day or 3.5-months post-injury recovery groups. Behavioral analysis assessed sensorimotor function, locomotion, anxiety, and spatial memory. Neuropathological analysis included serum quantification of neurofilament light (NfL), mass spectrometry of the hippocampal proteome, and ex vivo magnetic resonance imaging (MRI). Repeated mTBI rats had evidence of acute cognitive deficits and prolonged sensorimotor impairments. Serum NfL was elevated at 7 days post injury, with levels correlating with sensorimotor deficits; however, no NfL differences were observed at 3.5 months. Several hippocampal proteins were altered by repeated mTBI, including those associated with energy metabolism, neuroinflammation, and impaired neurogenic capacity. Diffusion MRI analysis at 3.5 months found widespread reductions in white matter integrity. Taken together, these findings provide novel insights into the nature and progression of repeated mTBI neuropathology that may underlie lingering or chronic neurobehavioral deficits.
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Affiliation(s)
- Louise Pham
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC 3086, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Jesse Bain
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Cheng Huang
- Monash Proteomics & Metabolomics Facility, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Mujun Sun
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Anup D Shah
- Monash Proteomics & Metabolomics Facility, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia; Monash Bioinformatics Platform, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Ralf B Schittenhelm
- Monash Proteomics & Metabolomics Facility, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Christopher G Sobey
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC 3086, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, The Alfred Hospital, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, The Alfred Hospital, Melbourne, VIC 3004, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Stuart J McDonald
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC 3086, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.
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20
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Sergio LE, Gorbet DJ, Adams MS, Dobney DM. The Effects of Mild Traumatic Brain Injury on Cognitive-Motor Integration for Skilled Performance. Front Neurol 2020; 11:541630. [PMID: 33041992 PMCID: PMC7525090 DOI: 10.3389/fneur.2020.541630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
Adults exposed to blast and blunt impact often experience mild traumatic brain injury, affecting neural functions related to sensory, cognitive, and motor function. In this perspective article, we will review the effects of impact and blast exposure on functional performance that requires the integration of these sensory, cognitive, and motor control systems. We describe cognitive-motor integration and how it relates to successfully navigating skilled activities crucial for work, duty, sport, and even daily life. We review our research on the behavioral effects of traumatic impact and blast exposure on cognitive-motor integration in both younger and older adults, and the neural networks that are involved in these types of skills. Overall, we have observed impairments in rule-based skilled performance as a function of both physical impact and blast exposure. The extent of these impairments depended on the age at injury and the sex of the individual. It appears, however, that cognitive-motor integration deficits can be mitigated by the level of skill expertise of the affected individual, suggesting that such experience imparts resiliency in the brain networks that underly the control of complex visuomotor performance. Finally, we discuss the next steps needed to comprehensively understand the impact of trauma and blast exposure on functional movement control.
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Affiliation(s)
- Lauren E. Sergio
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Diana J. Gorbet
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Meaghan S. Adams
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Vision-Science to Application (VISTA) Program, York University, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Danielle M. Dobney
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Vision-Science to Application (VISTA) Program, York University, Toronto, ON, Canada
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