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Twohey E, Velasco G, Neidecker J, Giovane R. Knockout rates across the states as a way of predicting injury and knockout based on fighter sex, weight, or experience. PHYSICIAN SPORTSMED 2024; 52:395-399. [PMID: 37990916 DOI: 10.1080/00913847.2023.2285716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
Combat sports, such as boxing and mixed martial arts [MMA], have the unique objective to finish a bout by way of knockout [KO] or technical knockout [TKO]. There are potentially both short- and long-term neurological injuries that can happen as a result of the repeated head trauma sustained in bouts, and thus it is imperative to identify the athletes that are at increased risk. Using an online database of professional boxing bouts [boxrec.com] over a 6-month period, KO/TKO rates were calculated across different states, weight classes, sex, and Fight Exposure Score [FES] categories. There was found to be a significant association between KO/TKO rates and weight class, sex, and FES category with heavyweights, males and FES 0 boxers having higher KO/TKO rates. KO/TKO rates were increased in winless boxers. KO/TKO rates across the states are documented in the study.
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Affiliation(s)
- Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, USA
| | - George Velasco
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - John Neidecker
- Sports Medicine, Orthopaedic Specialists of North Carolina, Raleigh, NC, USA
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Da Broi M, Al Awadhi A, Voruz P, Nouri A, Schaller K. The spectrum of acute and chronic consequences of neurotrauma in professional and amateur boxing - A call to action is advocated to better understand and prevent this phenomenon. BRAIN & SPINE 2023; 4:102743. [PMID: 38510617 PMCID: PMC10951782 DOI: 10.1016/j.bas.2023.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
Introduction Despite changes in regulations, boxing-related injuries and fatalities are still occurring. The numbers available in the literature regarding mortality and long-term consequences may not accurately represent the actual situation. Indeed, the real extent of this phenomenon remains poorly known. Research question Delineating the spectrum of acute and chronic consequences of boxing-related traumatic brain injuries (TBI). Material and methods Narrative review of the literature concerning acute and chronic boxing-related TBI. Keywords such as mortality, boxing, subdural hematoma were used to search in PubMed and Google scholar. An updated analysis of the Velazquez fatalities collection in boxing was undertaken. Results The Velazquez collection includes 2076 fatalities from 1720 to the present with a death rate of 10 athletes per year. More than half of the deaths (N = 1354, 65.2%) occurred after a knock-out, and nearly 75% happened during professional bouts. In Australia, from 1832 to 2020, 163 fatalities were recorded (75% professional). In Japan, from 1952 to 2016, 38 deaths were recorded with a mean age of 23.9 years. Up to 40% of retired professional boxers in the United States were diagnosed with symptoms of chronic brain injury. Clinical dementia is far more prevalent among professional boxers than in amateurs with an incidence of 20%. Discussion and conclusions A concerted effort to raise awareness and shed light on boxing-related neuro-trauma is required. Similar considerations can be made for other combat sports or contact sports. A call to action to address this knowledge gap, decrease and prevent this phenomenon is advocated.
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Affiliation(s)
- Michele Da Broi
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Abdullah Al Awadhi
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Voruz
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
| | - Aria Nouri
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
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Donnelly RR, Ugbolue UC, Gao Y, Gu Y, Dutheil F, Baker JS. A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing. Clin J Sport Med 2023; 33:658-674. [PMID: 37862081 PMCID: PMC10597432 DOI: 10.1097/jsm.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. DATA SOURCES This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. MAIN RESULTS From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). CONCLUSIONS Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.
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Affiliation(s)
- Robert R. Donnelly
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Ukadike Chris Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Yang Gao
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
| | - Yaodong Gu
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
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Zhuang X, Bennett L, Nandy R, Cordes D, Bernick C, Ritter A. Longitudinal Changes in Cognitive Functioning and Brain Structure in Professional Boxers and Mixed Martial Artists After They Stop Fighting. Neurology 2022; 99:e2275-e2284. [PMID: 36104283 PMCID: PMC9694836 DOI: 10.1212/wnl.0000000000201158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study compares longitudinal changes in cognitive functioning and brain structures in male fighters who transitioned to an inactive fighting status without any further exposure to repetitive head impacts (RHIs) and fighters remaining active with continual exposure to RHIs. METHODS Participants were recruited from the Professional Fighters Brain Health Study. At time point (TP)1, all fighters were active, with continual exposure to RHIs. At TP2, fighters were considered "transitioned" if they had no sanctioned professional fights and had not been sparring for the past 2 years. Fighters were considered "active" if they continued to train and compete. All fighters underwent cognitive testing and 3T MRI at both TPs. A subset of our fighters (50%) underwent blood sampling for the characterization of neurofilament light (NfL) levels at both TPs. Linear mixed-effect models were applied to investigate the potentially different longitudinal trajectories (interaction effect between group and time) of cognitive function measures, NfL levels, and regional thickness measures (derived from structural MRI) between transitioned and active fighters. RESULTS Forty-five male transitioned fighters (aged 31.69 ± 6.27 years [TP1]; 22 boxers, 22 mixed martial artists, and 1 martial artist) and 45 demographically matched male active fighters (aged 30.24 ± 5.44 years [TP1]; 17 boxers, 27 mixed martial artists, and 1 martial artist) were included in the analyses. Significantly different longitudinal trajectories between transitioned and active fighters were observed in verbal memory (p FDR = 4.73E-04), psychomotor speed (p FDR = 4.73E-04), processing speed (p FDR = 3.90E-02), and NfL levels (p = 0.02). Transitioned fighters demonstrated longitudinally improved cognitive functioning and decreased NfL levels, and active fighters demonstrated declines in cognitive performance and stable NfL levels. Of 68 cortical regions inspected, 54 regions demonstrated a consistently changing trajectory, with thickness measures stabilizing on a group level for transitioned fighters and subtly declining over time for active fighters. DISCUSSION After fighters' cessation of RHI exposure, cognitive function and brain thickness measures may stabilize and blood NfL levels may decline. This study could be a starting point to identify potential predictors of individuals who are at a higher risk of RHI-related long-term neurologic conditions.
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Affiliation(s)
- Xiaowei Zhuang
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Lauren Bennett
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Rajesh Nandy
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Dietmar Cordes
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Charles Bernick
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Aaron Ritter
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle.
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D'Alonzo BA, Bretzin AC, Chandran A, Boltz AJ, Robison HJ, Collins CL, Morris SN. Epidemiology of Injuries in National Collegiate Athletic Association Men's Lacrosse: 2014-2015 Through 2018-2019. J Athl Train 2021; 56:758-765. [PMID: 34280286 DOI: 10.4085/1062-6050-612-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The popularity of National Collegiate Athletic Association (NCAA) men's lacrosse has been steadily increasing since the early 1980s. BACKGROUND Injury surveillance is an important tool to aid in identifying emerging patterns of sport-related injury in NCAA men's lacrosse. METHODS Injury data collected from a sample of men's lacrosse teams through the NCAA Injury Surveillance Program for the academic years 2014-2015 through 2018-2019 were analyzed. Athlete exposures were estimated and computed based on collected exposure data. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated to estimate differences in injury rates. RESULTS The overall injury rate was 4.90 per 1000 athlete exposures (AEs), and the competition injury rate was higher than the practice injury rate (IRR = 2.59; 95% CI = 2.35, 2.84). The overall preseason injury rate was higher than the regular and postseason injury rates. The most reported injuries were concussions (8.0%), ankle sprains (7.7%), and hamstring tears (6.9%). CONCLUSIONS Study findings were comparable with existing epidemiological evidence. The overall burden of concussions and lower extremity injuries warrant further attention in this population.
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Affiliation(s)
| | - Abigail C Bretzin
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | | | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Sarah N Morris
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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A preliminary investigation of corpus callosum subregion white matter vulnerability and relation to chronic outcome in boxers. Brain Imaging Behav 2021; 14:772-786. [PMID: 30565025 DOI: 10.1007/s11682-018-0018-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Microstructural neuropathology occurs in the corpus callosum (CC) after repetitive sports concussion in boxers and can be dose-dependent. However, the specificity and relation of CC changes to boxing exposure extent and post-career psychiatric and neuropsychological outcomes are largely unknown. Using deterministic diffusion tensor imaging (DTI) techniques, boxers and demographically-matched, noncontact sport athletes were compared to address literature gaps. Ten boxers and 9 comparison athletes between 26 and 59 years old (M = 44.63, SD = 9.24) completed neuropsychological testing and MRI. Quantitative DTI metrics were estimated for CC subregions. Group×Region interaction effects were observed on fractional anisotropy (FA; η2p ≥ .21). Follow-up indicated large effects of group (η2p ≥ .26) on splenium FA (boxers<comparisons) and genu mean diffusivity (MD; boxers>comparisons), but not radial diffusivity (RD). The group of boxers had moderately elevated number of psychiatric symptoms and reduced neuropsychological scores relative to the comparison group. In boxers, years sparring, professional bouts, and knockout history correlated strongly (r > |.40|) with DTI metrics and fine motor dexterity. In the comparison group, splenium FA correlated positively with psychiatric symptoms. In the boxer group, neuropsychological scores correlated with DTI metrics in all CC subregions. Results suggested relative vulnerability of the splenium and, to a lesser extent, the genu to chronic, repetitive head injury from boxing. Dose-dependent associations of professional boxing history extent with DTI white matter structure indices as well as fine motor dexterity were supported. Results indicated that symptoms of depression and executive dysfunction may provide the strongest indicators of global CC disruption from boxing.
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Lee JK, Wu J, Bullen J, Banks S, Bernick C, Modic MT, Ruggieri P, Bennett L, Jones SE. Association of Cavum Septum Pellucidum and Cavum Vergae With Cognition, Mood, and Brain Volumes in Professional Fighters. JAMA Neurol 2020; 77:35-42. [PMID: 31498371 DOI: 10.1001/jamaneurol.2019.2861] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Many studies have investigated the imaging findings showing sequelae of repetitive head trauma, with mixed results. Objective To determine whether fighters (boxers and mixed martial arts fighters) with cavum septum pellucidum (CSP) and cavum vergae (CV) have reduced volumes in various brain structures or worse clinical outcomes on cognitive and mood testing. Design, Setting, and Participants This cohort study assessed participants from the Professional Fighters Brain Health Study. Data were collected from April 14, 2011, to January 17, 2018, and were analyzed from September 1, 2018, to May 23, 2019. This study involved a referred sample of 476 active and retired professional fighters. Eligible participants were at least 18 years of age and had at least a fourth-grade reading level. Healthy age-matched controls with no history of trauma were also enrolled. Exposures Presence of CSP, CV, and their total (additive) length (CSPV length). Main Outcomes and Measures Information regarding depression, impulsivity, and sleepiness among study participants was obtained using the Patient Health Questionnaire depression scale, Barrett Impulsiveness Scale, and the Epworth Sleepiness Scale. Cognition was assessed using raw scores from CNS Vital Signs. Volumes of various brain structures were measured via magnetic resonance imaging. Results A total of 476 fighters (440 men, 36 women; mean [SD] age, 30.0 [8.2] years [range, 18-72 years]) and 63 control participants (57 men, 6 women; mean [SD] age, 30.8 [9.6] years [range, 18-58 years]) were enrolled in the study. Compared with fighters without CV, fighters with CV had significantly lower mean psychomotor speed (estimated difference, -11.3; 95% CI, -17.4 to -5.2; P = .004) and lower mean volumes in the supratentorium (estimated difference, -31 191 mm3; 95% CI, -61 903 to -479 mm3; P = .05) and other structures. Longer CSPV length was associated with lower processing speed (slope, -0.39; 95% CI, -0.49 to -0.28; P < .001), psychomotor speed (slope, -0.43; 95% CI, -0.53 to -0.32; P < .001), and lower brain volumes in the supratentorium (slope, -1072 mm3 for every 1-mm increase in CSPV length; 95% CI, -1655 to -489 mm3; P < .001) and other structures. Conclusions and Relevance This study suggests that the presence of CSP and CV is associated with lower regional brain volumes and cognitive performance in a cohort exposed to repetitive head trauma.
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Affiliation(s)
| | - Jenny Wu
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sarah Banks
- Department of Psychology, University of California San Diego Health-La Jolla, San Diego
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
| | - Michael T Modic
- Department of Radiology, Vanderbilt University, Medical Center North, South Nashville, Tennessee
| | - Paul Ruggieri
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Bennett
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
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Bryant BR, Narapareddy BR, Bray MJC, Richey LN, Krieg A, Shan G, Peters ME, Bernick CB. The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume. Int Rev Psychiatry 2020; 32:89-95. [PMID: 31587599 DOI: 10.1080/09540261.2019.1665501] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has long been established that fighting sports such as boxing and mixed martial arts can lead to head injury. Prior work from this group on the Professional Fighters Brain Health Study found that exposure to repetitive head impacts is associated with lower brain volumes and decreased processing speed in fighters. Current and previously licensed professional fighters were recruited, divided into active and retired cohorts, and matched with a control group that had no prior experience in sports with likely head trauma. This study examined the relationship between age of first exposure (AFE) to fighting sports and brain structure (MRI regional volume), cognitive performance (CNS Vital Signs, iComet C3), and clinical neuropsychiatric symptoms (PHQ-9, Barratt Impulsiveness Scale). Brain MRI data showed significant correlations between earlier AFE and smaller bilateral hippocampal and posterior corpus callosum volumes for both retired and active fighters. Earlier AFE in active fighters was correlated with decreased processing speed and decreased psychomotor speed. Retired fighters showed a correlation between earlier AFE and higher measures of depression and impulsivity. Overall, the results help to inform clinicians, governing bodies, parents, and athletes of the risks associated with beginning to compete in fighting sports at a young age.
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Affiliation(s)
- Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guogen Shan
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles B Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Bennett LL, Arias JJ, Ford PJ, Bernick C, Banks SJ. Concussion reporting and perceived knowledge of professional fighters. PHYSICIAN SPORTSMED 2019; 47:295-300. [PMID: 30479188 PMCID: PMC6536361 DOI: 10.1080/00913847.2018.1552481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: For concussions to be effectively managed in sports, they need to be correctly identified and reported. The extent to which professional athletes correctly recognize concussions, and their willingness to report symptoms, is not yet well understood. Given the risk of head injuries leading to concussions across combat sports, insight into professional fighters' knowledge and reporting of concussive symptoms is essential to improve concussion management. Methods: To investigate understanding and reporting patterns of concussions sustained while training or competing, 257 fighters completed a self-report questionnaire assessing self-perception of concussion knowledge, trust of ringside medical providers, and reported number of previous head injuries. Fighting history, including number of knockouts, was obtained from self-report (amateur) and published (professional) records. Results: Significant gaps in fighters' perceived knowledge of concussion symptoms and long-term effects of multiple concussions emerged. Approximately 40% of fighters reported returning to training or competition the same day a head injury was sustained, while 21% of fighters endorsed concealing symptoms of head injury from medical providers and coaches. Conclusions: Confusion surrounding terms used to describe head injuries amongst fighters (e.g., concussions, knockouts), coupled with limited understanding of concussive symptoms and a desire to return to competition, likely contributes to significant underreporting of symptoms.
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Affiliation(s)
- Lauren L. Bennett
- Postdoctoral Fellow, Neuropsychology Program, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Jalayne J. Arias
- Assistant Professor, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Paul J. Ford
- Director and F.J. O’Neill Chair in Bioethics, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles Bernick
- Assistant Medical Director, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Sarah J. Banks
- Head, Neuropsychology Program, Cleveland Clinic Lou Ruvo Center for Brain Health†
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10
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Mishra VR, Sreenivasan KR, Zhuang X, Yang Z, Cordes D, Banks SJ, Bernick C. Understanding white matter structural connectivity differences between cognitively impaired and nonimpaired active professional fighters. Hum Brain Mapp 2019; 40:5108-5122. [PMID: 31403734 DOI: 10.1002/hbm.24761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022] Open
Abstract
Long-term traumatic brain injury due to repeated head impacts (RHI) has been shown to be a risk factor for neurodegenerative disorders, characterized by a loss in cognitive performance. Establishing the correlation between changes in the white matter (WM) structural connectivity measures and neuropsychological test scores might help to identify the neural correlates of the scores that are used in daily clinical setting to investigate deficits due to repeated head blows. Hence, in this study, we utilized high angular diffusion MRI (dMRI) of 69 cognitively impaired and 70 nonimpaired active professional fighters from the Professional Fighters Brain Health Study, and constructed structural connectomes to understand: (a) whether there is a difference in the topological WM organization between cognitively impaired and nonimpaired active professional fighters, and (b) whether graph-theoretical measures exhibit correlations with neuropsychological scores in these groups. A dMRI derived structural connectome was constructed for every participant using brain regions defined in AAL atlas as nodes, and the product of fiber number and average fractional anisotropy of the tracts connecting the nodes as edges. Our study identified a topological WM reorganization due to RHI in fighters prone to cognitive decline that was correlated with neuropsychological scores. Furthermore, graph-theoretical measures were correlated differentially with neuropsychological scores between groups. We also found differentiated WM connectivity involving regions of hippocampus, precuneus, and insula within our cohort of cognitively impaired fighters suggesting that there is a discernible WM topological reorganization in fighters prone to cognitive decline.
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Affiliation(s)
- Virendra R Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | | | - Xiaowei Zhuang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | - Zhengshi Yang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | - Dietmar Cordes
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | - Sarah J Banks
- Department of Neurosciences, University of California at San Diego, San Diego, California
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
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11
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Kim GH, Kang I, Jeong H, Park S, Hong H, Kim J, Kim JY, Edden RAE, Lyoo IK, Yoon S. Low Prefrontal GABA Levels Are Associated With Poor Cognitive Functions in Professional Boxers. Front Hum Neurosci 2019; 13:193. [PMID: 31244630 PMCID: PMC6579878 DOI: 10.3389/fnhum.2019.00193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Cognitive dysfunction has long been recognized as a frequently observed symptom in individuals with repetitive mild traumatic brain injury (rmTBI) such as professional boxers. The exact neurobiological mechanisms underlying this cognitive deficit have not yet been identified, but it is agreed upon that the prefrontal cortex (PFC) is one of the most commonly affected brain regions in professional boxers. Noting the pivotal role of the two major brain metabolites in human cognitive functions, γ-aminobutyric acid (GABA) and glutamate/glutamine (Glx), we hypothesized that alterations in levels of GABA and Glx in the PFC would be prominent and may correlate with cognitive deficits in professional boxers. Twenty male professional boxers (Boxers) and 14 age-matched healthy males who had never experienced any TBI (CON) were recruited. Using a 3T magnetic resonance imaging (MRI) scanner, single-voxel proton magnetic resonance spectroscopy with Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence was performed to evaluate the levels of GABA and Glx in the PFC. Cognitive function was assessed using the memory and attention domains from the Cambridge Neuropsychological Test Automated Battery. The Boxers showed lower GABA level in the PFC compared to the CON, while also showing lower performance in the attention and memory domains. There were no significant between-group differences in Glx levels. Furthermore, the GABA level correlated with memory performance in the Boxers, but not in attention performance. The current findings may suggest that alterations in GABA levels in the PFC may be a potential neurochemical correlate underlying memory dysfunction related to rmTBI.
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Affiliation(s)
- Geon Ha Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Neurology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Ilhyang Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyeonseok Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Haejin Hong
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jinsol Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jung Yoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Richard A E Edden
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.,F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea.,College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
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12
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Breitschuh S, Schöne M, Tozzi L, Kaufmann J, Strumpf H, Fenker D, Frodl T, Bogerts B, Schiltz K. Aggressiveness of martial artists correlates with reduced temporal pole grey matter concentration. Psychiatry Res Neuroimaging 2018; 281:24-30. [PMID: 30216861 DOI: 10.1016/j.pscychresns.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/04/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
Perception and practice of violence have hedonistic aspects associated with positive arousal (appetitive aggression). Earlier studies have mainly investigated the aetiology of aggressive behaviour in forensic/psychiatric patients. The present study examined structural brain characteristics in healthy people practicing violent sports (martial artists) compared to controls not showing violent behaviour. Aggressiveness was assessed in 21 male healthy martial artists and 26 age-matched male healthy controls using the aggressivity factors questionnaire (FAF). Participants underwent structural T1-weighted MRI. Grey matter (GM) differences were analysed using voxel-based morphometry. Whole-brain analyses of the main effects of group and aggressiveness and their interaction were computed. An interaction effect between group and aggressiveness was evident in a brain cluster comprising the left temporal pole and left inferior temporal gyrus. In martial artists, aggressiveness was inversely related to mean GM concentration in this cluster while in controls the opposite pattern was evident. Since these temporal brain regions are relevant for emotion/aggression regulation and threat appraisal, the increased GM concentration in aggressive controls might reflect a stronger cognitive top-down inhibition of their aggressiveness. Lower GM concentration in more aggressive martial artists may indicate a reduced need of inhibitory cognitive control because of their improved self-regulation skills.
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Affiliation(s)
- Stephanie Breitschuh
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Salus-Institute, Salus gGmbH, 39116 Magdeburg, Germany.
| | - Maria Schöne
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Salus-Institute, Salus gGmbH, 39116 Magdeburg, Germany
| | - Leonardo Tozzi
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Department of Psychiatry, Trinity College Institute of Neuroscience, Dublin 2, Ireland
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Hendrik Strumpf
- Department of Neurology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Daniela Fenker
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Otto-von- Guericke-University, 39120 Magdeburg, Germany; Department of Psychiatry, Trinity College Institute of Neuroscience, Dublin 2, Ireland; German Center for Neurodegenerative Diseases, Site Magdeburg, 39120 Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Salus-Institute, Salus gGmbH, 39116 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Otto-von- Guericke-University, 39120 Magdeburg, Germany
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, Otto-von- Guericke-University, 39120 Magdeburg, Germany; Department of Forensic Psychiatry, Psychiatric Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; Center for Behavioral Brain Sciences (CBBS), Otto-von- Guericke-University, 39120 Magdeburg, Germany.
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13
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Le RK, Saunders TD, Breedlove KM, Bradney DA, Lucas JM, Bowman TG. Differences in the Mechanism of Head Impacts Measured Between Men's and Women's Intercollegiate Lacrosse Athletes. Orthop J Sports Med 2018; 6:2325967118807678. [PMID: 30480018 PMCID: PMC6249660 DOI: 10.1177/2325967118807678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Lacrosse is a rapidly growing sport in the United States. Comparing the magnitude and frequency of head impact mechanisms between sexes will provide data for injury prevention techniques and risk reduction of head injuries. Purpose To compare sex-specific differences in the magnitude and frequency of head impact mechanisms in National Collegiate Athletic Association (NCAA) Division III intercollegiate lacrosse athletes. Study Design Cohort study; Level of evidence, 2. Methods A total of 31 NCAA Division III intercollegiate lacrosse athletes (16 men [mean age, 21 ± 1 years; mean height, 179.70 ± 5.82 cm; mean weight, 80.71 ± 6.33 kg] and 15 women [mean age, 20 ± 1 years; mean height, 165.43 ± 5.25 cm; mean weight, 64.08 ± 7.59 kg]) voluntarily participated in this study. Participants wore xPatch sensors at every event during the 2015 spring season. Sensors recorded the magnitude, frequency, and location of head impacts over 10g. Linear (g) and rotational (deg/s2) acceleration determined impact magnitudes. We calculated incidence rates (IRs; per 1000 athlete-exposures [AEs]) and incidence rate ratios (IRRs) with 95% CIs to determine frequency differences. Film footage from each event was synchronized with the time of each head impact for verification and mechanism coding. Sex and impact mechanism served as the independent variables. Results A significant interaction was found between impact mechanism and sex (P < .001) and main effects for impact mechanism (P < .001) and sex (P < .001). The most common mechanism in men's lacrosse was head to body (IR, 970.55/1000 AEs [95% CI, 266.14-331.98]), and in women's lacrosse, stick to head (IR, 289.87/1000 AEs [95% CI, 124.32-184.55]) was most common. Only 9 of 419 impermissible head impacts in men's lacrosse games were classed as penalties (2%); 7 of 25 impermissible head impacts in women's lacrosse games were called as penalties (28%). Conclusion The impact mechanisms of head to body in men's lacrosse and stick to head in women's lacrosse are penalties but occur frequently, suggesting that a focus on stressing rule enforcement is warranted. Because mechanism and sex affect the magnitude of head impacts, proper offensive and defensive techniques against opponents should be encouraged to reduce head impacts.
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Affiliation(s)
- Rachel K Le
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
| | - Tabitha D Saunders
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
| | | | - Debbie A Bradney
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
| | - Jill M Lucas
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
| | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
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14
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Mishra V, Sreenivasan K, Banks SJ, Zhuang X, Yang Z, Cordes D, Bernick C. Investigating structural and perfusion deficits due to repeated head trauma in active professional fighters. NEUROIMAGE-CLINICAL 2017; 17:616-627. [PMID: 29234598 PMCID: PMC5716952 DOI: 10.1016/j.nicl.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
Repeated head trauma experienced by active professional fighters results in various structural, functional and perfusion damage. However, whether there are common regions of structural and perfusion damage due to fighting and whether these structural and perfusion differences are associated with neuropsychological measurements in active professional fighters is still unknown. To that end, T1-weighted and pseudocontinuous arterial spin labeling MRI on a group of healthy controls and active professional fighters were acquired. Voxelwise group comparisons, in a univariate and multivariate sense, were performed to investigate differences in gray and white matter density (GMD, WMD) and cerebral blood flow (CBF) between the two groups. A significantly positive association between global GMD and WMD was obtained with psychomotor speed and reaction time, respectively, in our cohort of active professional fighters. In addition, regional WMD deficit was observed in a cluster encompassing bilateral pons, hippocampus, and thalamus in fighters (0.49 ± 0.04 arbitrary units (a.u.)) as compared to controls (0.51 ± 0.05a.u.). WMD in the cluster of active fighters was also significantly associated with reaction time. Significantly lower CBF was observed in right inferior temporal lobe with both partial volume corrected (46.9 ± 14.93 ml/100 g/min) and non-partial volume corrected CBF maps (25.91 ± 7.99 ml/100 g/min) in professional fighters, as compared to controls (65.45 ± 22.24 ml/100 g/min and 35.22 ± 12.18 ml/100 g/min respectively). A paradoxical increase in CBF accompanying right cerebellum and fusiform gyrus in the active professional fighters (29.52 ± 13.03 ml/100 g/min) as compared to controls (19.43 ± 12.56 ml/100 g/min) was observed with non-partial volume corrected CBF maps. Multivariate analysis with both structural and perfusion measurements found the same clusters as univariate analysis in addition to a cluster in right precuneus. Both partial volume corrected and non-partial volume corrected CBF of the cluster in the thalamus had a significantly positive association with the number of fights. In addition, GMD of the cluster in right precuneus was significantly associated with psychomotor speed in our cohort of active professional fighters. Our results suggest a heterogeneous pattern of structural and CBF deficits due to repeated head trauma in active professional fighters. This finding indicates that investigating both structural and CBF changes in the same set of participants may help to understand the pathophysiology and progression of cognitive decline due to repeated head trauma. Repetitive head trauma revealed no global structural or global perfusion deficits. Cluster of significantly lower WMD was associated with reaction time in fighters. Fighters had lower CBF in right inferior temporal lobe. Multivariate analysis revealed a cluster associated with number of fights. Combined analysis of structural and perfusion measurements is recommended.
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Affiliation(s)
- Virendra Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States.
| | - Karthik Sreenivasan
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
| | - Sarah J Banks
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
| | - Xiaowei Zhuang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
| | - Zhengshi Yang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
| | - Dietmar Cordes
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, NV, United States
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15
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Mishra VR, Zhuang X, Sreenivasan KR, Banks SJ, Yang Z, Bernick C, Cordes D. Multimodal MR Imaging Signatures of Cognitive Impairment in Active Professional Fighters. Radiology 2017; 285:555-567. [PMID: 28741982 DOI: 10.1148/radiol.2017162403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose To investigate whether combining multiple magnetic resonance (MR) imaging modalities such as T1-weighted and diffusion-weighted MR imaging could reveal imaging biomarkers associated with cognition in active professional fighters. Materials and Methods Active professional fighters (n = 297; 24 women and 273 men) were recruited at one center. Sixty-two fighters (six women and 56 men) returned for a follow-up examination. Only men were included in the main analysis of the study. On the basis of computerized testing, fighters were separated into the cognitively impaired and nonimpaired groups on the basis of computerized testing. T1-weighted and diffusion-weighted imaging were performed, and volume and cortical thickness, along with diffusion-derived metrics of 20 major white matter tracts were extracted for every subject. A classifier was designed to identify imaging biomarkers related to cognitive impairment and was tested in the follow-up dataset. Results The classifier allowed identification of seven imaging biomarkers related to cognitive impairment in the cohort of active professional fighters. Areas under the curve of 0.76 and 0.69 were obtained at baseline and at follow-up, respectively, with the optimized classifier. The number of years of fighting had a significant (P = 8.8 × 10-7) negative association with fractional anisotropy of the forceps major (effect size [d] = 0.34) and the inferior longitudinal fasciculus (P = .03; d = 0.17). A significant difference was observed between the impaired and nonimpaired groups in the association of fractional anisotropy in the forceps major with number of fights (P = .03, d = 0.38) and years of fighting (P = 6 × 10-8, d = 0.63). Fractional anisotropy of the inferior longitudinal fasciculus was positively associated with psychomotor speed (P = .04, d = 0.16) in nonimpaired fighters but no association was observed in impaired fighters. Conclusion Without enforcement of any a priori assumptions on the MR imaging-derived measurements and with a multivariate approach, the study revealed a set of seven imaging biomarkers that were associated with cognition in active male professional fighters. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Virendra R Mishra
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Xiaowei Zhuang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Karthik R Sreenivasan
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Sarah J Banks
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Zhengshi Yang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Charles Bernick
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Dietmar Cordes
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
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16
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Ruddock AD, Wilson DC, Thompson SW, Hembrough D, Winter EM. Strength and Conditioning for Professional Boxing. Strength Cond J 2016. [DOI: 10.1519/ssc.0000000000000217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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18
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Herweh C, Hess K, Meyding-Lamadé U, Bartsch AJ, Stippich C, Jost J, Friedmann-Bette B, Heiland S, Bendszus M, Hähnel S. Reduced white matter integrity in amateur boxers. Neuroradiology 2016; 58:911-20. [PMID: 27230917 DOI: 10.1007/s00234-016-1705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing. METHODS DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ). RESULTS All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights. CONCLUSIONS TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.
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Affiliation(s)
- Christian Herweh
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Klaus Hess
- Department of Neurology, University of Heidelberg Medical School, Heidelberg, Germany
| | | | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Stippich
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Joachim Jost
- National Training Center for Boxing, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, University of Heidelberg Medical School, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Hähnel
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Bernick C, Banks SJ, Shin W, Obuchowski N, Butler S, Noback M, Phillips M, Lowe M, Jones S, Modic M. Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: the Professional Fighters' Brain Health Study. Br J Sports Med 2015; 49:1007-11. [PMID: 25633832 PMCID: PMC4518758 DOI: 10.1136/bjsports-2014-093877] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/22/2022]
Abstract
Objectives Cumulative head trauma may alter brain structure and function. We explored the relationship between exposure variables, cognition and MRI brain structural measures in a cohort of professional combatants. Methods 224 fighters (131 mixed martial arts fighters and 93 boxers) participating in the Professional Fighters Brain Health Study, a longitudinal cohort study of licensed professional combatants, were recruited, as were 22 controls. Each participant underwent computerised cognitive testing and volumetric brain MRI. Fighting history including years of fighting and fights per year was obtained from self-report and published records. Statistical analyses of the baseline evaluations were applied cross-sectionally to determine the relationship between fight exposure variables and volumes of the hippocampus, amygdala, thalamus, caudate, putamen. Moreover, the relationship between exposure and brain volumes with cognitive function was assessed. Results Increasing exposure to repetitive head trauma measured by number of professional fights, years of fighting, or a Fight Exposure Score (FES) was associated with lower brain volumes, particularly the thalamus and caudate. In addition, speed of processing decreased with decreased thalamic volumes and with increasing fight exposure. Higher scores on a FES used to reflect exposure to repetitive head trauma were associated with greater likelihood of having cognitive impairment. Conclusions Greater exposure to repetitive head trauma is associated with lower brain volumes and lower processing speed in active professional fighters.
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Affiliation(s)
- Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Sarah J Banks
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Wanyong Shin
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy Obuchowski
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sam Butler
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Noback
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | | | - Mark Lowe
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Jones
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Modic
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
Chronic traumatic encephalopathy (CTE) formerly known as dementia pugilistica is a long-term neurodegenerative disorder associated with repeated subconcussive head injuries in high-contact sports. We reviewed the existing literature on CTE and examined epidemiological trends, risk factors, and its temporal progression, and proposed the underlying pathophysiological mechanisms that may provide unique insights to clinicians with an in-depth understanding of the disease to aid in the diagnosis and prevention, and provide future perspectives for research via search of Medline and Cochrane databases as well as manual review of bibliographies from selected articles and monographs. The prevalence of CTE in recent years is on the rise and almost exclusively affects men, with pathologic signs characterized by progressive memory loss, behavioral changes, and violent tendencies with some patients demonstrating Parkinsonian-like symptoms and signs. Many patients with CTE die following suicide, accident, or complications of drug or alcohol use. Postmortem pathologic analysis is characterized by neurofibrillary tangles and Aβ plaques in 50 % of cases. Currently, there are no ante-mortem diagnostic criteria, but modern imaging techniques such as functional magnetic resonance (MR) imaging, MR spectroscopy, and diffusion tension imaging hold promise for delineating the future diagnostic criteria. Further long-term longitudinal studies are warranted to investigate risk factors that will enhance understanding of the disease progression and its pathogenesis.
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21
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Neselius S, Brisby H, Marcusson J, Zetterberg H, Blennow K, Karlsson T. Neurological assessment and its relationship to CSF biomarkers in amateur boxers. PLoS One 2014; 9:e99870. [PMID: 24941067 PMCID: PMC4062456 DOI: 10.1371/journal.pone.0099870] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/20/2014] [Indexed: 12/14/2022] Open
Abstract
Background Mild traumatic brain injury (TBI) or concussion is common in many sports. Today, neuropsychological evaluation is recommended in the monitoring of a concussion and in return-to-play considerations. To investigate the sensitivity of neuropsychological assessment, we tested amateur boxers post bout and compared with controls. Further the relationship between neuropsychological test results and brain injury biomarkers in the cerebrospinal fluid (CSF) were investigated. Method Thirty amateur boxers on high elite level with a minimum of 45 bouts and 25 non-boxing matched controls were included. Memory tests (Rey Osterrieth Complex Figure, Listening Span, Digit Span, Controlled Word Association Test, and computerized testing of episodic memory), tests of processing speed and executive functions (Trail Making, Reaction Time, and Finger Tapping) were performed and related to previously published CSF biomarker results for the axonal injury marker neurofilament light (NFL). Results The neurological assessment showed no significant differences between boxers and controls, although elevated CSF NFL, as a sign of axonal injury, was detected in about 80% of the boxers 1–6 days post bout. The investigation of the relationship between neuropsychological evaluation and CSF NFL concentrations revealed that boxers with persisting NFL concentration elevation after at least 14 days resting time post bout, had a significantly poorer performance on Trail Making A (p = 0.041) and Simple Reaction Time (p = 0.042) compared to other boxers. Conclusion This is the first study showing traumatic axonal brain injury can be present without measureable cognitive impairment. The repetitive, subconcussive head trauma in amateur boxing causes axonal injury that can be detected with analysis of CSF NFL, but is not sufficient to produce impairment in memory tests, tests of processing speed, or executive functions. The association of prolonged CSF NFL increase in boxers with impairment of processing speed is an interesting observation, which needs to be verified in larger studies.
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Affiliation(s)
- Sanna Neselius
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jan Marcusson
- Geriatric Section, University Hospital in Linköping, Linköping, Sweden
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Disability Research, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Linnaeus Centre HEAD, Linköping University, Linköping, Sweden
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Banks SJ, Obuchowski N, Shin W, Lowe M, Phillips M, Modic M, Bernick C. The Protective Effect of Education on Cognition in Professional Fighters. Arch Clin Neuropsychol 2013; 29:54-9. [DOI: 10.1093/arclin/act079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hemelryck W, Germonpré P, Papadopoulou V, Rozloznik M, Balestra C. Long term effects of recreational SCUBA diving on higher cognitive function. Scand J Med Sci Sports 2013; 24:928-34. [DOI: 10.1111/sms.12100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- W. Hemelryck
- DAN Europe Research Division; Military Hospital Queen Astrid; Brussels Belgium
- Center for Hyperbaric Oxygen Therapy; Military Hospital Queen Astrid; Brussels Belgium
- Environmental and Occupational Physiology Department; Haute Ecole Paul Henri Spaak; Brussels Belgium
| | - P. Germonpré
- DAN Europe Research Division; Military Hospital Queen Astrid; Brussels Belgium
- Center for Hyperbaric Oxygen Therapy; Military Hospital Queen Astrid; Brussels Belgium
| | - V. Papadopoulou
- Environmental and Occupational Physiology Department; Haute Ecole Paul Henri Spaak; Brussels Belgium
- Department of Bioengineering; Imperial College London; London UK
| | - M. Rozloznik
- Environmental and Occupational Physiology Department; Haute Ecole Paul Henri Spaak; Brussels Belgium
| | - C. Balestra
- DAN Europe Research Division; Military Hospital Queen Astrid; Brussels Belgium
- Environmental and Occupational Physiology Department; Haute Ecole Paul Henri Spaak; Brussels Belgium
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24
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Bernick C, Banks S, Phillips M, Lowe M, Shin W, Obuchowski N, Jones S, Modic M. Professional fighters brain health study: rationale and methods. Am J Epidemiol 2013; 178:280-6. [PMID: 23735309 DOI: 10.1093/aje/kws456] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Repetitive head trauma is a risk factor for Alzheimer's disease and is the primary cause of chronic traumatic encephalopathy. However, little is known about the natural history of, and risk factors for, chronic traumatic encephalopathy or about means of early detection and intervention. The Professional Fighters Brain Health Study is a longitudinal study of active professional fighters (boxers and mixed martial artists), retired professional fighters, and controls matched for age and level of education. The main objective of the Professional Fighters Brain Health Study is to determine the relationships between measures of head trauma exposure and other potential modifiers and changes in brain imaging and neurological and behavioral function over time. The study is designed to extend over 5 years, and we anticipate enrollment of more than 400 boxers and mixed martial artists. Participants will undergo annual evaluations that include 3-tesla magnetic resonance imaging scanning, computerized cognitive assessments, speech analysis, surveys of mood and impulsivity, and blood sampling for genotyping and exploratory biomarker studies. Statistical models will be developed and validated to predict early and progressive changes in brain structure and function. A composite fight exposure index, developed as a summary measure of cumulative traumatic exposure, shows promise as a predictor of brain volumes and cognitive function.
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Affiliation(s)
- Charles Bernick
- Cleveland Clinic’s Lou Ruvo Center for Brain Health, 888West Bonneville Avenue, Las Vegas, NV 89106, USA.
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25
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Bernick C, Banks S. What boxing tells us about repetitive head trauma and the brain. ALZHEIMERS RESEARCH & THERAPY 2013; 5:23. [PMID: 23731821 PMCID: PMC3706825 DOI: 10.1186/alzrt177] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Boxing and other combat sports may serve as a human model to study the effects of repetitive head trauma on brain structure and function. The initial description of what is now known as chronic traumatic encephalopathy (CTE) was reported in boxers in 1928. In the ensuing years, studies examining boxers have described the clinical features of CTE, its relationship to degree of exposure to fighting, and an array of radiologic findings. The field has been hampered by issues related to study design, lack of longitudinal follow-up, and absence of agreed-upon clinical criteria for CTE. A recently launched prospective cohort study of professional fighters, the Professional Fighters Brain Health Study, attempts to overcome some of the problems in studying fighters. Here, we review the cross-sectional results from the first year of the project.
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Affiliation(s)
- Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106, USA
| | - Sarah Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106, USA
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26
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Abstract
In this review the authors discuss persistent and cumulative alterations in both cognitive and motor function after sports concussions detected with some of the newest, most sophisticated brain investigation techniques. Ranging from subclinical neurophysiological alterations in young concussed athletes to quantifiable cognitive and motor function declines in former athletes in late adulthood with concussions sustained decades earlier, this review is also intended to provide new insights into the neuropathophysiology of sports concussion.
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Affiliation(s)
- Louis De Beaumont
- 1Montreal Sacred Heart Hospital Research Centre, Montreal
- 2Department of Psychology, University of Quebec at Trois-Rivières, Quebec, Canada; and
| | - Luke C. Henry
- 3University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nadia Gosselin
- 1Montreal Sacred Heart Hospital Research Centre, Montreal
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27
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Brainard LL, Beckwith JG, Chu JJ, Crisco JJ, McAllister TW, Duhaime AC, Maerlender AC, Greenwald RM. Gender differences in head impacts sustained by collegiate ice hockey players. Med Sci Sports Exerc 2012; 44:297-304. [PMID: 21716150 DOI: 10.1249/mss.0b013e31822b0ab4] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to quantify the frequency, magnitude, and location of head impacts sustained by male and female collegiate ice hockey players during two seasons of play. METHODS During two seasons, 88 collegiate athletes (51 females, 37 males) on two female and male National Collegiate Athletic Association varsity ice hockey teams wore instrumented helmets. Each helmet was equipped with six single-axis accelerometers and a miniature data acquisition system to capture and record head impacts sustained during play. Data collected from the helmets were postprocessed to compute linear and rotational accelerations of the head as well as impact location. The head impact exposure data (frequency, location, and magnitude) were then compared between genders. RESULTS Female hockey players experienced a significantly lower (P < 0.001) number of impacts per athlete exposure than males (females = 1.7 ± 0.7, males = 2.9 ± 1.2). The frequency of impacts by location was the same between genders (P > 0.278) for all locations except the right side of the head, where males received fewer impacts than females (P = 0.031). Female hockey players were 1.1 times more likely than males to sustain an impact less than 50 g, whereas males were 1.3 times more likely to sustain an impact greater than 100 g. Similarly, males were 1.9 times more likely to sustain an impact with peak rotational acceleration greater than 5000 rad·s(-2) and 3.5 times more likely to sustain an impact greater than 10,000 rad·s(-2). CONCLUSIONS Although the incidence of concussion has typically been higher for female hockey players than male hockey players, female players sustain fewer impacts and impacts resulting in lower head acceleration than males. Further study is required to better understand the intrinsic and extrinsic risk factors that lead to higher rates of concussion for females that have been previously reported.
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Valerio J, Illes J. Ethical Implications of Neuroimaging in Sports Concussion. J Head Trauma Rehabil 2012; 27:216-21. [DOI: 10.1097/htr.0b013e3182229b6c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Saing T, Dick M, Nelson PT, Kim RC, Cribbs DH, Head E. Frontal cortex neuropathology in dementia pugilistica. J Neurotrauma 2012; 29:1054-70. [PMID: 22017610 PMCID: PMC3325552 DOI: 10.1089/neu.2011.1957] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dementia pugilistica (DP) is associated with chronic traumatic brain injury (CTBI), and leads to a "punch drunk" syndrome characterized by impairments in memory and executive function, behavioral changes, and motor signs. Microscopic features include the accumulation of neurofibrillary tangles (NFTs), beta-amyloid (Aβ), and TAR DNA binding protein 43 (TDP-43) pathology. Here we describe detailed clinical and neuropathological data about a 55-year-old retired boxer (ApoE3/4), who presented with executive dysfunction and behavioral impairments. At autopsy, significant Aβ pathology was seen, primarily in the form of diffuse plaques. Tau pathology was extensive and was determined to be of Braak and Braak stage VI. Frontal white matter showed evidence of glial tau inclusions (astrocytes and oligodendroglia). Cerebrovascular pathology was minimal with patchy amyloid angiopathy. Inflammation was another key feature, including microglial activation and significant C1q labeling of neurons, along with NFTs. TDP-43-positive pathology was also observed. Inflammation may be a key inciting as well as propagating feature of DP neuropathology.
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Affiliation(s)
- Tommy Saing
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
| | - Malcolm Dick
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
| | - Peter T. Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Ronald C. Kim
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Pathology, University of California–Irvine, Irvine, California
| | - David H. Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Elizabeth Head
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Neurology, University of Kentucky, Lexington, Kentucky
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Department of Molecular and Biomedical Pharmacology, University of Kentucky, Lexington, Kentucky
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Lakhan SE, Kirchgessner A. Chronic traumatic encephalopathy: the dangers of getting "dinged". SPRINGERPLUS 2012; 1:2. [PMID: 23984220 PMCID: PMC3581107 DOI: 10.1186/2193-1801-1-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/12/2012] [Indexed: 01/05/2023]
Abstract
Chronic traumatic encephalopathy (CTE) is a form of neurodegeneration that results from repetitive brain trauma. Not surprisingly, CTE has been linked to participation in contact sports such as boxing, hockey and American football. In American football getting "dinged" equates to moments of dizziness, confusion, or grogginess that can follow a blow to the head. There are approximately 100,000 to 300,000 concussive episodes occurring in the game of American football alone each year. It is believed that repetitive brain trauma, with or possibly without symptomatic concussion, sets off a cascade of events that result in neurodegenerative changes highlighted by accumulations of hyperphosphorylated tau and neuronal TAR DNA-binding protein-43 (TDP-43). Symptoms of CTE may begin years or decades later and include a progressive decline of memory, as well as depression, poor impulse control, suicidal behavior, and, eventually, dementia similar to Alzheimer's disease. In some individuals, CTE is also associated with motor neuron disease similar to amyotrophic lateral sclerosis. Given the millions of athletes participating in contact sports that involve repetitive brain trauma, CTE represents an important public health issue. In this review, we discuss recent advances in understanding the etiology of CTE. It is now known that those instances of mild concussion or "dings" that we may have previously not noticed could very well be causing progressive neurodegenerative damage to a player's brain. In the future, focused and intensive study of the risk factors could potentially uncover methods to prevent and treat this disease.
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Affiliation(s)
| | - Annette Kirchgessner
- Global Neuroscience Initiative Foundation, Los Angeles, CA, USA
- School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
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31
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Costanza A, Weber K, Gandy S, Bouras C, Hof PR, Giannakopoulos P, Canuto A. Review: Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates. Neuropathol Appl Neurobiol 2012; 37:570-84. [PMID: 21696410 DOI: 10.1111/j.1365-2990.2011.01186.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Professional boxers and other contact sport athletes are exposed to repetitive brain trauma that may affect motor functions, cognitive performance, emotional regulation and social awareness. The term of chronic traumatic encephalopathy (CTE) was recently introduced to regroup a wide spectrum of symptoms such as cerebellar, pyramidal and extrapyramidal syndromes, impairments in orientation, memory, language, attention, information processing and frontal executive functions, as well as personality changes and behavioural and psychiatric symptoms. Magnetic resonance imaging usually reveals hippocampal and vermis atrophy, a cavum septum pellucidum, signs of diffuse axonal injury, pituitary gland atrophy, dilated perivascular spaces and periventricular white matter disease. Given the partial overlapping of the clinical expression, epidemiology and pathogenesis of CTE and Alzheimer's disease (AD), as well as the close association between traumatic brain injuries (TBIs) and neurofibrillary tangle formation, a mixed pathology promoted by pathogenetic cascades resulting in either CTE or AD has been postulated. Molecular studies suggested that TBIs increase the neurotoxicity of the TAR DNA-binding protein 43 (TDP-43) that is a key pathological marker of ubiquitin-positive forms of frontotemporal dementia (FTLD-TDP) associated or not with motor neurone disease/amyotrophic lateral sclerosis (ALS). Similar patterns of immunoreactivity for TDP-43 in CTE, FTLD-TDP and ALS as well as epidemiological correlations support the presence of common pathogenetic mechanisms. The present review provides a critical update of the evolution of the concept of CTE with reference to its neuropathological definition together with an in-depth discussion of the differential diagnosis between this entity, AD and frontotemporal dementia.
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Affiliation(s)
- A Costanza
- Department of Psychiatry, University Hospitals and Faculty of Medicine, University of Geneva School of Medicine, Geneva, Switzerland
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Tepsic J, Vucic V, Arsic A, Mazic S, Djelic M, Glibetic M. Unfavourable plasma and erythrocyte phospholipid fatty acid profile in elite amateur boxers. Eur J Sport Sci 2011; 13:414-21. [PMID: 23834548 DOI: 10.1080/17461391.2011.630105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Research on possible physiological changes as a consequence of a specific lifestyle and long-term strenuous exercise in boxing has been sparse. We determined plasma and erythrocyte phospholipid (PL) fatty acids (FA) profile of 16 elite amateur male boxers (22.4±3.3 years of age), and compared them with a control group composed of 19 sedentary (24.4±3.4) year-old men. The percentages of total saturated fatty acids (SFA) and monosaturated FA in plasma phospholipids were significantly higher (P <0.001) in boxers compared to the control group. On the other hand, all studied polyunsaturated fatty acids (PUFA) in plasma PL with the exception of eicosapentaenoic acid (EPA, 20:5, n-3) and docosatetraenoic acid (DTA, 22:4, n-6) were significantly lower in boxers than in sedentary men. Total PUFA, n-6 PUFA and n-3 PUFA were also significantly lower in boxers (P <0.001), whereas the n-6/n-3 ratio was higher in boxers than in control group (P <0.01). Boxers had significantly higher proportion of all SFA in erythrocyte PL compared to the control group (P <0.05). In addition, the percentage of linoleic acid was lower in boxers' erythrocyte PL than in the control group (P <0.05). The results show two potentially unfavourable main features of the FA profile of boxers, that is, a higher n-6/n-3 ratio in plasma PL and a higher percentage of SFA in both plasma and erythrocyte phospholipids compared to controls. As SFA correlates directly with the incidence of cardiovascular disease and high n-6/n-3 ratio has been shown to stimulate carcinogenesis and modulate inflammation and autoimmunity, this profile could be detrimental to the health of boxers. The mechanism underlying these differences requires further investigation; however the results suggest benefits of nutritional intervention.
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Affiliation(s)
- Jasna Tepsic
- Institute for Medical Research, Belgrade, Serbia.
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Rieder C, Jansen P. No Neuropsychological Consequence in Male and Female Soccer Players after a Short Heading Training. Arch Clin Neuropsychol 2011; 26:583-91. [DOI: 10.1093/arclin/acr055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Crisco JJ, Greenwald RM. Let's get the head further out of the game: a proposal for reducing brain injuries in helmeted contact sports. Curr Sports Med Rep 2011; 10:7-9. [PMID: 21228645 DOI: 10.1249/jsr.0b013e318205e063] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Although much of the lay media attention surrounding sport-related concussion (SRC) focuses on professional athletes, SRC is a common injury in pediatric sports. The anatomy, biomechanics, and response to injury of the developing pediatric brain differ from those of the adult. Similarly, the neurocognitive abilities of the child are developing more rapidly than in an adult. The effects of concussive brain injury on the life of a child are different from those of an adult. This article focuses on the aspects of SRC that are specific to the younger athletes.
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