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Ransom DM, Ahumada L, Amankwah EK, Katzenstein JM, Goldenberg NA, Bauer TA, Mularoni PP. Effects of Cumulative Head Impact Exposure in Adolescent Male Contact and Collision Sport Student Athletes. J Head Trauma Rehabil 2024; 39:284-292. [PMID: 37862133 DOI: 10.1097/htr.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE This prospective cohort study aimed to investigate the association between head impact exposure (HIE) and neuropsychological sequelae in high school football and ice hockey players over 1 year. SETTING Community sample. PARTICIPANTS A cohort of 52 adolescent American football and ice hockey players were enrolled in the study, with a final study sample of 35 included in analyses. DESIGN The study followed a prospective cohort design, with participants undergoing neuropsychological screening and accelerometer-based measurement of HIE over 1 season. MAIN MEASURES Changes in cognition, emotions, behavior, and reported symptoms were assessed using standardized neuropsychological tests and self-reported questionnaires. RESULTS Cumulative HIE was not consistently associated with changes in cognition, emotions, behavior, or reported symptoms. However, it was linked to an isolated measure of processing speed, showing inconsistent results based on the type of HIE. History of previous concussion was associated with worsened verbal memory recognition (ImPACT Verbal Memory) but not on a more robust measure of verbal memory (California Verbal Learning Test [CVLT]). Reported attention-deficit/hyperactivity disorder history predicted improved neurocognitive change scores. No associations were found between reported history of anxiety/depression or headaches/migraines and neuropsychological change scores. CONCLUSION Overall, our findings do not support the hypothesis that greater HIE is associated with an increase in neuropsychological sequelae over time in adolescent football and ice hockey players. The results align with the existing literature, indicating that HIE over 1 season of youth sports is not consistently associated with significant neuropsychological changes. However, the study is limited by a small sample size, attrition over time, and the absence of performance validity testing for neurocognitive measures. Future studies with larger and more diverse samples, longer follow-up, and integration of advanced imaging and biomarkers are needed to comprehensively understand the relationship between HIE and neurobehavioral outcomes. Findings can inform guidelines for safe youth participation in contact sports while promoting the associated health and psychosocial benefits.
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Affiliation(s)
- Danielle M Ransom
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Ransom, Katzenstein, and Mularoni); School of Medicine, Johns Hopkins University, Baltimore, Maryland (Drs Ransom, Ahumada, Amankwah, Katzenstein, Goldenberg, and Mularoni); Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Dr Ahumada); Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Amankwah and Goldenberg); and SenseTech, LLC, Denver, Colorado (Dr Bauer)
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Schaffert J, Datoc A, Sanders GD, Didehbani N, LoBue C, Cullum CM. Repetitive head-injury exposure and later-in-life cognitive and emotional outcomes among former collegiate football players: a CLEAATS investigation. Int Rev Psychiatry 2024; 36:233-242. [PMID: 39255023 DOI: 10.1080/09540261.2024.2352572] [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: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 09/11/2024]
Abstract
This study measured the relationship between head-injury exposure and later-in-life cognitive and emotional symptoms in aging collegiate football players who participated in the College Level Aging Athlete Study. Linear regressions examined the relationship between various head-injury exposure variables (head-injury exposure estimate [HIEE], number of diagnosed concussions, and symptomatic hits to the head) and subjective cognitive function, objective cognitive function, and emotional/mood symptoms. Additional regressions evaluated the impact of emotional symptoms on subjective cognitive decline and objective cognitive function. Participants (n = 216) were 50-87 years old (M = 63.4 [8.5]), 91% White, and well-educated (bachelor's/graduate degree = 92%). HIEE did not predict scores on cognitive or emotional/mood symptom measures (p's > .169). Diagnosed concussions had a small effect on depression symptoms (p = .002, b = 0.501, R2 = .052) and subjective cognitive symptoms (p = .002, b = 0.383, R2 = .051). An emotional symptom index had a stronger relationship (p < .001, b = 0.693, R2 = .362) with subjective cognitive functioning but no significant relationship with objective cognitive function (p = .052, b = -0.211, R2 = .020). Controlling for emotional symptoms, the relationship between concussions and subjective cognitive symptoms was attenuated (p = .078, R2 = .011). Findings suggested that head-injury exposure was not significantly related to cognitive or emotional/mood outcomes in former collegiate football players and highlighted the importance of current emotional/mood symptoms on subjective cognitive function.
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Affiliation(s)
- Jeff Schaffert
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alison Datoc
- Department of Psychiatry, Children's Health Andrews Institute, Orthopaedics and Sports Medicine, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gavin D Sanders
- Department of Psychiatry, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nyaz Didehbani
- Department of Psychiatry, Physical Medicine and Rehabilitation, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian LoBue
- Department of Psychiatry, Neurological Surgery, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Department of Psychiatry, Neurology, and Neurological Surgery, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Strong RW, Grashow R, Roberts AL, Passell E, Scheuer L, Terry DP, Cohan S, Pascual-Leone A, Weisskopf MG, Zafonte RD, Germine LT. Association of Retrospectively Reported Concussion Symptoms with Objective Cognitive Performance in Former American-Style Football Players. Arch Clin Neuropsychol 2023; 38:875-890. [PMID: 36861317 DOI: 10.1093/arclin/acad008] [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] [Accepted: 01/05/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers. METHODS In total, 353 former professional football players (Mage = 54.3) completed both (1) an online cognitive test battery measuring objective cognitive performance and (2) a survey querying demographic information, current health conditions, and measures of past football exposure, including recollected concussion symptoms playing professional football, diagnosed concussions, years of professional play, and age of first football exposure. Testing occurred an average of 29 years after former players' final season of professional play. In addition, a comparison sample of 5,086 male participants (nonplayers) completed one or more cognitive tests. RESULTS Former players' cognitive performance was associated with retrospectively reported football concussion symptoms (rp = -0.19, 95% CI -0.09 to -0.29; p < 0.001), but not with diagnosed concussions, years of professional play, or age of first football exposure. This association could be due to differences in pre-concussion cognitive functioning, however, which could not be estimated based on available data. CONCLUSIONS Future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.
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Affiliation(s)
- Roger W Strong
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Douglas P Terry
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cohan
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Schaffert J, Didehbani N, LoBue C, Hart J, Wilmoth K, Cullum CM. No association between age beginning tackle football, or years played and neurocognitive performance later-in-life among older National Football League retirees. Arch Clin Neuropsychol 2023; 38:644-649. [PMID: 36533487 PMCID: PMC10202547 DOI: 10.1093/arclin/acac101] [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] [Accepted: 11/15/2022] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE In a retrospective cohort, we evaluated whether age beginning tackle football (ABTF) and more total years of playing football (TYPF) were associated with worse later-in-life neuropsychological change among older retired National Football League (NFL) players. METHOD Participants were 19 older NFL retirees aged 54-79, including 12 who returned for follow-up evaluation 15-51 months later. Mixed-linear models evaluated the association between ABTF/TYFP and baseline neuropsychological composite scores (executive functioning/attention/speed, language, memory), and neuropsychological composites over time. RESULTS ABTF and TYPF were not significantly associated with neuropsychological composites at baseline or over time (all p's > .05). There were no significant differences in neuropsychological performance between those ABTF <12 and ≥ 12 years old (all p's ≥ .475) or between those with TYPF <19 or ≥ 19 years played (median split; all p's ≥ .208). CONCLUSIONS Preliminary findings suggest that ABTF and TYPF does not worsen neurocognitive decline later-in-life among older NFL retirees.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristin Wilmoth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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5
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Ransom DM, Ahumada LM, Mularoni PP, Trammell TR. Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers. JAMA Netw Open 2023; 6:e2311086. [PMID: 37129896 PMCID: PMC10155066 DOI: 10.1001/jamanetworkopen.2023.11086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Importance Professional motorsport drivers are regularly exposed to biomechanical forces comparable with those experienced by contact and collision sport athletes, and little is known about the potential short-term and long-term neurologic sequelae. Objective To determine whether cumulative impact exposure is associated with oculomotor functioning in motorsport drivers from the INDYCAR professional open-wheel automobile racing series. Design, Setting, and Participants This is a longitudinal retrospective cohort study conducted across 3 racing seasons (2017-2019). Statistical analyses were conducted in November 2021. Data were retrieved from a secondary care setting associated with the INDYCAR series. INDYCAR series drivers who participated in 3 professional level racing seasons and were involved in at least 1 contact incident (ie, crash) in 2 of the 3 seasons were included in the study. Exposure Cumulative acceleration and deceleration forces and total contact incidents (ie, crashes) measured via accident data recorder third generation chassis and ear accelerometers. Main Outcomes and Measures Postseries oculomotor performance, including predictive saccades, vergence smooth pursuit, and optokinetic nystagmus, was measured annually with a head-mounted, clinical eye tracking system (Neurolign Dx 100). Results Thirteen drivers (mean [SD] age, 29.36 [7.82] years; all men) sustained median resultant acceleration forces of 38.15 g (observed range, 12.01-93.05 g; 95% CI, 30.62-65.81 g) across 81 crashes. A 2-way multivariate analysis of variance did not reveal a statistically significant association between ear and chassis average resultant g forces, total number of contact incidents, and racing season assessed (F9,12 = 0.955; P = .54; Wilks Λ = 0.44). Conclusions and Relevance In this cohort study of professional drivers from the INDYCAR series, there were no statistically significant associations among cumulative impact exposure, racing season assessed, and oculomotor performance. Longitudinal studies across racing seasons using multidimensional examination modalities (eg, neurocognitive testing, advanced imaging, biomarkers, and physical examination) are critical to understand potential neurological and neurobehavioral sequelae and long-term consequences of cumulative impact exposure.
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Affiliation(s)
- Danielle M Ransom
- Division of Neuropsychology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luis M Ahumada
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - P Patrick Mularoni
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Division of Sports Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Schaffert J, Didehbani N, LoBue C, Hart J, Motes M, Rossetti H, Wilmoth K, Goette W, Lacritz L, Cullum CM. Neurocognitive outcomes of older National Football League retirees. Brain Inj 2022; 36:1364-1371. [PMID: 36437496 DOI: 10.1080/02699052.2022.2143567] [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: 11/29/2022]
Abstract
OBJECTIVE Determine if head-injury exposure relates to later-in-life cognitive decline in older National Football League (NFL) retirees. METHOD NFL retirees (aged 50+) with or without cognitive impairment underwent baseline (n = 53) and follow-up (n = 29; 13-59 months later) neuropsychological evaluations. Cognitively normal (CN) retirees (n = 26) were age- and education-matched to healthy controls (n = 26). Cognitively impaired (CI) retirees with mild cognitive impairment or dementia (n = 27) were matched to a clinical sample (CS) by age, sex, education, and diagnosis (n = 83). ANOVAs compared neuropsychological composites at baseline and over time between retirees and their matched groups. Regression models evaluated whether concussions, concussions with loss of consciousness (LOC), or games played predicted neuropsychological functioning. RESULTS At baseline, CN retirees had slightly worse memory than controls (MCN retirees = 50.69, SECN retirees = 1.320; MHealthy controls = 57.08, SEHealthy controls = 1.345; p = 0.005). No other group diferences were observed, and head-injury exposure did not predict neurocognitive performance at baseline or over time. CONCLUSIONS Head-injury exposure was not associated with later-in-life cognition, regardless of cognitive diagnosis. Some retirees may exhibit lower memory scores compared to age-matched peers, though this is of unclear clinical significance.
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Affiliation(s)
- Jeff Schaffert
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nyaz Didehbani
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian LoBue
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Hart
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Motes
- Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Heidi Rossetti
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristin Wilmoth
- Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Will Goette
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura Lacritz
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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7
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LoBue C, Cullum CM, Hart J. Examination of the Proposed Criteria for Traumatic Encephalopathy Syndrome: Case Report of a Former Professional Football Player. J Neuropsychiatry Clin Neurosci 2022; 34:268-274. [PMID: 35272492 DOI: 10.1176/appi.neuropsych.21090225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Christian LoBue
- Department of Psychiatry (all authors), Department of Neurological Surgery (LoBue, Cullum), and Department of Neurology (Cullum, Hart), University of Texas Southwestern Medical Center, Dallas; School of Behavioral and Brain Sciences, University of Texas at Dallas (Hart)
| | - C Munro Cullum
- Department of Psychiatry (all authors), Department of Neurological Surgery (LoBue, Cullum), and Department of Neurology (Cullum, Hart), University of Texas Southwestern Medical Center, Dallas; School of Behavioral and Brain Sciences, University of Texas at Dallas (Hart)
| | - John Hart
- Department of Psychiatry (all authors), Department of Neurological Surgery (LoBue, Cullum), and Department of Neurology (Cullum, Hart), University of Texas Southwestern Medical Center, Dallas; School of Behavioral and Brain Sciences, University of Texas at Dallas (Hart)
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8
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Van Patten R, Iverson GL, Terry DP, Levi CR, Gardner AJ. Predictors and Correlates of Perceived Cognitive Decline in Retired Professional Rugby League Players. Front Neurol 2021; 12:676762. [PMID: 34707552 PMCID: PMC8542796 DOI: 10.3389/fneur.2021.676762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Rugby league is an international full-contact sport, with frequent concussive injuries. Participation in other full-contact sports such as American football has been considered to be a risk factor for neuropsychiatric sequelae later-in-life, but little research has addressed the mental and cognitive health of retired professional rugby league players. We examined predictors and correlates of perceived (self-reported) cognitive decline in retired National Rugby League (NRL) players. Methods: Participants were 133 retired male elite level rugby league players in Australia. Participants completed clinical interviews, neuropsychological testing, and self-report measures. The Informant Questionnaire on Cognitive Decline in the Elderly, self-report (IQCODE-Self), measured perceived cognitive decline. Results: The median age of the sample was 55.0 (M = 53.1, SD = 13.9, range = 30-89) and the median years of education completed was 12.0 (M = 11.9, SD = 2.6, range = 7-18). The retired players reported a median of 15.0 total lifetime concussions (M = 28.0, SD = 36.6, range = 0-200). The mean IQCODE-Self score was 3.2 (SD = 0.5; Range = 1.3-5.0); 10/133 (7.5%) and 38/133 (28.6%) scored above conservative and liberal cutoffs for cognitive decline on the IQCODE-Self, respectively. Perceived cognitive decline was positively correlated with current depressive symptoms, negatively correlated with years of professional sport exposure and resilience, and unrelated to objective cognition and number of self-reported concussions. A multiple regression model with perceived cognitive decline regressed on age, concussion history, professional rugby league exposure, depression, resilience, objective cognitive functioning, daytime sleepiness, and pain severity showed depression as the only significant predictor. Conclusion: This is the first large study examining subjectively experienced cognitive decline in retired professional rugby league players. Similar to studies from the general population and specialty clinics, no relationship was found between objective cognitive test performance and perceived cognitive decline. Depressive symptoms emerged as the strongest predictor of perceived cognitive decline, suggesting that subjective reports of worsening cognition in retired elite rugby league players might reflect psychological distress rather than current cognitive impairment.
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Affiliation(s)
- Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - 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
| | - 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), Liverpool, NSW, Australia
- School of Medicine, 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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Schaffert J, Didehbani N, LoBue C, Hart J, Rossetti H, Lacritz L, Cullum CM. Frequency and Predictors of Traumatic Encephalopathy Syndrome in a Prospective Cohort of Retired Professional Athletes. Front Neurol 2021; 12:617526. [PMID: 33708171 PMCID: PMC7940833 DOI: 10.3389/fneur.2021.617526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, p = 0.087), number of concussions (OR = 1.020, p = 0.532), number of concussions with loss of consciousness (OR = 1.141 p = 0.188), and years playing professionally (OR = 0.976, p = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, p < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - John Hart
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Callier Center, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Heidi Rossetti
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Laura Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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10
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Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan Iii WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med 2021; 55:683-690. [PMID: 33397673 DOI: 10.1136/bjsports-2020-103400] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players. METHODS In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates. RESULTS Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol. CONCLUSION Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D DeFreese
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
| | - Michael McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan Iii
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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11
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Schaffert J, LoBue C, Fields L, Wilmoth K, Didehbani N, Hart J, Cullum CM. Neuropsychological functioning in ageing retired NFL players: a critical review. Int Rev Psychiatry 2020; 32:71-88. [PMID: 31592681 DOI: 10.1080/09540261.2019.1658572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent discovery of chronic traumatic encephalopathy in former National Football League (NFL) players has led to a surge of papers investigating cognitive functioning in these former athletes. This critical review of the literature focused on the neuropsychological functioning in these ageing athletes, and included 22 articles published between 2013 and 2019, of which 13 reported on neuroradiological imaging and four focused on dose-response relationships of repetitive head injury on cognitive outcomes. Four studies suggest higher prevalence of MCI and neurodegenerative disease among NFL retirees, although a quantifiable risk and prevalence of cognitive impairment and dementia in these players remains unknown. Decreased verbal memory has been found in some players across multiple studies, though with unknown clinical significance due to small sample sizes, unreported effect sizes, and absence of longitudinal data. Studies investigating a dose-response relationship between cognitive decline and head injury have generated mixed findings utilizing various measures of head injury exposure. Neuroradiological findings are inconsistent, but suggest that some NFL players may be at greater risk for reduced white matter integrity. Future research is needed to understand the relationship between sports-related concussions and the risk of long-term cognitive decline and neurodegenerative disease in ageing NFL players.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Departments of Psychiatry and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindy Fields
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristin Wilmoth
- Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Callier Center, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Departments of Neurology and Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology and Neurotherapeutics, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Long-Term Cognitive Performance of Retired Athletes with Sport-Related Concussion: A Systematic Review and Meta-Analysis. Brain Sci 2019; 9:brainsci9080199. [PMID: 31412586 PMCID: PMC6721785 DOI: 10.3390/brainsci9080199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 01/07/2023] Open
Abstract
Objective: The purpose of this systematic review is to quantitatively estimate (or invest) the impacts of sports-related concussions (SRCs) on cognitive performance among retired athletes more than 10 years after retirement. Methods: Six databases including (MEDLINE, Scopus, Web of Science, SPORTDiscus, CINAHL, and PsycArtilces) were employed to retrieve the related studies. Studies that evaluate the association between cognitive function and the SRC of retired athletes sustaining more than 10 years were included. Results: A total of 11 studies that included 792 participants (534 retired athletes with SRC) were identified. The results indicated that the retired athletes with SRCs, compared to the non-concussion group, had significant cognitive deficits in verbal memory (SMD = -0.29, 95% CI -0.59 to -0.02, I2 = 52.8%), delayed recall (SMD = -0.30, 95% CI -0.46 to 0.07, I2 = 27.9%), and attention (SMD = -0.33, 95% CI -0.59 to -0.06, I2 = 0%). Additionally, meta-regression demonstrated that the period of time between testing and the last concussion is significantly associated with reduced verbal memory (β = -0.03681, p = 0.03), and increasing age is significantly associated with the verbal memory (β = -0.03767, p = 0.01), immediate recall (β = -0.08684, p = 0.02), and delay recall (β = -0.07432, p = 0.02). Conclusion: The retired athletes who suffered from SRCs during their playing career had declined cognitive performance in partial domains (immediate recall, visuospatial ability, and reaction time) later in life.
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