1
|
Arciniega H, Baucom ZH, Tuz-Zahra F, Tripodis Y, John O, Carrington H, Kim N, Knyazhanskaya EE, Jung LB, Breedlove K, Wiegand TLT, Daneshvar DH, Rushmore RJ, Billah T, Pasternak O, Coleman MJ, Adler CH, Bernick C, Balcer LJ, Alosco ML, Koerte IK, Lin AP, Cummings JL, Reiman EM, Stern RA, Shenton ME, Bouix S. Brain morphometry in former American football players: findings from the DIAGNOSE CTE research project. Brain 2024; 147:3596-3610. [PMID: 38533783 PMCID: PMC11449133 DOI: 10.1093/brain/awae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
Exposure to repetitive head impacts in contact sports is associated with neurodegenerative disorders including chronic traumatic encephalopathy (CTE), which currently can be diagnosed only at post-mortem. American football players are at higher risk of developing CTE given their exposure to repetitive head impacts. One promising approach for diagnosing CTE in vivo is to explore known neuropathological abnormalities at post-mortem in living individuals using structural MRI. MRI brain morphometry was evaluated in 170 male former American football players ages 45-74 years (n = 114 professional; n = 56 college) and 54 same-age unexposed asymptomatic male controls (n = 54, age range 45-74). Cortical thickness and volume of regions of interest were selected based on established CTE pathology findings and were assessed using FreeSurfer. Group differences and interactions with age and exposure factors were evaluated using a generalized least squares model. A separate logistic regression and independent multinomial model were performed to predict each traumatic encephalopathy syndrome (TES) diagnosis, core clinical features and provisional level of certainty for CTE pathology using brain regions of interest. Former college and professional American football players (combined) showed significant cortical thickness and/or volume reductions compared to unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula, temporal pole and superior frontal gyrus. Post hoc analyses identified group-level differences between former professional players and unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula and superior frontal gyrus. Former college players showed significant volume reductions in the hippocampus, amygdala and superior frontal gyrus compared to the unexposed asymptomatic controls. We did not observe Age × Group interactions for brain morphometric measures. Interactions between morphometry and exposure measures were limited to a single significant positive association between the age of first exposure to organized tackle football and right insular volume. We found no significant relationship between brain morphometric measures and the TES diagnosis core clinical features and provisional level of certainty for CTE pathology outcomes. These findings suggested that MRI morphometrics detect abnormalities in individuals with a history of repetitive head impact exposure that resemble the anatomic distribution of pathological findings from post-mortem CTE studies. The lack of findings associating MRI measures with exposure metrics (except for one significant relationship) or TES diagnosis and core clinical features suggested that brain morphometry must be complemented by other types of measures to characterize individuals with repetitive head impacts.
Collapse
Affiliation(s)
- Hector Arciniega
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Concussion Center, NYU Langone Health, New York, NY 10016, USA
| | - Zachary H Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Omar John
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Concussion Center, NYU Langone Health, New York, NY 10016, USA
| | - Holly Carrington
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Nicholas Kim
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Evdokiya E Knyazhanskaya
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Leonard B Jung
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, Munich, Bavaria 80336, Germany
| | - Katherine Breedlove
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tim L T Wiegand
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, Munich, Bavaria 80336, Germany
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
| | - R Jarrett Rushmore
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Tashrif Billah
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10017, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10017, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Alzheimer’s Disease Research Center and CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, University Hospital Ludwig-Maximilians-Universität, Munich, Bavaria 80336, Germany
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, 82152 Munich, Bavaria, Germany
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Eric M Reiman
- Banner Alzheimer’s Institute and Arizona Alzheimer’s Consortium, Phoenix, AZ 85006, USA
- Department of Psychiatry, University of Arizona, Phoenix, AZ 85004, USA
- Department of Psychiatry, Arizona State University, Phoenix, AZ 85008, USA
- Neurogenomics Division, Translational Genomics Research Institute and Alzheimer’s Consortium, Phoenix, AZ 85004, USA
| | - Robert A Stern
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Neurology, Boston University Alzheimer’s Disease Research Center and CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sylvain Bouix
- Department of Software Engineering and Information Technology, École de technologie supérieure, Université du Québec, Montréal, QC H3C 1K3, Canada
| |
Collapse
|
2
|
Agrawal S, Yu L, Leurgans SE, Kapasi A, Barnes LL, Bennett DA, Boyle PA, Schneider JA. Grey matter ageing-related tau astrogliopathy: associations with brain pathologies and cognitive decline. Brain 2024; 147:3501-3512. [PMID: 39045644 PMCID: PMC11449137 DOI: 10.1093/brain/awae250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/29/2024] [Accepted: 06/30/2024] [Indexed: 07/25/2024] Open
Abstract
Grey matter ageing-related tau astrogliopathy (ARTAG) pathology is common in aged brains and detected in multiple brain regions. However, the associations of grey matter ARTAG with Alzheimer's disease and other common age-related proteinopathies, in addition to clinical phenotypes, including Alzheimer's dementia and cognitive decline, remain unclear. We examined 442 decedents (mean age at death = 90 years, males = 32%) from three longitudinal community-based clinical-pathological studies. Using AT8 immunohistochemistry, grey matter ARTAG pathology was counted in the superior frontal region, anterior temporal tip and amygdala and summarized as a severity score ranging from zero (none) to six (severe). Alzheimer's disease and other common age-related neuropathologies were also evaluated. The diagnosis of Alzheimer's dementia was based on clinical evaluations; annual tests of cognitive performance were summarized as global cognition and five cognitive domains. Multivariable logistic regression tested the associations of grey matter ARTAG pathology with an array of age-related neuropathologies. To evaluate associations of grey matter ARTAG pathology with Alzheimer's dementia and cognitive decline, we used logistic regression and linear mixed-effect models. Grey matter ARTAG pathology was seen in 324 (73%) participants, of which 303 (68%) participants had ARTAG in the amygdala, 246 (56%) in the anterior temporal tip and 137 (31%) in the superior frontal region. Grey matter ARTAG pathology from each of the three regions was associated with a pathological diagnosis of Alzheimer's disease and limbic-predominant age-related TAR DNA-binding protein 43 encephalopathy-neuropathological change but not with vascular pathology. In fully adjusted models that controlled for demographics, Alzheimer's disease and common age-related pathologies, an increase in severity of grey matter ARTAG pathology in the superior frontal cortex, but not in the amygdala or the anterior temporal tip, was associated with higher odds of Alzheimer's dementia and faster decline in global cognition, episodic memory and semantic memory. These results provide compelling evidence that grey matter ARTAG, specifically in the superior frontal cortex, contributes to Alzheimer's dementia and cognitive decline in old age.
Collapse
Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sue E Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Alifiya Kapasi
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Patricia A Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
3
|
Grashow R, Terry DP, Iverson GL, DiGregorio H, Dairi I, Brown C, Atkeson PS, Whittington AJ, Reese L, Kim JH, Konstantinides N, Taylor HA, Speizer FE, Daneshvar DH, Zafonte RD, Weisskopf MG, Baggish AL. Perceived Chronic Traumatic Encephalopathy and Suicidality in Former Professional Football Players. JAMA Neurol 2024:2824064. [PMID: 39312218 PMCID: PMC11420824 DOI: 10.1001/jamaneurol.2024.3083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 09/26/2024]
Abstract
Importance Participation in American-style football (ASF) has been linked to chronic traumatic encephalopathy neuropathological change (CTE-NC), a specific neuropathologic finding that can only be established at autopsy. Despite being a postmortem diagnosis, living former ASF players may perceive themselves to have CTE-NC. At present, the proportion and clinical correlates of living former professional ASF athletes with perceived CTE who report suicidality are unknown. Objective To determine the proportion, clinical correlates, and suicidality of living former professional ASF players with perceived CTE. Design, Setting, and Participants A cross-sectional study within the Football Players Health Study at Harvard University was conducted from 2017 to 2020. Using electronic and paper surveys, this population-based study included former ASF players who contracted with a professional league from 1960 to 2020 and volunteered to fill out a baseline survey. Data for this study were analyzed from June 2023 through March 2024. Exposures Data included demographics, football-related exposures (eg, position, career duration), and current health problems (anxiety, attention-deficit/hyperactivity disorder, depression, diabetes, emotional and behavioral dyscontrol symptoms, headache, hyperlipidemia, hypertension, low testosterone level, pain, sleep apnea, and subjective cognitive function). Main Outcomes and Measures The proportion of participants reporting perceived CTE. Univariable and multivariable models were used to determine clinical and suicidality correlates of perceived CTE. Results Among 4180 former professional ASF players who volunteered to fill out a baseline survey, 1980 (47.4%) provided follow-up data (mean [SD] age, 57.7 [13.9] years). A total of 681 participants (34.4%) reported perceived CTE. Subjective cognitive difficulties, low testosterone level, headache, concussion signs and symptoms accrued during playing years, depressive/emotional and behavioral dyscontrol symptoms, pain, and younger age were significantly associated with perceived CTE. Suicidality was reported by 171 of 681 participants with perceived CTE (25.4%) and 64 of 1299 without perceived CTE (5.0%). After adjusting for established suicidality predictors (eg, depression), men with perceived CTE remained twice as likely to report suicidality (odds ratio, 2.06; 95% CI, 1.36-3.12; P < .001). Conclusions and Relevance This study found that approximately one-third of living former professional ASF players reported perceived CTE. Men with perceived CTE had an increased prevalence of suicidality and were more likely to have health problems associated with cognitive impairment compared with men without perceived CTE. Perceived CTE represents a novel risk factor for suicidality and, if present, should motivate the diagnostic assessment and treatment of medical and behavioral conditions that may be misattributed to CTE-NC.
Collapse
Affiliation(s)
- Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts
- Sports Concussion Program, Mass General for Children, Boston, Massachusetts
| | - Heather DiGregorio
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Paula S. Atkeson
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Alicia J. Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - LeRoy Reese
- Prevention Research Center, Morehouse School of Medicine, Atlanta, Georgia
| | - Jonathan H. Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Niki Konstantinides
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Frank E. Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Ross D. Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aaron L. Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| |
Collapse
|
4
|
Fortington LV, Cassidy JD, Castellani RJ, Gardner AJ, McIntosh AS, Austen M, Kerr ZY, Quarrie KL. Epidemiological Principles in Claims of Causality: An Enquiry into Repetitive Head Impacts (RHI) and Chronic Traumatic Encephalopathy (CTE). Sports Med 2024:10.1007/s40279-024-02102-4. [PMID: 39277838 DOI: 10.1007/s40279-024-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/17/2024]
Abstract
Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public.
Collapse
Affiliation(s)
- Lauren V Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rudolph J Castellani
- Division of Neuropathology, Northwestern University Feinberg School of Medicine and Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Chicago, IL, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew S McIntosh
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Michael Austen
- Australasian Faculty of Occupational and Environmental Medicine, Royal Australasian College of Physicians, Sydney, Australia
- Royal New Zealand College of Urgent Care, Auckland, New Zealand
- High Court of New Zealand, Auckland, New Zealand
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth L Quarrie
- New Zealand Rugby, 100 Molesworth Street, Wellington, New Zealand
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Auckland Bioengineering Institute (ABI), The University of Auckland, Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Karr JE, Ingram EO. Base rates of healthy community-dwelling adults meeting criteria for traumatic encephalopathy syndrome and levels of chronic traumatic encephalopathy certainty. Clin Neuropsychol 2024:1-25. [PMID: 39256925 DOI: 10.1080/13854046.2024.2399797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024]
Abstract
Objective: The National Institute of Neurological Disorders and Stroke (NINDS) recently revised criteria for Traumatic Encephalopathy Syndrome (TES) (Katz et al.), aiming to improve the specificity of former TES criteria (Montenigro et al.) and adding methods to gauge certainty of underlying Chronic Traumatic Encephalopathy (CTE). This study examined base rates of Montenigro et al. and Katz et al. TES criteria in healthy community-dwelling adults. Method: Participants consisted of healthy adults (n = 835; M = 48.1 ± 18.2 years-old, range = 18-85; 37.1% male; 64.1% White) without known history of neurotrauma or psychiatric or neurological conditions. The former and current TES criteria were operationalized using the NIH Toolbox Cognition, Motor, and Emotion batteries and PROMIS-29. Results: Per Katz et al. criteria, 36.9% had symptoms Suggestive of CTE (i.e. either cognitive impairment or neurobehavioral dysregulation), 4.1% had Possible CTE (i.e. requiring cognitive impairment and two additional criteria), and 0.8% had Probable CTE (i.e. requiring cognitive impairment and three additional criteria). The requirement of cognitive impairment for Possible CTE certainty decreased the base rate of Possible CTE tenfold from Montenigro et al. criteria (40.1%). Conclusion: The Katz et al. criteria were met less frequently by healthy adults than the Montenigro et al. criteria. Requiring cognitive impairment and more supportive TES features when gauging CTE certainty may reduce false-positive diagnoses. This finding supports the role of neuropsychologists in the diagnosis and monitoring of patients in TES research studies. To assess specificity, future research should examine base rates of Katz et al. criteria in other psychiatric and neurological conditions.
Collapse
Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
6
|
Vasilevskaya A, Anastassiadis C, Thapa S, Taghdiri F, Khodadadi M, Multani N, Rusjan P, Ozzoude M, Tarazi A, Mushtaque A, Wennberg R, Houle S, Green R, Colella B, Vasdev N, Blennow K, Zetterberg H, Karikari T, Sato C, Moreno D, Rogaeva E, Mikulis D, Davis KD, Tator C, Tartaglia MC. 18F-Flortaucipir (AV1451) imaging identifies grey matter atrophy in retired athletes. J Neurol 2024; 271:6068-6079. [PMID: 39037476 PMCID: PMC11377597 DOI: 10.1007/s00415-024-12573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/06/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The long-term consequences of concussions may include pathological neurodegeneration as seen in Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE). Tau-PET showed promise as a method to detect tau pathology of CTE, but more studies are needed OBJECTIVE: This study aimed (1) to assess the association of imaging evidence of tau pathology with brain volumes in retired athletes and (2) to examine the relationship between tau-PET and neuropsychological functioning. METHODS Former contact sport athletes were recruited through the Canadian Football League Alumni Association or the Canadian Concussion Centre clinic. Athletes completed MRI, [18F]flortaucipir tau-PET, and a neuropsychological battery. Memory composite was created by averaging the Rey Auditory Verbal Learning Test and Rey Visual Design Learning Test z-scores. Grey matter (GM) volumes were age/intracranial volume corrected using normal control MRIs. Tau-PET % positivity in GM was calculated as the number of positive voxels (≥ 1.3 standardized uptake value ratio (SUVR)/total voxels). RESULTS 47 retired contact sport athletes negative for AD (age:51 ± 14; concussions/athlete:15 ± 2) and 54 normal controls (age:50 ± 13) were included. Tau-PET positive voxels had significantly lower GM volumes, compared to tau-PET negative voxels (- 0.37 ± 0.41 vs. - 0.31 ± 0.37, paired p = .006). There was a significant relationship between GM tau-PET % positivity and memory composite score (r = - .366, p = .02), controlled for age, PET scanner, and PET scan duration. There was no relationship between tau-PET measures and concussion number, or years of sport played. CONCLUSION A higher tau-PET signal was associated with reduced GM volumes and lower memory scores. Tau-PET may be useful for identifying those at risk for neurodegeneration.
Collapse
Affiliation(s)
- Anna Vasilevskaya
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Chloe Anastassiadis
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Simrika Thapa
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Pablo Rusjan
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Miracle Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
| | - Apameh Tarazi
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Asma Mushtaque
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Sylvain Houle
- Brain Health Imaging Centre, Campbell Research Institute, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robin Green
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Brenda Colella
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Neil Vasdev
- Brain Health Imaging Centre, Campbell Research Institute, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada
| | - David Mikulis
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Karen Deborah Davis
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Charles Tator
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th Floor 6KD-407, Toronto, ON, M5T 2S8, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
7
|
Wallingford A, Junn C. Chronic Traumatic Encephalopathy. Phys Med Rehabil Clin N Am 2024; 35:607-618. [PMID: 38945654 DOI: 10.1016/j.pmr.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This article focuses on neuropathologic diagnostic criteria for chronic traumatic encephalopathy (CTE) and consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES). CTE as a tauopathy has a unique pattern for diagnosis and differs from other neurodegenerative diseases. We discuss the history, neuropathology, and mechanism of CTE as well as the preliminary reasearch diagnostic criteria for TES, which is the proposed clinical presentation of suspected CTE.
Collapse
Affiliation(s)
- Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Cherry Junn
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue Box 359740, Seattle, WA 98104, USA.
| |
Collapse
|
8
|
Tanaka H, Lee S, Martinez-Valbuena I, Couto B, Tartaglia MC, de Gordoa JSR, Erro ME, Lang AE, Forrest SL, Kovacs GG. Ageing-related tau astrogliopathy severely affecting the substantia nigra. Neuropathol Appl Neurobiol 2024; 50:e13000. [PMID: 39036836 DOI: 10.1111/nan.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
AIMS Astrocytic tau pathology is a major feature of tauopathies and ageing-related tau astrogliopathy (ARTAG). The substantia nigra (SN) is one of the important degenerative areas in tauopathies with parkinsonism. Nigral tau pathology is usually reported as neuronal predominant with less prominent astrocytic involvement. We aimed to identify cases with prominent astrocytic tau pathology in the SN. METHODS We use the term nigral tau-astrogliopathy (NITAG) to describe cases showing an unusually high density of ARTAG with less neuronal tau pathology in the SN. We collected clinical information and studied the distribution of tau pathology, morphological features and immunostaining profiles in three cases. RESULTS Three cases, all males with parkinsonism, were identified with the following clinicopathological diagnoses: (i) atypical parkinsonism with tau pathology reminiscent to that in postencephalitic parkinsonism (69-year-old); (ii) multiple system atrophy (73-year-old); (iii) traumatic encephalopathy syndrome/chronic traumatic encephalopathy (84-year-old). Double-labelling immunofluorescence confirmed co-localization of GFAP and phosphorylated tau in affected astrocytes. Staining profiles of NITAG revealed immunopositivity for various phosphorylated tau antibodies. Some astrocytic tau lesions were also seen in other brainstem regions and cerebral grey matter. CONCLUSIONS We propose NITAG is a rare neuropathological feature, and not a distinct disease entity, in the frame of multiple system ARTAG, represented by abundant tau-positive astrocytes in various brain regions but having the highest density in the SN. The concept of NITAG allows the stratification of cases with various background pathologies to understand its relevance and contribution to neuronal dysfunction.
Collapse
Affiliation(s)
- Hidetomo Tanaka
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Seojin Lee
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Ivan Martinez-Valbuena
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | | | - M Elena Erro
- Department of Neurology, Hospital Universitario de Navarra and Biobank, Navarrabiomed, Pamplona, Navarra, Spain
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Shelley L Forrest
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Scanlon MM, Shields MM, Perl DP, Priemer DS. Chronic traumatic encephalopathy pathognomonic lesions occurring in isolation adjacent to infiltrative and non-infiltrative white matter lesions. J Neuropathol Exp Neurol 2024; 83:695-700. [PMID: 38749058 PMCID: PMC11258416 DOI: 10.1093/jnen/nlae046] [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] [Indexed: 07/20/2024] Open
Abstract
Chronic traumatic encephalopathy (CTE) is defined by perivascular neuronal phosphorylated-tau accumulation at cortical sulcal depths. CTE has been mainly described in the context of repetitive, impact-type traumatic brain injury (rTBI), principally from contact sports. Rarely, CTE has been associated with single TBIs, including in relationship to healed leucotomy sites in brains from formerly institutionalized psychiatric patients without documented rTBI. Given that leucotomy principally involves severing of white matter, this could suggest involvement of axonal injury in CTE pathophysiology. We present three cases wherein isolated CTE pathology was identified adjacent to distinct white matter lesions. Case 1 is a 41-year-old man with history of hereditary hemorrhagic telangiectasia and resection of a cerebral arteriovenous malformation (AVM). Case 2 is a 46-year-old man with glioblastoma. Case 3 is a 52-year-old man with a remote cerebral infarct. Isolated CTE lesions were found adjacent to the aforementioned pathologies in each case. Additional CTE lesions were not identified despite extensive sampling. Multiple age-related tau astrogliopathy (ARTAG)-like lesions were also identified at other sulcal depths near the AVM resection site in Case 1. These cases may provide insights regarding the pathophysiology of the CTE pathognomonic lesion and the development of ARTAG-like pathology adjacent to long-standing mass lesions.
Collapse
Affiliation(s)
- Michaela M Scanlon
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Margaret M Shields
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Daniel P Perl
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Defense/Uniformed Services University Brain Tissue Repository, Uniformed Services University, Bethesda, Maryland, USA
| | - David S Priemer
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Defense/Uniformed Services University Brain Tissue Repository, Uniformed Services University, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Edelstein R, Gutterman S, Newman B, Van Horn JD. Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics? Neuroinformatics 2024:10.1007/s12021-024-09680-8. [PMID: 39078562 DOI: 10.1007/s12021-024-09680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/31/2024]
Abstract
Over the past decade, the intricacies of sports-related concussions among female athletes have become readily apparent. Traditional clinical methods for diagnosing concussions suffer limitations when applied to female athletes, often failing to capture subtle changes in brain structure and function. Advanced neuroinformatics techniques and machine learning models have become invaluable assets in this endeavor. While these technologies have been extensively employed in understanding concussion in male athletes, there remains a significant gap in our comprehension of their effectiveness for female athletes. With its remarkable data analysis capacity, machine learning offers a promising avenue to bridge this deficit. By harnessing the power of machine learning, researchers can link observed phenotypic neuroimaging data to sex-specific biological mechanisms, unraveling the mysteries of concussions in female athletes. Furthermore, embedding methods within machine learning enable examining brain architecture and its alterations beyond the conventional anatomical reference frame. In turn, allows researchers to gain deeper insights into the dynamics of concussions, treatment responses, and recovery processes. This paper endeavors to address the crucial issue of sex differences in multimodal neuroimaging experimental design and machine learning approaches within female athlete populations, ultimately ensuring that they receive the tailored care they require when facing the challenges of concussions. Through better data integration, feature identification, knowledge representation, validation, etc., neuroinformaticists, are ideally suited to bring clarity, context, and explainabilty to the study of sports-related head injuries in males and in females, and helping to define recovery.
Collapse
Affiliation(s)
- Rachel Edelstein
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA.
| | - Sterling Gutterman
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
| | - Benjamin Newman
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
| |
Collapse
|
11
|
Pulukuri SV, Fagle TR, Trujillo-Rodriguez D, van Amerongen S, Bernick C, Geda YE, Wethe JV, Peskind ER, Katz DI, Alosco ML, Palmisano JN, Tripodis Y, Adler CH, Balcer LJ, Reiman EM, Shenton ME, Cummings JL, Stern RA. Characterizing Neurobehavioral Dysregulation Among Former American Football Players: Findings From the DIAGNOSE CTE Research Project. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230133. [PMID: 39034669 DOI: 10.1176/appi.neuropsych.20230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Neurobehavioral dysregulation (NBD), a core clinical feature of traumatic encephalopathy syndrome, encompasses neuropsychiatric symptoms reported among individuals with a history of repetitive head impact exposure, including contact sport athletes. The objective of this study was to examine the construct and subconstructs of NBD through a series of factor and cluster analyses. METHODS Six clinician-scientists selected self-report questionnaire items relevant to NBD from seven available neuropsychiatric scales through a blinded voting process. These items were subjected to confirmatory factor analyses in a sample of 178 former college and professional American football players and 60 asymptomatic individuals without a history of repetitive head impact exposure. All participants were enrolled in the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project. Factor scores were generated on the basis of the optimal expert-informed model for NBD. Construct validity was assessed with neuropsychiatric scales not included in generation of the factor scores. Cluster analyses with NBD factor scores were used to examine symptom profiles. RESULTS Factor analyses confirmed that NBD was composed of four subconstructs: explosivity, emotional dyscontrol, impulsivity, and affective lability. Cluster analyses indicated four distinct symptom profiles of NBD in this group of former football players: asymptomatic (N=80, 45%), short fuse (N=33, 19%), high affective lability (N=34, 19%), and high NBD (N=31, 17%). CONCLUSIONS These findings characterize NBD as a multifaceted clinical construct with a heterogeneous presentation, providing a foundation for empirical work on the diagnostic criteria for traumatic encephalopathy syndrome and research on the neurobiological underpinnings of NBD.
Collapse
Affiliation(s)
- Surya V Pulukuri
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Tessa R Fagle
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Diana Trujillo-Rodriguez
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Suzan van Amerongen
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Charles Bernick
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Yonas E Geda
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Jennifer V Wethe
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Elaine R Peskind
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Douglas I Katz
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Michael L Alosco
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Joseph N Palmisano
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Yorghos Tripodis
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Charles H Adler
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Laura J Balcer
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Eric M Reiman
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Martha E Shenton
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Jeffrey L Cummings
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| | - Robert A Stern
- Chronic Traumatic Encephalopathy Center (Pulukuri, Fagle, Trujillo-Rodriguez, van Amerongen, Katz, Alosco, Tripodis, Stern), Graduate Program in Neuroscience (Trujillo-Rodriguez), Department of Neurology (Katz, Alosco, Stern), Alzheimer's Disease Research Center (Alosco, Tripodis, Stern), Department of Neurosurgery and Department of Anatomy and Neurobiology (Stern), Boston University Chobanian and Avedisian School of Medicine, Boston; Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit (VU) Amsterdam, VU University Medical Center, and Department of Neurodegeneration, Amsterdam Neuroscience, Amsterdam (van Amerongen); Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Bernick); Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix (Geda); Department of Psychiatry and Psychology (Wethe) and Department of Neurology (Adler), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Peskind); Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Mass. (Katz); Biostatistics and Epidemiology Data Analytics Center (Palmisano) and Department of Biostatistics (Tripodis), Boston University School of Public Health; Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York (Balcer); Banner Alzheimer's Institute, University of Arizona, Translational Genomics Research Institute, Arizona State University, and Arizona Alzheimer's Consortium, Phoenix (Reiman); Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston (Shenton); Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, University of Nevada Las Vegas (Cummings)
| |
Collapse
|
12
|
Tiemensma M, Byard RW, Vink R, Affleck AJ, Blumbergs P, Buckland ME. Chronic traumatic encephalopathy (CTE) in the context of longstanding intimate partner violence. Acta Neuropathol 2024; 148:1. [PMID: 38976081 PMCID: PMC11230984 DOI: 10.1007/s00401-024-02757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024]
Affiliation(s)
- M Tiemensma
- Forensic Pathology Unit, Royal Darwin Hospital, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - R W Byard
- The University of Adelaide, Frome Rd, Adelaide, 5005, Australia
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia
| | - R Vink
- Clinical and Health Sciences, University of South Australia, Adelaide, 5001, Australia
| | - A J Affleck
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P Blumbergs
- The University of Adelaide, Frome Rd, Adelaide, 5005, Australia
| | - M E Buckland
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| |
Collapse
|
13
|
Recht G, Hou J, Buddenbaum C, Cheng H, Newman SD, Saykin AJ, Kawata K. Multiparameter cortical surface morphology in former amateur contact sport athletes. Cereb Cortex 2024; 34:bhae301. [PMID: 39077916 DOI: 10.1093/cercor/bhae301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
The lifetime effects of repetitive head impacts have captured considerable public and scientific interest over the past decade, yet a knowledge gap persists in our understanding of midlife neurological well-being, particularly in amateur level athletes. This study aimed to identify the effects of lifetime exposure to sports-related head impacts on brain morphology in retired, amateur athletes. This cross-sectional study comprised of 37 former amateur contact sports athletes and 21 age- and sex-matched noncontact athletes. High-resolution anatomical, T1 scans were analyzed for the cortical morphology, including cortical thickness, sulcal depth, and sulcal curvature, and cognitive function was assessed using the Dementia Rating Scale-2. Despite no group differences in cognitive functions, the contact group exhibited significant cortical thinning particularly in the bilateral frontotemporal regions and medial brain regions, such as the cingulate cortex and precuneus, compared to the noncontact group. Deepened sulcal depth and increased sulcal curvature across all four lobes of the brain were also notable in the contact group. These data suggest that brain morphology of middle-aged former amateur contact athletes differs from that of noncontact athletes and that lifetime exposure to repetitive head impacts may be associated with neuroanatomical changes.
Collapse
Affiliation(s)
- Grace Recht
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
| | - Jiancheng Hou
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
- Research Center for Cross-Straits Cultural Development, Fujian Normal University, Cangshan Campus, No. 8 Shangshan Road, Cangshan District, Fuzhou, Fujian 350007, China
| | - Claire Buddenbaum
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
| | - Hu Cheng
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, 1101 E. 10th Street, Bloomington, IN 47405, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, United States
| | - Sharlene D Newman
- Alabama Life Research Institute, College of Arts & Sciences, University of Alabama, 211 Peter Bryce Blvd., Tuscaloosa, AL 35401, United States
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN 46202, United States
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd, Indianapolis, IN 46202, United States
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, 1025 E. 10th Street, Bloomington, IN 47405, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, United States
- Department of Pediatrics, Indiana University School of Medicine, 1130 W Michigan St, Indianapolis, IN 46202, United States
| |
Collapse
|
14
|
Tiemensma M, Byard RW. Domestic violence and chronic traumatic encephalopathy (CTE) - a forensic perspective. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00856-x. [PMID: 38916792 DOI: 10.1007/s12024-024-00856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Abstract
Chronic Traumatic Encephalopathy, or CTE, is an entity characterized by neurological deficits that are thought to arise from repetitive episodes of blunt head trauma. It has gained considerable attention recently in those who have engaged in contact sports. However, given that it is caused by mechanical cerebral strain from nonspecific blunt impact, it seems reasonable to assume that it could arise from a multitude of causes, such as craniocentric domestic violence. While the literature is somewhat contradictory, the possibilities are that CTE may be caused by either the incremental additive effects of less severe trauma, or from more forceful impacts, or from a combination of both of these mechanisms. Another issue to consider is the degree of acceleration/rotation trauma associated with particular events. Careful study of the chronology, nature and dose-relationships of previous head impacts in victims of inflicted lethal head trauma will, therefore, be required. This will help to clarify its significance in cases of domestic violence and also specifically whether it can be additive from more minor impacts, or whether there is a threshold of force required before it occurs.
Collapse
Affiliation(s)
- Marianne Tiemensma
- Forensic Pathology Unit, Royal Darwin Hospital, Northern Territory, Darwin, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Roger W Byard
- The University of Adelaide, Frome Rd, Adelaide, 5005, Australia.
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia.
| |
Collapse
|
15
|
Kim DD, Sharma AK, Anazodo U, Kertesz A, Borrie M, Lawrence KS, Singhsnaeh A, Ang LC, Finger E. Longitudinal clinicoradiological findings in pathologically confirmed chronic traumatic encephalopathy. J Neurol 2024; 271:3660-3671. [PMID: 38514471 DOI: 10.1007/s00415-024-12275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Affiliation(s)
- David Dongkyung Kim
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Amit Kumar Sharma
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Udunna Anazodo
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Andrew Kertesz
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | | | - Keith St Lawrence
- Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - Arunee Singhsnaeh
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Canada
| | - Lee Cyn Ang
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
| |
Collapse
|
16
|
Taghdiri F, Khodadadi M, Sadia N, Mushtaque A, Scott OFT, Hirsch‐Reinhagen V, Tator C, Wennberg R, Kovacs GG, Tartaglia MC. Unusual combinations of neurodegenerative pathologies with chronic traumatic encephalopathy (CTE) complicates clinical prediction of CTE. Eur J Neurol 2024; 31:e16259. [PMID: 38404144 PMCID: PMC11235773 DOI: 10.1111/ene.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND PURPOSE Chronic traumatic encephalopathy (CTE) has gained widespread attention due to its association with multiple concussions and contact sports. However, CTE remains a postmortem diagnosis, and the link between clinical symptoms and CTE pathology is poorly understood. This study aimed to investigate the presence of copathologies and their impact on symptoms in former contact sports athletes. METHODS This was a retrospective case series design of 12 consecutive cases of former contact sports athletes referred for autopsy. Analyses are descriptive and include clinical history as well as the pathological findings of the autopsied brains. RESULTS All participants had a history of multiple concussions, and all but one had documented progressive cognitive, psychiatric, and/or motor symptoms. The results showed that 11 of the 12 participants had evidence of CTE in the brain, but also other copathologies, including different combinations of tauopathies, and other rare entities. CONCLUSIONS The heterogeneity of symptoms after repetitive head injuries and the diverse pathological combinations accompanying CTE complicate the prediction of CTE in clinical practice. It is prudent to consider the possibility of multiple copathologies when clinically assessing patients with repetitive head injuries, especially as they age, and attributing neurological or cognitive symptoms solely to presumptive CTE in elderly patients should be discouraged.
Collapse
Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Mozhgan Khodadadi
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Nusrat Sadia
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Asma Mushtaque
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Olivia F. T. Scott
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
| | - Veronica Hirsch‐Reinhagen
- Division of NeuropathologyVancouver General HospitalVancouverBritish ColumbiaCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Charles Tator
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Richard Wennberg
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Laboratory Medicine ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders ClinicToronto Western HospitalTorontoOntarioCanada
| | - M. Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Canadian Concussion CentreKrembil Brain Institute, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| |
Collapse
|
17
|
Hirad AA, Mix D, Venkataraman A, Meyers SP, Mahon BZ. Strain concentration drives the anatomical distribution of injury in acute and chronic traumatic brain injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.22.595352. [PMID: 38826417 PMCID: PMC11142169 DOI: 10.1101/2024.05.22.595352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Brain tissue injury caused by mild traumatic brain injury (mTBI) disproportionately concentrates in the midbrain, cerebellum, mesial temporal lobe, and the interface between cortex and white matter at sulcal depths 1-12. The bio-mechanical principles that explain why physical impacts to different parts of the skull translate to common foci of injury concentrated in specific brain structures are unknown. A general and longstanding idea, which has not to date been directly tested in humans, is that different brain regions are differentially susceptible to strain loading11,13-15. We use Magnetic Resonance Elastography (MRE) in healthy participants to develop whole-brain bio-mechanical vulnerability maps that independently define which regions of the brain exhibit disproportionate strain concentration. We then validate those vulnerability maps in a prospective cohort of mTBI patients, using diffusion MRI data collected at three cross-sectional timepoints after injury: acute, sub-acute, chronic. We show that regions that exhibit high strain, measured with MRE, are also the sites of greatest injury, as measured with diffusion MR in mTBI patients. This was the case in acute, subacute, and chronic subgroups of the mTBI cohort. Follow-on analyses decomposed the biomechanical cause of increased strain by showing it is caused jointly by disproportionately higher levels of energy arriving to 'high-strain' structures, as well as the inability of 'high strain' structures to effectively disperse that energy. These findings establish a causal mechanism that explains the anatomy of injury in mTBI based on in vivo rheological properties of the human brain.
Collapse
Affiliation(s)
- Adnan A. Hirad
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 1462, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY 14642, USA
- Del Monte Neuroscience Institute, University of Rochester, NY, USA
| | - Doran Mix
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 1462, USA
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, 1462
| | - Arun Venkataraman
- Department of Physics and Astronomy, University of Rochester, NY, 14623, USA
| | - Steven P. Meyers
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, 1462, USA
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, 1462, USA
| | - Bradford Z. Mahon
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, 1462, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15206
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA 15206
| |
Collapse
|
18
|
Hollin G. Commentary: Three questions for the study of traumatic brain injury in animals. Anat Rec (Hoboken) 2024. [PMID: 38783642 PMCID: PMC7616512 DOI: 10.1002/ar.25465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Gregory Hollin
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| |
Collapse
|
19
|
Ortiz C, Pearson A, McCartan R, Roche S, Carothers N, Browning M, Perez S, He B, Ginsberg SD, Mullan M, Mufson EJ, Crawford F, Ojo J. Overexpression of pathogenic tau in astrocytes causes a reduction in AQP4 and GLT1, an immunosuppressed phenotype and unique transcriptional responses to repetitive mild TBI without appreciable changes in tauopathy. J Neuroinflammation 2024; 21:130. [PMID: 38750510 PMCID: PMC11096096 DOI: 10.1186/s12974-024-03117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
Epidemiological studies have unveiled a robust link between exposure to repetitive mild traumatic brain injury (r-mTBI) and elevated susceptibility to develop neurodegenerative disorders, notably chronic traumatic encephalopathy (CTE). The pathogenic lesion in CTE cases is characterized by the accumulation of hyperphosphorylated tau in neurons around small cerebral blood vessels which can be accompanied by astrocytes that contain phosphorylated tau, the latter termed tau astrogliopathy. However, the contribution of tau astrogliopathy to the pathobiology and functional consequences of r-mTBI/CTE or whether it is merely a consequence of aging remains unclear. We addressed these pivotal questions by utilizing a mouse model harboring tau-bearing astrocytes, GFAPP301L mice, subjected to our r-mTBI paradigm. Despite the fact that r-mTBI did not exacerbate tau astrogliopathy or general tauopathy, it increased phosphorylated tau in the area underneath the impact site. Additionally, gene ontology analysis of tau-bearing astrocytes following r-mTBI revealed profound alterations in key biological processes including immunological and mitochondrial bioenergetics. Moreover, gene array analysis of microdissected astrocytes accrued from stage IV CTE human brains revealed an immunosuppressed astroglial phenotype similar to tau-bearing astrocytes in the GFAPP301L model. Additionally, hippocampal reduction of proteins involved in water transport (AQP4) and glutamate homeostasis (GLT1) was found in the mouse model of tau astrogliopathy. Collectively, these findings reveal the importance of understanding tau astrogliopathy and its role in astroglial pathobiology under normal circumstances and following r-mTBI. The identified mechanisms using this GFAPP301L model may suggest targets for therapeutic interventions in r-mTBI pathogenesis in the context of CTE.
Collapse
Affiliation(s)
- Camila Ortiz
- The Roskamp Institute, Sarasota, FL, USA.
- The Open University, Milton Keynes, UK.
| | - Andrew Pearson
- The Roskamp Institute, Sarasota, FL, USA
- The Open University, Milton Keynes, UK
| | | | | | | | | | | | - Bin He
- Barrow Neurological Institute, Phoenix, AZ, USA
| | - Stephen D Ginsberg
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, USA
- Departments of Psychiatry, Neuroscience and Physiology, and NYU Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - Fiona Crawford
- The Roskamp Institute, Sarasota, FL, USA
- The Open University, Milton Keynes, UK
- James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Joseph Ojo
- The Roskamp Institute, Sarasota, FL, USA
- The Open University, Milton Keynes, UK
| |
Collapse
|
20
|
Barbas H, Garcia-Cabezas MA, John Y, Bautista J, McKee A, Zikopoulos B. Cortical circuit principles predict patterns of trauma induced tauopathy in humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.02.592271. [PMID: 38746103 PMCID: PMC11092596 DOI: 10.1101/2024.05.02.592271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Connections in the cortex of diverse mammalian species are predicted reliably by the Structural Model for direction of pathways and signal processing (reviewed in 1,2). The model is rooted in the universal principle of cortical systematic variation in laminar structure and has been supported widely for connection patterns in animals but has not yet been tested for humans. Here, in postmortem brains of individuals neuropathologically diagnosed with chronic traumatic encephalopathy (CTE) we studied whether the hyperphosphorylated tau (p-tau) pathology parallels connection sequence in time by circuit mechanisms. CTE is a progressive p-tau pathology that begins focally in perivascular sites in sulcal depths of the neocortex (stages I-II) and later involves the medial temporal lobe (MTL) in stages III-IV. We provide novel quantitative evidence that the p-tau pathology in MTL A28 and nearby sites in CTE stage III closely follows the graded laminar patterns seen in homologous cortico-cortical connections in non-human primates. The Structural Model successfully predicted the laminar distribution of the p-tau neurofibrillary tangles and neurites and their density, based on the relative laminar (dis)similarity between the cortical origin (seed) and each connection site. The findings were validated for generalizability by a computational progression model. By contrast, the early focal perivascular pathology in the sulcal depths followed local columnar connectivity rules. These findings support the general applicability of a theoretical model to unravel the direction and progression of p-tau pathology in human neurodegeneration via a cortico-cortical mechanism. Cortical pathways converging on medial MTL help explain the progressive spread of p-tau pathology from focal cortical sites in early CTE to widespread lateral MTL areas and beyond in later disease stages.
Collapse
Affiliation(s)
- Helen Barbas
- Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA 022152
- Graduate Program in Neuroscience, Boston Univ. and School of Medicine
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
- Center for Systems Neuroscience, Boston University, Boston, MA
| | - Miguel Angel Garcia-Cabezas
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Yohan John
- Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA 022152
| | - Julied Bautista
- Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA 022152
| | - Ann McKee
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Basilis Zikopoulos
- Graduate Program in Neuroscience, Boston Univ. and School of Medicine
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
- Center for Systems Neuroscience, Boston University, Boston, MA
- Human Systems Neuroscience Laboratory, Department of Health Sciences, Boston University
| |
Collapse
|
21
|
Pszczołowska M, Walczak K, Miśków W, Antosz K, Batko J, Kurpas D, Leszek J. Chronic Traumatic Encephalopathy as the Course of Alzheimer's Disease. Int J Mol Sci 2024; 25:4639. [PMID: 38731858 PMCID: PMC11083609 DOI: 10.3390/ijms25094639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
This editorial investigates chronic traumatic encephalopathy (CTE) as a course of Alzheimer's disease (AD). CTE is a debilitating neurodegenerative disease that is the result of repeated mild traumatic brain injury (TBI). Many epidemiological studies show that experiencing a TBI in early or middle life is associated with an increased risk of dementia later in life. Chronic traumatic encephalopathy (CTE) and Alzheimer's disease (AD) present a series of similar neuropathological features that were investigated in this work like recombinant tau into filaments or the accumulation and aggregation of Aβ protein. However, these two conditions differ from each other in brain-blood barrier damage. The purpose of this review was to evaluate information about CTE and AD from various articles, focusing especially on new therapeutic possibilities for the improvement in cognitive skills.
Collapse
Affiliation(s)
- Magdalena Pszczołowska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (M.P.)
| | - Kamil Walczak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (M.P.)
| | - Weronika Miśków
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (M.P.)
| | - Katarzyna Antosz
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (M.P.)
| | - Joanna Batko
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (M.P.)
| | - Donata Kurpas
- Faculty of Health Sciences, Wroclaw Medical University, Ul. Kazimierza Bartla 5, 51-618 Wrocław, Poland
| | - Jerzy Leszek
- Clinic of Psychiatry, Department of Psychiatry, Wroclaw Medical University, Ludwika Pasteura 10, 50-367 Wrocław, Poland
| |
Collapse
|
22
|
Tanaka H, Martinez-Valbuena I, Forrest SL, Couto B, Reyes NG, Morales-Rivero A, Lee S, Li J, Karakani AM, Tang-Wai DF, Tator C, Khadadadi M, Sadia N, Tartaglia MC, Lang AE, Kovacs GG. Distinct involvement of the cranial and spinal nerves in progressive supranuclear palsy. Brain 2024; 147:1399-1411. [PMID: 37972275 PMCID: PMC10994524 DOI: 10.1093/brain/awad381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
The most frequent neurodegenerative proteinopathies include diseases with deposition of misfolded tau or α-synuclein in the brain. Pathological protein aggregates in the PNS are well-recognized in α-synucleinopathies and have recently attracted attention as a diagnostic biomarker. However, there is a paucity of observations in tauopathies. To characterize the involvement of the PNS in tauopathies, we investigated tau pathology in cranial and spinal nerves (PNS-tau) in 54 tauopathy cases [progressive supranuclear palsy (PSP), n = 15; Alzheimer's disease (AD), n = 18; chronic traumatic encephalopathy (CTE), n = 5; and corticobasal degeneration (CBD), n = 6; Pick's disease, n = 9; limbic-predominant neuronal inclusion body 4-repeat tauopathy (LNT), n = 1] using immunohistochemistry, Gallyas silver staining, biochemistry, and seeding assays. Most PSP cases revealed phosphorylated and 4-repeat tau immunoreactive tau deposits in the PNS as follows: (number of tau-positive cases/available cases) cranial nerves III: 7/8 (88%); IX/X: 10/11 (91%); and XII: 6/6 (100%); anterior spinal roots: 10/10 (100%). The tau-positive inclusions in PSP often showed structures with fibrillary (neurofibrillary tangle-like) morphology in the axon that were also recognized with Gallyas silver staining. CBD cases rarely showed fine granular non-argyrophilic tau deposits. In contrast, tau pathology in the PNS was not evident in AD, CTE and Pick's disease cases. The single LNT case also showed tau pathology in the PNS. In PSP, the severity of PNS-tau involvement correlated with that of the corresponding nuclei, although, occasionally, p-tau deposits were present in the cranial nerves but not in the related brainstem nuclei. Not surprisingly, most of the PSP cases presented with eye movement disorder and bulbar symptoms, and some cases also showed lower-motor neuron signs. Using tau biosensor cells, for the first time we demonstrated seeding capacity of tau in the PNS. In conclusion, prominent PNS-tau distinguishes PSP from other tauopathies. The morphological differences of PNS-tau between PSP and CBD suggest that the tau pathology in PNS could reflect that in the central nervous system. The high frequency and early presence of tau lesions in PSP suggest that PNS-tau may have clinical and biomarker relevance.
Collapse
Affiliation(s)
- Hidetomo Tanaka
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - Ivan Martinez-Valbuena
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - Shelley L Forrest
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Nikolai Gil Reyes
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Alonso Morales-Rivero
- University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Seojin Lee
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - Jun Li
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - Ali M Karakani
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - David F Tang-Wai
- University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario M5S 3H2, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Charles Tator
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Mozhgan Khadadadi
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Nusrat Sadia
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Maria Carmela Tartaglia
- University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario M5S 3H2, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario M5T 0S8, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario M5S 3H2, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario M5T 0S8, Canada
- Department of Medicine/Division of Neurology, University of Toronto, Toronto, Ontario M5S 3H2, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario M5T 0S8, Canada
| |
Collapse
|
23
|
Iverson GL, Gardner AJ, Castellani RJ, Kissinger-Knox A. Applying the Consensus Criteria for Traumatic Encephalopathy Syndrome Retrospectively to Case Studies of Boxers from the 20th Century. Neurotrauma Rep 2024; 5:337-347. [PMID: 38595792 PMCID: PMC11002329 DOI: 10.1089/neur.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
There are no validated diagnostic criteria for traumatic encephalopathy syndrome (TES). During the early and middle 20th century, TES was described as a clinical condition that was experienced by some high-exposure boxers-and it was believed to reflect chronic traumatic brain injury. Consensus criteria for the diagnosis of TES were published in 2021. We applied the consensus criteria for TES retrospectively to cases of chronic brain damage in boxers described in articles published in the 20th century that were obtained from narrative and systematic reviews. The sample included 157 boxers identified in 21 articles published between 1929 and 1999. Two authors reviewed each case description and coded the criteria for TES. For the core clinical features, cognitive impairment was noted in 63.1%, and in 28.7% of cases the person's cognitive functioning appeared to be broadly normal. Neurobehavioral dysregulation was present in 25.5%. One third (34.4%) were identified as progressive, 30.6% were not progressive, and the course could not be clearly determined in 35.0%. In total, 29.9% met the TES consensus criteria, 28.0% did not, and 42.0% had insufficient information to make a diagnostic determination. TES, in the 20th century, was described as a neurological condition, not a psychiatric disorder-and this supports the decision of the 2021 consensus group to remove primary and secondary psychiatric diagnoses from being a core diagnostic feature. Future research is needed to determine whether, or the extent to which, cognitive impairment or neurobehavioral dysregulation described as characterizing TES are associated with chronic traumatic encephalopathy neuropathological change.
Collapse
Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Sports Concussion Program, Mass General for Children, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, Mass General for Children, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Banks SJ, Yhang E, Tripodis Y, Su Y, Protas H, Adler CH, Balcer LJ, Bernick C, Mez JB, Palmisano J, Barr WB, Wethe JV, Dodick DW, Mcclean MD, Martin B, Hartlage K, Turner A, Turner RW, Malhotra A, Colman M, Pasternak O, Lin AP, Koerte IK, Bouix S, Cummings JL, Shenton ME, Reiman EM, Stern RA, Alosco ML. Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea. Neurol Clin Pract 2024; 14:e200263. [PMID: 38425491 PMCID: PMC10900387 DOI: 10.1212/cpj.0000000000200263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024]
Abstract
Background and Objectives Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players. Methods The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested. Results Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup. Discussion Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.
Collapse
Affiliation(s)
- Sarah J Banks
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eukyung Yhang
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yi Su
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Hillary Protas
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles H Adler
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Laura J Balcer
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles Bernick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jesse B Mez
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Joseph Palmisano
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - William B Barr
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jennifer V Wethe
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - David W Dodick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael D Mcclean
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Brett Martin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Kaitlin Hartlage
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Arlener Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert W Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Atul Malhotra
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael Colman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Ofer Pasternak
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Alexander P Lin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Inga K Koerte
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Sylvain Bouix
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey L Cummings
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Martha E Shenton
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eric M Reiman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert A Stern
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael L Alosco
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| |
Collapse
|
25
|
Shepherd CE, McCann H, McLean CA, Iverson GL, Gardner AJ. Chronic traumatic encephalopathy neuropathologic change in former Australian rugby players. Neuropathol Appl Neurobiol 2024; 50:e12972. [PMID: 38502287 DOI: 10.1111/nan.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
AIMS We applied the 2021 consensus criteria for both chronic traumatic encephalopathy neuropathological change and traumatic encephalopathy syndrome in a small case series of six former elite-level Australian rugby code players. METHODS Neuropathological assessment of these cases was carried out at the Sydney and Victorian Brain Banks. Clinical data were collected via clinical interviews and health questionnaires completed by the participants and/or their next of kin, and neuropsychological testing was conducted with participants who were capable of completing this testing. RESULTS All cases exhibited progressive cognitive impairment during life. Chronic traumatic encephalopathy neuropathological change was identified in four out of the six cases. However, coexisting neuropathologies were common, with limbic-predominant age-related TDP-43 encephalopathy and ageing-related tau astrogliopathy seen in all cases, intermediate or high Alzheimer's disease neuropathological change seen in four cases and hippocampal sclerosis seen in two of the six cases. CONCLUSION The presence of multiple neuropathologies in these cases complicates clinical diagnostic efforts for traumatic encephalopathy syndrome. It will be important for further clinicopathological studies on larger groups to report all neuropathological comorbidities found in cases diagnosed with either chronic traumatic encephalopathy neuropathological change and/or traumatic encephalopathy syndrome.
Collapse
Affiliation(s)
- Claire E Shepherd
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Heather McCann
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
- Mass General for Children Sports Concussion Program, Boston, Massachusetts, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
26
|
Yoshida K, Forrest SL, Ichimata S, Tanaka H, Kon T, Tartaglia MC, Tator CH, Lang AE, Nishida N, Kovacs GG. Revisiting the relevance of Hirano bodies in neurodegenerative diseases. Neuropathol Appl Neurobiol 2024; 50:e12978. [PMID: 38634242 DOI: 10.1111/nan.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
AIMS Hirano bodies (HBs) are eosinophilic pathological structures with two morphological phenotypes commonly found in the hippocampal CA1 region in Alzheimer's disease (AD). This study evaluated the prevalence and distribution of HBs in AD and other neurodegenerative diseases. METHODS This cross-sectional study systematically evaluated HBs in a cohort of 193 cases with major neurodegenerative diseases, including AD (n = 91), Lewy body disease (LBD, n = 87), progressive supranuclear palsy (PSP, n = 36), multiple system atrophy (MSA, n = 14) and controls (n = 26). The prevalence, number and morphology of HBs in the stratum lacunosum (HBL) and CA1 pyramidal cell layer were examined. In addition, we investigated the presence of HBs in five additional hippocampal subregions. RESULTS The morphological types of HBs in CA1 were divided into three, including a newly discovered type, and were evaluated separately, with their morphology confirmed in three dimensions: (1) classic rod-shaped HB (CHB), (2) balloon-shaped HB (BHB) and the newly described (3) string-shaped HB (SHB). The prevalence of each HB type differed between disease groups: Compared with controls, for CHB in AD, AD + LBD, PSP and corticobasal degeneration, for BHB in AD + LBD and PSP, and SHB in AD + LBD and PSP were significantly increased. Regression analysis showed that CHBs were independently associated with higher Braak NFT stage, BHBs with LBD and TDP-43 pathology, SHBs with higher Braak NFT stage, PSP and argyrophilic grain disease and HBLs with MSA. CONCLUSIONS This study demonstrates that HBs are associated with diverse neurodegenerative diseases and shows that morphological types appear distinctively in various conditions.
Collapse
Affiliation(s)
- Koji Yoshida
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Shelley L Forrest
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Dementia Research Centre, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Shojiro Ichimata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Hidetomo Tanaka
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
| | - Tomoya Kon
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Maria Carmela Tartaglia
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, Krembil Discovery Tower, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| |
Collapse
|
27
|
Butler ML, Pervaiz N, Ypsilantis P, Wang Y, Cammasola Breda J, Mazzilli S, Nicks R, Spurlock E, Hefti MM, Huber BR, Alvarez VE, Stein TD, Campbell JD, McKee AC, Cherry JD. Repetitive head impacts induce neuronal loss and neuroinflammation in young athletes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.26.586815. [PMID: 38585925 PMCID: PMC10996668 DOI: 10.1101/2024.03.26.586815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Repetitive head impacts (RHI) sustained from contact sports are the largest risk factor for chronic traumatic encephalopathy (CTE). Currently, CTE can only be diagnosed after death and the multicellular cascade of events that trigger initial hyperphosphorylated tau (p-tau) deposition remain unclear. Further, the symptoms endorsed by young individuals with early disease are not fully explained by the extent of p-tau deposition, severely hampering development of therapeutic interventions. Here, we show that RHI exposure associates with a multicellular response in young individuals (<51 years old) prior to the onset of CTE p-tau pathology that correlates with number of years of RHI exposure. Leveraging single nucleus RNA sequencing of tissue from 8 control, 9 RHI-exposed, and 11 low stage CTE individuals, we identify SPP1+ inflammatory microglia, angiogenic and inflamed endothelial cell profiles, reactive astrocytes, and altered synaptic gene expression in excitatory and inhibitory neurons in all individuals with exposure to RHI. Surprisingly, we also observe a significant loss of cortical sulcus layer 2/3 neurons in contact sport athletes compared to controls independent of p-tau pathology. These results provide robust evidence that multiple years of RHI exposure is sufficient to induce lasting cellular alterations that may underlie p-tau deposition and help explain the early clinical symptoms observed in young former contact sport athletes. Furthermore, these data identify specific cellular responses to repetitive head impacts that may direct future identification of diagnostic and therapeutic strategies for CTE.
Collapse
Affiliation(s)
- Morgane L.M.D. Butler
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
| | - Nida Pervaiz
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | - Yichen Wang
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Julia Cammasola Breda
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Sarah Mazzilli
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | | | | | - Marco M. Hefti
- Department of Pathology, University of Iowa Health Care, Iowa City IA, USA
| | - Bertrand R. Huber
- VA Boston Healthcare System, Jamaica Plain MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Victor E. Alvarez
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- VA Bedford Healthcare System, Bedford MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Joshua D. Campbell
- Section of Computational Biomedicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Jonathan D. Cherry
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Boston University Alzheimer’s Disease and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston MA
- VA Boston Healthcare System, Jamaica Plain MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| |
Collapse
|
28
|
López A, López-Muñoz S, Caballero G, Castrejon N, Rojo L, Vidal-Robau N, Muñoz A, Ortiz E, Rodrigo M, García A, Cuatrecasas M, Ribalta T, Aldecoa I. Flanagan's condensed protocol for neurodegenerative diseases. Implementation in a clinical autopsy setting with partial supervision of a neuropathologist. Virchows Arch 2024:10.1007/s00428-024-03781-0. [PMID: 38472413 DOI: 10.1007/s00428-024-03781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
The Condensed Protocol (CP) was originally developed for the evaluation of Alzheimer's Disease (AD) and other neurodegenerative diseases as a workable alternative to the complex and costly established autopsy guidelines. The study objective is to examine the degree of implementation of the CP in the pathology department of a third level university hospital in a period of 5 years. Clinical autopsies performed between 2016 and 2021 on patients aged 65 years or over and did not require a specific neuropathological examination were reviewed. Histological screening and staging of neurodegenerative diseases was performed using the original immunohistochemical stains. Out of 255 autopsies, 204 met the inclusion criteria and 190 could be reviewed. The CP was applied to 99 cases; histological signs of neurodegenerative disease were observed in 92. Sampling errors were detected in 59 cases. Immunohistochemical studies were performed in 68 cases. The diseases identified were: 31 cases of AD (12 low grade; 19 intermediate), 18 amyloid angiopathy, 15 primary age-related tauopathy, 6 argyrophilic grain disease, 3 progressive supranuclear palsy, 1 Lewy body disease (of 22 cases), and 2 limbic-predominant age TDP43 encephalopathy (of 5 cases). In 30 out of 83 cases, there was more severe vascular pathology in complete sections of frontal cortex and lentiform nucleus. The CP allows reliable detection and staging of AD and related neurodegenerative diseases in clinical autopsies. However, supervision by a neuropathologist seems necessary for a fully successful implementation of the CP in a clinical hospital setting.
Collapse
Affiliation(s)
- Aitana López
- Graduate Student. Medical School Casanova Campus, University of Barcelona, Barcelona, Spain
| | - Samuel López-Muñoz
- Pathology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Gabriela Caballero
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Natalia Castrejon
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Leonardo Rojo
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Nuria Vidal-Robau
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Abel Muñoz
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Estrella Ortiz
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Maite Rodrigo
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Adriana García
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Teresa Ribalta
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department, Biomedical Diagnostic Center, Hospital Clinic - University of Barcelona, Villarroel 170. 08036, Barcelona, Spain.
- Neurological Tissue Bank of the Biobank-FCRB/IDIBAPS, Hospital Clinic - University of Barcelona, Barcelona, Spain.
| |
Collapse
|
29
|
Su Y, Protas H, Luo J, Chen K, Alosco ML, Adler CH, Balcer LJ, Bernick C, Au R, Banks SJ, Barr WB, Coleman MJ, Dodick DW, Katz DI, Marek KL, McClean MD, McKee AC, Mez J, Daneshvar DH, Palmisano JN, Peskind ER, Turner RW, Wethe JV, Rabinovici G, Johnson K, Tripodis Y, Cummings JL, Shenton ME, Stern RA, Reiman EM. Flortaucipir tau PET findings from former professional and college American football players in the DIAGNOSE CTE research project. Alzheimers Dement 2024; 20:1827-1838. [PMID: 38134231 PMCID: PMC10984430 DOI: 10.1002/alz.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/27/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Tau is a key pathology in chronic traumatic encephalopathy (CTE). Here, we report our findings in tau positron emission tomography (PET) measurements from the DIAGNOSE CTE Research Project. METHOD We compare flortaucipir PET measures from 104 former professional players (PRO), 58 former college football players (COL), and 56 same-age men without exposure to repetitive head impacts (RHI) or traumatic brain injury (unexposed [UE]); characterize their associations with RHI exposure; and compare players who did or did not meet diagnostic criteria for traumatic encephalopathy syndrome (TES). RESULTS Significantly elevated flortaucipir uptake was observed in former football players (PRO+COL) in prespecified regions (p < 0.05). Association between regional flortaucipir uptake and estimated cumulative head impact exposure was only observed in the superior frontal region in former players over 60 years old. Flortaucipir PET was not able to differentiate TES groups. DISCUSSION Additional studies are needed to further understand tau pathology in CTE and other individuals with a history of RHI.
Collapse
Affiliation(s)
- Yi Su
- Banner Alzheimer's Institute and Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
| | - Hillary Protas
- Banner Alzheimer's Institute and Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
| | - Ji Luo
- Banner Alzheimer's Institute and Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
| | - Kewei Chen
- Banner Alzheimer's Institute and Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
| | - Michael L. Alosco
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Charles H. Adler
- Department of NeurologyMayo Clinic College of Medicine, Mayo Clinic ArizonaScottsdaleArizonaUSA
| | - Laura J. Balcer
- Departments of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
- Department of Population Health and OphthalmologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain HealthLas VegasNevadaUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Rhoda Au
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Slone Epidemiology Center; Departments of Anatomy & Neurobiology, Neurology, and MedicineDepartment of EpidemiologyBoston University Chobanian & Avedisian School of Medicine; Boston University School of Public HealthBostonMassachusettsUSA
| | - Sarah J. Banks
- Departments of Neuroscience and PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - William B. Barr
- Departments of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Michael J. Coleman
- Departments of Psychiatry and RadiologyPsychiatry Neuroimaging LaboratoryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - David W. Dodick
- Department of NeurologyMayo Clinic College of Medicine, Mayo Clinic ArizonaScottsdaleArizonaUSA
| | - Douglas I. Katz
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Encompass Health Braintree Rehabilitation HospitalBraintreeMassachusettsUSA
| | - Kenneth L. Marek
- Institute for Neurodegenerative Disorders, Invicro, LLCNew HavenConnecticutUSA
| | - Michael D. McClean
- Department of Environmental HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Ann C. McKee
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Jesse Mez
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
| | - Daniel H. Daneshvar
- Department of Physical Medicine & RehabilitationMassachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Joseph N. Palmisano
- Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public HealthBostonMassachusettsUSA
| | - Elaine R. Peskind
- Department of Psychiatry and Behavioral SciencesVA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System; University of Washington School of MedicineSeattleWashingtonUSA
| | - Robert W. Turner
- Department of Clinical Research & LeadershipThe George Washington University School of Medicine & Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Jennifer V. Wethe
- Department of Psychiatry and PsychologyMayo Clinic School of Medicine, Mayo Clinic ArizonaScottsdaleArizonaUSA
| | - Gil Rabinovici
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Keith Johnson
- Gordon Center for Medical Imaging, Mass General Research Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Yorghos Tripodis
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Jeffrey L. Cummings
- Department of Brain HealthChambers‐Grundy Center for Transformative NeuroscienceSchool of Integrated Health Sciences, University of Nevada Las VegasLas VegasNevadaUSA
| | - Martha E. Shenton
- Departments of Psychiatry and RadiologyPsychiatry Neuroimaging LaboratoryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Robert A. Stern
- Department of NeurologyBoston University Alzheimer's Disease Research CenterBoston University CTE CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Eric M. Reiman
- Banner Alzheimer's Institute and Arizona Alzheimer's ConsortiumPhoenixArizonaUSA
- University of Arizona, Arizona State University, Translational Genomics Research InstitutePhoenixArizonaUSA
| | | |
Collapse
|
30
|
Alexander A, Alvarez VE, Huber BR, Alosco ML, Mez J, Tripodis Y, Nicks R, Katz DI, Dwyer B, Daneshvar DH, Martin B, Palmisano J, Goldstein LE, Crary JF, Nowinski C, Cantu RC, Kowall NW, Stern RA, Delalle I, McKee AC, Stein TD. Cortical-sparing chronic traumatic encephalopathy (CSCTE): a distinct subtype of CTE. Acta Neuropathol 2024; 147:45. [PMID: 38407651 PMCID: PMC11348287 DOI: 10.1007/s00401-024-02690-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive head impacts (RHI) and pathologically defined as neuronal phosphorylated tau aggregates around small blood vessels and concentrated at sulcal depths. Cross-sectional studies suggest that tau inclusions follow a stereotyped pattern that begins in the neocortex in low stage disease, followed by involvement of the medial temporal lobe and subcortical regions with significant neocortical burden in high stage CTE. Here, we define a subset of brain donors with high stage CTE and with a low overall cortical burden of tau inclusions (mean semiquantitative value ≤1) and classify them as cortical-sparing CTE (CSCTE). Of 620 brain donors with pathologically diagnosed CTE, 66 (11%) met criteria for CSCTE. Compared to typical high stage CTE, those with CSCTE had a similar age at death and years of contact sports participation and were less likely to carry apolipoprotein ε4 (p < 0.05). CSCTE had less overall tau pathology severity, but a proportional increase of disease burden in medial temporal lobe and brainstem regions compared to the neocortex (p's < 0.001). CSCTE also had lower prevalence of comorbid neurodegenerative disease. Clinically, CSCTE participants were less likely to have dementia (p = 0.023) and had less severe cognitive difficulties (as reported by informants using the Functional Activities Questionnaire (FAQ); p < 0.001, meta-cognitional index T score; p = 0.002 and Cognitive Difficulties Scale (CDS); p < 0.001,) but had an earlier onset age of behavioral (p = 0.006) and Parkinsonian motor (p = 0.013) symptoms when compared to typical high stage CTE. Other comorbid tauopathies likely contributed in part to these differences: when cases with concurrent Alzheimer dementia or frontal temporal lobar degeneration with tau pathology were excluded, differences were largely retained, but only remained significant for FAQ (p = 0.042), meta-cognition index T score (p = 0.014) and age of Parkinsonian motor symptom onset (p = 0.046). Overall, CSCTE appears to be a distinct subtype of high stage CTE with relatively greater involvement of subcortical and brainstem regions and less severe cognitive symptoms.
Collapse
Affiliation(s)
- Abigail Alexander
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Bertrand R Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Raymond Nicks
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Douglas I Katz
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Palmisano
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - John F Crary
- Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence and Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Nowinski
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ivana Delalle
- Division of Neuropathology, Lifespan Academic Medical Center, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- VA Bedford Healthcare System, Bedford, MA, USA.
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
- Departments of Pathology and Laboratory Medicine, Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- , 150 S. Huntington Avenue, Boston, MA, 02130, USA.
| |
Collapse
|
31
|
Taskina D, Zhu C, Schwab N, Hazrati LN. Brain pathology and symptoms linked to concussion history: beyond chronic traumatic encephalopathy. Brain Commun 2024; 6:fcad314. [PMID: 38560515 PMCID: PMC10977958 DOI: 10.1093/braincomms/fcad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/13/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Repeated head trauma acquired through sports injuries has been associated with the development of long-term disabling symptoms that negatively impact the quality of life. In this retrospective case series, 52 male former professional athletes involved in contact sports and with a history of multiple concussions were evaluated for chronic clinical symptoms and post-mortem neuropathological diagnoses. The clinical symptoms of 19 cases were examined in greater detail for symptom type, severity and duration. Information on neurological, psychiatric and physical symptoms, substance use profiles and concussion histories was obtained from the athletes' next of kin and assessed in relation to post-mortem neuropathological diagnoses. Cases were categorized into three different neuropathological groups: no major neuropathological findings, the presence of only chronic traumatic encephalopathy (CTE) and the diagnosis(es) of other neurodegenerative diseases. Age at death and the presence of DNA damage in the post-mortem brains were analysed for correlation with the clinical symptoms. In this case series, 14/52 (26.9%) cases (mean age 48.2 ± 11.4) had neuropathological evidence of low-stage/low-burden CTE. A total of 11/52 (21.2%) cases (mean age 38.7 ± 12.7) presented a similar profile and severity of behavioural symptoms to those with CTE, despite the lack of significant post-mortem neuropathological findings. A total of 27/52 (51.9%) cases (mean age 75.5 ± 8.7) presented with complex post-mortem neurodegenerative diagnoses, including Alzheimer's disease and other mixed pathologies, and clinical symptoms associated with language, memory and sensory dysfunction. The presence of DNA damage in the brain was found in all neuropathological groups, predominantly in the ependymal lining of ventricles, and phosphorylated histone H2AX staining was correlated with higher age at death (r = 0.59) and symptoms of language dysfunction (r = 0.56). Findings from our case series suggest that post-concussive symptoms are not driven by CTE. Our findings show that proteinopathies alone may not account for the complexity of the clinical manifestations and suggest the possibility of other drivers, such as DNA damage, as potentially useful markers of brain trauma. Broadening the search for biological markers that reflect the effects of brain injury, even when proteinopathy is not observed, and taking a symptom-driven approach are therefore advised.
Collapse
Affiliation(s)
- Daria Taskina
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Cherrie Zhu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Nicole Schwab
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Lili-Naz Hazrati
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| |
Collapse
|
32
|
van Amerongen S, Pulukuri SV, Tuz-Zahra F, Tripodis Y, Cherry JD, Bernick C, Geda YE, Wethe JV, Katz DI, Alosco ML, Adler CH, Balcer LJ, Ashton NJ, Blennow K, Zetterberg H, Daneshvar DH, Colasurdo EA, Iliff JJ, Li G, Peskind ER, Shenton ME, Reiman EM, Cummings JL, Stern RA. Inflammatory biomarkers for neurobehavioral dysregulation in former American football players: findings from the DIAGNOSE CTE Research Project. J Neuroinflammation 2024; 21:46. [PMID: 38336728 PMCID: PMC10854026 DOI: 10.1186/s12974-024-03034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Traumatic encephalopathy syndrome (TES) is defined as the clinical manifestation of the neuropathological entity chronic traumatic encephalopathy (CTE). A core feature of TES is neurobehavioral dysregulation (NBD), a neuropsychiatric syndrome in repetitive head impact (RHI)-exposed individuals, characterized by a poor regulation of emotions/behavior. To discover biological correlates for NBD, we investigated the association between biomarkers of inflammation (interleukin (IL)-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α) in cerebrospinal fluid (CSF) and NBD symptoms in former American football players and unexposed individuals. METHODS Our cohort consisted of former American football players, with (n = 104) or without (n = 76) NBD diagnosis, as well as asymptomatic unexposed individuals (n = 55) from the DIAGNOSE CTE Research Project. Specific measures for NBD were derived (i.e., explosivity, emotional dyscontrol, impulsivity, affective lability, and a total NBD score) from a factor analysis of multiple self-report neuropsychiatric measures. Analyses of covariance tested differences in biomarker concentrations between the three groups. Within former football players, multivariable linear regression models assessed relationships among log-transformed inflammatory biomarkers, proxies for RHI exposure (total years of football, cumulative head impact index), and NBD factor scores, adjusted for relevant confounding variables. Sensitivity analyses tested (1) differences in age subgroups (< 60, ≥ 60 years); (2) whether associations could be identified with plasma inflammatory biomarkers; (3) associations between neurodegeneration and NBD, using plasma neurofilament light (NfL) chain protein; and (4) associations between biomarkers and cognitive performance to explore broader clinical symptoms related to TES. RESULTS CSF IL-6 was higher in former American football players with NBD diagnosis compared to players without NBD. Furthermore, elevated levels of CSF IL-6 were significantly associated with higher emotional dyscontrol, affective lability, impulsivity, and total NBD scores. In older football players, plasma NfL was associated with higher emotional dyscontrol and impulsivity, but also with worse executive function and processing speed. Proxies for RHI exposure were not significantly associated with biomarker concentrations. CONCLUSION Specific NBD symptoms in former American football players may result from multiple factors, including neuroinflammation and neurodegeneration. Future studies need to unravel the exact link between NBD and RHI exposure, including the role of other pathophysiological pathways.
Collapse
Affiliation(s)
- Suzan van Amerongen
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Surya V Pulukuri
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Fatima Tuz-Zahra
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jonathan D Cherry
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Yonas E Geda
- Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Jennifer V Wethe
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Douglas I Katz
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Michael L Alosco
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Colasurdo
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
| | - Jeffrey J Iliff
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Gail Li
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System Geriatric Research, Seattle, WA, USA
| | - Elaine R Peskind
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Robert A Stern
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| |
Collapse
|
33
|
Saltiel N, Tripodis Y, Menzin T, Olaniyan A, Baucom Z, Yhang E, Palmisano JN, Martin B, Uretsky M, Nair E, Abdolmohammadi B, Shah A, Nicks R, Nowinski C, Cantu RC, Daneshvar DH, Dwyer B, Katz DI, Stern RA, Alvarez V, Huber B, Boyle PA, Schneider JA, Mez J, McKee A, Alosco ML, Stein TD. Relative Contributions of Mixed Pathologies to Cognitive and Functional Symptoms in Brain Donors Exposed to Repetitive Head Impacts. Ann Neurol 2024; 95:314-324. [PMID: 37921042 PMCID: PMC10842014 DOI: 10.1002/ana.26823] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Exposure to repetitive head impacts (RHI) is associated with later-life cognitive symptoms and neuropathologies, including chronic traumatic encephalopathy (CTE). Cognitive decline in community cohorts is often due to multiple pathologies; however, the frequency and contributions of these pathologies to cognitive impairment in people exposed to RHI are unknown. Here, we examined the relative contributions of 13 neuropathologies to cognitive symptoms and dementia in RHI-exposed brain donors. METHODS Neuropathologists examined brain tissue from 571 RHI-exposed donors and assessed for the presence of 13 neuropathologies, including CTE, Alzheimer disease (AD), Lewy body disease (LBD), and transactive response DNA-binding protein 43 (TDP-43) inclusions. Cognitive status was assessed by presence of dementia, Functional Activities Questionnaire, and Cognitive Difficulties Scale. Spearman rho was calculated to assess intercorrelation of pathologies. Additionally, frequencies of pathological co-occurrence were compared to a simulated distribution assuming no intercorrelation. Logistic and linear regressions tested associations between neuropathologies and dementia status and cognitive scale scores. RESULTS The sample age range was 18-97 years (median = 65.0, interquartile range = 46.0-76.0). Of the donors, 77.2% had at least one moderate-severe neurodegenerative or cerebrovascular pathology. Stage III-IV CTE was the most common neurodegenerative disease (43.1%), followed by TDP-43 pathology, AD, and hippocampal sclerosis. Neuropathologies were intercorrelated, and there were fewer unique combinations than expected if pathologies were independent (p < 0.001). The greatest contributors to dementia were AD, neocortical LBD, hippocampal sclerosis, cerebral amyloid angiopathy, and CTE. INTERPRETATION In this sample of RHI-exposed brain donors with wide-ranging ages, multiple neuropathologies were common and correlated. Mixed neuropathologies, including CTE, underlie cognitive impairment in contact sport athletes. ANN NEUROL 2024;95:314-324.
Collapse
Affiliation(s)
- Nicole Saltiel
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Talia Menzin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Aliyah Olaniyan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Zach Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Eukyung Yhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N. Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Evan Nair
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Arsal Shah
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | - Raymond Nicks
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
| | | | - Robert C. Cantu
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, USA
| | - Daniel H. Daneshvar
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Brigid Dwyer
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor Alvarez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Bertrand Huber
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Jesse Mez
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ann McKee
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Research Center and CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, U.S. Department of Veteran Affairs, Bedford, MA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| |
Collapse
|
34
|
Ly MT, Tuz-Zahra F, Tripodis Y, Adler CH, Balcer LJ, Bernick C, Zetterberg H, Blennow K, Peskind ER, Au R, Banks SJ, Barr WB, Wethe JV, Bondi MW, Delano-Wood LM, Cantu RC, Coleman MJ, Dodick DW, McClean MD, Mez JB, Palmisano J, Martin B, Hartlage K, Lin AP, Koerte IK, Cummings JL, Reiman EM, Shenton ME, Stern RA, Bouix S, Alosco ML. Association of Vascular Risk Factors and CSF and Imaging Biomarkers With White Matter Hyperintensities in Former American Football Players. Neurology 2024; 102:e208030. [PMID: 38165330 PMCID: PMC10870736 DOI: 10.1212/wnl.0000000000208030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recent data link exposure to repetitive head impacts (RHIs) from American football with increased white matter hyperintensity (WMH) burden. WMH might have unique characteristics in the context of RHI beyond vascular risk and normal aging processes. We evaluated biological correlates of WMH in former American football players, including markers of amyloid, tau, inflammation, axonal injury, neurodegeneration, and vascular health. METHODS Participants underwent clinical interviews, MRI, and lumbar puncture as part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project. Structural equation modeling tested direct and indirect effects between log-transformed total fluid-attenuated inversion recovery (FLAIR) lesion volumes (TLV) and the revised Framingham stroke risk profile (rFSRP), MRI-derived global metrics of cortical thickness and fractional anisotropy (FA), and CSF levels of amyloid β1-42, p-tau181, soluble triggering receptor expressed on myeloid cells 2 (sTREM2), and neurofilament light. Covariates included age, race, education, body mass index, APOE ε4 carrier status, and evaluation site. Models were performed separately for former football players and a control group of asymptomatic men unexposed to RHI. RESULTS In 180 former football players (mean age = 57.2, 36% Black), higher log(TLV) had direct associations with the following: higher rFSRP score (B = 0.26, 95% CI 0.07-0.40), higher p-tau181 (B = 0.17, 95% CI 0.01-0.43), lower FA (B = -0.28, 95% CI -0.42 to -0.13), and reduced cortical thickness (B = -0.25, 95% CI -0.45 to -0.08). In 60 asymptomatic unexposed men (mean age = 59.3, 40% Black), there were no direct effects on log(TLV) (rFSRP: B = -0.03, 95% CI -0.48 to 0.57; p-tau181: B = -0.30, 95% CI -1.14 to 0.37; FA: B = -0.07, 95% CI -0.48 to 0.42; or cortical thickness: B = -0.28, 95% CI -0.64 to 0.10). The former football players showed stronger associations between log(TLV) and rFSRP (1,069% difference in estimates), p-tau181 (158%), and FA (287%) than the unexposed men. DISCUSSION Risk factors and biological correlates of WMH differed between former American football players and asymptomatic unexposed men. In addition to vascular health, p-tau181 and diffusion tensor imaging indices of white matter integrity showed stronger associations with WMH in the former football players. FLAIR WMH may have specific risk factors and pathologic underpinnings in RHI-exposed individuals.
Collapse
Affiliation(s)
- Monica T Ly
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Fatima Tuz-Zahra
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Yorghos Tripodis
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Charles H Adler
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Laura J Balcer
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Charles Bernick
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Henrik Zetterberg
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Kaj Blennow
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Elaine R Peskind
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Rhoda Au
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Sarah J Banks
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - William B Barr
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jennifer V Wethe
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Mark W Bondi
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Lisa M Delano-Wood
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Robert C Cantu
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael J Coleman
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - David W Dodick
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael D McClean
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jesse B Mez
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Joseph Palmisano
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Brett Martin
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Kaitlin Hartlage
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Alexander P Lin
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Inga K Koerte
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Jeffrey L Cummings
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Eric M Reiman
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Martha E Shenton
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Robert A Stern
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Sylvain Bouix
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| | - Michael L Alosco
- From the VA San Diego Healthcare System (M.T.L., M.W.B., L.M.D.-W.), CA; Department of Psychiatry (M.T.L., S.J.B., M.W.B., L.M.D.-W.), University of California San Diego Health, La Jolla; Departments of Biostatistics (F.T.-Z., Y.T.), Epidemiology (R.A.), Environmental Health (M.D.M.), Biostatistics and Epidemiology Data Analytics Center (J.P., B.M., K.H.), Boston University School of Public Health, MA; Boston University Alzheimer's Disease Research Center (Y.T., J.B.M., M.L.A., R.A., R.C.C., R.A.S.), Boston University CTE Center; Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Departments of Neurology (C.H.A., D.W.D.) and Psychiatry and Psychology (J.V.W.), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (L.J.B.), Population Health and Ophthalmology, (L.J.B.), and Neurology (W.B.B.), NYU Grossman School of Medicine; Cleveland Clinic Lou Ruvo Center for Brain Health (C.B.), Las Vegas, NV; Department of Neurology (C.B.), University of Washington, Seattle; Department of Neurodegenerative Disease (H.Z.), and UK Dementia Research Institute (H.Z.), University College London Institute of Neurology, UK; Hong Kong Center for Neurodegenerative Diseases (H.Z.), China; Wisconsin Alzheimer's Disease Research Center (H.Z.), University of Wisconsin-Madison; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg; Department of Psychiatry and Neurochemistry (K.B.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden; VA Northwest Mental Illness Research, Education, and Clinical Center (E.R.P.), Seattle, WA; Department of Psychiatry and Behavioral Sciences (E.R.P.), University of Washington School of Medicine, Seattle; Framingham Heart Study (R.A., J.B.M.); Slone Epidemiology Center (R.A.), Boston University, MA; Department of Neurosciences (S.J.B.), University of California San Diego; Psychiatry Neuroimaging Laboratory (M.J.C., A.P.L., I.K.K., M.E.S., S.B.), Departments of Psychiatry Radiology (M.E.S.), and Center for Clinical Spectroscopy (A.P.L.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (I.K.K.), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwigs-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (J.L.C.), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Banner Alzheimer's Institute (E.M.R.), Phoenix; Department of Psychiatry (E.M.R.), University of Arizona, Phoenix; Arizona State University (E.M.R.), Phoenix; Translational Genomics Research Institute (E.M.R.), Phoenix; Arizona Alzheimer's Consortium (E.M.R.), Phoenix; and Department of Software Engineering and Information Technology (S.B.), École de technologie supérieure, Université du Québec, Montréal, Canada
| |
Collapse
|
35
|
Grandizoli Saletti P, Casillas-Espinosa PM, Panagiotis Lisgaras C, Bi Mowrey W, Li Q, Liu W, Brady RD, Ali I, Silva J, Yamakawa G, Hudson M, Li C, Braine EL, Coles L, Cloyd JC, Jones NC, Shultz SR, Moshé SL, O'Brien TJ, Galanopoulou AS. Tau Phosphorylation Patterns in the Rat Cerebral Cortex After Traumatic Brain Injury and Sodium Selenate Effects: An Epibios4rx Project 2 Study. J Neurotrauma 2024; 41:222-243. [PMID: 36950806 PMCID: PMC11079442 DOI: 10.1089/neu.2022.0219] [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] [Indexed: 03/24/2023] Open
Abstract
Sodium selenate (SS) activates protein phosphatase 2 (PP2A) and reduces phosphorylated tau (pTAU) and late post-traumatic seizures after lateral fluid percussion injury (LFPI). In EpiBioS4Rx Project 2, a multi-center international study for post-traumatic targets, biomarkers, and treatments, we tested the target relevance and modification by SS of pTAU forms and PP2A and in the LFPI model, at two sites: Einstein and Melbourne. In Experiment 1, adult male rats were assigned to LFPI and sham (both sites) and naïve controls (Einstein). Motor function was monitored by neuroscores. Brains were studied with immunohistochemistry (IHC), Western blots (WBs), or PP2A activity assay, from 2 days to 8 weeks post-operatively. In Experiment 2, LFPI rats received SS for 7 days (SS0.33: 0.33 mg/kg/day; SS1: 1 mg/kg/day, subcutaneously) or vehicle (Veh) post-LFPI and pTAU, PR55 expression, or PP2A activity were studied at 2 days and 1 week (on treatment), or 2 weeks (1 week off treatment). Plasma selenium and SS levels were measured. In Experiment 1 IHC, LFPI rats had higher cortical pTAU-Ser202/Thr205-immunoreactivity (AT8-ir) and pTAU-Ser199/202-ir at 2 days, and pTAU-Thr231-ir (AT180-ir) at 2 days, 2 weeks, and 8 weeks, ipsilaterally to LFPI, than controls. LFPI-2d rats also had higher AT8/total-TAU5-ir in cortical extracts ipsilateral to the lesion (WB). PP2A (PR55-ir) showed time- and region-dependent changes in IHC, but not in WB. PP2A activity was lower in LFPI-1wk than in sham rats. In Experiment 2, SS did not affect neuroscores or cellular AT8-ir, AT180-ir, or PR55-ir in IHC. In WB, total cortical AT8/total-TAU-ir was lower in SS0.33 and SS1 LFPI rats than in Veh rats (2 days, 1 week); total cortical PR55-ir (WB) and PP2A activity were higher in SS1 than Veh rats (2 days). SS dose dependently increased plasma selenium and SS levels. Concordant across-sites data confirm time and pTAU form-specific cortical increases ipsilateral to LFPI. The discordant SS effects may either suggest SS-induced reduction in the numbers of cells with increased pTAU-ir, need for longer treatment, or the involvement of other mechanisms of action.
Collapse
Affiliation(s)
- Patricia Grandizoli Saletti
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
| | - Pablo M. Casillas-Espinosa
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Christos Panagiotis Lisgaras
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
| | - Wenzhu Bi Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx New York, USA
| | - Qianyun Li
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
| | - Wei Liu
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
| | - Rhys D. Brady
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Idrish Ali
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Juliana Silva
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Glenn Yamakawa
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Matt Hudson
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Crystal Li
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Emma L. Braine
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Lisa Coles
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - James C. Cloyd
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Nigel C. Jones
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Solomon L. Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
- Isabelle Rapin Division of Child Neurology, Albert Einstein College of Medicine, Bronx New York, USA
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx New York, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx New York, USA
| | - Terence J. O'Brien
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx New York, USA
- Isabelle Rapin Division of Child Neurology, Albert Einstein College of Medicine, Bronx New York, USA
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx New York, USA
| |
Collapse
|
36
|
Walsh M, Uretsky M, Tripodis Y, Nowinski CJ, Rasch A, Bruce H, Ryder M, Martin BM, Palmisano JN, Katz DI, Dwyer B, Daneshvar DH, Walley AY, Kim TW, Goldstein LE, Stern RA, Alvarez VE, Huber BR, McKee AC, Stein TD, Mez J, Alosco ML. Clinical and Neuropathological Correlates of Substance Use in American Football Players. J Alzheimers Dis 2024; 101:971-986. [PMID: 39269838 DOI: 10.3233/jad-240300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy more frequently found in deceased former football players. CTE has heterogeneous clinical presentations with multifactorial causes. Previous literature has shown substance use (alcohol/drug) can contribute to Alzheimer's disease and related tauopathies pathologically and clinically. Objective To examine the association between substance use and clinical and neuropathological endpoints of CTE. Methods Our sample included 429 deceased male football players. CTE was neuropathologically diagnosed. Informant interviews assessed features of substance use and history of treatment for substance use to define indicators: history of substance use treatment (yes vs no, primary variable), alcohol severity, and drug severity. Outcomes included scales that were completed by informants to assess cognition (Cognitive Difficulties Scale, BRIEF-A Metacognition Index), mood (Geriatric Depression Scale-15), behavioral regulation (BRIEF-A Behavioral Regulation Index, Barratt Impulsiveness Scale-11), functional ability (Functional Activities Questionnaire), as well as CTE status and cumulative p-tau burden. Regression models tested associations between substance use indicators and outcomes. Results Of the 429 football players (mean age = 62.07), 313 (73%) had autopsy confirmed CTE and 100 (23%) had substance use treatment history. Substance use treatment and alcohol/drug severity were associated with measures of behavioral regulation (FDR-p-values<0.05, ΔR2 = 0.04-0.18) and depression (FDR-p-values<0.05, ΔR2 = 0.02-0.05). Substance use indicators had minimal associations with cognitive scales, whereas p-tau burden was associated with all cognitive scales (p-values <0.05). Substance use treatment had no associations with neuropathological endpoints (FDR-p-values>0.05). Conclusions Among deceased football players, substance use was common and associated with clinical symptoms.
Collapse
Affiliation(s)
- Michael Walsh
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Christopher J Nowinski
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Abigail Rasch
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Hannah Bruce
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Megan Ryder
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brett M Martin
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Douglas I Katz
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Theresa W Kim
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lee E Goldstein
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - Robert A Stern
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bertrand Russell Huber
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
| | - Ann C McKee
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| |
Collapse
|
37
|
Nader S, Karlovich E, Cortes EP, Insausti R, Meloni G, Jacobs M, Crary JF, Morgello S. Predictors of hippocampal tauopathy in people with and at risk for human immunodeficiency virus infection. J Neurovirol 2023; 29:647-657. [PMID: 37926797 DOI: 10.1007/s13365-023-01181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Combination antiretroviral therapy (cART) has extended lifespans of people living with HIV (PWH), increasing both the risk for age-related neuropathologies and the importance of distinguishing effects of HIV and its comorbidities from neurodegenerative disorders. The accumulation of hyperphosphorylated tau (p-tau) in hippocampus is a common degenerative change, with specific patterns of hippocampal subfield vulnerability observed in different disease contexts. Currently, associations between chronic HIV, its comorbidities, and p-tau burden and distribution in the hippocampus are unexplored. We used immunohistochemistry with antibody AT8 to analyze hippocampal p-tau in brain tissues of PWH (n = 71) and HIV negative controls (n = 25), for whom comprehensive clinical data were available. Using a morphology-based neuroanatomical segmentation protocol, we annotated digital slide images to measure percentage p-tau areas in the hippocampus and its subfields. Factors predicting p-tau burden and distribution were identified in univariate analyses, and those with significance at p ≤ 0.100 were advanced to multivariable regression. The patient sample had a mean age of 61.5 years. Age predicted overall hippocampal p-tau burden. Subfield p-tau predictors were for Cornu Ammonis (CA)1, age; for CA2 and subiculum, seizure history; for CA3, seizure history and head trauma; and for CA4/dentate, history of hepatitis C virus (HCV) infection. In this autopsy sample, hippocampal p-tau burden and distribution were not predicted by HIV, viral load, or immunologic status, with viral effects limited to associations between HCV and CA4/dentate vulnerability. Hippocampal p-tau pathologies in cART-era PWH appear to reflect age and comorbidities, but not direct effects of HIV infection.
Collapse
Affiliation(s)
- Sophie Nader
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esma Karlovich
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Etty P Cortes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo Insausti
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA
| | - Gregory Meloni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Jacobs
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John F Crary
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Susan Morgello
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Icahn Building 9th Floor, Room 20A, 1425 Madison Avenue, 10029, New York, NY, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
38
|
Stewart W, Buckland ME, Abdolmohammadi B, Affleck AJ, Alvarez VE, Gilchrist S, Huber BR, Lee EB, Lyall DM, Nowinski CJ, Russell ER, Stein TD, Suter CM, McKee AC. Risk of chronic traumatic encephalopathy in rugby union is associated with length of playing career. Acta Neuropathol 2023; 146:829-832. [PMID: 37872234 PMCID: PMC10627955 DOI: 10.1007/s00401-023-02644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Affiliation(s)
- William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK.
- Department of Neuropathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Bobak Abdolmohammadi
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Victor E Alvarez
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Shannon Gilchrist
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Bertrand R Huber
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christopher J Nowinski
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
| | - Emma R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Thor D Stein
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Ann C McKee
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| |
Collapse
|
39
|
Byard R, Tiemensma M, Buckland ME, Vink R. Chronic traumatic encephalopathy (CTE)-features and forensic considerations. Forensic Sci Med Pathol 2023; 19:620-624. [PMID: 37058211 PMCID: PMC10752833 DOI: 10.1007/s12024-023-00624-3] [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: 03/28/2023] [Indexed: 04/15/2023]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative condition, in which the only known cause is exposure to repeated episodes of blunt head trauma. It most often occurs in professional and amateur athletes who have had frequent and repetitive cranial impacts during contact sports, but may also be found in victims of domestic violence, military personnel exposed to explosive devices and in individuals with severe epilepsy. The pathognomonic pathological findings are of neurofibrillary tangles and pretangles in the depths of the cerebral sulci caused by perivascular accumulation of phosphorylated Tau (pTau). Cases may be high profile requiring an evaluation of whether the neuropathological findings of CTE can be related to injuries previously sustained on the sporting field. Failure to examine the brain or to adequately sample appropriate areas at autopsy may lead to cases being overlooked and to an underestimation of the incidence of this condition in the community. Performing immunohistochemical staining for pTau in three areas from the neocortex has been found to be a useful screening tool for CTE. Ascertaining whether there is a history of head trauma, including exposure to contact sports, as a standard part of forensic clinical history protocols will help identify at-risk individuals so that Coronial consideration of the need for brain examination can be appropriately informed. Repetitive head trauma, particularly from contact sport, is being increasingly recognized as a cause of significant preventable neurodegeneration.
Collapse
Affiliation(s)
- Roger Byard
- Adelaide School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, 5005, Adelaide, SA, Australia.
- Forensic Science South Australia, 5000, Adelaide, SA, Australia.
| | - Marianne Tiemensma
- Forensic Pathology Unit, Royal Darwin Hospital, 0800, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, 5042, Bedford Park, SA, Australia
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, 2050, Camperdown, NSW, Australia
| | - Robert Vink
- Clinical and Health Sciences, University of South Australia, 5001, Adelaide, SA, Australia
| |
Collapse
|
40
|
Dams-O'Connor K, Seifert AC, Crary JF, Delman BN, Del Bigio MR, Kovacs GG, Lee EB, Nolan AL, Pruyser A, Selmanovic E, Stewart W, Woodoff-Leith E, Folkerth RD. The neuropathology of intimate partner violence. Acta Neuropathol 2023; 146:803-815. [PMID: 37897548 PMCID: PMC10627910 DOI: 10.1007/s00401-023-02646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd-8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd-9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.
Collapse
Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan C Seifert
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - John F Crary
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Marc R Del Bigio
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, Room 401 Brodie Centre, 727 McDermot Avenue, Winnipeg, MB, Canada
- Diagnostic Services - Pathology, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND) and Department of Laboratory Medicine and Pathobiology, Krembil Discovery Tower, University of Toronto, 60 Leonard Ave, Toronto, ON, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Ariel Pruyser
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Enna Selmanovic
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Stewart
- Department of Neuropathology, Elizabeth University Hospital, Glasgow, G514TF, Queen, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G128QQ, UK
| | - Emma Woodoff-Leith
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Rebecca D Folkerth
- Office of Chief Medical Examiner, 520 First Avenue, New York, NY, 10116, USA.
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
41
|
Stern RA, Trujillo-Rodriguez D, Tripodis Y, Pulukuri SV, Alosco ML, Adler CH, Balcer LJ, Bernick C, Baucom Z, Marek KL, McClean MD, Johnson KA, McKee AC, Stein TD, Mez J, Palmisano JN, Cummings JL, Shenton ME, Reiman EM. Amyloid PET across the cognitive spectrum in former professional and college American football players: findings from the DIAGNOSE CTE Research Project. Alzheimers Res Ther 2023; 15:166. [PMID: 37798671 PMCID: PMC10552261 DOI: 10.1186/s13195-023-01315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Exposure to repetitive head impacts (RHI) in American football players can lead to cognitive impairment and dementia due to neurodegenerative disease, particularly chronic traumatic encephalopathy (CTE). The pathognomonic lesion of CTE consists of perivascular aggregates of hyper-phosphorylated tau in neurons at the depths of cortical sulci. However, it is unclear whether exposure to RHI accelerates amyloid-β (Aβ) plaque formation and increases the risk for Alzheimer's disease (AD). Although the Aβ neuritic plaques characteristic of AD are observed in a minority of later-stage CTE cases, diffuse plaques are more common. This study examined whether former professional and college American football players, including those with cognitive impairment and dementia, have elevated neuritic Aβ plaque density, as measured by florbetapir PET. Regardless of cognitive and functional status, elevated levels of florbetapir uptake were not expected. METHODS We examined 237 men ages 45-74, including 119 former professional (PRO) and 60 former college (COL) football players, with and without cognitive impairment and dementia, and 58 same-age men without a history of contact sports or TBI (unexposed; UE) and who denied cognitive or behavioral symptoms at telephone screening. Former players were categorized into four diagnostic groups: normal cognition, subjective memory impairment, mild cognitive impairment, and dementia. Positive florbetapir PET was defined by cortical-cerebellar average SUVR of ≥ 1.10. Multivariable linear regression and analysis of covariance (ANCOVA) compared florbetapir average SUVR across diagnostic and exposure groups. Multivariable logistic regression compared florbetapir positivity. Race, education, age, and APOE4 were covariates. RESULTS There were no diagnostic group differences either in florbetapir average SUVR or the proportion of elevated florbetapir uptake. Average SUVR means also did not differ between exposure groups: PRO-COL (p = 0.94, 95% C.I. = [- 0.033, 0.025]), PRO-UE (p = 0.40, 95% C.I. = [- 0.010, 0.029]), COL-UE (p = 0.36, 95% CI = [0.0004, 0.039]). Florbetapir was not significantly associated with years of football exposure, cognition, or daily functioning. CONCLUSIONS Cognitive impairment in former American football players is not associated with PET imaging of neuritic Aβ plaque deposition. These findings are inconsistent with a neuropathological diagnosis of AD in individuals with substantial RHI exposure and have both clinical and medico-legal implications. TRIAL REGISTRATION NCT02798185.
Collapse
Affiliation(s)
- Robert A Stern
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA.
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Diana Trujillo-Rodriguez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Graduate Program in Neuroscience, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Surya V Pulukuri
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
| | - Michael L Alosco
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura J Balcer
- Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Zachary Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth L Marek
- Institute for Neurodegenerative Disorders, Invicro, LLC, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Harvard Medical School, Gordon Center for Medical Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann C McKee
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Thor D Stein
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Boston, MA, L525, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Joseph N Palmisano
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey L Cummings
- Department of Brain Health, School of Integrated Health Sciences, Chambers-Grundy Center for Transformative Neuroscience, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| |
Collapse
|
42
|
McKee AC, Mez J, Abdolmohammadi B, Butler M, Huber BR, Uretsky M, Babcock K, Cherry JD, Alvarez VE, Martin B, Tripodis Y, Palmisano JN, Cormier KA, Kubilus CA, Nicks R, Kirsch D, Mahar I, McHale L, Nowinski C, Cantu RC, Stern RA, Daneshvar D, Goldstein LE, Katz DI, Kowall NW, Dwyer B, Stein TD, Alosco ML. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol 2023; 80:1037-1050. [PMID: 37639244 PMCID: PMC10463175 DOI: 10.1001/jamaneurol.2023.2907] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Importance Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). Objective To characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes. Design, Setting, and Participants This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022. Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023. Exposures Repetitive head impacts from contact sports. Main Outcomes and Measures Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation. Results Among the 152 deceased contact sports participants (mean [SD] age, 22.97 [4.31] years; 141 [92.8%] male) included in the study, CTE was diagnosed in 63 (41.4%; median [IQR] age, 26 [24-27] years). Of the 63 brain donors diagnosed with CTE, 60 (95.2%) were diagnosed with mild CTE (stages I or II). Brain donors who had CTE were more likely to be older (mean difference, 3.92 years; 95% CI, 2.74-5.10 years) Of the 63 athletes with CTE, 45 (71.4%) were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer. For those who played football, duration of playing career was significantly longer in those with vs without CTE (mean difference, 2.81 years; 95% CI, 1.15-4.48 years). Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. Cognitive and neurobehavioral symptoms were frequent among all brain donors. Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status. Conclusions and Relevance This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. Future studies that include young brain donors unexposed to repetitive head impacts are needed to clarify the association among exposure, white matter and microvascular pathologic findings, CTE, and clinical symptoms.
Collapse
Affiliation(s)
- Ann C. McKee
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jesse Mez
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Bobak Abdolmohammadi
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Morgane Butler
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Bertrand Russell Huber
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts
| | - Madeline Uretsky
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Katharine Babcock
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Jonathan D. Cherry
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Victor E. Alvarez
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Brett Martin
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Joseph N. Palmisano
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Kerry A. Cormier
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Caroline A. Kubilus
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Raymond Nicks
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Daniel Kirsch
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Ian Mahar
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa McHale
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Christopher Nowinski
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
| | - Robert C. Cantu
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
- Department of Neurosurgery, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Robert A. Stern
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurosurgery, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Daniel Daneshvar
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Rehabilitation Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lee E. Goldstein
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Psychiatry, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Biomedical, Electrical, and Computer Engineering, Boston University College of Engineering, Boston, Massachusetts
| | - Douglas I. Katz
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Neil W. Kowall
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Thor D. Stein
- Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- VA Bedford Healthcare System, US Department of Veteran Affairs, Bedford, Massachusetts
| | - Michael L. Alosco
- Alzheimer’s Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| |
Collapse
|
43
|
Mayer AR, Dodd AB, Dodd RJ, Stephenson DD, Ling JM, Mehos CJ, Patton DA, Robertson-Benta CR, Gigliotti AP, Vermillion MS, Noghero A. Head Kinematics, Blood Biomarkers, and Histology in Large Animal Models of Traumatic Brain Injury and Hemorrhagic Shock. J Neurotrauma 2023; 40:2205-2216. [PMID: 37341029 PMCID: PMC10701512 DOI: 10.1089/neu.2022.0338] [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] [Indexed: 06/22/2023] Open
Abstract
Traumatic brain injury (TBI) and severe blood loss resulting in hemorrhagic shock (HS) are each leading causes of mortality and morbidity worldwide, and present additional treatment considerations when they are comorbid (TBI+HS) as a result of competing pathophysiological responses. The current study rigorously quantified injury biomechanics with high precision sensors and examined whether blood-based surrogate markers were altered in general trauma as well as post-neurotrauma. Eighty-nine sexually mature male and female Yucatan swine were subjected to a closed-head TBI+HS (40% of circulating blood volume; n = 68), HS only (n = 9), or sham trauma (n = 12). Markers of systemic (e.g., glucose, lactate) and neural functioning were obtained at baseline, and at 35 and 295 min post-trauma. Opposite and approximately twofold differences existed for both magnitude (device > head) and duration (head > device) of quantified injury biomechanics. Circulating levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase L1 (UCH-L1) demonstrated differential sensitivity for both general trauma (HS) and neurotrauma (TBI+HS) relative to shams in a temporally dynamic fashion. GFAP and NfL were both strongly associated with changes in systemic markers during general trauma and exhibited consistent time-dependent changes in individual sham animals. Finally, circulating GFAP was associated with histopathological markers of diffuse axonal injury and blood-brain barrier breach, as well as variations in device kinematics following TBI+HS. Current findings therefore highlight the need to directly quantify injury biomechanics with head mounted sensors and suggest that GFAP, NfL, and UCH-L1 are sensitive to multiple forms of trauma rather than having a single pathological indication (e.g., GFAP = astrogliosis).
Collapse
Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychology, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Rebecca J. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Carissa J. Mehos
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cidney R. Robertson-Benta
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Andrew P. Gigliotti
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Meghan S. Vermillion
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Alessio Noghero
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| |
Collapse
|
44
|
Phansalkar R, Goodwill VS, Nirschl JJ, De Lillo C, Choi J, Spurlock E, Coughlin DG, Pizzo D, Sigurdson CJ, Hiniker A, Alvarez VE, Mckee AC, Lin JH. TDP43 pathology in chronic traumatic encephalopathy retinas. Acta Neuropathol Commun 2023; 11:152. [PMID: 37737191 PMCID: PMC10515050 DOI: 10.1186/s40478-023-01650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head trauma. Brain pathology in CTE is characterized by neuronal loss, gliosis, and a distinctive pattern of neuronal accumulation of hyper-phosphorylated tau (p-tau) and phospho-TDP43 (p-TDP43). Visual anomalies have been reported by patients with CTE, but the ocular pathology underlying these symptoms is unknown. We evaluated retinal pathology in post-mortem eyes collected from 8 contact sport athletes with brain autopsy-confirmed stage IV CTE and compared their findings to retinas from 8 control patients without CTE and with no known history of head injury. Pupil-optic nerve cross sections were prepared and stained with hematoxylin and eosin (H&E), p-tau, p-TDP43, and total TDP43 by immunohistochemistry. No significant retinal degeneration was observed in CTE eyes compared to control eyes by H&E. Strong cytoplasmic p-TDP43 and total TDP43 staining was found in 6/8 CTE eyes in a subset of inner nuclear layer interneurons (INL) of the retina, while only 1/8 control eyes showed similar p-TDP43 pathology. The morphology and location of these inner nuclear layer interneurons were most compatible with retinal horizontal cells, although other retinal cell types present in INL could not be ruled out. No p-tau pathology was observed in CTE or control retinas. These findings identify novel retinal TDP43 pathology in CTE retinas and support further investigation into the role of p-TDP43 in producing visual deficits in patients with CTE.
Collapse
Affiliation(s)
| | - Vanessa S Goodwill
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Jeffrey J Nirschl
- Departments of Ophthalmology and Pathology, Stanford University, Stanford, CA, USA
| | | | - Jihee Choi
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth Spurlock
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - David G Coughlin
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Donald Pizzo
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | | | - Annie Hiniker
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Ann C Mckee
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jonathan H Lin
- Departments of Ophthalmology and Pathology, Stanford University, Stanford, CA, USA.
- VA Palo Alto Healthcare System, Palo Alto, CA, USA.
| |
Collapse
|
45
|
Beversdorf DQ, Paretsky M. Traumatic Encephalopathy Syndrome: Can It Stand the Test of Time? Neurology 2023; 101:461-462. [PMID: 37380430 DOI: 10.1212/wnl.0000000000207711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- David Q Beversdorf
- From the Department of Radiology, Neurology, and Psychology, College of Arts & Sciences, University of Missouri, Columbia.
| | - Melissa Paretsky
- From the Department of Radiology, Neurology, and Psychology, College of Arts & Sciences, University of Missouri, Columbia
| |
Collapse
|
46
|
Zou Y, Qi B, Tan J, Guan L, Zhang Q, Sun Y, Huang F. Deciphering the Inhibitory Mechanism of Naphthoquinone-Dopamine on the Aggregation of Tau Core Fragments PHF6* and PHF6. ACS Chem Neurosci 2023; 14:3265-3277. [PMID: 37585669 DOI: 10.1021/acschemneuro.3c00434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
The formation of neurofibrillary tangles by abnormal aggregation of tau protein is considered to be an important pathological characteristic of tauopathies, including Alzheimer's disease and chronic traumatic encephalopathy. Two hexapeptides 275VQIINK280 and 306VQIVYK311 in the microtubule binding region, named PHF6* and PHF6, are known to be aggregation-prone and responsible for tau fibrillization. Previous experiments reported that naphthoquinone-dopamine (NQDA) could effectively inhibit the aggregation of PHF6* and PHF6 and disrupt the fibrillar aggregates into nontoxic species, displaying a dual effect on the amyloid aggregation. However, the underlying molecular mechanism remains mostly elusive. Herein, we performed all-atom molecular dynamics (MD) simulations for 114 μs in total to systematically investigate the impacts of NQDA on the oligomerization of PHF6* and PHF6. The conformational ensembles of PHF6* and PHF6 peptides generated by replica exchange MD simulations show that NQDA could effectively prevent the hydrogen bond formation, reduce the ability of peptides to self-assemble into long β-strand and large β-sheets, and induce peptides to form a loosely packed and coil-rich oligomer. The interaction analysis shows that the binding of NQDA to PHF6* is mainly through hydrophobic interactions with residue I277 and hydrogen bonding interactions with Q276; for the PHF6 peptides, NQDA displays a strong π-π stacking interaction with residue Y310, thus impeding the Y310-Y310 π-π stacking and I308-Y310 CH-π interactions. The DA group of NQDA displays a stronger cation-π interaction than the NQ group, while the NQ group exhibits a stronger π-π stacking interaction. MD simulations demonstrate that NQDA prevents the conformational conversion to β-sheet-rich aggregates and displays an inhibitory effect on the oligomerization dynamics of PHF6* and PHF6. Our results provide a complete picture of inhibitory mechanisms of NQDA on PHF6* and PHF6 oligomerization, which may pave the way for designing drug candidates for the treatment of tauopathies.
Collapse
Affiliation(s)
- Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Bote Qi
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Jingwang Tan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Lulu Guan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, P. R. China
| | - Qingwen Zhang
- College of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, P. R. China
| | - Yunxiang Sun
- Department of Physics, Ningbo University, 818 Fenghua Road, Ningbo 315211, Zhejiang, P. R. China
| | - Fengjuan Huang
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo 315211, Zhejiang, P. R. China
| |
Collapse
|
47
|
Rossi C, Campese N, Colosimo C. Emerging Symptomatic Treatment of Chronic Traumatic Encephalopathy (CTE): a narrative review. Expert Opin Pharmacother 2023; 24:1415-1425. [PMID: 37300418 DOI: 10.1080/14656566.2023.2224501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is an emergent neurodegenerative tauopathy well characterized pathologically but with limited consensus about clinical criteria. The clinical features include cognitive, behavioral, and motor symptoms such as parkinsonism, gait, balance disorder, and bulbar impairment. Their recognition derives from retrospective studies in pathologically confirmed CTE patients. This is one of the main reasons for the lack of specific pharmacological studies targeting symptoms or pathologic pathways of this disease. AREAS COVERED In this narrative review, we overview the possible symptomatic treatment options for CTE, based on pathological similarities with other neurodegenerative diseases that may share common pathological pathways with CTE. The PubMed database was screened for articles addressing the symptomatic treatment of CTE and Traumatic Encephalopathy Syndrome (TES). Additional references were retrieved by reference cross-check and retained if pertinent to the subject. The clinicaltrials.gov database was screened for ongoing trials on the treatment of CTE. EXPERT OPINION The similarities with the other tauopathies allow us, in the absence of disease-specific evidence, to translate some knowledge from these neurodegenerative disorders to CTE's symptomatic treatment, but any conclusion should be drawn cautiously and a patient-tailored strategy should be always preferred balancing the risks and benefits of each treatment.
Collapse
Affiliation(s)
- Carlo Rossi
- Neurology Unit, F. Lotti Hospital of Pontedera. Azienda Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy
| | - Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carlo Colosimo
- Department of Neurology, S. Maria University Hospital, Terni, Italy
| |
Collapse
|
48
|
Suter CM, Affleck AJ, Pearce AJ, Junckerstorff R, Lee M, Buckland ME. Chronic traumatic encephalopathy in a female ex-professional Australian rules footballer. Acta Neuropathol 2023; 146:547-549. [PMID: 37391669 PMCID: PMC10412665 DOI: 10.1007/s00401-023-02610-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alan J Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | | | - Maggie Lee
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia.
| |
Collapse
|
49
|
Lee CD, Meehan WP, Bazarian J. Participation of Children in American Football. N Engl J Med 2023; 389:660-662. [PMID: 37585634 DOI: 10.1056/nejmclde2302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
|
50
|
Flavin WP, Hosseini H, Ruberti JW, Kavehpour HP, Giza CC, Prins ML. Traumatic brain injury and the pathways to cerebral tau accumulation. Front Neurol 2023; 14:1239653. [PMID: 37638180 PMCID: PMC10450935 DOI: 10.3389/fneur.2023.1239653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Tau is a protein that has received national mainstream recognition for its potential negative impact to the brain. This review succinctly provides information on the structure of tau and its normal physiological functions, including in hibernation and changes throughout the estrus cycle. There are many pathways involved in phosphorylating tau including diabetes, stroke, Alzheimer's disease (AD), brain injury, aging, and drug use. The common mechanisms for these processes are put into context with changes observed in mild and repetitive mild traumatic brain injury (TBI). The phosphorylation of tau is a part of the progression to pathology, but the ability for tau to aggregate and propagate is also addressed. Summarizing both the functional and dysfunctional roles of tau can help advance our understanding of this complex protein, improve our care for individuals with a history of TBI, and lead to development of therapeutic interventions to prevent or reverse tau-mediated neurodegeneration.
Collapse
Affiliation(s)
- William P. Flavin
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Helia Hosseini
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
| | - Jeffrey W. Ruberti
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | - H. Pirouz Kavehpour
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Mechanical and Aerospace Engineering, UCLA, Los Angeles, CA, United States
| | - Christopher C. Giza
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Mayumi L. Prins
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| |
Collapse
|