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Merino J, Whelan BM, Finch E. Examining the occurrence and outcomes of concussion and mTBI in mixed martial arts athletes: a systematic review. PHYSICIAN SPORTSMED 2023; 51:394-404. [PMID: 35377825 DOI: 10.1080/00913847.2022.2061836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mixed martial arts (MMA) is a sport growing in popularity around the world. However, many individuals participate in the sport with little understanding of the potential short- and long-term consequences of injuries sustained while participating. Specifically, individuals are placed at a high risk of minor traumatic brain injury (mTBI) and concussive episodes as a result of head injuries incurred during training and competition. AIMS The current review aimed to examine the literature surrounding the occurrence and outcomes of mTBI in MMA athletes to gain a better understanding of these consequences. METHODS Twenty-five studies were identified within the current review, of which 14 examined occurrence of mTBI within the sport setting, and elevenidentified outcomes of injury. RESULTS Overall, studies found that MMA athletes experienced mTBI and concussion to a greater extent than athletes in other sports. Deficits in memory, reaction time and processing speed were identified following occurrence of mTBI; however, several gaps in outcome measurement were identified within the current literature, including a lack of focus on speech and language outcomes. CONCLUSION Future research should examine a wider variety of outcomes to provide a clearer understanding of the consequences of participating in the sport.
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Affiliation(s)
- Joanne Merino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
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Esagoff AI, Heckenlaible NJ, Bray MJC, Pasuizaca A, Bryant BR, Shan G, Peters ME, Bernick CB, Narapareddy BR. Sparring and the Brain: The Associations between Sparring and Regional Brain Volumes in Professional Mixed Martial Arts Fighters. Sports Med 2023; 53:1641-1649. [PMID: 36972014 DOI: 10.1007/s40279-023-01838-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Mixed martial arts (MMA) fighters, due to exposure to repetitive head impacts, are at risk for brain atrophy and neurodegenerative sequelae. Simultaneously, motor skills training and cognition-rich activities have been linked with larger regional brain volumes. The majority of an MMA fighter's sporting activity occurs during practice (e.g., sparring) rather than formal competition. This study, therefore, aims to be the first to explore regional brain volumes associated with sparring in MMA fighters. METHODS Ninety-four active, professional MMA fighters from the Professional Fighters Brain Health Study met inclusion criteria for this cross-sectional analysis. Adjusted multivariable regression analyses were utilized to examine the relationship between the number of sparring practice rounds per week during typical training and a select number of regional brain volumes (i.e., caudate, thalamus, putamen, hippocampus, amygdala). RESULTS A higher number of weekly sparring rounds during training was significantly associated with larger left (beta = 13.5 µL/round, 95% CI 2.26-24.8) and right (beta = 14.9 µL/round, 95% CI 3.64-26.2) caudate volumes. Sparring was not significantly associated with left or right thalamus, putamen, hippocampus, or amygdala volumes. CONCLUSIONS More weekly rounds of sparring was not significantly associated with smaller volumes in any of the brain regions studied in active, professional MMA fighters. Sparring's significant association with larger caudate volume raises questions about whether fighters who spar more experience attenuated trauma-related decreases in caudate volume relative to fighters who spar less, whether fighters who spar more experience minimal or even positive changes to caudate volume, whether baseline differences in caudate size may have mediated results, or whether some other mechanism may be at play. Given limitations inherent to the cross-sectional study design, more research is needed to further explore the brain effects of sparring in MMA.
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Affiliation(s)
- Aaron I Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA.
| | - Nicolas J Heckenlaible
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Andres Pasuizaca
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Guogen Shan
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Charles B Bernick
- Department of Neurology, University of Washington, Seattle, WA, USA
- Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
- Institute of Living, Hartford Hospital, Hartford, CT, USA
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Ritter A, Shan G, Montes A, Randall R, Bernick C. Traumatic encephalopathy syndrome: application of new criteria to a cohort exposed to repetitive head impacts. Br J Sports Med 2023; 57:389-394. [PMID: 36517216 PMCID: PMC10086298 DOI: 10.1136/bjsports-2022-105819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the characteristics of those who fulfil the recent National Institute of Neurological Disease and Stroke (NINDS) Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome (TES) and test whether they show differences in MRI-based regional brain volumes, cognitive domains, and certain plasma biomarkers. METHODS Professional fighters 35 years of age or older and/or retired were included. Participants were categorised as either having TES (TES+) or not (non-TES). TES+ participants were further subtyped by their cognitive profile. Multiple linear regression models were used to compare MRI-based regional brain volumes, cognitive performance, plasma tau and neurofilament light levels between TES- and TES+ groups. RESULTS 176 participants (110 boxers and 66 MMA) were included in the analysis. 72 (41%)/176 were categorised as having TES, the likelihood of TES increasing with age. TES+ participants tended to be boxers, started fighting at a younger age, had more professional fights and knocked out more frequently. The TES+ group had lower regional brain volumes including both grey and white matter structures. TES+ also had lower scores on simple and choice reaction time, psychomotor speed and Trails A . CONCLUSION The new TES criteria does distinguish a group of fighters with differences in regional brain volumes and reduced cognitive function. Our findings support the use of the NINDS criteria for TES in further research of the long-term effects of repetitive head impacts.
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Affiliation(s)
- Aaron Ritter
- Neurological Institute, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Guogen Shan
- Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Arturo Montes
- Medicine, University of Las Vegas, Las Vegas, Nevada, USA
| | - Rebekah Randall
- Neurological Institute, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Charles Bernick
- Department of Neurology, University of Washington, Seattle, Washington, USA
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Zhuang X, Bennett L, Nandy R, Cordes D, Bernick C, Ritter A. Longitudinal Changes in Cognitive Functioning and Brain Structure in Professional Boxers and Mixed Martial Artists After They Stop Fighting. Neurology 2022; 99:e2275-e2284. [PMID: 36104283 PMCID: PMC9694836 DOI: 10.1212/wnl.0000000000201158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study compares longitudinal changes in cognitive functioning and brain structures in male fighters who transitioned to an inactive fighting status without any further exposure to repetitive head impacts (RHIs) and fighters remaining active with continual exposure to RHIs. METHODS Participants were recruited from the Professional Fighters Brain Health Study. At time point (TP)1, all fighters were active, with continual exposure to RHIs. At TP2, fighters were considered "transitioned" if they had no sanctioned professional fights and had not been sparring for the past 2 years. Fighters were considered "active" if they continued to train and compete. All fighters underwent cognitive testing and 3T MRI at both TPs. A subset of our fighters (50%) underwent blood sampling for the characterization of neurofilament light (NfL) levels at both TPs. Linear mixed-effect models were applied to investigate the potentially different longitudinal trajectories (interaction effect between group and time) of cognitive function measures, NfL levels, and regional thickness measures (derived from structural MRI) between transitioned and active fighters. RESULTS Forty-five male transitioned fighters (aged 31.69 ± 6.27 years [TP1]; 22 boxers, 22 mixed martial artists, and 1 martial artist) and 45 demographically matched male active fighters (aged 30.24 ± 5.44 years [TP1]; 17 boxers, 27 mixed martial artists, and 1 martial artist) were included in the analyses. Significantly different longitudinal trajectories between transitioned and active fighters were observed in verbal memory (p FDR = 4.73E-04), psychomotor speed (p FDR = 4.73E-04), processing speed (p FDR = 3.90E-02), and NfL levels (p = 0.02). Transitioned fighters demonstrated longitudinally improved cognitive functioning and decreased NfL levels, and active fighters demonstrated declines in cognitive performance and stable NfL levels. Of 68 cortical regions inspected, 54 regions demonstrated a consistently changing trajectory, with thickness measures stabilizing on a group level for transitioned fighters and subtly declining over time for active fighters. DISCUSSION After fighters' cessation of RHI exposure, cognitive function and brain thickness measures may stabilize and blood NfL levels may decline. This study could be a starting point to identify potential predictors of individuals who are at a higher risk of RHI-related long-term neurologic conditions.
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Affiliation(s)
- Xiaowei Zhuang
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Lauren Bennett
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Rajesh Nandy
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Dietmar Cordes
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Charles Bernick
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle
| | - Aaron Ritter
- From the Lou Ruvo Center for Brain Health (X.Z., D.C., C.B., A.R.), Cleveland Clinic, Las Vegas; Interdisciplinary Neuroscience PhD Program (X.Z.), University of Nevada, Las Vegas; Pickup Family Neurosciences Institute (L.B.), Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Department of Biostatistics & Epidemiology (R.N.), School of Public Health, University of North Texas Health Science Center, Fort Worth; University of Colorado Boulder (D.C.); and UW Medicine (C.B.), Seattle.
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Tulendiyeva A, Saliev T, Andassova Z, Issabayev A, Fakhradiyev I. Historical overview of injury prevention in traditional martial arts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00785-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bennett LL, Stephen SJ, Bernick C, Shan G, Banks SJ. Sex Moderates the Relationship That Number of Professional Fights Has With Cognition and Brain Volumes. Front Neurol 2020; 11:574458. [PMID: 33250844 PMCID: PMC7673387 DOI: 10.3389/fneur.2020.574458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: Incidence of concussions and report of symptoms are greater among women across sports. While structural brain changes and cognitive declines are associated with repetitive head impact (RHI), the role of sex is not well-understood. This study aimed to determine if there is a moderating effect of sex on the relationship the number of professional fights has with cognitive functioning and regional brain volumes in a cohort of boxers, mixed martial artists, and martial artists. Methods: A total of 55 women were matched with 55 men based on age, years of education, ethnicity, and fighting style. Cognition was assessed via the CNS Vital Signs computerized cognitive battery and supplemental measures. Structural brain scans, demographic data, and number of professional fights (NoPF) were also considered. The matched pairs were compared via analysis of covariance, accounting for total brain volume. Within-subject moderation models were utilized to assess the moderating effect of sex on the relationship between NoPF and brain volumes and cognitive performance. Results: Men were observed to have poorer performance on measures of psychomotor speed when compared to women. On a series of analyses assessing the role of sex as a moderator of the relationship between NoPF and regional brain volumes/cognitive performance, a significant moderation effect was observed across multiple measures of cognitive functioning, such that men had poorer performance. Differences in numerous regional brain volumes were also observed, such that the relationship between NoPF and brain volumes was steeper among men. Conclusion: Sex was observed to be an important moderator in the relationship between NoPF, aspects of cognitive functioning, and volumes of numerous brain regions, suggesting that sex differences in neuroanatomic and cognitive response to RHI deserve further attention.
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Affiliation(s)
- Lauren L Bennett
- Neuropsychologist, Pickup Family Neurosciences Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, United States
| | - Steve J Stephen
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Guogen Shan
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Sarah J Banks
- Departments of Neurosciences and Psychiatry, University of California, San Diego, San Diego, CA, United States
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