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Gallacher J, Pickering J, Bayer A, Heslop L, Morgan G, Watkins A, Martin R, Elwood P. Amateur Boxing and Dementia: Cognitive Impairment Within the 35-Year Caerphilly Cohort Study. Clin J Sport Med 2022; 32:329-333. [PMID: 35470341 DOI: 10.1097/jsm.0000000000000976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term effects of amateur boxing in a representative population sample of men. DESIGN The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently through medical records. SETTING AND ASSESSMENT OF RICK FACTORS The Caerphilly Prospective Study investigates risk factors for a range of chronic diseases of diseases. These include life style and behavior, together with biological factors relevant to vascular disease. PARTICIPANTS 1123 adult men aged 45 to 59 years at baseline, followed for 35 years. MAIN OUTCOME MEASURES Cognitive impairment. RESULTS A report by a subject of having boxed "seriously" when younger was associated with a 2-fold increase in cognitive impairment [odds ratio (OR) = 2.27; 95% confidence intervals = 1.18-4.38]. For amnestic (Alzheimer-like) impairment, this rises to OR = 2.78 (95% confidence limits 1.37-5.65). Having boxed is associated with an "advancement" in the onset of the dementia (4.8 years; 95% confidence limits 0.9-8.8 years). CONCLUSIONS Amateur boxing is associated with an increased risk and an earlier onset of cognitive impairment and dementia.
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Affiliation(s)
- John Gallacher
- Department of Psychiatry, University of Oxford, England, United Kingdom
| | - Janet Pickering
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Anthony Bayer
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Luke Heslop
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Gareth Morgan
- Hywel Dda Health Board, Cardiff, Wales, United Kingdom ; and
| | - Angela Watkins
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhodri Martin
- Cwm Taf University Health Board, Cardiff, Wales, United Kingdom
| | - Peter Elwood
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
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2
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Doan BK, Heaton KJ, Self BP, Butler Samuels MA, Adam GE. Quantifying head impacts and neurocognitive performance in collegiate boxers. J Sports Sci 2021; 40:509-517. [PMID: 34930100 DOI: 10.1080/02640414.2021.2001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Head impacts and neurocognition were quantified in 27 intercollegiate male boxers engaged in two, two-minute sparring rounds. Head impacts were measured using Instrumented Boxing Headgear (IBH). Pre and post-sparring neurocognitive performance was compared using two computerized neuropsychological test batteries (CNTs): Immediate Post-concussion Assessment and Cognitive Testing (ImPACT™) and Automated Neuropsychological Assessment Metrics - Military Battery (ANAM4® MIL). An average of 27.63 ± 17.87 impacts above the 9.6 g IBH threshold were recorded per boxer, with average peak linear acceleration of 23.48 ± 15.20 g and average peak rotational acceleration of 1761.40 ± 1064.34 rad/s2. Small, but measurable declines in delayed memory and improvement in response time from pre- to post-bout were noted. Number of impacts and concussion history predicted degraded memory performance. This is a runique quantificationof head impacts in collegiate boxing, which were similar in frequency and location, but lower in magnitude as compared to amateur boxing. Improved understanding of impact kinematics may enhance safety in boxing and other contact sports. Subtle post-bout decrements in delayed memory performance and mild improvement in response time reinforce prior research and provide evidence of congruence in our two CNT assessments, which may facilitate comparisons of outcomes across settings utilizing these tests.
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Affiliation(s)
- Brandon K Doan
- Associate Professor of Exercise Science, Georgia Gwinnett College, School of Science & Technology, Lawrenceville, GA, USA
| | - Kristin J Heaton
- Research Psychologist, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Brian P Self
- Professor, Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Michelle A Butler Samuels
- Associate Professor, Department of Behavioral Sciences and Leadership, United States Air Force Academy, Usaf Academy, CO, USA
| | - Gina E Adam
- Commander, US Army Medical Materiel Development Activity (USAMMDA), MD, USA
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3
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Nakamura K, Uchida M, Sato T. Basic research on the primary prevention of boxing-related sports injuries with the development of a quantitative motion analysis software. J Phys Ther Sci 2021; 33:495-498. [PMID: 34177114 PMCID: PMC8219606 DOI: 10.1589/jpts.33.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/26/2021] [Indexed: 12/05/2022] Open
Abstract
[Purpose] To develop a quantitative motion analysis software specific to boxing (Fist
Tactics Support) and to verify its effectiveness based on the percentage of hits that land
on the participants. [Participants and Methods] A total of 24 male professional boxers
were divided into two groups: those who used Fist Tactics Support to analyze fight videos
and instituted training changes based on the results (Fist Tactics Support group, 12
participants) and those who did not (control group, 12 participants). The overall
percentage of hits that landed on the participants in the fights was compared between the
two groups and between pre- and post-intervention. [Results] There were no significant
differences between the two groups; however, the percentage of hits that landed on the
boxers of the Fist Tactics Support group was significantly lower at post-intervention than
at pre-intervention. [Conclusion] The use of scientific analysis results in boxing may
facilitate the primary prevention of sports injuries.
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Affiliation(s)
- Kouichi Nakamura
- Department of Physical Therapy, Faculty of Health Science, Tokoha University: 1-30 Mizuochi-cho, Aoi-ku, Shizuoka-shi, Shizuoka 420-0831, Japan
| | - Masaki Uchida
- Department of Physical Therapy, Faculty of Health Science, Tokoha University: 1-30 Mizuochi-cho, Aoi-ku, Shizuoka-shi, Shizuoka 420-0831, Japan
| | - Tomonori Sato
- Department of Physical Therapy, Faculty of Health Science, Tokoha University: 1-30 Mizuochi-cho, Aoi-ku, Shizuoka-shi, Shizuoka 420-0831, Japan
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4
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Leeds DD, D'Lauro C, Johnson BR. Predictive Power of Head Impact Intensity Measures for Recognition Memory Performance. Mil Med 2019; 184:206-217. [PMID: 30901472 DOI: 10.1093/milmed/usy415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/25/2018] [Indexed: 11/14/2022] Open
Abstract
Subconcussive head injuries are connected to both short-term cognitive changes and long-term neurodegeneration. Further study is required to understand what types of subconcussive impacts might prove detrimental to cognition. We studied cadets at the US Air Force Academy engaged in boxing and physical development, measuring head impact motions during exercise with accelerometers. These head impact measures were compared with post-exercise memory performance. Investigators explored multiple techniques for characterizing the magnitude of head impacts. Boxers received more head impacts and achieved lower performance in post-exercise memory than non-boxers. For several measures of impact motion, impact intensity appeared to set an upper bound on post-exercise memory performance - stronger impacts led to lower expected memory performance. This trend was most significant when impact intensity was measured through a novel technique, applying principal component analysis to boxer motion. Principal component analysis measures also captured more distinct impact information than seven traditional impact measures also tested.
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Affiliation(s)
- Daniel D Leeds
- Computer and Information Sciences Department, Fordham University, John Mulcahy Hall - Room 340, 441 East Fordham Road, Bronx, NY
| | - Christopher D'Lauro
- United States Air Force Academy, Department of Behavioral Science and Leadership, 2354 Fairchild Drive, Suite 5L60, USAF Academy, CO
| | - Brian R Johnson
- Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, 503 Robert Grant Ave, Silver Spring, MD
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5
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Abstract
Traumatic brain injury remains a major cause of morbidity and mortality throughout the world, affecting young and old alike. Pathologic data have been developed through observations of human autopsies and developing animal models to investigate mechanisms, although animal models do not represent the polypathology of human brain injury and there are likely to be significant differences in the anatomic basis of injury and cellular responses between species. Traumatic brain injury can be defined pathologically as either focal or diffuse, and can be considered to be either primary, directly related to the force associated with the neurotrauma, or secondary, developing as a downstream consequence of the neurotrauma. While neuropathology has traditionally focused on severe head injury, there is increasing recognition of the long-term consequences of traumatic brain injury, particularly repetitive mild traumatic brain injury, and a possible long-term association with chronic traumatic encephalopathy.
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Affiliation(s)
- Colin Smith
- Department of Neuropathology, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom.
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6
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Bang SA, Song YS, Moon BS, Lee BC, Lee HY, Kim JM, Kim SE. Neuropsychological, Metabolic, and GABAA Receptor Studies in Subjects with Repetitive Traumatic Brain Injury. J Neurotrauma 2015; 33:1005-14. [PMID: 26414498 DOI: 10.1089/neu.2015.4051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repetitive traumatic brain injury (rTBI) occurs as a result of mild and accumulative brain damage. A prototype of rTBI is chronic traumatic encephalopathy (CTE), which is a degenerative disease that occurs in patients with histories of multiple concussions or head injuries. Boxers have been the most commonly studied patient group because they may experience thousands of subconcussive hits over the course of a career. This study examined the consequences of rTBI with structural brain imaging and biomolecular imaging and investigated whether the neuropsychological features of rTBI were related to the findings of the imaging studies. Five retired professional boxers (mean age, 46.8 ± 3.19 years) and four age-matched controls (mean age, 48.5 ± 3.32 years) were studied. Cognitive-motor related functional impairment was assessed, and all subjects underwent neuropsychological evaluation and behavioral tasks, as well as structural brain imaging and functional-molecular imaging. In neuropsychological tests, boxers showed deficits in delayed retrieval of visuospatial memory and motor coordination, which had a meaningful relationship with biomolecular imaging results indicative of neuronal injury. Morphometric abnormalities were not found in professional boxers by structural magnetic resonance imaging (MRI). Glucose metabolism was impaired in frontal areas associated with cognitive dysfunction, similar to findings in Alzheimer's disease. Low binding potential (BP) of (18)F-flumazenil (FMZ) was found in the angular gyrus and temporal cortical regions, revealing neuronal deficits. These results suggested that cognitive impairment and motor dysfunction reflect chronic damage to neurons in professional boxers with rTBI.
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Affiliation(s)
- Seong Ae Bang
- 1 Department of Neuroscience, Seoul National University College of Medicine , Seoul, Republic of Korea.,2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Yoo Sung Song
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Byung Seok Moon
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Byung Chul Lee
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,4 Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology , Suwon, Republic of Korea
| | - Ho-Young Lee
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Jong-Min Kim
- 5 Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sang Eun Kim
- 1 Department of Neuroscience, Seoul National University College of Medicine , Seoul, Republic of Korea.,2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,3 Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University , Seoul, Republic of Korea.,4 Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology , Suwon, Republic of Korea
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7
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Neselius S, Brisby H, Marcusson J, Zetterberg H, Blennow K, Karlsson T. Neurological assessment and its relationship to CSF biomarkers in amateur boxers. PLoS One 2014; 9:e99870. [PMID: 24941067 PMCID: PMC4062456 DOI: 10.1371/journal.pone.0099870] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/20/2014] [Indexed: 12/14/2022] Open
Abstract
Background Mild traumatic brain injury (TBI) or concussion is common in many sports. Today, neuropsychological evaluation is recommended in the monitoring of a concussion and in return-to-play considerations. To investigate the sensitivity of neuropsychological assessment, we tested amateur boxers post bout and compared with controls. Further the relationship between neuropsychological test results and brain injury biomarkers in the cerebrospinal fluid (CSF) were investigated. Method Thirty amateur boxers on high elite level with a minimum of 45 bouts and 25 non-boxing matched controls were included. Memory tests (Rey Osterrieth Complex Figure, Listening Span, Digit Span, Controlled Word Association Test, and computerized testing of episodic memory), tests of processing speed and executive functions (Trail Making, Reaction Time, and Finger Tapping) were performed and related to previously published CSF biomarker results for the axonal injury marker neurofilament light (NFL). Results The neurological assessment showed no significant differences between boxers and controls, although elevated CSF NFL, as a sign of axonal injury, was detected in about 80% of the boxers 1–6 days post bout. The investigation of the relationship between neuropsychological evaluation and CSF NFL concentrations revealed that boxers with persisting NFL concentration elevation after at least 14 days resting time post bout, had a significantly poorer performance on Trail Making A (p = 0.041) and Simple Reaction Time (p = 0.042) compared to other boxers. Conclusion This is the first study showing traumatic axonal brain injury can be present without measureable cognitive impairment. The repetitive, subconcussive head trauma in amateur boxing causes axonal injury that can be detected with analysis of CSF NFL, but is not sufficient to produce impairment in memory tests, tests of processing speed, or executive functions. The association of prolonged CSF NFL increase in boxers with impairment of processing speed is an interesting observation, which needs to be verified in larger studies.
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Affiliation(s)
- Sanna Neselius
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jan Marcusson
- Geriatric Section, University Hospital in Linköping, Linköping, Sweden
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Disability Research, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Linnaeus Centre HEAD, Linköping University, Linköping, Sweden
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8
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Putukian M. Neuropsychological Testing as It Relates to Recovery From Sports-related Concussion. PM R 2011; 3:S425-32. [DOI: 10.1016/j.pmrj.2011.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 10/15/2022]
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9
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Tichý J. A neurologist's view on boxing*. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1997.tb00399.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Loosemore M, Knowles CH, Whyte GP. Amateur boxing and risk of chronic traumatic brain injury: systematic review of observational studies. BMJ 2007; 335:809. [PMID: 17916811 PMCID: PMC2034739 DOI: 10.1136/bmj.39342.690220.55] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the risk of chronic traumatic brain injury from amateur boxing. SETTING Secondary research performed by combination of sport physicians and clinical academics. DESIGN, DATA SOURCES, AND METHODS: Systematic review of observational studies in which chronic traumatic brain injury was defined as any abnormality on clinical neurological examination, psychometric testing, neuroimaging studies, and electroencephalography. Studies were identified through database (1950 to date) and bibliographic searches without language restrictions. Two reviewers extracted study characteristics, quality, and data, with adherence to a protocol developed from a widely recommended method for systematic review of observational studies (MOOSE). RESULTS 36 papers had relevant extractable data (from a detailed evaluation of 93 studies of 943 identified from the initial search). Quality of evidence was generally poor. The best quality studies were those with a cohort design and those that used psychometric tests. These yielded the most negative results: only four of 17 (24%) better quality studies found any indication of chronic traumatic brain injury in a minority of boxers studied. CONCLUSION There is no strong evidence to associate chronic traumatic brain injury with amateur boxing.
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Affiliation(s)
- Mike Loosemore
- English Institute of Sport, London Region, Olympic Medical Institute, Northwick Park Hospital, Harrow HA1 3UJ.
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11
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Collie A, Maruff P, Makdissi M, McStephen M, Darby DG, McCrory P. Statistical procedures for determining the extent of cognitive change following concussion. Br J Sports Med 2005; 38:273-8. [PMID: 15155425 PMCID: PMC1724830 DOI: 10.1136/bjsm.2003.000293] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychological (NP) testing is now often used to help to determine if the cognitive function of a concussed athlete has declined. The NP test score after concussion is compared with the baseline test score. Many clinicians simply subtract one from the other and make a clinical decision about the significance or otherwise of the resulting "difference score". Such techniques are inadequate, as they fail to account for the many factors that may confound interpretation of serially acquired cognitive test scores. This is a review of a number of alternative approaches used in other areas of medicine for differentiating "true" changes from changes caused by these confounding factors. A case example is used to illustrate the effect that the statistical approach may have on clinical decision making.
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Affiliation(s)
- A Collie
- Center for Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
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12
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Abstract
TBI is one of the most important public health problems in the world. Although the relationship between TBI and hypopituitarism has been known for a long time, neuroendocrine changes were investigated in detail recently. The prevalence of neuroendocrine abnormalities in patients with TBI is very high. Gonadotropin and GH deficiencies appear to be the most common defects. Although combative sports are very popular around the world, trauma due to sports is not generally considered as a cause of TBI in most of the epidemiological studies. All the studies regarding TBI in sports published so far in the literature based on neuropshycological or radiological assessment and no neuroendocrine changes were investigated. In a recent study, pituitary functions in amateur boxers have been investigated and it has been reported that boxing is a cause of TBI and isolated GH deficiency is very common among amateur boxers. It seems that acute or chronic head trauma in sports is a possible cause of hypopituitarism. In this review, current data regarding TBI in sports are discussed.
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13
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Collie A, Maruff P, McStephen M, Darby DG. Psychometric issues associated with computerised neuropsychological assessment of concussed athletes. Br J Sports Med 2004; 37:556-9. [PMID: 14665603 PMCID: PMC1724721 DOI: 10.1136/bjsm.37.6.556] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Psychometric issues associated with computerised neuropsychological assessment in sports concussion are put forward. Issues critical to ensuring test reliability and sensitivity are discussed, with particular reference to how inappropriate test design can affect clinical decision making.
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Affiliation(s)
- A Collie
- CogState Limited, Carlton, Australia.
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14
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Affiliation(s)
- A Collie
- CogState Ltd, Melbourne, Victoria, Australia.
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15
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Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. Clin J Sport Med 2003; 13:28-32. [PMID: 12544161 DOI: 10.1097/00042752-200301000-00006] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the repeatability of a computerized cognitive test designed to monitor recovery from concussion and assist team physicians make return to play decisions (CogSport). To determine the correlation between CogSport and two conventional neuropsychological tests. DESIGN Prospective, serial investigation of cognitive function. SETTING Professional and semi-professional Australian Football clubs and a university affiliated research institute in Melbourne, Australia. PARTICIPANTS Three-hundred healthy young adults, including 240 elite athletes. MAIN OUTCOME MEASURES Intra-class correlation (ICC) coefficients for CogSport performance measures administered serially. ICC between CogSport performance measures and conventional neuropsychological tests. Normative data for CogSport performance measures. RESULTS Measures of psychomotor function, decision making, working memory and learning were highly reliable. Some measures also displayed high correlations with conventional neuropsychological tests of information processing and attention. Preliminary normative data is described. CONCLUSIONS CogSport is a highly reliable cognitive function test when administered to healthy young adults and elite athletes. CogSport measures similar cognitive functions as conventional tests used commonly in concussion research.
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Affiliation(s)
- Alexander Collie
- Centre for Neuroscience, The University of Melbourne, Parkville, Victoria, Australia.
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16
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Trotter G. Outside Outpatient Ethics: Is It Ethical for Physicians to Serve Ringside? THE JOURNAL OF CLINICAL ETHICS 2002. [DOI: 10.1086/jce200213414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
- P Jako
- International amateur Boxing Association, Veress Palne u 33, 1053 Budapest, Hungary.
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18
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Collie A, Darby D, Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med 2001; 35:297-302. [PMID: 11579059 PMCID: PMC1724391 DOI: 10.1136/bjsm.35.5.297] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Professional and amateur participants in many sports are at risk of brain injury caused by impact with other players or objects. In many cases, mild cognitive deficits may persist after the common neurological signs of brain injury have passed. In recent years, the athlete's cognitive status after concussion has been measured with conventional "paper and pencil" neuropsychological tests. However, such tests are not ideal for sporting settings, as they are designed for the detection of gross cognitive impairments at a single assessment, not for the identification of mild cognitive deficits on repeated assessment. A number of computerised cognitive assessment tests and test batteries have been developed over the past two decades. These batteries offer major scientific and practical advantages over conventional neuropsychological tests which make them ideal for the assessment of cognitive function in sportspeople. This review first describes the problems associated with cognitive assessment of people with sports related cognitive deficits, and then critically examines the utility of conventional neuropsychological and computerised cognitive tests in sporting settings.
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Affiliation(s)
- A Collie
- Centre for Neuroscience, University of Melbourne, Parkville, Victoria, Australia.
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19
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Abstract
The increased popularity of contact sports worldwide exposes a large number of participants to both acute and chronic traumatic brain injury. Chronic traumatic brain injury (CTBI) represents the cumulative, long-term neurological consequences of repetitive concussive and subconcussive blows to the brain. Although this condition has been described primarily in boxing, it may be anticipated in other contact sports such as soccer, football, ice hockey, and the martial arts. Since treatment options in CTBI are relatively limited, the prevention of CTBI is of paramount importance. Minimizing the frequency and severity of acute brain injury in sport will be instrumental in accomplishing this goal. The prevention of CTBI will need to be sport specific and will undoubtedly rely on limiting the exposure of high-risk athletes, utilizing of protective equipment, enforcing strict rule adherence, training and supervising athletes, and increasing medical surveillance.
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Affiliation(s)
- M H Rabadi
- Brain Injury Program, Burke Rehabilitation Hospital, White Plains, New York 10605, USA
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20
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Kutner KC, Erlanger DM, Tsai J, Jordan B, Relkin NR. Lower cognitive performance of older football players possessing apolipoprotein E epsilon4. Neurosurgery 2000; 47:651-7; discussion 657-8. [PMID: 10981753 DOI: 10.1097/00006123-200009000-00026] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine whether the cognitive status of professional football players varies as a function of age and apolipoprotein E (APOE) genotype. METHODS Fifty-three active players underwent APOE and neuropsychological assessments. Players were grouped according to age (proxy indicator of high/low exposure to contact) and the presence/absence of at least one copy of the epsilon4 allele. Outcome measures were overall cognitive performance and scores in cognitive domains. RESULTS As a group, older players possessing APOE epsilon4 exhibited significantly lower cognitive test scores than did all other players studied, including non-epsilon4-possessing players and younger epsilon4-carriers. Measures of general cognitive functioning, information-processing speed and accuracy, and attention were related to poorer performance among the epsilon4-carrying players. In an analysis of variance model, the interaction between APOE genotype and age was significant (P = 0.004). As determined using linear regression, age accounted for 34% of the variance in the memory index among APOE epsilon4-possessing players but did not contribute significantly to variance among the non-epsilon4-possessing players. Older APOE epsilon4-carriers were significantly overrepresented among players whose scores indicated possible cognitive impairment, with the criterion of performing two or more standard deviations below the general normal values in a summary index of general cognitive functioning. CONCLUSION Older professional football players who possessed the APOE epsilon4 allele scored lower on cognitive tests than did players without this allele or less experienced players of any genotype. The cognitive status of professional athletes with repeated exposure to head trauma may therefore be influenced by age, inherited factors such as APOE genotype, and cumulative exposure to contact.
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Affiliation(s)
- K C Kutner
- Department of Neurology and Neuroscience, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York 10021, USA
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21
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Margulies S. The postconcussion syndrome after mild head trauma: is brain damage overdiagnosed? Part 1. J Clin Neurosci 2000; 7:400-8. [PMID: 10942660 DOI: 10.1054/jocn.1999.0681] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Many investigators attribute the postconcussion syndrome following mild closed head injury to permanent brain damage. The evidence supporting this conclusion is reviewed, including the force necessary to cause permanent brain damage; the basis for determining whether the patient was exposed to sufficient force in the accident to permanently damage the brain; the basis for determining whether the patient actually has permanent brain damage (not just brain dysfunction) traceable to the accident; and whether the location and severity of brain damage is sufficient to account for the postconcussion syndrome. CONCLUSION the evidence for permanent traumatic brain damage as the cause of the postconcussion syndrome following mild closed head injury is weak.
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Kutner KC, Erlanger DM, Tsai J, Jordan B, Relkin NR. Lower Cognitive Performance of Older Football Players Possessing Apolipoprotein E ε4. Neurosurgery 2000. [DOI: 10.1227/00006123-200009000-00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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