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Boltz AJ, Lempke LB, Syrydiuk RA, Duma S, Pasquina P, McAllister TW, McCrea M, Chandran A, Broglio SP. Association of Sport Helmet Status on Concussion Presentation and Recovery in Male Collegiate Student-Athletes. Ann Biomed Eng 2024:10.1007/s10439-024-03575-0. [PMID: 38977528 DOI: 10.1007/s10439-024-03575-0] [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: 10/16/2023] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
Sporting helmets contain force attenuating materials which reduce traumatic head injury risk and may influence sport-related concussion (SRC) sequelae. The purpose of this study was to examine the association of sport helmet status with SRC-clinical presentation and recovery trajectories in men's collegiate athletes. Sport helmet status was based on the nature of sports being either helmeted/non-helmeted. 1070 SRCs in helmeted (HELM) sports (Men's-Football, Ice Hockey, and Lacrosse), and 399 SRCs in non-helmeted (NOHELM) sports (Men's-Basketball, Cheerleading, Cross Country/Track & Field, Diving, Gymnastics, Soccer, Swimming, Tennis, and Volleyball) were analyzed. Multivariable negative binomial regression models analyzed associations between sport helmet status and post-injury cognition, balance, and symptom severity, adjusting for covariate effects (SRC history, loss of consciousness, anterograde/retrograde amnesia, event type). Kaplan-Meier curves evaluated median days to: initiation of return to play (iRTP) protocol, and unrestricted RTP (URTP) by sport helmet status. Log-rank tests were used to evaluate differential iRTP/URTP between groups. Two independent multivariable Weibull accelerated failure time models were used to examine differential iRTP and URTP between groups, after adjusting for aforementioned covariates and symptom severity score. Overall, the median days to iRTP and URTP was 6.3 and 12.0, respectively, and was comparable across NOHELM- and HELM-SRCs. Post-injury symptom severity was lower (Score Ratio 0.90, 95%CI 0.82, 0.98), and cognitive test performance was higher (Score Ratio 1.03, 95%CI 1.02, 1.05) in NOHELM-compared to HELM-SRCs. Estimated time spent recovering to iRTP/URTP was comparable between sport helmet status groups. Findings suggest that the grouping of sports into helmeted and non-helmeted show slight differences in clinical presentation but not recovery.
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Affiliation(s)
- Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
| | - Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Reid A Syrydiuk
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Stefan Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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Huibregtse ME, Sweeney SH, Stephens MR, Cheng H, Chen Z, Block HJ, Newman SD, Kawata K. Association Between Serum Neurofilament Light and Glial Fibrillary Acidic Protein Levels and Head Impact Burden in Women's Collegiate Water Polo. J Neurotrauma 2023; 40:1130-1143. [PMID: 36259456 PMCID: PMC10266555 DOI: 10.1089/neu.2022.0300] [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] [Indexed: 12/13/2022] Open
Abstract
Recent investigations have identified water polo athletes as at risk for concussions and repetitive subconcussive head impacts. Head impact exposure in collegiate varsity women's water polo, however, has not yet been longitudinally quantified. We aimed to determine the relationship between cumulative and acute head impact exposure across pre-season training and changes in serum biomarkers of brain injury. Twenty-two Division I collegiate women's water polo players were included in this prospective observational study. They wore sensor-installed mouthguards during all practices and scrimmages during eight weeks of pre-season training. Serum samples were collected at six time points (at baseline, before and after scrimmages during weeks 4 and 7, and after the eight-week pre-season training period) and assayed for neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) using Simoa® Human Neurology 2-Plex B assay kits. Serum GFAP increased over time (e.g., an increase of 0.6559 pg/mL per week; p = 0.0087). Neither longitudinal nor acute pre-post scrimmage changes in GFAP, however, were associated with head impact exposure. Contrarily, an increase in serum NfL across the study period was associated with cumulative head impact magnitude (sum of peak linear acceleration: B = 0.015, SE = 0.006, p = 0.016; sum of peak rotational acceleration: B = 0.148, SE = 0.048, p = 0.006). Acute changes in serum NfL were not associated with head impacts recorded during the two selected scrimmages. Hormonal contraceptive use was associated with lower serum NfL and GFAP levels over time, and elevated salivary levels of progesterone were also associated with lower serum NfL levels. These results suggest that detecting increases in serum NfL may be a useful way to monitor cumulative head impact burden in women's contact sports and that female-specific factors, such as hormonal contraceptive use and circulating progesterone levels, may be neuroprotective, warranting further investigations.
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Affiliation(s)
- Megan E. Huibregtse
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Sage H. Sweeney
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Mikayla R. Stephens
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Hu Cheng
- Department of Department of Psychological and Brain Sciences and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Zhongxue Chen
- Department of Mathematics and Statistics, College of Arts, Sciences and Education, Florida International University, Miami, Florida, USA
- Department of Epidemiology and Biostatistics, School of Public Health, and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Hannah J. Block
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
- Department of Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
| | - Sharlene D. Newman
- Alabama Life Research Institute, College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
- Department of Electrical and Computer Engineering, College of Engineering, and College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, College of Arts and Sciences, University of Alabama, Tuscaloosa, Alabama, USA
| | - Keisuke Kawata
- Department of Kinesiology and College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
- Department of Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, USA
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Caccese JB, Bryk KN, Porfido T, Bretzin AC, Peek K, Kaminski TW, Kontos AP, Chrisman SPD, Putukian M, Buckley TA, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Esopenko C. Cognitive and Behavioral Outcomes in Male and Female NCAA Soccer Athletes across Multiple Years: A CARE Consortium Study. Med Sci Sports Exerc 2023; 55:409-417. [PMID: 36288576 DOI: 10.1249/mss.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared with a control group of noncontact athletes. METHODS Generalized estimating equations were used to compare changes in annual, preseason baseline measures of neurocognitive function, neurobehavioral and psychological symptoms, and postural stability between collegiate soccer players ( n = 75; 51 [68%] female soccer players) and noncontact athletes ( n = 210; 133 [63%] female noncontact athletes) across three consecutive years. RESULTS Among all participants, the group-time interaction was not significant for any outcome measures. Overall, soccer players reported lower (better) Brief Symptom Inventory 18 Depression ( P = 0.004, Exp(B) = 0.36, 95% confidence interval [CI] = 0.18-0.73), Global Severity Index ( P = 0.006, Exp(B) = 0.53, 95% CI = 0.33-0.84), and Post-Concussion Symptom Scale Symptom Severity ( P < 0.001, Exp(B) = 0.45, 95% CI = 0.22-0.95) scores than noncontact athletes. No other outcome measures were different between soccer players and noncontact athletes. CONCLUSIONS Among collegiate athletes, soccer players report similar or better psychosocial functioning and symptom scores than noncontact athletes. Importantly, neurocognitive functioning, neurobehavioral and psychological symptoms, and postural stability do not worsen over time in collegiate soccer players relative to their noncontact counterparts. Our findings suggest that despite possible exposure to repetitive head impacts, collegiate soccer players do not exhibit changes in observable function and symptoms across multiple seasons.
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Affiliation(s)
| | - Kelsey N Bryk
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Tara Porfido
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, AUSTRALIA
| | - Thomas W Kaminski
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA
| | - Margot Putukian
- Major League Soccer, New York, NY (previously Princeton University, Princeton, NJ)
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul F Pasquina
- Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Jenkins AS, Pollock JR, Moore ML, Makovicka JL, Brinkman JC, Chhabra A. The 100 Most-Cited and Influential Articles in Collegiate Athletics. Orthop J Sports Med 2022; 10:23259671221108401. [PMID: 35837444 PMCID: PMC9274432 DOI: 10.1177/23259671221108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics. Purpose To identify the 100 most-cited research publications related to collegiate athletics. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence. Results Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies. Conclusion The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author's prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.
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Affiliation(s)
- Anna S Jenkins
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - M Lane Moore
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Basinas I, McElvenny DM, Pearce N, Gallo V, Cherrie JW. A Systematic Review of Head Impacts and Acceleration Associated with Soccer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095488. [PMID: 35564889 PMCID: PMC9100160 DOI: 10.3390/ijerph19095488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Epidemiological studies of the neurological health of former professional soccer players are being undertaken to identify whether heading the ball is a risk factor for disease or premature death. A quantitative estimate of exposure to repeated sub-concussive head impacts would provide an opportunity to investigate possible exposure-response relationships. However, it is unclear how to formulate an appropriate exposure metric within the context of epidemiological studies. We have carried out a systematic review of the scientific literature to identify the factors that determine the magnitude of head impact acceleration during experiments and from observations during playing or training for soccer, up to the end of November 2021. Data were extracted from 33 experimental and 27 observational studies from male and female amateur players including both adults and children. There was a high correlation between peak linear and angular accelerations in the observational studies (p < 0.001) although the correlation was lower for the experimental data. We chose to rely on an analysis of maximum or peak linear acceleration for this review. Differences in measurement methodology were identified as important determinants of measured acceleration, and we concluded that only data from accelerometers fixed to the head provided reliable information about the magnitude of head acceleration from soccer-related impacts. Exposures differed between men and women and between children and adults, with women on average experiencing higher acceleration but less frequent impacts. Playing position appears to have some influence on the number of heading impacts but less so on the magnitude of the head acceleration. Head-to-head collisions result in high levels of exposure and thus probably risk causing a concussion. We concluded, in the absence of evidence to the contrary, that estimates of the cumulative number of heading impacts over a playing career should be used as the main exposure metric in epidemiological studies of professional players.
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Affiliation(s)
- Ioannis Basinas
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Damien M. McElvenny
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Valentina Gallo
- Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands;
| | - John W. Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh EH14 4AS, UK
- Correspondence:
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6
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Characterization of Head Impact Exposure in Women's Collegiate Soccer. J Appl Biomech 2021; 38:2-11. [PMID: 34911036 DOI: 10.1123/jab.2020-0304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
Soccer players are regularly exposed to head impacts by intentionally heading the ball. Evidence suggests repetitive subconcussive head impacts may affect the brain, and females may be more vulnerable to brain injury than males. This study aimed to characterize head impact exposure among National Collegiate Athletic Association women's soccer players using a previously validated mouthpiece-based sensor. Sixteen players were instrumented during 72 practices and 24 games. Head impact rate and rate of risk-weighted cumulative exposure were compared across session type and player position. Head kinematics were compared across session type, impact type, player position, impact location, and ball delivery method. Players experienced a mean (95% confidence interval) head impact rate of 0.468 (0.289 to 0.647) head impacts per hour, and exposure rates varied by session type and player position. Headers accounted for 89% of head impacts and were associated with higher linear accelerations and rotational accelerations than nonheader impacts. Headers in which the ball was delivered by a long kick had greater peak kinematics (all P < .001) than headers in which the ball was delivered by any other method. Results provide increased understanding of head impact frequency and magnitude in women's collegiate soccer and may help inform efforts to prevent brain injury.
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Kaminski TW, Chrisman SPD, Glutting J, Wahlquist V, Eagle S, Putukian M, Tierney R, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Kontos AP, Investigators CARES. Mechanisms of injury for concussions in collegiate soccer: an NCAA/DoD CARE consortium study. SCI MED FOOTBALL 2021; 6:325-330. [DOI: 10.1080/24733938.2021.1991586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Ne’wark, DE, USA
| | - Victoria Wahlquist
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margot Putukian
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F. Pasquina
- Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Asken BM, Rabinovici GD. Professional Soccer and Dementia Risk-The Ugly Side of the Beautiful Game. JAMA Neurol 2021; 78:1049-1051. [PMID: 34338741 DOI: 10.1001/jamaneurol.2021.2246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Breton M Asken
- Department of Neurology, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
| | - Gil D Rabinovici
- Department of Neurology, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.,Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco.,Memory and Aging Center, University of California, San Francisco.,Associate Editor, JAMA Neurology
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Asken BM, Rabinovici GD. Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review. Acta Neuropathol Commun 2021; 9:96. [PMID: 34022959 PMCID: PMC8141132 DOI: 10.1186/s40478-021-01197-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND SCOPE OF REVIEW Varying severities and frequencies of head trauma may result in dynamic acute and chronic pathophysiologic responses in the brain. Heightened attention to long-term effects of head trauma, particularly repetitive head trauma, has sparked recent efforts to identify neuroimaging biomarkers of underlying disease processes. Imaging modalities like structural magnetic resonance imaging (MRI) and positron emission tomography (PET) are the most clinically applicable given their use in neurodegenerative disease diagnosis and differentiation. In recent years, researchers have targeted repetitive head trauma cohorts in hopes of identifying in vivo biomarkers for underlying biologic changes that might ultimately improve diagnosis of chronic traumatic encephalopathy (CTE) in living persons. These populations most often include collision sport athletes (e.g., American football, boxing) and military veterans with repetitive low-level blast exposure. We provide a clinically-oriented review of neuroimaging data from repetitive head trauma cohorts based on structural MRI, FDG-PET, Aβ-PET, and tau-PET. We supplement the review with two patient reports of neuropathology-confirmed, clinically impaired adults with prior repetitive head trauma who underwent structural MRI, FDG-PET, Aβ-PET, and tau-PET in addition to comprehensive clinical examinations before death. REVIEW CONCLUSIONS Group-level comparisons to controls without known head trauma have revealed inconsistent regional volume differences, with possible propensity for medial temporal, limbic, and subcortical (thalamus, corpus callosum) structures. Greater frequency and severity (i.e., length) of cavum septum pellucidum (CSP) is observed in repetitive head trauma cohorts compared to unexposed controls. It remains unclear whether CSP predicts a particular neurodegenerative process, but CSP presence should increase suspicion that clinical impairment is at least partly attributable to the individual's head trauma exposure (regardless of underlying disease). PET imaging similarly has not revealed a prototypical metabolic or molecular pattern associated with repetitive head trauma or predictive of CTE based on the most widely studied radiotracers. Given the range of clinical syndromes and neurodegenerative pathologies observed in a subset of adults with prior repetitive head trauma, structural MRI and PET imaging may still be useful for differential diagnosis (e.g., assessing suspected Alzheimer's disease).
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology & Biomedical Imaging, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
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Biegon A. Considering Biological Sex in Traumatic Brain Injury. Front Neurol 2021; 12:576366. [PMID: 33643182 PMCID: PMC7902907 DOI: 10.3389/fneur.2021.576366] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Published epidemiological studies of traumatic brain injury (TBI) of all severities consistently report higher incidence in men. Recent increases in the participation of women in sports and active military service as well as increasing awareness of the very large number of women who sustain but do not report TBI as a result of intimate partner violence (IPV) suggest that the number of women with TBI is significantly larger than previously believed. Women are also grossly under-represented in clinical and natural history studies of TBI, most of which include relatively small numbers of women, ignore the role of sex- and age-related gonadal hormone levels, and report conflicting results. The emerging picture from recent studies powered to detect effects of biological sex as well as age (as a surrogate of hormonal status) suggest young (i.e., premenopausal) women are more likely to die from TBI relative to men of the same age group, but this is reversed in the 6th and 7th decades of life, coinciding with postmenopausal status in women. New data from concussion studies in young male and female athletes extend this finding to mild TBI, since female athletes who sustained mild TBI are significantly more likely to report more symptoms than males. Studies including information on gonadal hormone status at the time of injury are still too scarce and small to draw reliable conclusions, so there is an urgent need to include biological sex and gonadal hormone status in the design and analysis of future studies of TBI.
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Affiliation(s)
- Anat Biegon
- Department of Radiology and Neurology, Stony Brook University School of Medicine, Stony Brook, NY, United States
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