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Bryant AM, Kerr ZY, Walton SR, Barr WB, Guskiewicz KM, McCrea MA, Brett BL. Investigating the association between subjective and objective performance-based cognitive function among former collegiate football players. Clin Neuropsychol 2023; 37:595-616. [PMID: 35670306 PMCID: PMC9726994 DOI: 10.1080/13854046.2022.2083021] [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: 01/23/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies have observed variable associations of prior contact sport participation with subjective and objective measures of cognitive function. This study directly investigated the association between subjective self-report and objective performance-based cognition among former collegiate football players, as well as its relationship to self-reported concussion history. METHODS Former collegiate football players (N = 57; mean age = 37.9 years [SD = 1.49]) retired from sport 15-years prior were enrolled. Linear regression models examined associations between subjective cognition (Quality of Life in Neurological Disorders Cognitive Functioning-Short Form), and performance on a neuropsychological battery. Domain specific (executive function) metrics of subjective (Behavior Rating Inventory of Executive Function-Adult) and objective cognition were also exclusively examined. Associations between self-reported concussion history with subjective and objective measures were tested. Potential influential factors (sleep quality and distress) were included as covariates. RESULTS Subjective cognition was not significantly associated with any objective measures of cognitive functioning (p's > .05). Greater self-reported concussion history was inversely associated with subjective cognition (B = -2.49, p = .004), but not objective performance-based cognition (p's > .05). Distress was significantly related to all metrics of subjective cognition (p's < .001) as well as performance on delayed recall and verbal fluency (p's < .05). Sleep quality was only significantly related to timed visuospatial sequencing (p = .033). CONCLUSIONS Reliance on self-reported measures of cognitive functioning alone is insufficient when assessing cognition in former contact sport athletes. Assessment of other factors known to influence subjective cognitive complaints should also be examined in determining the presence of cognitive deficits.
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Affiliation(s)
- Andrew M. Bryant
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Samuel R. Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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2
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Piantella S, McDonald SJ, Wright BJ. Gender and Workplace Stress Affect the Association Between Concussion History and Depression Symptoms in Professional Jockeys. Arch Clin Neuropsychol 2022; 38:537-547. [DOI: 10.1093/arclin/acac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Professional jockeys experience high rates of concussion, workplace stress, and poor mental health. The present cross-sectional study, for the first time, concurrently assessed the potential interplay between concussion history and workplace stress with current depression symptoms.
Method
Seventy-two professional flat-track jockeys (male = 49, female = 23) were grouped based on self-reported concussion history (CG; n = 56) and those who did not report a concussion history (NCG; total n = 16). Analyses featured both between (CG vs NCG) and within group (CG only) assessment on self-reported measures of workplace stress and depression symptoms (affect, daily functioning).
Results
Jockeys in the CG had more symptoms of negative affect than the NCG. This association, however, was nonsignificant after covarying for age, gender, and workplace stress. Higher workplace stress (p = .005) and gender (p = .001) were associated with poorer daily functioning after controlling for concussion history (CG vs. NCG) and age. Gender moderated the association between concussion group and poorer daily functioning (β = −18.739, t (71) = −2.924, p = .005), with the difference between CG and NCG significant for females, but not males (β = 33.648, t (71) = 3.420, p = .001).
Conclusions
The findings provide preliminary evidence that previously concussed females may be more likely to report poorer daily functioning than males with a history of concussion, and that workplace stress may reduce the association between a history of concussion and depression symptoms. Prospective studies are required to validate and extend these findings.
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Affiliation(s)
- Stefan Piantella
- Department of Psychology , Counselling, & Therapy, , Bundoora, Victoria , Australia
- La Trobe University , Counselling, & Therapy, , Bundoora, Victoria , Australia
| | - Stuart J McDonald
- Department of Neuroscience , Central Clinical School, , Melbourne, Victoria , Australia
- Monash University , Central Clinical School, , Melbourne, Victoria , Australia
| | - Bradley J Wright
- Department of Psychology , Counselling, & Therapy, , Bundoora, Victoria , Australia
- La Trobe University , Counselling, & Therapy, , Bundoora, Victoria , Australia
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3
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Associations of lifetime concussion history and repetitive head impact exposure with resting-state functional connectivity in former collegiate American football players: An NCAA 15-year follow-up study. PLoS One 2022; 17:e0273918. [PMID: 36084077 PMCID: PMC9462826 DOI: 10.1371/journal.pone.0273918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to examine associations of lifetime concussion history (CHx) and an advanced metric of lifetime repetitive head impact exposure with resting-state functional connectivity (rsFC) across the whole-brain and among large-scale functional networks (Default Mode; Dorsal Attention; and Frontoparietal Control) in former collegiate football players. Individuals who completed at least one year of varsity collegiate football were eligible to participate in this observational cohort study (n = 48; aged 36–41 years; 79.2% white/Caucasian; 12.5±4.4 years of football played; all men). Individuals were excluded if they reported history/suspicion of psychotic disorder with active symptoms, contraindications to participation in study procedures (e.g., MRI safety concern), or inability to travel. Each participant provided concussion and football playing histories. Self-reported concussion history was analyzed in two different ways based on prior research: dichotomous “High” (≥3 concussions; n = 28) versus “Low” (<3 concussions; n = 20); and four ordinal categories (0–1 concussion [n = 19]; 2–4 concussions [n = 8]; 5–7 concussions [n = 9]; and ≥8 concussions [n = 12]). The Head Impact Exposure Estimate (HIEE) was calculated from football playing history captured via structured interview. Resting-state fMRI and T1-weighted MRI were acquired and preprocessed using established pipelines. Next, rsFC was calculated using the Seitzman et al., (2020) 300-ROI functional atlas. Whole-brain, within-network, and between-network rsFC were calculated using all ROIs and network-specific ROIs, respectively. Effects of CHx and HIEE on rsFC values were examined using separate multivariable linear regression models, with a-priori α set to 0.05. We observed no statistically significant associations between rsFC outcomes and either CHx or HIEE (ps ≥ .12). Neither CHx nor HIEE were associated with neural signatures that have been observed in studies of typical and pathological aging. While CHx and repetitive head impacts have been associated with changes in brain health in older former athletes, our preliminary results suggest that associations with rsFC may not be present in early midlife former football players.
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4
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Kerr ZY, Chandran A, Brett BL, Walton SR, DeFreese JD, Mannix R, Echemendia RJ, McCrea MA, Guskiewicz KM, Meehan WP. The stability of self-reported professional football concussion history among former players: A longitudinal NFL-LONG study. Brain Inj 2022; 36:968-976. [PMID: 35971311 DOI: 10.1080/02699052.2022.2109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To examine the stability of former National Football League (NFL) players' recall of professional football concussion. METHODS Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 … 10, >10). Participants were categorized into four 'recall stability' groups, based upon concussion recall [e.g., 'Same' (same number recalled), 'Increased' (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. 'Recall stability group' functioning scores were compared. RESULTS Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the 'Same' vs 'Increased' groups. CONCLUSIONS Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Columbia, Pennsylvania, USA.,Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael A McCrea
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William P Meehan
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
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5
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DeFreese JD, Walton SR, Kerr ZY, Brett BL, Chandran A, Mannix R, Campbell H, Echemendia RJ, McCrea MA, Meehan WP, Guskiewicz KM. Transition-Related Psychosocial Factors and Mental Health Outcomes in Former National Football League Players: An NFL-LONG Study. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2022; 44:169-176. [PMID: 35279017 DOI: 10.1123/jsep.2021-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Transition from professional sport to nonsport endeavors has implications for postcareer health and well-being of athletes. The purpose of the current study was to examine associations among transition-related psychosocial factors and current mental health outcomes in former National Football League (NFL) players. Participants were former NFL players (n = 1,784; mean age = 52.3 ± 16.3 years) who responded to a questionnaire assessing the nature of their discontinuation from professional football (i.e., any degree of voluntary choice vs. forced discontinuation), prediscontinuation transition planning (yes vs. no), and current symptoms of depression and anxiety. After adjusting for relevant covariates, having an involuntary discontinuation and no transition plan prior to discontinuation were associated with greater depressive and anxiety symptom severity. Autonomy in discontinuation and pretransition planning are important to former NFL football players' mental health. Increasing autonomy in the discontinuation decision and pretransition planning represent psychoeducational intervention targets for this population.
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Affiliation(s)
- J D DeFreese
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | - Samuel R Walton
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | | | - Avinash Chandran
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
- Datalys Center for Sports Injury Research and Prevention, Inc., University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | | | - Ruben J Echemendia
- University of Missouri-Kansas City, Kansas City, MO,USA
- University Orthopedics Center Concussion Clinic, State College, PA,USA
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Lawn RB, Jha SC, Liu J, Sampson L, Murchland AR, Sumner JA, Roberts AL, Disner SG, Grodstein F, Kang JH, Kubzansky LD, Chibnik LB, Koenen KC. The association of posttraumatic stress disorder, depression, and head injury with mid-life cognitive function in civilian women. Depress Anxiety 2022; 39:220-232. [PMID: 34970809 PMCID: PMC8901526 DOI: 10.1002/da.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women. METHODS The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses' Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury. RESULTS History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention ( β = -.15, p = .001) and learning/working memory ( β = -.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries. CONCLUSIONS Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.
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Affiliation(s)
- Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaili C. Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jiaxuan Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Audrey R. Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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7
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Brett BL, Kerr ZY, Walton SR, Chandran A, Defreese JD, Mannix R, Echemendia RJ, Meehan WP, Guskiewicz KM, McCrea M. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2022; 93:272-279. [PMID: 34663623 PMCID: PMC8854336 DOI: 10.1136/jnnp-2021-326602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories. METHODS Former American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms. RESULTS Among the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=-0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time. CONCLUSIONS Concussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, indianapolis, IN, USA
| | - J D Defreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - William P Meehan
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
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8
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Hume PA, Quarrie KL, Lewis GN, Theadom A. NZ-RugbyHealth Study: Self-reported Injury Experience and Current Health of Former Rugby Union and Non-contact Sport Players. Sports Med 2022; 52:1701-1713. [PMID: 35088235 PMCID: PMC9213390 DOI: 10.1007/s40279-021-01630-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
Background There is limited research on associations between playing rugby union and player health post-retirement. Objective This study investigated differences in self-reported sport injury history and current self-reported health characteristics between former New Zealand rugby and non-contact sport players with a view to identifying issues to be further investigated with stronger epidemiological research designs. Methods Using a cross-sectional design, the NZ-RugbyHealth study surveyed 470 former rugby and non-contact sport players (43.8 ± 8.1 years; 127 elite rugby, 271 community rugby, 72 non-contact sport) recruited from October 2012 to April 2014. Demographic information, engagement in sport, sport injuries, medical conditions, mood, alcohol and substance use and ratings of current health status were obtained from a self-report 58-item general health e-questionnaire. We highlighted standardised differences in means of > 0.6 and differences in relative percentages of > 1.43 for variables between groups as representing at least moderate effect sizes, and of being worthy of follow-up studies. Results Higher percentages of the elite rugby player group had sustained injuries of a given body-site type (e.g. neck sprain/strain, thigh bruising, hamstring strain) combination than the non-contact sports players. Higher percentages of the rugby groups reported having sustained concussion (94% for elite, 82% for community, 26% for non-contact), injuries requiring hospitalisation (73%, 46%, 25%), injuries that stopped participation in sport permanently (28%, 28%, 11%) and sport-related surgery (72%, 46%, 32%) during their playing career. Both rugby groups had a higher prevalence of osteoarthritis (37%, 18%, 6%) than non-contact athletes and community rugby players had higher levels of hazardous alcohol consumption (38%, 40%, 25%) in retirement than non-contact athletes. There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use and current physical or psychological health ratings. Conclusions Former rugby player groups were at higher risk than the non-contact player group for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of the groups (43.8 years on average) means that health issues that typically do not emerge until later life may not have yet manifested. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01630-7.
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Affiliation(s)
- Patria A Hume
- Sport Performance Research Institute New Zealand, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand.
| | - Kenneth L Quarrie
- Sport Performance Research Institute New Zealand, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.,New Zealand Rugby, Wellington, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute (HRRI), Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand
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9
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Walton SR, Kerr ZY, Mannix R, Brett BL, Chandran A, DeFreese JD, McCrea MA, Guskiewicz KM, Meehan WP, Echemendia RJ. Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study. Sports Med 2021; 52:1189-1203. [PMID: 34773581 DOI: 10.1007/s40279-021-01589-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing. OBJECTIVES We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns. METHODS In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1-2 (n = 309); 3-5 (n = 413); 6-9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx. RESULTS More than one-third of participants reported being currently "extremely concerned" about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being "not at all concerned" regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being "not at all" or "slightly" concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently "moderately" or "extremely" concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns. CONCLUSIONS Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player's functioning and well-being.
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Affiliation(s)
- Samuel R Walton
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Mannix
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Jonathan D DeFreese
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M Guskiewicz
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention and Boston Children's Hospital, Waltham, MA, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri, Kansas City, Kansas City, MO, USA.
- University Orthopedics Center Concussion Clinic, 101 Regent Ct., State College, PA, 16801, USA.
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Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, Meehan WP, McCrea M, Guskiewicz KM, Kerr ZY. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study. Med Sci Sports Exerc 2021; 54:424-431. [PMID: 34593716 DOI: 10.1249/mss.0000000000002802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate prevalences of MCI and dementia diagnoses in former National Football League (NFL) players ≥50 years old and examine the relationships among these diagnoses and an array of predictors of long-term brain health. METHODS A cross-section of former NFL players (n = 922; aged [mean ± SD] 64.8 ± 8.9 years) completed a questionnaire. Prevalences of self-reported medical diagnoses of MCI and dementia were reported alongside U.S. population estimates across 5-year age intervals (e.g., 60-64 years). Prevalence ratios (PRs) were calculated for multiple predictors of long-term brain health. RESULTS Overall, MCI and dementia prevalences were n = 219(23.8%) and n = 82(8.9%), respectively. Each diagnosis was more prevalent in former NFL players across age groups than U.S. norms, with greater disparities at relatively younger ages (e.g., 65-69) compared with older ages. Greater prevalences of MCI and dementia were associated with: self-reported concussion history (10+ vs. 0; PRadjusted[95%CI] = 1.66[1.02-2.71] and 2.61[1.01-6.71], respectively); recent pain intensity (PRadjusted[95%CI] = 1.13[1.07-1.20] and 1.15[1.03-1.28]); and diagnoses of depression (PRadjusted[95%CI] = 2.70[1.92-3.81] and 3.22[1.69-6.14]), anxiety (PRadjusted[95%CI] = 1.96[1.26-3.07] and 3.14[1.47-6.74]), or both (PRadjusted[95%CI] = 3.11[2.38-4.08] and 4.43[2.71-7.25]). Higher MCI prevalence was related to sleep apnea (PRadjusted[95%CI] = 1.30[1.06-1.60]); higher dementia prevalence was associated with age (5-year interval, PRadjusted[95%CI] = 1.42[1.26-1.60]) and race (non-White vs. White, PRadjusted[95%CI] = 1.64[1.07-2.53]). CONCLUSIONS Self-reported MCI and dementia prevalences were higher in former NFL players than national estimates and were associated with numerous personal factors, including mood-related disorders and a high number of self-reported concussions. Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.
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Affiliation(s)
- Samuel R Walton
- Department of Exercise and Sport Science and Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN Division of Emergency Medicine, Boston Children's Hospital, Boston, MA Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA Department of Psychology, University of Missouri - Kansas City, Kansas City, MO University Orthopedics Center Concussion Care Clinic, State College, PA Sports Medicine Division, Boston Children's Hospital, Boston, MA The Micheli Center for Sports Injury Prevention, Boston, MA Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
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11
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Brett BL, Meier TB, Savitz J, Guskiewicz KM, McCrea M. Research Letter: Sleep Mediates the Association Between Prior Concussion and Depressive Symptoms. J Head Trauma Rehabil 2021; 36:E284-E288. [PMID: 33656485 PMCID: PMC8249320 DOI: 10.1097/htr.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test sleep quality as one mechanistic pathway through which repeated concussion increases risk of depression later in life among former contact sport athletes. SETTING Multicenter study enrolled former American collegiate football players from 16 different National Collegiate Athletic Association member institutions. PARTICIPANTS Fifty-eight former American collegiate football players approximately 15 years following sport discontinuation. DESIGN Participants completed in-person evaluations including comprehensive semistructured interviews with detailed concussion history and sport history, as well as self-reported measures of depression symptom severity (Beck Depression Inventory-II) and sleep quality (Pittsburgh Sleep Quality Index). Years of football participation were included as a covariate. Mediation modeling examined the degree to which sleep quality accounted for the association between repeated concussion and depression symptoms. RESULTS Within the mediation model, concussion history significantly predicted sleep quality (B = 1.03; 95% CI, 0.37 to 1.65; P = .002) and sleep quality significantly predicted depressive symptom severity (controlling for the effects of concussion history; B = 0.15; 95% CI, 0.06 to 0.24; P = .001). The association between prior concussion and depressive symptom severity was fully mediated by sleep quality. With inclusion of the indirect effects, concussion history did not predict depressive symptom severity (direct effect: B = 0.14; 95% CI, -0.09 to 0.41; P = .249; indirect effect: 0.15; 95% CI, 0.03 to 0.29; P = .016). CONCLUSIONS Current findings raise the possibility that the greater risk of depression reported in those with a history of mTBI/concussion is mediated by sleep quality, a common sequela of mTBI. These findings highlight potential opportunities for prophylactic sleep-related intervention among individuals with multiple prior concussions to mitigate the risk of depression.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Oxley College of Health Sciences, Tulsa, Oklahoma
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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Brett BL, Walton SR, Kerr ZY, Nelson LD, Chandran A, Defreese JD, Echemendia RJ, Guskiewicz KM, Meehan Iii WP, McCrea MA. Distinct latent profiles based on neurobehavioural, physical and psychosocial functioning of former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2021; 92:282-290. [PMID: 33483350 DOI: 10.1136/jnnp-2020-324244] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify subgroups of former National Football League (NFL) players using latent profile analysis (LPA) and examine their associations with total years of participation (TYP) and self-reported lifetime sport-related concussion history (SR-CHx). METHODS Former NFL players (N=686) aged 50-70 years, with an average 18.0 TYP (±4.5) completed a questionnaire. SR-CHx distributions included: low (0-3; n=221); intermediate (4-8; n=209) and high (9+; n=256). LPA measures included: Quality of Life in Neurological Disorders Emotional-Behavioral Dyscontrol, Patient Reported Outcomes Measurement Information System Cognitive Function, Emotional Support, Self-Efficacy, Meaning and Purpose, Physical Function, Pain Interference, Participation in Social Roles and Activities, Anxiety, Depression, Fatigue, and Sleep Disturbance. Demographic, medical/psychiatric history, current psychosocial stressors, TYP and SR-CHx were compared across latent profiles (LPs). RESULTS A five profile solution emerged: (LP1) global higher functioning (GHF; 26.5%); (LP2) average functioning (10.2%); (LP3) mild somatic (pain and physical functioning) concerns (22.0%); (LP4) somatic and cognitive difficulties with mild anxiety (SCA; 27.5%); LP5) global impaired functioning (GIF; 13.8%). The GIF and SCA groups reported the largest number ofe- medical/psychiatric conditions and higher psychosocial stressor levels. SR-CHx was associated with profile group (χ2(8)=100.38, p<0.001); with a higher proportion of GIF (72.6%) and SCA (43.1%) groups reporting being in the high SR-CHx category, compared with GHF (23.1%), average (31.4%) and somatic (27.8%) groups. TYP was not significantly associated with group (p=0.06), with greater TYP reported by the GHF group. CONCLUSIONS Five distinct profiles of self-reported functioning were identified among former NFL players. Several comorbid factors (ie, medical/psychiatric diagnoses and psychosocial stressors) and SR-CHx were associated with greater neurobehavioural and psychosocial dysfunction.
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Affiliation(s)
- Benjamin L Brett
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA .,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel R Walton
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zachery Y Kerr
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lindsay D Nelson
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D Defreese
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, State College, Pennsylvania, USA
| | - Kevin M Guskiewicz
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Michael A McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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McGivern A, Shannon S, Breslin G. Resilience, well-being, depression symptoms and concussion levels in equestrian athletes. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-08-2020-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to conduct the first cross-sectional survey on depression, Resilience, well-being, depression symptoms and concussion levels in equestrian athletes and to assess whether past concussion rates were associated with depression, resilience and well-being.
Design/methodology/approach
In total, 511 participants from Canada, Republic of Ireland, UK, Australia and USA took part in an international cross-sectional, online survey evaluating concussion history, depression symptoms, resilience and well-being.
Findings
In total, 27.1% of athletes met clinically relevant symptoms of major depressive disorder. Significant differences were shown in the well-being and resilience scores between countries. Significant relationships were observed between reported history of concussion and both high depression scores and low well-being scores.
Practical implications
Findings highlight the need for mental health promotion and support in equestrian sport.
Social implications
Results support previous research suggesting a need for enhanced mental health support for equestrians. There is reason to believe that mental illness could still be present in riders with normal levels of resilience and well-being.
Originality/value
This study examined an understudied athlete group: equestrian athletes and presents important findings with implications for the physical and mental health of this population.
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14
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Longworth T, McDonald A, Cunningham C, Khan H, Fitzpatrick J. Do rugby league players under-report concussion symptoms? A cross-sectional study of elite teams based in Australia. BMJ Open Sport Exerc Med 2021; 7:e000860. [PMID: 33520253 PMCID: PMC7817803 DOI: 10.1136/bmjsem-2020-000860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To determine the rate of under-reporting of concussion and its symptoms in elite rugby league players in Australia. Methods The study was conducted in the preseason of the 2020 National Rugby League (NRL) competition. A total of 151 male, NRL club contracted rugby league players across three professional clubs participated. The participants completed a voluntary, anonymous survey exploring player demographics, concussion data, under-reporting instances and reasons for under-reporting over the 2018 and 2019 rugby league seasons. Results 17.2% of surveyed players reported sustaining a likely concussion over the past 2 years and not reporting to medical staff. 22% of NRL first grade players admitted to not reporting at least one concussion during the 2018 and 2019 seasons. The most common reason not to report was the player ‘not wanting to be ruled out of the game or training session’ (57.7%), followed by ‘not wanting to let down the coaches or teammates’ (23.1%). 85.4% of surveyed players reported having concussion education by their club in the previous two seasons. Conclusions 17.2 % of elite rugby league players in Australia chose not to report likely concussive episodes and concussion-related symptoms during the 2018 and 2019 seasons. Clinicians need to be aware of under-reporting in athletes when assessing players following head injuries. The findings highlight the need for development of validated, objective testing for concussion following sports-associated head injury.
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Affiliation(s)
- Thomas Longworth
- Registrar, Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia.,Sports Medicine, Eastern Suburbs Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Andrew McDonald
- Sports Medicine, Eastern Suburbs Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Corey Cunningham
- Medical, New South Wales Institute of Sport, Sydney Olympic Park, New South Wales, Australia
| | - Hussain Khan
- Sports Medicine, Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia
| | - Jane Fitzpatrick
- Centre for Health and Exercise Sports Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Research Committee, Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
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15
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Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan Iii WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med 2021; 55:683-690. [PMID: 33397673 DOI: 10.1136/bjsports-2020-103400] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players. METHODS In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates. RESULTS Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol. CONCLUSION Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D DeFreese
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
| | - Michael McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan Iii
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Saliva microRNA Biomarkers of Cumulative Concussion. Int J Mol Sci 2020; 21:ijms21207758. [PMID: 33092191 PMCID: PMC7589940 DOI: 10.3390/ijms21207758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022] Open
Abstract
Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.
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17
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Kristjánsdóttir H, Brynjarsdóttir RM, Kristensen ISU, Sigurjónsdóttir HÁ, Claessen LÓE, Jónsdóttir MK. Self-reported concussion history among Icelandic female athletes with and without a definition of concussion. Clin Neuropsychol 2020; 34:70-82. [PMID: 32990154 DOI: 10.1080/13854046.2020.1814873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examined whether Icelandic female athletes in contact sports, based their self-reported concussion history on adequate medical definitions, by assessing self-reported concussion history with and without a definition of concussion. Another aim was to examine whether currently active athletes were more knowledgeable of concussions than retired athletes. METHODS Participants (age = 26.9, SD = 7.1) were 508 former (34.5%) and current (65.5%) elite female athletes in soccer (41%), handball (30.6%), basketball (19.1%), ice hockey (4.5%) and combat sports (4.7%). An online questionnaire (QuestionPro) was distributed to females in contact sports (snowball sampling). Participants later came for an in-person interview where the authenticity of previous responses was confirmed. In the questionnaire, participants answered background questions and questions about concussion history. First, they reported the total number of sustained concussions without a prompt. They reported the number of sustained concussions again after reading a definition of concussion. Participants could not correct their previous answers. Pearson's Chi-square was used for group comparisons. RESULTS The prevalence of reported concussions increased from 40.2% to 64.8% following a definition. There was no significant difference in how many participants changed their answer when asked about sustaining SRCs before and after reading the definition based on whether the participants were still competitive or retired X 2(1) = 0.69, p = 0.41. CONCLUSIONS Our data suggest that understanding of concussions is inadequate among female athletes. Self-report will continue to be an essential source of clinical information and prompting with a definition can increase the reliability of self-reported concussions.
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Affiliation(s)
- Hafrún Kristjánsdóttir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | | | - Ingunn S U Kristensen
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Helga Á Sigurjónsdóttir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - Lára Ósk Eggertsdóttir Claessen
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - María K Jónsdóttir
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
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18
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Wright DK, Gardner AJ, Wojtowicz M, Iverson GL, O'Brien TJ, Shultz SR, Stanwell P. White Matter Abnormalities in Retired Professional Rugby League Players with a History of Concussion. J Neurotrauma 2020; 38:983-988. [PMID: 32245344 DOI: 10.1089/neu.2019.6886] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The topic of potential long-term neurological consequences from having multiple concussions during a career in collision sports is controversial. We sought to investigate white matter microstructure using diffusion tensor imaging (DTI) in retired professional Australian National Rugby League (NRL) players (n = 11) with a history of multiple self-reported concussions compared with age- and education-matched controls (n = 13) who have had no history of brain trauma. Diffusion-weighted images were acquired with a Siemens 3T scanner. All participants completed a clinical interview. There were no significant differences between groups on measures of depression, anxiety, stress, or post-concussion symptoms; however, NRL players scored significantly higher on the alcohol use disorder identification test (AUDIT). Voxelwise analyses of DTI measures were performed using tract-based spatial statistics (TBSS) with age and AUDIT scores included as covariates. TBSS revealed significantly reduced fractional anisotropy (FA), and increased radial diffusivity (RD), axial diffusivity (AD), and trace (TR) in white matter regions of recently retired NRL players compared with controls. FA was significantly reduced in the right superior longitudinal fasciculus and right corticospinal tract while TR, RD, and AD were increased in these regions, as well as the corpus callosum, forceps major, right uncinate fasciculus, and left corticospinal tract. In summary, DTI in a small cohort of recently retired professional NRL players with a history of multiple concussions showed differences in white matter microstructure compared with age- and education-matched controls with no history of brain trauma.
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Affiliation(s)
- David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Gardner
- Hunter New England Local Health District Sports Concussion Program, New Lambton Heights, New South Wales, Australia
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,MassGeneral Hospital for ChildrenTM Sport Concussion Program Foundation, and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
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Remmers T, Van Kann D, Kremers S, Ettema D, de Vries SI, Vos S, Thijs C. Investigating longitudinal context-specific physical activity patterns in transition from primary to secondary school using accelerometers, GPS, and GIS. Int J Behav Nutr Phys Act 2020; 17:66. [PMID: 32423411 PMCID: PMC7236458 DOI: 10.1186/s12966-020-00962-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Previous longitudinal studies indicate that physical activity (PA) significantly declines from primary-to secondary school, and report both changes in individual and environmental determinants of PA. In order to understand this transition and to prevent this negative trend, it is important to gather contextually rich data on possible mechanisms that drive this decline. Therefore, the aim of this study was to investigate changes of PA patterns in transition between primary and secondary school, and to add domain-specific insights of how, where, and when these changes occur. METHODS In total, 175 children participated in a 7-day accelerometer- and Global Positioning System (GPS) protocol at their last year of primary and their first year of secondary school. GPS data-points were overlaid with Geographical Information Systems (GIS) data using ArcGIS 10.1 software. Based on the GPS locations of individual data-points, we identified child's PA at home, school, local sports grounds, shopping centers, and other locations. Also, trips in active and passive transport were identified according to previously validated GPS speed-algorithms. Longitudinal multi-level linear mixed models were fitted adjusting for age, gender, meteorological circumstances, and the nested structure of days within children and children within schools. Outcome measures were minutes spent in light PA and moderate-to-vigorous PA, specified for the time-segments before school, during school, after school and weekend days. RESULTS Total PA significantly declined from primary to secondary school. Although transport-related PA increased before- and during school, decreases were found for especially afterschool time spent at sports grounds and transport-related PA during weekends. CONCLUSIONS This is the first study that demonstrated longitudinal changes of context- and domain-specific PA patterns in transition between primary and secondary school, based on device-assessed PA. Given the importance of this transition-period for the development of long-term PA patterns, results from this study warrant the development of evidence-based PA programs in this transition period, while acknowledging the integrative role of schools, parents, and afterschool sports providers. More specifically, the results underline the need to increase children's PA levels in primary schools, promote afterschool PA at secondary schools, and to prevent the drop-out in sports participation at secondary schools.
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Affiliation(s)
- Teun Remmers
- School of Sport Studies, Fontys University of Applied Sciences, P.O. Box 347, Eindhoven, AH, 5600, The Netherlands.
- Department of Epidemiology, Maastricht, Maastricht University (Medical Center+), CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
| | - Dave Van Kann
- School of Sport Studies, Fontys University of Applied Sciences, P.O. Box 347, Eindhoven, AH, 5600, The Netherlands
- Department of Health Promotion, Maastricht University (Medical Center+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Stef Kremers
- Department of Health Promotion, Maastricht University (Medical Center+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Dick Ettema
- Department of Human Geography and Planning, Utrecht University, Utrecht, the Netherlands
| | - Sanne I de Vries
- The Hague University of Applied Sciences, Research group Healthy Lifestyle in a Supporting Environment, The Hague, the Netherlands
| | - Steven Vos
- School of Sport Studies, Fontys University of Applied Sciences, P.O. Box 347, Eindhoven, AH, 5600, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Carel Thijs
- Department of Epidemiology, Maastricht, Maastricht University (Medical Center+), CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
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Guell X, Arnold Anteraper S, Gardner AJ, Whitfield-Gabrieli S, Kay-Lambkin F, Iverson GL, Gabrieli J, Stanwell P. Functional Connectivity Changes in Retired Rugby League Players: A Data-Driven Functional Magnetic Resonance Imaging Study. J Neurotrauma 2020; 37:1788-1796. [PMID: 32183583 DOI: 10.1089/neu.2019.6782] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is considerable interest in the long-term brain health of retired contact and collision sport athletes; however, little is known about possible underlying changes in functional brain connectivity in this group. We evaluated whole-brain functional connectivity patterns using multi-voxel pattern analysis (MVPA) to determine whether alterations in functional connectivity distinguish retired professional athletes from a matched group of healthy community control subjects. Thirty-two retired athletes with a history of multiple self-reported sport-related concussions and 36 healthy community control subjects who were similar in age and education, completed functional magnetic resonance imaging. We identified brain regions with abnormal functional connectivity patterns using whole-brain MVPA as implemented in the Conn toolbox. First-level MVPA was performed using 64 principal component analysis (PCA) components. Second-level F test was performed using the first three MVPA components for retired athletes > controls group contrast. Post hoc seed-to-voxel analyses using the MVPA cluster results as seeds were performed to characterize functional connectivity abnormalities from brain regions identified by MVPA. MVPA revealed one cluster of abnormal functional connectivity located in cerebellar lobule V. This region of lobule V corresponded to the ventral attention network. Post hoc seed-to-voxel analysis using the cerebellar MVPA cluster as a seed revealed multiple areas of cerebral cortical hyper-connectivity and hypo-connectivity in retired athletes when compared with controls. This initial report suggests that cerebellar dysfunction might be present and clinically important in some retired athletes.
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Affiliation(s)
- Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Andrew J Gardner
- Hunter New England Local Health District Sport Concussion Program, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Peter Stanwell
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
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21
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Belanger HG, Wortzel HS, Vanderploeg RD, Cooper DB. A model for intervening with veterans and service members who are concerned about developing Chronic Traumatic Encephalopathy (CTE). Clin Neuropsychol 2019; 34:1105-1123. [DOI: 10.1080/13854046.2019.1699166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Heather G. Belanger
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- James A, Haley Veterans Hospital, United States Special Operations Command, 9Line LLC, Tampa, FL, USA
| | - Hal S. Wortzel
- Rocky Mountain MIRECC, Rocky Mountain Regional Medical Center, Aurora, CO, USA
- Departments of Psychiatry, Neurology, and PM&R, University of Colorado, Aurora, CO, USA
| | - Rodney D. Vanderploeg
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Douglas B. Cooper
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Polytrauma Rehabilitation Center, Audie Murphy Memorial VA Hospital, San Antonio, TX, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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22
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The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthop Sports Phys Ther 2019; 49:768-778. [PMID: 31672116 DOI: 10.2519/jospt.2019.9105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105.
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23
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Roberts AL, Pascual-Leone A, Speizer FE, Zafonte RD, Baggish AL, Taylor H, Nadler LM, Courtney TK, Connor A, Grashow R, Stillman AM, Marengi DA, Weisskopf MG. Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study. Am J Sports Med 2019; 47:2871-2880. [PMID: 31468987 PMCID: PMC7163246 DOI: 10.1177/0363546519868989] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes. HYPOTHESIS It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety. STUDY DESIGN Descriptive epidemiology study. METHODS The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%). RESULTS Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play. CONCLUSION The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.
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Affiliation(s)
- Andrea L. Roberts
- Andrea L. Roberts, PhD,
Department of Environmental Health, Harvard T.H. Chan School of Public Health,
677 Huntington Ave, Boston, MA 02115, USA (
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Terpstra AR, Vasquez BP, Colella B, Tartaglia MC, Tator CH, Mikulis D, Davis KD, Wennberg R, Green REA. Comprehensive Neuropsychiatric and Cognitive Characterization of Former Professional Football Players: Implications for Neurorehabilitation. Front Neurol 2019; 10:712. [PMID: 31447753 PMCID: PMC6696977 DOI: 10.3389/fneur.2019.00712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms. Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports. Design: Between-groups analyses. Main measures: Neuropsychiatric. Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive. Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task). Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions (x ¯ = 6 . 1 ), but not former players with ≤ 3 concussions (x ¯ = 2 . 0 ), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task. Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.
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Affiliation(s)
- Alex R. Terpstra
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Brandon P. Vasquez
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Neuropsychology & Cognitive Health, Baycrest, Toronto, ON, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - Charles H. Tator
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - David Mikulis
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Karen D. Davis
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robin E. A. Green
- Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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25
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Grashow RG, Roberts AL, Zafonte R, Pascual-Leone A, Taylor H, Baggish A, Nadler L, Courtney TK, Connor A, Weisskopf MG. Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort. Orthop J Sports Med 2019; 7:2325967119829212. [PMID: 30746383 PMCID: PMC6360475 DOI: 10.1177/2325967119829212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.
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Affiliation(s)
- Rachel G Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ann Connor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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26
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Disruption of function: Neurophysiological markers of cognitive deficits in retired football players. Clin Neurophysiol 2019; 130:111-121. [DOI: 10.1016/j.clinph.2018.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
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27
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Hume PA, Theadom A, Lewis GN, Quarrie KL, Brown SR, Hill R, Marshall SW. A Comparison of Cognitive Function in Former Rugby Union Players Compared with Former Non-Contact-Sport Players and the Impact of Concussion History. Sports Med 2018; 47:1209-1220. [PMID: 27558141 DOI: 10.1007/s40279-016-0608-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM This study investigated differences in cognitive function between former rugby and non-contact-sport players, and assessed the association between concussion history and cognitive function. METHODS Overall, 366 former players (mean ± standard deviation [SD] age 43.3 ± 8.2 years) were recruited from October 2012 to April 2014. Engagement in sport, general health, sports injuries and concussion history, and demographic information were obtained from an online self-report questionnaire. Cognitive functioning was assessed using the online CNS Vital Signs neuropsychological test battery. Cohen's d effect size statistics were calculated for comparisons across player groups, concussion groups (one or more self-reported concussions versus no concussions) and between those groups with CNS Vital Signs age-matched norms (US norms). Individual differences within groups were represented as SDs. RESULTS The elite-rugby group (n = 103) performed worse on tests of complex attention, processing speed, executive functioning, and cognitive flexibility than the non-contact-sport group (n = 65), and worse than the community-rugby group (n = 193) on complex attention. The community-rugby group performed worse than the non-contact group on executive functioning and cognitive flexibility. Compared with US norms, all three former player groups performed worse on verbal memory and reaction time; rugby groups performed worse on processing speed, cognitive flexibility and executive functioning; and the community-rugby group performed worse on composite memory. The community-rugby group and non-contact-sport group performed slightly better than US norms on complex attention, as did the elite-rugby group for motor speed. All three player groups had greater individual differences than US norms on composite memory, verbal memory and reaction time. The elite-rugby group had greater individual differences on processing speed and complex attention, and the community-rugby group had greater individual differences on psychomotor speed and motor speed. The average number of concussions recalled per player was greater for elite rugby and community rugby than non-contact sport. Former players who recalled one or more concussions (elite rugby, 85 %; community rugby, 77 %; non-contact sport, 23 %) had worse scores on cognitive flexibility, executive functioning, and complex attention than players who did not recall experiencing a concussion. CONCLUSIONS Past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits (as indicated by worse CNS Vital Signs scores) in athletes post retirement from competitive sport.
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Affiliation(s)
- Patria A Hume
- Faculty of Health and Environmental Sciences, Sports Performance Research Institute New Zealand, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | - Scott R Brown
- Faculty of Health and Environmental Sciences, Sports Performance Research Institute New Zealand, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Rosamund Hill
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Stephen W Marshall
- University of North Carolina Injury Prevention Research Centre, Chapel Hill, NC, USA
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28
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Verhoeven H, Van Hecke L, Van Dyck D, Baert T, Van de Weghe N, Clarys P, Deforche B, Van Cauwenberg J. Differences in physical environmental characteristics between adolescents' actual and shortest cycling routes: a study using a Google Street View-based audit. Int J Health Geogr 2018; 17:16. [PMID: 29843715 PMCID: PMC5975511 DOI: 10.1186/s12942-018-0136-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective evaluation of the physical environmental characteristics (e.g. speed limit, cycling infrastructure) along adolescents' actual cycling routes remains understudied, although it may provide important insights into why adolescents prefer one cycling route over another. The present study aims to gain insight into the physical environmental characteristics determining the route choice of adolescent cyclists by comparing differences in physical environmental characteristics between their actual cycling routes and the shortest possible cycling routes. METHODS Adolescents (n = 204; 46.5% boys; 14.4 ± 1.2 years) recruited at secondary schools in and around Ghent (city in Flanders, northern part of Belgium) were instructed to wear a Global Positioning System device in order to identify cycling trips. For all identified cycling trips, the shortest possible route that could have been taken was calculated. Actual cycling routes that were not the shortest possible cycling routes were divided into street segments. Segments were audited with a Google Street View-based tool to assess physical environmental characteristics along actual and shortest cycling routes. RESULTS Out of 160 actual cycling trips, 73.1% did not differ from the shortest possible cycling route. For actual cycling routes that were not the shortest cycling route, a speed limit of 30 km/h, roads having few buildings with windows on the street side and roads without cycle lane were more frequently present compared to the shortest possible cycling routes. A mixed land use, roads with commercial destinations, arterial roads, cycle lanes separated from traffic by white lines, small cycle lanes and cycle lanes covered by lighting were less frequently present along actual cycling routes compared to the shortest possible cycling routes. CONCLUSIONS Results showed that distance mainly determines the route along which adolescents cycle. In addition, adolescents cycled more along residential streets (even if no cycle lane was present) and less along busy, arterial roads. Local authorities should provide shortcuts free from motorised traffic to meet adolescents' preference to cycle along the shortest route and to avoid cycling along arterial roads.
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Affiliation(s)
- Hannah Verhoeven
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Linde Van Hecke
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Delfien Van Dyck
- Research Foundation - Flanders (FWO), Brussels, Belgium
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
| | - Tim Baert
- Department of Geography – CartoGIS, Faculty of Sciences, Ghent University, Krijgslaan 281, 9000 Ghent, Belgium
| | - Nico Van de Weghe
- Department of Geography – CartoGIS, Faculty of Sciences, Ghent University, Krijgslaan 281, 9000 Ghent, Belgium
| | - Peter Clarys
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Benedicte Deforche
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Jelle Van Cauwenberg
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Research Foundation - Flanders (FWO), Brussels, Belgium
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29
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Aldag M, Armstrong RC, Bandak F, Bellgowan PSF, Bentley T, Biggerstaff S, Caravelli K, Cmarik J, Crowder A, DeGraba TJ, Dittmer TA, Ellenbogen RG, Greene C, Gupta RK, Hicks R, Hoffman S, Latta RC, Leggieri MJ, Marion D, Mazzoli R, McCrea M, O'Donnell J, Packer M, Petro JB, Rasmussen TE, Sammons-Jackson W, Shoge R, Tepe V, Tremaine LA, Zheng J. The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review. J Neurotrauma 2018; 34:S26-S43. [PMID: 28937953 DOI: 10.1089/neu.2017.5218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The United States Department of Defense Blast Injury Research Program Coordinating Office organized the 2015 International State-of-the-Science meeting to explore links between blast-related head injury and the development of chronic traumatic encephalopathy (CTE). Before the meeting, the planning committee examined articles published between 2005 and October 2015 and prepared this literature review, which summarized broadly CTE research and addressed questions about the pathophysiological basis of CTE and its relationship to blast- and nonblast-related head injury. It served to inform participants objectively and help focus meeting discussion on identifying knowledge gaps and priority research areas. CTE is described generally as a progressive neurodegenerative disorder affecting persons exposed to head injury. Affected individuals have been participants primarily in contact sports and military personnel, some of whom were exposed to blast. The symptomatology of CTE overlaps with Alzheimer's disease and includes neurological and cognitive deficits, psychiatric and behavioral problems, and dementia. There are no validated diagnostic criteria, and neuropathological evidence of CTE has come exclusively from autopsy examination of subjects with histories of exposure to head injury. The perivascular accumulation of hyperphosphorylated tau (p-tau) at the depths of cortical sulci is thought to be unique to CTE and has been proposed as a diagnostic requirement, although the contribution of p-tau and other reported pathologies to the development of clinical symptoms of CTE are unknown. The literature on CTE is limited and is focused predominantly on head injuries unrelated to blast exposure (e.g., football players and boxers). In addition, comparative analyses of clinical case reports has been challenging because of small case numbers, selection biases, methodological differences, and lack of matched controls, particularly for blast-exposed individuals. Consequently, the existing literature is not sufficient to determine whether the development of CTE is associated with head injury frequency (e.g., single vs. multiple exposures) or head injury type (e.g., impact, nonimpact, blast-related). Moreover, the incidence and prevalence of CTE in at-risk populations is unknown. Future research priorities should include identifying additional risk factors, pursuing population-based longitudinal studies, and developing the ability to detect and diagnose CTE in living persons using validated criteria.
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Affiliation(s)
- Matt Aldag
- 1 Booz Allen Hamilton , McLean, Virginia
| | - Regina C Armstrong
- 2 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Faris Bandak
- 3 Defense Advanced Research Projects Agency , Arlington, Virginia
| | | | | | - Sean Biggerstaff
- 6 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | | | - Joan Cmarik
- 7 Office of the Principal Assistant for Acquisition, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Alicia Crowder
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | | | | | - Richard G Ellenbogen
- 10 Departments of Neurological Surgery and Global Health Medicine, University of Washington , Seattle, Washington
| | - Colin Greene
- 11 Joint Trauma Analysis and Prevention of Injuries in Combat Program, Frederick, Maryland
| | - Raj K Gupta
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | | | | | | | - Michael J Leggieri
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Donald Marion
- 16 Defense and Veterans Brain Injury Center , Silver Spring, Maryland
| | | | | | | | - Mark Packer
- 20 Hearing Center of Excellence , Lackland, Texas
| | - James B Petro
- 21 Office of the Assistant Secretary of Defense, Research and Engineering, Arlington, Virginia
| | - Todd E Rasmussen
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Wendy Sammons-Jackson
- 22 Office of the Principal Assistant for Research and Technology , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Richard Shoge
- 23 Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command , Fort Detrick, Maryland
| | | | | | - James Zheng
- 25 Program Executive Office Soldier , Fort Belvoir, Virginia
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Mc Fie S, Abrahams S, Patricios J, Suter J, Posthumus M, September AV. Inflammatory and apoptotic signalling pathways and concussion severity: a genetic association study. J Sports Sci 2018; 36:2226-2234. [PMID: 29509495 DOI: 10.1080/02640414.2018.1448570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective was to investigate the relationship between IL-1B rs16944, IL-6 rs1800795, and CASP8 rs3834129 genetic polymorphisms and concussion severity. Rugby players from high school, senior amateur, and professional teams completed a concussion severity questionnaire and donated a DNA sample. Participants (n = 163) were split into symptom severity groups around the median number and duration of symptoms. The frequency of participants with high symptom counts (more than five symptoms) increased across the IL-1B (C/C: 35%; C/T: 51%; T/T: 56%; P = 0.047) and the IL-6 (C/C: 31%; C/G: 44%; G/G: 58%; P = 0.027) genotypes. The C-C inferred interleukin allele construct frequency, created from combining the IL-1B and IL-6 genotype data, was lower in participants reporting a high symptom count (18%), compared to those with a low symptom count (fewer than six symptoms, 36%, P = 0.002). Similarly, the C-C inferred interleukin allele construct frequency was lower in those reporting prolonged symptom duration (more than one week, 16%), as opposed to short symptom duration (less than one week, 34%, P = 0.015). This study provides evidence of novel inflammatory pathway genetic associations with concussion severity, which supports the hypothesis implicating neuroinflammation in the development of concussion symptoms.
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Affiliation(s)
- Sarah Mc Fie
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa
| | - Shameemah Abrahams
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa
| | - Jon Patricios
- b Morningside Sports Medicine Clinic , Johannesburg , South Africa.,c Section of Sports Medicine , University of Pretoria , Pretoria , South Africa.,d Department of Emergency Medicine , University of the Witwatersrand , Johannesburg , South Africa
| | - Jason Suter
- e Sports Science Sports and Exercise Medicine Clinic , Cape Town , South Africa
| | - Michael Posthumus
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa
| | - Alison V September
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa
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Katz BP, Kudela M, Harezlak J, McCrea M, McAllister T, Broglio SP. Baseline Performance of NCAA Athletes on a Concussion Assessment Battery: A Report from the CARE Consortium. Sports Med 2018; 48:1971-1985. [DOI: 10.1007/s40279-018-0875-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pearce AJ, Rist B, Fraser CL, Cohen A, Maller JJ. Neurophysiological and cognitive impairment following repeated sports concussion injuries in retired professional rugby league players. Brain Inj 2018; 32:498-505. [PMID: 29388850 DOI: 10.1080/02699052.2018.1430376] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Concussion is regarded as a common injury in rugby league, however no studies have explored the long-term neurophysiological and cognitive effects of repeated concussion injuries in this sport. METHODS Former professional rugby athletes (n = 25) were compared to 25 age-matched participants with no history of a concussion. All participants completed standardised motor dexterity, reaction time, and cognitive tasks for working memory, associative learning and rule acquisition and reversal. Single-pulse transcranial magnetic stimulation (TMS) acquired motor evoked potentials and cortical silent period (cSP), as well as paired-pulse TMS for short latency intracortical inhibition and long intracortical inhibition (LICI). RESULTS Compared to controls, dexterity and visuomotor reaction time was slower in the rugby group compared to controls (p = 0.02, p < 0.01, respectively). The rugby group also demonstrated poorer cognitive performance than controls (p range 0.02 to < 0.01). TMS revealed significantly reduced cSP at suprathreshold stimulation intensities (p range 0.02 to <0.01), and increased LICI (p = 0.03) in the rugby group. DISCUSSION These findings of motor and cognitive changes, along with neurophysiological alterations, particularly with intracortical inhibition, nearly two decades post-concussion provides evidence for long-term sequelae for athletes with a history of repeated head trauma in contact sports.
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Affiliation(s)
- Alan J Pearce
- a Department of Rehabilitation, Nutrition and Sport , La Trobe University , Melbourne, Australia
| | - Billymo Rist
- a Department of Rehabilitation, Nutrition and Sport , La Trobe University , Melbourne, Australia.,b Mental Edge Consulting , Melbourne , Australia
| | - Clare L Fraser
- c Save Sight Institute, Department of Ophthalmology , The University of Sydney , Sydney, Australia
| | - Adrian Cohen
- d Central Clinical School, Discipline of Clinical Ophthalmology and Eye Health , University of Sydney , Sydney, Australia
| | - Jerome J Maller
- e Monash Alfred Psychiatric Research Centre, The Alfred and Central Clinical School , Monash University , Melbourne, Australia.,f General Electric Healthcare , Melbourne, Australia
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Kerr ZY, Register-Mihalik JK, Kay MC, DeFreese JD, Marshall SW, Guskiewicz KM. Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes. Am J Sports Med 2018; 46:22-29. [PMID: 28942673 DOI: 10.1177/0363546517728264] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined. PURPOSE Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player's career was before or after a 1976 rule change to limit contact ("spearing"). RESULTS Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found ( P = .08). Compared with those in the pre-spearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post-spearing rule change group than the pre-spearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions. CONCLUSION A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players' intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephen W Marshall
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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34
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Reider B. Full Disclosure. Am J Sports Med 2018; 46:19-21. [PMID: 29283282 DOI: 10.1177/0363546517744756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Rau TF, Patel SA, Guzik EE, Sorich E, Pearce AJ. Efficacy of a repeat testing protocol for cognitive fatigue assessment: a preliminary study in postconcussive syndrome participants. Concussion 2017; 2:CNC44. [PMID: 30202588 PMCID: PMC6122690 DOI: 10.2217/cnc-2017-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022] Open
Abstract
Aim: A small but notable number of individuals who suffer a concussion report ongoing cognitive difficulties. This preliminary study investigated the efficacy of repetitive test application to discern cognitive impairment in those with ongoing symptoms. Methods: Participants (n = 17) with continuing self-reported symptoms following a concussion (∼9 months postinjury) were compared with 17 age group matched controls for working memory and word-list learning. Results: Both groups performed similarly after the first trial for both assessments. However, in subsequent trials, the postconcussion group performed significantly worse than controls. Discussion: While further studies to understand the mechanisms are warranted, data from this preliminary study suggest that a repetitive test application may be useful to discern cognitive fatigue in individuals who report ongoing concerns following a concussion.
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Affiliation(s)
- Thomas F Rau
- The Neural Injury Center, The University of Montana, 32 Campus Drive, Missoula, MT 59812, USA.,The Neural Injury Center, The University of Montana, 32 Campus Drive, Missoula, MT 59812, USA
| | - Sarjubhai A Patel
- The Neural Injury Center, The University of Montana, 32 Campus Drive, Missoula, MT 59812, USA.,The Neural Injury Center, The University of Montana, 32 Campus Drive, Missoula, MT 59812, USA
| | - Erik E Guzik
- Department of Biomedical & Pharmaceutical Sciences, The University of Montana Western, 208 Business & Technology Building, 710 S Atlantic St, Dillon, MT 59725, USA.,Department of Biomedical & Pharmaceutical Sciences, The University of Montana Western, 208 Business & Technology Building, 710 S Atlantic St, Dillon, MT 59725, USA
| | - Edmond Sorich
- GLIA Diagnostics, PO Box 138N, Armadale, VIC 3143, Australia.,GLIA Diagnostics, PO Box 138N, Armadale, VIC 3143, Australia
| | - Alan J Pearce
- Department of Rehabilitation, Nutrition & Sport, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia.,Department of Rehabilitation, Nutrition & Sport, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Abstract
SETTING The Canadian Community Health Survey (CCHS) is a national cross-sectional health survey, which has collected information on injuries serious enough to limit normal activity. OBJECTIVE To assess the construct and discriminant validity of reporting 'concussion or other brain injury' in the CCHS as the respondents' most serious injury. METHODS Construct validity was assessed by describing the injury profile. Discriminant validity was assessed by examining differences between those reporting concussion or other brain injury, and either: respondents not reporting brain injury (population control); or respondents reporting orthopaedic injuries (orthopaedic control). RESULTS In total, 1,852 of the 682,455 eligible CCHS respondents (≥12 years) reported a concussion or other brain injury within the prior year, a population annual incidence of 0.29%. Those reporting concussion or other brain injury were younger and male (p < 0.001), with an injury acquired by falling (p < 0.001) or sport or physical exercise (p < 0.001). Most (78.4%) who reported concussions or other brain injuries received medical attention from a health professional within 48 hours of their injury. The reported injury profiles appear to differ from the population controls and those reporting orthopaedic injuries. CONCLUSIONS The report of 'concussion or other brain injury' in the CCHS may be a valid source of population-based traumatic brain injury epidemiological data.
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Affiliation(s)
- Kevin E Gordon
- a Division of Pediatric Neurology , Department of Pediatrics Dalhousie University , Halifax , NS , Canada
| | - Stefan Kuhle
- b Perinatal Epidemiology Research Unit, Department of Pediatrics and Department of Obstetrics and Gynaecology , Dalhousie University , Halifax , NS , Canada
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37
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Wilmoth K, LoBue C, Clem MA, Reddy R, Hynan LS, Didehbani N, Bell K, Womack KB, Hart J, Batjer H, Cullum CM. Consistency of traumatic brain injury reporting in older adults with and without cognitive impairment. Clin Neuropsychol 2017; 32:524-529. [PMID: 28988512 DOI: 10.1080/13854046.2017.1378371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Medical history information regarding prior traumatic brain injury (TBI) usually relies on self-report, although little is known about the reliability of this information with regard to injuries sustained years or decades earlier. Even less is known about the reliability of self-reported medical history information in older individuals with cognitive impairment. To this end, we assessed the test-retest reliability of self-reported TBI history in a large, national sample. METHODS Participants (n = 4309) were older adults with intact cognition, mild cognitive impairment (MCI) and Alzheimer's disease (AD) from the National Alzheimer's Coordinating Center. Subjects provided TBI history information at baseline and one annual follow-up visit. Consistency of self-reported history of TBI with <5 minutes loss of consciousness (mLOC) and TBI with ≥5 mLOC reported at time 1 and 2 was analyzed across diagnostic groups. RESULTS Overall, subjects provided reports of TBI history at follow-up that were highly consistent with baseline reports (97.8-99.6% agreement), and Cohen's kappa coefficients were all larger than .80 and statistically significant, maximum p < .001. Furthermore, level of cognitive impairment was not a significant predictor of consistency in reporting. CONCLUSIONS These data are some of the first to suggest that self-report may be a consistent method of obtaining remote TBI history in the absence of medical records for older individuals, regardless of cognitive impairment.
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Affiliation(s)
- Kristin Wilmoth
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Christian LoBue
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Matthew A Clem
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Rajadhar Reddy
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Linda S Hynan
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.,b Department of Clinical Science , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Nyaz Didehbani
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Kathleen Bell
- c Department of Physical Medicine and Rehabilitation , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Kyle B Womack
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.,d Department of Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - John Hart
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.,d Department of Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Hunt Batjer
- e Department of Neurological Surgery , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - C Munro Cullum
- a Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.,d Department of Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas , TX , USA.,e Department of Neurological Surgery , University of Texas Southwestern Medical Center , Dallas , TX , USA
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Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry 2017; 7:e1236. [PMID: 28926003 PMCID: PMC5639242 DOI: 10.1038/tp.2017.197] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/16/2017] [Accepted: 07/30/2017] [Indexed: 12/14/2022] Open
Abstract
Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.
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Mc Fie S, Abrahams S, Patricios J, Suter J, Posthumus M, September AV. The association between harm avoidance personality traits and self-reported concussion history in South African rugby union players. J Sci Med Sport 2017; 21:16-21. [PMID: 28778825 DOI: 10.1016/j.jsams.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Personality traits have been proposed to affect the risk of sports concussion, but evidence is limited. Cloninger's Tridimensional Personality Questionnaire (TPQ) measures novelty seeking, harm avoidance (HA), and reward dependence traits. The aim of this study was to investigate the relationship between TPQ scores and concussion history in rugby union players. DESIGN Cross-sectional study. METHODS Rugby players from high schools, senior amateur clubs, and professional teams provided a self-reported concussion history and completed the TPQ. Participants reporting no previous concussions formed the control group, while participants reporting concussion formed the case group. A one-way analysis of covariance, with age as a covariate, was used to examine the differences in TPQ scores between groups. RESULTS Of the 309 participants, 54% reported a minimum of one concussion (junior: 47%; amateur: 52%; professional: 72%). HA scores were significantly higher in junior players without a history of concussion compared to cases (p=0.006). Specifically, the junior control group had higher "anticipatory worry" (p=0.009) and "fear of uncertainty" (p=0.008). In contrast, the professional control group had lower HA scores than cases (p=0.009), while the amateur cohort displayed no differences between control and case groups. CONCLUSIONS This study identified a novel association between HA and concussion in rugby players, adding evidence to the role of personality in a multifactorial risk-model of concussion. The findings suggest that lower HA may lead to increased dangerous play in youth rugby, influencing concussion susceptibility. Contrasting associations in the professional cohort suggest further research is required to understand the role of personality in concussion.
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Affiliation(s)
- Sarah Mc Fie
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Shameemah Abrahams
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Jon Patricios
- Morningside Sports Medicine Clinic, Johannesburg, South Africa; Section of Sports Medicine, University of Pretoria, Pretoria, South Africa; Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Jason Suter
- Sports Science Sports and Exercise Medicine Clinic, Cape Town, South Africa
| | - Michael Posthumus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Alison V September
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.
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Bryson CN, Cramer RJ, Schmidt AT. Traumatic brain injury and lifetime suicidality: Applying the interpersonal-psychological theory perspective. DEATH STUDIES 2017; 41:399-405. [PMID: 28426348 DOI: 10.1080/07481187.2017.1320340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present article investigates the traumatic brain injury (TBI)-suicide link, assessing whether (a) TBI accounts for variance in suicide risk, and (b) the interpersonal-psychological theory of suicide can be applied to TBI status. Matched case-control procedures applied to archival college student health data identified TBI and non-TBI subsamples (84 total). Individuals with a TBI possessed higher suicide risk than those without. Even accounting for the relative influence of strong suicide risk factors (i.e., depression, perceived burdensomeness, thwarted belongingness, and acquired capability), TBI was robustly associated with suicide risk. TBI history would be valuable to ascertain in assessing suicide risk.
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Affiliation(s)
- Claire N Bryson
- a Department of Psychology and Philosophy , Sam Houston State University , Huntsville , Texas , USA
| | - Robert J Cramer
- b School of Community and Environmental Health , Old Dominion University , Norfolk , Virginia , USA
| | - Adam T Schmidt
- c Department of Psychological Sciences , Texas Tech University , Lubbock , Texas , USA
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41
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McMillan TM, McSkimming P, Wainman-Lefley J, Maclean LM, Hay J, McConnachie A, Stewart W. Long-term health outcomes after exposure to repeated concussion in elite level: rugby union players. J Neurol Neurosurg Psychiatry 2017; 88:505-511. [PMID: 27951526 DOI: 10.1136/jnnp-2016-314279] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is continuing concern about effects of concussion in athletes, including risk of the neurodegenerative disease chronic traumatic encephalopathy. However, information on long-term health and wellbeing in former athletes is limited. METHOD Outcome after exposure to repeated brain injury was investigated in 52 retired male Scottish international rugby players (RIRP) and 29 male controls who were similar in age and social deprivation. Assessment included history of playing rugby and traumatic brain injury, general and mental health, life stress, concussion symptoms, cognitive function, disability and markers of chronic stress (allostatic load). RESULTS The estimated number of concussions in RIRP averaged 14 (median=7; IQR 5-40). Performance was poorer in RIRP than controls on a test of verbal learning (p=0.022) and of fine co-ordination of the dominant hand (p=0.038) and not significantly different on other cognitive tests (p>0.05). There were no significant associations between number of concussions and performance on cognitive tests. Other than a higher incidence of cardiovascular disease in controls, no group differences were detected in general or mental health or estimates of allostatic load. In RIRP, persisting symptoms attributed to concussion were more common if reporting more than nine concussions (p=0.028), although these symptoms were not perceived to affect social or work functioning. CONCLUSIONS Despite a high number of concussions in RIRP, differences in mental health, social or work functioning were not found late after injury. Subtle group differences were detected on two cognitive tests, the cause of which is uncertain. Prospective group comparison studies on representative cohorts are required.
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Affiliation(s)
- T M McMillan
- Institute for Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - P McSkimming
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - J Wainman-Lefley
- Institute for Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - L M Maclean
- Institute for Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - J Hay
- Department of Neuropathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, Glasgow, UK
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - W Stewart
- Department of Neuropathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, Glasgow, UK.,Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
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42
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Alosco ML, Jarnagin J, Tripodis Y, Martin B, Chaisson C, Baugh CM, Torres A, Nowinski CJ, Cantu RC, Stern RA. Utility of providing a concussion definition in the assessment of concussion history in former NFL players. Brain Inj 2017; 31:1116-1123. [PMID: 28471243 DOI: 10.1080/02699052.2017.1294709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Former National Football League (NFL) players' working knowledge of concussion has not yet been evaluated, despite this population being a major clinical research target due to the association between repetitive head impacts (RHI) and long-term clinical impairments. This study examined former NFL players' understanding of the current concussion definition, and the association between number of concussions with clinical function. METHODS 95 former NFL players (mean age = 55.29; mean NFL year = 8.10) self-reported number of concussions before being provided with a concussion definition and after being read a modern definition of concussion. Subjects reported number of concussions with loss of consciousness (LOC). Principal Component Analysis of a battery of tests generated behaviour/mood, psychomotor speed/executive function, and verbal and visual memory factor scores. RESULTS Post-definition number of concussions (median = 50) was five times the pre-definition (median = 10; p < 0.001). Greater pre- (p = 0.019) and post-definition concussions (p = 0.036) correlated with worse behaviour/mood scores, after controlling for years of football played, with specific effects for depressive symptoms and impulsivity. LOC did not account for variance beyond number of concussions. CONCLUSIONS Practitioners and clinical researchers should provide a definition of concussion in the assessment of concussion history in former football players to facilitate accuracy and standardization.
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Affiliation(s)
- Michael L Alosco
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA
| | - Johnny Jarnagin
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA
| | - Yorghos Tripodis
- c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA
| | - Brett Martin
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Christine Chaisson
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA.,d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Christine M Baugh
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,e Interfaculty Initiative in Health Policy , Harvard University , Cambridge , MA , USA
| | - Alcy Torres
- f Pediatric Neurology , Boston University School of Medicine , Boston , MA , USA.,g Pediatric Neurology , Boston Medical Center , Boston , MA , USA
| | | | - Robert C Cantu
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,h Concussion Legacy Foundation , Waltham , MA , USA.,i Department of Neurosurgery , Boston University School of Medicine , Boston , MA , USA
| | - Robert A Stern
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,i Department of Neurosurgery , Boston University School of Medicine , Boston , MA , USA.,j Department of Anatomy & Neurobiology , Boston University School of Medicine , Boston , MA , USA
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Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, Castellani RJ, Turner M, Jordan BD, Randolph C, Dvořák J, Hayden KA, Tator CH, McCrory P, Iverson GL. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017; 51:969-977. [PMID: 28455362 PMCID: PMC5466926 DOI: 10.1136/bjsports-2017-097791] [Citation(s) in RCA: 389] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/14/2022]
Abstract
Objective Systematic review of possible long-term effects of sports-related concussion in retired athletes. Data sources Ten electronic databases. Study selection Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury. Data extraction Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors. Results Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes. Conclusion Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
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Affiliation(s)
- Geoff Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina, Chapel Hill, USA
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Co-Director, NorthShore Neurological Institute; University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Robert C Cantu
- Department of Neurosurgery, Emerson Hospital, Concord, MA, and Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, USA
| | - Rudolph J Castellani
- Center for Neuropathology, Western Michigan University, and Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Michael Turner
- The International Concussion and Head Injury Research Foundation, Marylebone, UK
| | | | | | - Jiří Dvořák
- Department of Nerology, University of Zurich, Schulthess Clinic, Swiss Concussion Center, Zurich, Switzerland
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Charles H Tator
- Canadian Concussion Centre, Toronto Western Hospital, University of Toronto, Krembil Neuroscience Centre, Toronto, Canada
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA
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44
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Buckley TA, Vallabhajosula S, Oldham JR, Munkasy BA, Evans KM, Krazeise DA, Ketcham CJ, Hall EE. Evidence of a conservative gait strategy in athletes with a history of concussions. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:417-423. [PMID: 30356549 PMCID: PMC6188874 DOI: 10.1016/j.jshs.2015.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/15/2014] [Accepted: 03/09/2015] [Indexed: 06/08/2023]
Abstract
BACKGROUND A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. METHODS There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1-2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. RESULTS There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. CONCLUSION This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions.
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Affiliation(s)
- Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
| | | | - Jessie R. Oldham
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
| | - Barry A. Munkasy
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - Kelsey M. Evans
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - David A. Krazeise
- Department of Intercollegiate Athletics, Stetson University, DeLand, FL 32723, USA
| | | | - Eric E. Hall
- Department of Exercise Science, Elon University, Elon, NC 27244, USA
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45
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Oldham JR, DiFabio MS, Kaminski TW, DeWolf RM, Buckley TA. Normative Tandem Gait in Collegiate Student-Athletes: Implications for Clinical Concussion Assessment. Sports Health 2016; 9:305-311. [PMID: 27899680 PMCID: PMC5496697 DOI: 10.1177/1941738116680999] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired balance is common after concussion. The third edition of the Sport Concussion Assessment Tool (SCAT-3) recommends the Balance Error Scoring System (BESS) and/or tandem gait for postconcussion balance assessment. The limitations of the BESS are well documented; however, tandem gait has received little attention throughout concussion literature. The purpose of this study was to provide normative data for tandem gait in collegiate student-athletes based on sport type, concussion history, and gender. HYPOTHESIS Tandem gait will be influenced by concussion history, sport, and gender. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS Four hundred collegiate student-athletes from both collision/contact (n = 200) and limited contact/noncontact (n = 200) sports performed 4 tandem gait trials, consistent with SCAT-3 guidelines. The dependent variables included the best of the 4 trials (BEST), the mean of the 4 trials (MEAN), and the mean of each of the trials individually (ORDER). Separate multivariate analyses of variance were performed for each of the independent variables to determine effect on BEST and MEAN trial times. Significant main effects were followed up with a 1-way analysis of variance (ANOVA). A separate 1-way ANOVA was used to assess ORDER differences. RESULTS The mean BEST was 10.37 ± 1.76 seconds, and the MEAN was 11.32 ± 0.70 seconds. There were no significant differences in BEST or MEAN tandem gait times, respectively, between those with and without concussion history ( P = 0.41 and P = 0.69, respectively), sport type ( P = 0.57 and P = 0.42, respectively), or gender ( P = 0.73 and P = 0.49, respectively). There were significant differences ( P < 0.05) between ORDER of the 4 tandem gait trials across the population, with improved times at each trial. CONCLUSION The results of this study provide a normative data set for tandem gait in healthy collegiate student-athletes and suggest that common determinants of balance, including concussion history, collision sport participation, and gender do not appear to influence performance, but ORDER could have significant clinical implications. CLINICAL RELEVANCE Clinicians may use these data to distinguish important determinants of tandem gait performance and improve awareness when returning an individual to play after a concussion.
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Affiliation(s)
- Jessie R Oldham
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - Melissa S DiFabio
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.,Biomechanics & Movement Science, University of Delaware, Newark, Delaware
| | - Thomas W Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - Ryan M DeWolf
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.,Biomechanics & Movement Science, University of Delaware, Newark, Delaware
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46
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Wojtowicz M, Iverson GL, Silverberg ND, Mannix R, Zafonte R, Maxwell B, Berkner PD. Consistency of Self-Reported Concussion History in Adolescent Athletes. J Neurotrauma 2016; 34:322-327. [PMID: 27349296 DOI: 10.1089/neu.2016.4412] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Relying on self-reported concussion injury history is common in both clinical care and research. However, young athletes may not provide consistent medical information. To date, little is known about the reliability of self-reported concussion history in high school students. This study examined whether student athletes reported their lifetime history of concussions consistently over time. Self-reported concussion history was examined in 4792 student athletes (ages 13-18) from Maine who completed a preseason health survey on two occasions (median re-test interval = 23.7 months; standard deviation = 7.3; interquartile range = 12.4-24.5). Consistency of self-reported concussion history was determined by differences in the number of concussions reported during the second survey. Inconsistent concussion history was defined primarily by a decrease in the number of lifetime concussions reported at the second testing, compared with at the first testing. The majority of the sample (80.3%) reported no change in the number of concussions between the two baseline assessments. A minority (15.9%; n = 763) reported more concussions during the second assessment. Only 3.8% (n = 181) of student athletes provided inconsistent concussion histories, defined as fewer concussions at the second assessment. Boys provided inconsistent concussion histories a little more frequently, compared with girls (5.3% and 2.0%, respectively; p < 0.001). Similarly, athletes with self-reported attention-deficit hyperactivity disorder (ADHD) provided inconsistent concussion histories somewhat more frequently, compared with those without ADHD (7.8% and 3.5%, respectively; p < 0.001). Of the athletes with inconsistent concussion histories, greater degree of inconsistency was associated with a greater number of concussions initially reported at baseline (rs = 0.54; p < 0.001). Only a small proportion of student athletes provided inconsistent concussion histories. Male gender, ADHD, and greater number of baseline concussions were significantly associated with inconsistency in reporting. Overall, these findings suggest that student athletes are quite consistent when reporting their concussion history when surveyed twice during high school.
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Affiliation(s)
- Magdalena Wojtowicz
- 1 Department of Psychiatry, Harvard Medical School , Boston, Massachusetts.,2 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.,3 MassGeneral Hospital for Children Sports Concussion Program , Boston, Massachusetts.,4 Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts
| | - Grant L Iverson
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.,3 MassGeneral Hospital for Children Sports Concussion Program , Boston, Massachusetts.,4 Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts.,5 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital , Boston, Massachusetts
| | - Noah D Silverberg
- 4 Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts.,5 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital , Boston, Massachusetts.,6 Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,7 GF Strong Rehabilitation Centre , Vancouver, British Columbia, Canada
| | - Rebekah Mannix
- 8 Division of Emergency Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Ross Zafonte
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.,3 MassGeneral Hospital for Children Sports Concussion Program , Boston, Massachusetts.,4 Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts.,5 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital , Boston, Massachusetts.,9 Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital , Boston, Massachusetts.,10 Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital , Boston, Massachusetts
| | - Bruce Maxwell
- 11 Department of Computer Science, Colby College , Waterville, Maine
| | - Paul D Berkner
- 12 Health Services, Colby College , Waterville, Maine.,13 Department of Biology, Colby College , Waterville, Maine
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47
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Pietrosimone B, Golightly YM, Mihalik JP, Guskiewicz KM. Concussion Frequency Associates with Musculoskeletal Injury in Retired NFL Players. Med Sci Sports Exerc 2016; 47:2366-72. [PMID: 25871466 DOI: 10.1249/mss.0000000000000684] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Concussion is commonly associated with immediate and persistent alterations in motor function affecting postural control and gait. Patients with lower extremity joint injury have demonstrated functional alterations in the cerebral cortex, suggesting that musculoskeletal injury may be linked to alterations in brain function. Therefore, we examined the associations between concussion frequency and lower extremity musculoskeletal injury sustained during professional careers of National Football League (NFL) players in a cross-sectional study. METHODS An inclusive health history survey was mailed to 3647 NFL players who retired during 1930-2001. Respondents reported total concussion frequency (zero, one, two, or three or more) and presence (yes/no) of specific knee and ankle musculoskeletal injury during their NFL career. Separate logistic regression models were used to estimate associations between concussion frequency and each musculoskeletal injury type, adjusting for number of years played in the NFL, body mass index while playing in the NFL, and playing position. RESULTS Data from 2429 players (66.6% response rate) were available for analysis. Nearly 61% reported experiencing a concussion while competing in the NFL. Meniscal tear was the most commonly reported musculoskeletal injury (32%). Compared with NFL players who did not sustain a concussion, retired NFL players with one, two, or three or more concussions had between 18% and 63%, 15% and 126%, and 73% and 165% higher odds of reporting various musculoskeletal injuries, respectively. CONCLUSIONS A history of concussions was associated with a history of musculoskeletal injuries during NFL careers. These data suggest that a higher number of concussions is linked with higher odds of reporting a musculoskeletal injury.
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Affiliation(s)
- Brian Pietrosimone
- 1Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Neuromuscular Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC; 3Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC; 4Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; 5Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; 6Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; 7Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; and 8Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC
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48
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Montenigro PH, Alosco ML, Martin BM, Daneshvar DH, Mez J, Chaisson CE, Nowinski CJ, Au R, McKee AC, Cantu RC, McClean MD, Stern RA, Tripodis Y. Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players. J Neurotrauma 2016; 34:328-340. [PMID: 27029716 DOI: 10.1089/neu.2016.4413] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The term "repetitive head impacts" (RHI) refers to the cumulative exposure to concussive and subconcussive events. Although RHI are believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined because of the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, which we term the "cumulative head impact index" (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and 3) to evaluate its predictive properties relative to other exposure metrics (i.e., duration of play, age of first exposure, concussion history). Participants included 93 former high school and collegiate football players who completed objective cognitive and self-reported behavioral/mood tests as part of a larger ongoing longitudinal study. Using established cutoff scores, we transformed continuous outcomes into dichotomous variables (normal vs. impaired). The CHII was computed for each participant and derived from a combination of self-reported athletic history (i.e., number of seasons, position[s], levels played), and impact frequencies reported in helmet accelerometer studies. A bivariate probit, instrumental variable model revealed a threshold dose-response relationship between the CHII and risk for later-life cognitive impairment (p < 0.0001), self-reported executive dysfunction (p < 0.0001), depression (p < 0.0001), apathy (p = 0.0161), and behavioral dysregulation (p < 0.0001). Ultimately, the CHII demonstrated greater predictive validity than other individual exposure metrics.
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Affiliation(s)
- Philip H Montenigro
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Michael L Alosco
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Brett M Martin
- 3 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Daniel H Daneshvar
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Jesse Mez
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,4 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts
| | - Christine E Chaisson
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,3 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts.,5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Christopher J Nowinski
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,6 Concussion Legacy Foundation , Waltham, Massachusetts
| | - Rhoda Au
- 4 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts.,7 Framingham Heart Study, Boston University School of Medicine , Boston, Massachusetts
| | - Ann C McKee
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,4 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts.,8 Department of Pathology, Boston University School of Medicine , Boston, Massachusetts.,9 VA Boston Healthcare System , Boston, Massachusetts
| | - Robert C Cantu
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,6 Concussion Legacy Foundation , Waltham, Massachusetts.,10 Department Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.,11 Department of Neurosurgery, Emerson Hospital , Concord, Massachusetts
| | - Michael D McClean
- 12 Environmental Health, Boston University School of Public Health , Boston, Massachusetts
| | - Robert A Stern
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.,4 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts.,10 Department Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| | - Yorghos Tripodis
- 1 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
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49
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Vanwolleghem G, Schipperijn J, Gheysen F, Cardon G, De Bourdeaudhuij I, Van Dyck D. Children's GPS-determined versus self-reported transport in leisure time and associations with parental perceptions of the neighborhood environment. Int J Health Geogr 2016; 15:16. [PMID: 27150842 PMCID: PMC4858916 DOI: 10.1186/s12942-016-0045-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/20/2016] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to examine both GPS-determined and self-reported walking, cycling and passive transport in leisure time during week- and weekend-days among 10 to 12-year old children. Comparisons between GPS-determined and self-reported transport in leisure time were investigated. Second, associations between parental perceptions of the neighborhood environment and GPS-determined walking, cycling and passive transport in leisure time were studied. Methods Children (10 to 12-years old; n = 126) wore a GPS device and an accelerometer for 7 consecutive days to assess objectively measured transport in leisure time and filled out a diary to assess self-reported transport in leisure time. Parents completed a questionnaire to assess parental perceptions of the neighborhood environment. Pearson correlations and t-tests were used to test for concurrent validity and differences between GPS-determined and self-reported transport in leisure time. Generalized linear models were used to determine the associations between the parental perceptions of the neighborhood environment and GPS-determined transport in leisure time. Results Overall, children under-reported their walking and cycling in leisure time, compared to GPS-determined measures (all p values <0.001). However, children reported their passive transport in leisure time during weekend days quite accurate. GPS-determined measures revealed that children walked most during weekdays (M = 3.96 trips/day; 26.10 min/day) and used passive transport more frequently during weekend days (M = 2.12 trips/day; 31.39 min/day). Only a few parental perceived environmental attributes of the neighborhood (i.e. residential density, land use mix access, quality and availability of walking and cycling facilities, and aesthetics) were significantly associated with children’s GPS-determined walking, cycling or passive transport in leisure time. Conclusions To accurately assess children’s active transport in leisure time, GPS measures are recommended over self-reports. More research using GPS with a focus on children’s transport in leisure time and investigating the associations with parental perceptions of the neighborhood environment is needed to confirm the results of the present study. Electronic supplementary material The online version of this article (doi:10.1186/s12942-016-0045-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Griet Vanwolleghem
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Jasper Schipperijn
- Research Unit for Active Living, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Freja Gheysen
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.,Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium
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50
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Yengo-Kahn AM, Johnson DJ, Zuckerman SL, Solomon GS. Concussions in the National Football League: A Current Concepts Review. Am J Sports Med 2016; 44:801-11. [PMID: 25899432 DOI: 10.1177/0363546515580313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. PURPOSE To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. STUDY DESIGN Systematic review of literature. METHODS English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. RESULTS Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). CONCLUSION The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community as well as the public should be cautious in interpreting the current literature surrounding concussion.
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Affiliation(s)
- Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Daniel J Johnson
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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