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Palou Martinez Y, Arrey Agbor DB, Panday P, Ejaz S, Gurugubelli S, Prathi SK, Nath TS. Mood Disorders in the Wake of Traumatic Brain Injury: A Systematic Review. Cureus 2024; 16:e62524. [PMID: 39022497 PMCID: PMC11253579 DOI: 10.7759/cureus.62524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Traumatic brain injury (TBI) frequently leads to a myriad of long-term consequences, among which mood disorders present a significant challenge. This systematic review delves into the complex interplay between TBI and subsequent mood disorders, focusing on research studies conducted over the past decade. Encompassing an age range from 12 years old to older adults (60+ years), our review aims to elucidate the epidemiological patterns, neurobiological mechanisms, and psychosocial factors that contribute to the development of mood disorders following TBI. By synthesizing the current literature, we seek to uncover the prevalence and clinical implications of this often-under-recognized comorbidity. For the quality appraisal of the reviewed articles, the Newcastle-Ottawa risk-of-bias tool and Scale for the Assessment of Narrative Review Articles (SANRA) checklist were employed. Ultimately, this review endeavors to provide a comprehensive understanding of the intricate relationship between TBI and mood disorders, offering insights crucial for improved management and intervention strategies in affected individuals.
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Affiliation(s)
- Yaneisi Palou Martinez
- Research and Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Divine Besong Arrey Agbor
- Clinical Research and Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Priyanka Panday
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samrah Ejaz
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Simhachalam Gurugubelli
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Memorial Healthcare, Gulfport, USA
| | - Suviksh K Prathi
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Research, St. George's University School of Medicine, St. George's, GRD
| | - Tuheen Sankar Nath
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Surgical Oncology, Tata Medical Centre, Kolkata, IND
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Delfin D, Wallace J, Baez S, Karr JE, Terry DP, Hibbler T, Yengo-Kahn A, Newman S. Social Support, Stress, and Mental Health: Examining the Stress-Buffering Hypothesis in Adolescent Football Athletes. J Athl Train 2024; 59:499-505. [PMID: 38014810 PMCID: PMC11127675 DOI: 10.4085/1062-6050-0324.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT Football sport participation has been linked to both positive and negative effects on overall health. Social support, a network that provides individuals with resources to cope effectively, may positively influence one's stress and mental health. However, little research has been conducted on adolescent football players. OBJECTIVE To examine the relationships among social support, psychological stress, and mental health in adolescent football athletes. DESIGN Cross-sectional study. SETTING High school athletes during the precompetitive and postcompetitive football season in rural Alabama. PATIENTS OR OTHER PARTICIPANTS Black and African American adolescent athletes (N = 93) competing for a school-sponsored football team. MAIN OUTCOME MEASURE(S) After a competitive season, participants completed a battery of social support, psychological stress, and mental health symptom measures using the National Institutes of Health Toolbox Application and Patient-Reported Outcomes Measurement Information System. The T-score means, Pearson correlations, and multiple regression analyses were calculated. RESULTS Social support was negatively correlated with psychological stress (emotional support, r = -0.386; family relationships, r = -0.412; peer relationships, r = -0.265) and mental health (depression, r = -0.367 and r = -0.323 for emotional support and family relationships, respectively), whereas psychological stress and mental health (depression, r = 0.751; anxiety, r = 0.732) were positively correlated. In regression analyses, social support measures (ie, emotional support, family relationships, and peer relationships) were used to predict psychological stress (F = 7.094, P < .001, R2 = 0.191), depression symptoms (F = 5.323, P < .001, R2 = 0.151), and anxiety symptoms (F = 1.644, P = .190, R2 = 0.052). CONCLUSIONS In line with the stress-buffering hypothesis, social support in the form of family relationships and overall emotional support garnered through sport participation may reduce psychological stress and help to preserve the mental health of football athletes. These findings indicate that perceived social support may act as a positive resource for the coping of Black and African American adolescent athletes. Further research is warranted to understand the effects of stress and social support on the mental health of adolescents, particularly racial and ethnic minorities who are underrepresented in the athletic training literature.
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Affiliation(s)
- Danae Delfin
- School of Physical Therapy & Rehabilitation Sciences, Athletic Training Program, University of South Florida, Tampa
| | - Jessica Wallace
- Department of Health Science, Athletic Training Program, The University of Alabama, Tuscaloosa
| | - Shelby Baez
- Department of Exercise & Sport Science, The University of North Carolina at Chapel Hill
| | - Justin E. Karr
- Department of Psychology, University of Kentucky, Lexington
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Nashville, TN
| | - Tamaria Hibbler
- Sports Medicine Department, University of Arkansas, Fayetteville
| | - Aaron Yengo-Kahn
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Nashville, TN
| | - Sharlene Newman
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa
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Grashow R, Shaffer-Pancyzk TV, Dairi I, Lee H, Marengi D, Baker J, Weisskopf MG, Speizer FE, Whittington AJ, Taylor HA, Keating D, Tenforde A, Guseh JS, Wasfy MM, Zafonte R, Baggish A. Healthspan and chronic disease burden among young adult and middle-aged male former American-style professional football players. Br J Sports Med 2022; 57:bjsports-2022-106021. [PMID: 36588423 PMCID: PMC9887383 DOI: 10.1136/bjsports-2022-106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the relationships between age, healthspan and chronic illness among former professional American-style football (ASF) players. METHODS We compared age-specific race-standardised and body mass index-standardised prevalence ratios of arthritis, dementia/Alzheimer's disease, hypertension and diabetes among early adult and middle-aged (range 25-59 years) male former professional ASF players (n=2864) with a comparator cohort from the National Health and Nutrition Examination Survey and National Health Interview Survey, two representative samples of the US general population. Age was stratified into 25-29, 30-39, 40-49 and 50-59 years. RESULTS Arthritis and dementia/Alzheimer's disease were more prevalent among ASF players across all study age ranges (all p<0.001). In contrast, hypertension and diabetes were more prevalent among ASF players in the youngest age stratum only (p<0.001 and p<0.01, respectively). ASF players were less likely to demonstrate intact healthspan (ie, absence of chronic disease) than the general population across all age ranges. CONCLUSION These data suggest the emergence of a maladaptive early ageing phenotype among former professional ASF players characterised by premature burden of chronic disease and reduced healthspan. Additional study is needed to investigate these findings and their impact on morbidity and mortality in former ASF players and other athlete groups.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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Leonelli BR, Kuhn T, Sanborn V, Gunstad J. Feasibility of Predicting In-Season Mental Health Problems in College Student-Athletes From Pre-season Assessment. Clin J Sport Med 2022; 32:e139-e144. [PMID: 33239509 DOI: 10.1097/jsm.0000000000000899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine whether pre-season assessment using a validated assessment tool, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), could predict college student-athletes identified as experiencing in-season mental health (MH) problems. DESIGN A prospective study of athletes who completed a pre-season evaluation in August 2018. SETTING AND PARTICIPANTS A total of 195 National Collegiate Athletic Association Division 1 student-athletes from a large midwestern university in northeast Ohio. INDEPENDENT VARIABLE The MMPI-2-RF, a 338-item self-report measure of constructs relevant to the assessment of psychopathology and personality. MAIN OUTCOME MEASURE Mental health problems of student-athletes tracked throughout the competitive season (August 2018-May 2019) by a team of athletic department personnel who met weekly with a licensed clinical psychologist. RESULTS In pre-season assessment, 71.8% of athletes clinically elevated at least one MMPI-2-RF scale and underreporting was higher in student-athletes than normative controls. Pre-season levels of internalizing psychopathology, diffuse physical symptoms, and unusual thoughts predicted increased likelihood of experiencing MH problems during the competitive season. CONCLUSIONS The current findings suggest that the MMPI-2-RF may be a promising tool for identifying student-athletes at risk for MH concerns.
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Affiliation(s)
- Brooke R Leonelli
- Department of Psychological Sciences, Kent State University, Kent, Ohio; and
| | - Tyler Kuhn
- Department of Psychological Sciences, Kent State University, Kent, Ohio; and
| | - Victoria Sanborn
- Department of Psychological Sciences, Kent State University, Kent, Ohio; and
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio; and
- Brain Health Research Institute, Kent State University, Kent, Ohio
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Keefer M, Walsh J, Adams K, Climstein M, Harris C, DeBeliso M. Tactical Masters Athletes: BMI Index Classifications. Sports (Basel) 2022; 10:sports10020022. [PMID: 35202061 PMCID: PMC8877940 DOI: 10.3390/sports10020022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding the nexus between aging, physical activity, and obesity has been a source of ongoing investigation. A considerable amount of research has focused on Masters athletes in this regard, suggesting a beneficial relationship between Masters sport participation and a healthy body mass index (BMI). Some consider Active Duty military personnel as tactical athletes. As such, it is of interest to determine if aging Active Duty military personnel (or Masters Tactical Athletes) might have a similar BMI as other Masters athletes (MA). As such, this investigation examined previously recorded data of Active Duty Enlisted United States Marines (n = 402, male, 46–50 years old). The BMI of the Marines was stratified into categories of: underweight, normal, overweight, and obese. The Marines obesity prevalence was compared to US adult males (40–59 years) as well as male North American MA who competed at the 2009 Sydney World Masters Games. The Marines obesity prevalence was significantly lower than US adult males (p < 0.001) and those MA that competed in softball (p < 0.001); however, it was similar to MA that competed in football, track/field, swimming, and volleyball (p > 0.05). The average Marine BMI = 26.7 kg/m2 was similar to MA who competed in football, swimming, and volley ball (p > 0.05); however, it was higher than MA who competed in track/field (p < 0.05) and lower than MA who played softball (p < 0.05). It should be noted that the average BMI for the Marines and all MA sport categories were classified as being overweight. Within the parameters of this investigation, Tactical MA (i.e., aging US Marines) enjoy a similar beneficial BMI as other North American MA.
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Affiliation(s)
- Marc Keefer
- Athletic Department, Central Washington University, Ellensburg, WA 98926, USA;
| | - Joe Walsh
- Sport Science Institute, Sydney 2000, Australia;
| | - Kent Adams
- Kinesiology Department, California State University, Monterey Bay, Marina, CA 93933, USA;
| | - Mike Climstein
- Faculty of Health, Southern Cross University, Lismore 4225, Australia;
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney 2000, Australia
| | - Chad Harris
- Metropolitan State University of Denver, Denver, CO 80204, USA;
| | - Mark DeBeliso
- College of Health Sciences, Southern Utah University, Cedar City, UT 84720, USA
- Correspondence:
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McCorkle TA, Barson JR, Raghupathi R. A Role for the Amygdala in Impairments of Affective Behaviors Following Mild Traumatic Brain Injury. Front Behav Neurosci 2021; 15:601275. [PMID: 33746719 PMCID: PMC7969709 DOI: 10.3389/fnbeh.2021.601275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
Mild traumatic brain injury (TBI) results in chronic affective disorders such as depression, anxiety, and fear that persist up to years following injury and significantly impair the quality of life for patients. Although a great deal of research has contributed to defining symptoms of mild TBI, there are no adequate drug therapies for brain-injured individuals. Preclinical studies have modeled these deficits in affective behaviors post-injury to understand the underlying mechanisms with a view to developing appropriate treatment strategies. These studies have also unveiled sex differences that contribute to the varying phenotypes associated with each behavior. Although clinical and preclinical studies have viewed these behavioral deficits as separate entities with unique neurobiological mechanisms, mechanistic similarities suggest that a novel approach is needed to advance research on drug therapy. This review will discuss the circuitry involved in the expression of deficits in affective behaviors following mild TBI in humans and animals and provide evidence that the manifestation of impairment in these behaviors stems from an amygdala-dependent emotional processing deficit. It will highlight mechanistic similarities between these different types of affective behaviors that can potentially advance mild TBI drug therapy by investigating treatments for the deficits in affective behaviors as one entity, requiring the same treatment.
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Affiliation(s)
- Taylor A. McCorkle
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Jessica R. Barson
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Ramesh Raghupathi
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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7
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Golding L, Gillingham RG, Perera NKP. The prevalence of depressive symptoms in high-performance athletes: a systematic review. PHYSICIAN SPORTSMED 2020; 48:247-258. [PMID: 31964205 DOI: 10.1080/00913847.2020.1713708] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities. Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged ≥ 17 years were included. Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias. Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%. Data synthesis: Higher levels of competition, injuries, > 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores. Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.
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Affiliation(s)
- Leigh Golding
- Australasian College of Sport and Exercise Physicians , Melbourne, Australia
| | | | - Nirmala Kanthi Panagodage Perera
- Department of Medical and Health Sciences, Linköping University , Linköping, Sweden.,Botnar Research Centre, Nuffield Department of Orthopaedics,Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham Universities Hospitals NHS Trust , Nottingham, UK.,Latrobe Sports and Exercise Medicine Research Centre, College of Science, Health and Engineering, Latrobe University , Bundoora, Australia
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8
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Wangnoo T, Zavorsky GS, Owen-Smith A. Association between Concussions and Suicidal Behaviors in Adolescents. J Neurotrauma 2020; 37:1401-1407. [PMID: 30520366 DOI: 10.1089/neu.2018.5721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
While there is increasing evidence on the long-term risks associated with concussions, the association between hopelessness, suicidal ideation, suicidal planning, and suicidal attempts in high school aged adolescents has not yet been explored. The current study aims to estimate the association between concussions and suicidal behaviors in Utah high school students. We analyzed the 2013 Utah Youth Risk Behavior Survey (YRBS), a state, representative survey of 2,195 ninth through 12th grade high school students. Bivariate and multi-variate logistic regressions controlling for race/ethnicity, sex, grade, and alcohol use were conducted to evaluate the adjusted odds ratio (OR) and 95% confidence interval (CI) of suicidal behaviors comparing students exposed to one or more concussions with those unexposed. Students with self-reported concussion exposure had significantly greater odds of reporting feeling sad or hopeless (OR = 1.7; 95% CI 1.4, 2.2, suicidal ideations [adjusted odds ratio (AOR) = 2.0; 95% CI 1.4, 2.7], suicidal planning [AOR = 2.0; 95% CI 1.4, 2.8], and suicidal attempts [OR = 2.3; 95% CI 1.4, 3.7]) after controlling for grade, sex, race, and alcohol-use. Results from this study suggest that high school students who have had a concussion are more likely to report suicidal behaviors, compared with high school students who did not report a concussion. Given the results, concussion prevention education efforts in high schools are warranted. In addition, it is imperative to educate parents, teachers, and health professionals how to recognize a concussion and any possible mental health outcomes as a result. Future longitudinal research is needed to better understand temporality of this association.
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9
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Harris SA, Chivers PT, McIntyre FL, Piggott B, Bulsara M, Farringdon FH. Exploring the association between recent concussion, subconcussive impacts and depressive symptoms in male Australian Football players. BMJ Open Sport Exerc Med 2020; 6:e000655. [PMID: 32201617 PMCID: PMC7061895 DOI: 10.1136/bmjsem-2019-000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the association between depressive symptoms and recent head-related trauma (diagnosed concussion, subconcussive impacts) in semiprofessional male Australian Football (AF) players. Methods Sixty-nine semiprofessional male players from a West Australian Football League (WAFL) club participated in the study (Mage=21.81, SD=2.91 years). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale. Injuries and potential confounding variables (eg, pre-existing mental health condition; alcohol or drug hangovers; experiencing a stressful event) were self-reported anonymously using the WAFL Injury Report Survey. Both tools were administered every 2-weeks over the first 22-weeks of the WAFL season. Controlling for potential confounding variables and other injuries, a repeated measures generalised estimating equations model assessed the risk of clinically relevant depressive symptoms occurring, when diagnosed concussion or subconcussive impacts were experienced. Results A total of 10 concussions and 183 subconcussive impacts were reported. Players who experienced a concussion were almost nine times more likely to experience clinically relevant depressive symptoms (OR 8.88, 95% CI 2.65 to 29.77, p<0.001). Although elevated, depressive symptoms following subconcussive impacts were not statistically significant (OR 1.13, 95% CI 0.67 to 1.92, p=0.641). Conclusion These findings indicate that semiprofessional AF athletes may be at risk of experiencing depressive symptoms after concussion. Severity (concussion vs subconcussive impacts) and dose (number of impacts) appear to have an important relationship with depressive symptom outcomes in this cohort and should be considered for further research and management of player welfare.
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Affiliation(s)
- Sarah Ann Harris
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paola T Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Fleur L McIntyre
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ben Piggott
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Fiona H Farringdon
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Ho RA, Hall GB, Noseworthy MD, DeMatteo C. Post-concussive depression: evaluating depressive symptoms following concussion in adolescents and its effects on executive function. Brain Inj 2020; 34:520-527. [DOI: 10.1080/02699052.2020.1725841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Rachelle A. Ho
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey B. Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Michael D. Noseworthy
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Carol DeMatteo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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11
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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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12
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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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13
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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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14
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Long AS, Niemeier JP, McWilliams A, Patterson CG, Perrin P, Templin M, Price DE. Comparison of Neurocognitive Changes Over One Competitive Season in Adolescent Contact and Non-contact Athletes. ACTA ACUST UNITED AC 2019. [DOI: 10.3928/19425864-20180430-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Abstract
Background Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this population. Objective The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels. Methods A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted. Results A total of 27 studies met inclusion criteria for review. Most of the included studies (67%, n = 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA, n = 23 studies; Canada, n = 3), often in male only (44.4%, n = 12) and college (70.4%, n = 19) samples. Depression is the most commonly studied mental health outcome (70.4%, n = 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains. Conclusion Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports. Electronic supplementary material The online version of this article (10.1007/s40279-017-0810-3) contains supplementary material, which is available to authorized users.
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16
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Raji CA, Henderson TA. PET and Single-Photon Emission Computed Tomography in Brain Concussion. Neuroimaging Clin N Am 2018; 28:67-82. [PMID: 29157854 DOI: 10.1016/j.nic.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
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Affiliation(s)
- Cyrus A Raji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF China Basin, 185 Berry Street, Suite 350, San Francisco, CA 94158, USA
| | - Theodore A Henderson
- The Synaptic Space Inc, Neuro-Laser Foundation, Neuro-Luminance Brain Health Centers Inc, Dr. Theodore Henderson Inc, 3979 East Arapahoe Road, Suite 200, Centennial, CO 80122, USA.
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17
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Cernak I, Stein DG, Elder GA, Ahlers S, Curley K, DePalma RG, Duda J, Ikonomovic M, Iverson GL, Kobeissy F, Koliatsos VE, Leggieri MJ, Pacifico AM, Smith DH, Swanson R, Thompson FJ, Tortella FC. Preclinical modelling of militarily relevant traumatic brain injuries: Challenges and recommendations for future directions. Brain Inj 2018; 31:1168-1176. [PMID: 28981339 PMCID: PMC9351990 DOI: 10.1080/02699052.2016.1274779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As a follow-up to the 2008 state-of-the-art (SOTA) conference on traumatic brain injuries (TBIs), the 2015 event organized by the United States Department of Veterans Affairs (VA) Office of Research and Development (ORD) analysed the knowledge gained over the last 7 years as it relates to basic scientific methods, experimental findings, diagnosis, therapy, and rehabilitation of TBIs and blast-induced neurotraumas (BINTs). The current article summarizes the discussions and recommendations of the scientific panel attending the Preclinical Modeling and Therapeutic Development Workshop of the conference, with special emphasis on factors slowing research progress and recommendations for ways of addressing the most significant pitfalls.
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Affiliation(s)
- Ibolja Cernak
- a Military and Veterans' Clinical Rehabilitation Research, Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Donald G Stein
- b Emory School of Medicine , Department of Emergency Medicine Brain Research Laboratory , Atlanta , Georgia , USA
| | - Gregory A Elder
- c James J. Peters VA Medical Center , Bronx , NY , USA.,d Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Stephn Ahlers
- e Operational and Undersea Medicine, Naval Medical Research Center , Silver Spring , MD , USA
| | - Kenneth Curley
- f Iatrikos Research and Development Strategies, LLC , Tampa , FL , USA.,g Department of Surgery , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Ralph G DePalma
- h VA ORD & Department of Surgery , Uniformed Services University of the Health Sciences, Office of Research and Development , Washington , DC , USA
| | - John Duda
- i Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Medical Center; and Department of Neurology , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Milos Ikonomovic
- j Department of Neurology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Grant L Iverson
- k Neuropsychology Outcome Assessment Laboratory, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
| | - Firas Kobeissy
- l Psychoproteomics and Nanotechnology Research Center, Department of Psychiatry , The Evelyn F and William L. McKnight Brain Institute, University of Florida , Gainesville , FL , USA
| | - Vassilis E Koliatsos
- m Department of Pathology (Neuropathology) and Neurology , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Michael J Leggieri
- n DoD Blast Injury Research Program Coordinating Office, U.S. Army Medical Research and Materiel Command , Ft Detrick , MD , USA
| | - Anthony M Pacifico
- o Alzheimer's and Epilepsy Research Programs, Congressionally Directed Medical Research Programs; US Department of Health and Human Services , Telemedicine and Advanced Technology Research Center , Fort Detrick , MD , USA
| | - Douglas H Smith
- p The Robert A. Groff Professor of Neurosurgery/Research and Education, Department of Neurosurgery/PENN's Center for Brain Injury and Repair , University of Pennsylvania , Philadelphia , PA , USA
| | - Raymond Swanson
- q Department of Neurology , University of California San Francisco; and Neurology Service, SFVAMC , San Francisco , CA , USA
| | - Floyd J Thompson
- r Brain Rehabilitation Research Center, Malcom Randall VAMC; Physiological Sciences and Professor Emeritus, Neuroscience, University of Florida , Gainesville , FL , USA
| | - Frank C Tortella
- s Branch of Brain Trauma Neuroprotection and Neurorestoration, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research ; Silver Spring , MD , USA
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18
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COACH CV: The Seven Clinical Phenotypes of Concussion. Brain Sci 2017; 7:brainsci7090119. [PMID: 28926944 PMCID: PMC5615260 DOI: 10.3390/brainsci7090119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
Our understanding of the diverse physiological manifestations of concussion is changing rapidly. This has an influence on the clinical assessment of patients who have sustained a concussion. The 2017 Consensus Statement on Concussion in Sport states that numerous post-injury clinical findings, such as cognitive deficits, post-traumatic headaches, dizziness, difficulties with oculomotor function, and depression have all been associated with a poorer prognosis in concussed patients. This demonstrates that there are several potential clinical manifestations after head injury warranting clinical evaluation. We have developed an acronym to guide the office-based assessment of concussed patients to consider each of the potential clinical phenotypes. "COACH CV" prompts the clinician to evaluate for cognitive problems, oculomotor dysfunction, affective disturbances, cervical spine disorders, headaches, and cardiovascular and vestibular anomalies.
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