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Roberts M, Popovich M, Almeida A. The Evaluation and Management of Concussion to Optimize Safe Recovery. Prim Care 2024; 51:269-282. [PMID: 38692774 DOI: 10.1016/j.pop.2024.02.009] [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: 05/03/2024]
Abstract
Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1 month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be cleared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning to work/school fully.
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Affiliation(s)
- Mark Roberts
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
| | - Michael Popovich
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA.
| | - Andrea Almeida
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
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2
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Bianchi D, Sethi NK, Velasco G, Qureshi UA, deWeber K. Care of The Older Fighter: Position Statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38708547 DOI: 10.1080/00913847.2024.2344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.
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Affiliation(s)
- Davide Bianchi
- Medbase Cornavin Sports Center, SwissBoxing, Geneva, Switzerland
| | - Nitin K Sethi
- Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - George Velasco
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uneeb A Qureshi
- United States Public Health Service, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kevin deWeber
- Program Director, SW Washington Sports Medicine Fellowship, Vancouver, WA USA
- Affiliate Associate Professor of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- Clinical Assistant Professor of Family Medicine, University of Washington, Seattle, WA, USA
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Fesharaki-Zadeh A. Navigating the Complexities of Traumatic Encephalopathy Syndrome (TES): Current State and Future Challenges. Biomedicines 2023; 11:3158. [PMID: 38137378 PMCID: PMC10740836 DOI: 10.3390/biomedicines11123158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a unique neurodegenerative disease that is associated with repetitive head impacts (RHI) in both civilian and military settings. In 2014, the research criteria for the clinical manifestation of CTE, traumatic encephalopathy syndrome (TES), were proposed to improve the clinical identification and understanding of the complex neuropathological phenomena underlying CTE. This review provides a comprehensive overview of the current understanding of the neuropathological and clinical features of CTE, proposed biomarkers of traumatic brain injury (TBI) in both research and clinical settings, and a range of treatments based on previous preclinical and clinical research studies. Due to the heterogeneity of TBI, there is no universally agreed-upon serum, CSF, or neuroimaging marker for its diagnosis. However, as our understanding of this complex disease continues to evolve, it is likely that there will be more robust, early diagnostic methods and effective clinical treatments. This is especially important given the increasing evidence of a correlation between TBI and neurodegenerative conditions, such as Alzheimer's disease and CTE. As public awareness of these conditions grows, it is imperative to prioritize both basic and clinical research, as well as the implementation of necessary safe and preventative measures.
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Affiliation(s)
- Arman Fesharaki-Zadeh
- Department of Neurology and Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
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Wan J, Zou Y, Sun R, Xu Z, Tang J, Gong Y, Wei G, Zhang Q. Destabilization mechanism of R3-R4 tau protofilament by purpurin: a molecular dynamics study. Phys Chem Chem Phys 2023. [PMID: 37314291 DOI: 10.1039/d3cp01039b] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The accumulation of tau protein aggregates is a common feature observed in many neurodegenerative diseases. However, the structural characteristics of tau aggregates can vary among different tauopathies. It has been established that the structure of the tau protofilament in Chronic traumatic encephalopathy (CTE) is similar to that of Alzheimer's disease (AD). In addition, a previous study found that purpurin, an anthraquinone, could inhibit and disassemble the pre-formed 306VQIVYK311 isoform of AD-tau protofilament. Herein, we used all-atom molecular dynamic (MD) simulation to investigate the distinctive features between CTE-tau and AD-tau protofilament and the influence of purpurin on CTE-tau protofilament. Our findings revealed notable differences at the atomic level between CTE-tau and AD-tau protofilaments, particularly in the β6-β7 angle and the solvent-accessible surface area (SASA) of the β4-β6 region. These structural disparities contributed to the distinct characteristics observed in the two types of tau protofilaments. Our simulations substantiated that purpurin could destabilize the CTE-tau protofilament and decrease β-sheet content. Purpurin molecules could insert the β4-β6 region and weaken the hydrophobic packing between β1 and β8 through π-π stacking. Interestingly, each of the three rings in purpurin exhibited unique binding preferences with the CTE-tau protofilament. Overall, our study sheds light on the structural distinctions between CTE-tau and AD-tau protofilaments, as well as the destabilizing mechanism of purpurin on CTE-tau protofilament, which may be helpful to the development of drugs to prevent CTE.
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Affiliation(s)
- Jiaqian Wan
- School of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, People's Republic of China.
| | - Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Hangzhou 310058, People's Republic of China
| | - Ruiqing Sun
- School of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, People's Republic of China.
| | - Zhengdong Xu
- School of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, People's Republic of China.
| | - Jiaxing Tang
- School of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, People's Republic of China.
| | - Yehong Gong
- School of Sports Science and Engineering, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, People's Republic of China
| | - Guanghong Wei
- Department of Physics, State Key Laboratory of Surface Physics, and Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
| | - Qingwen Zhang
- School of Physical Education, Shanghai University of Sport, 399 Changhai Road, Shanghai 200438, People's Republic of China.
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Mao Y, Zhao D, Li J, Fu W. Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century. Orthop J Sports Med 2023; 11:23259671221127669. [PMID: 37025124 PMCID: PMC10071201 DOI: 10.1177/23259671221127669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 04/08/2023] Open
Abstract
Background To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed. Purpose To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century. Study Design Systematic review; Level of evidence, 3. Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IRN), per 1000 competition exposures (IRE), and per 1000 minutes of competition (IRC) or training (IRT) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs. Results Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IRN in overall injuries was 223.9 (95% CI, 157.5-290.4), the IRE was 233.3 (95% CI, 161.3-305.2), and the IRC was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IRN (399.8), IRE (379.8), and IRC (23.9) were all significantly higher than in the amateur and female groups. The IRE (76.6 vs 250.6; P < .000) and IRC (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture. Conclusion IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies. Registration CRD42021289993 (PROSPERO).
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Dongmei Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
- Weili Fu, MD, Department of Orthopedics, Orthopedic Research
Institute, West China Hospital, Sichuan University, No. 37, Guoxue Alley,
Chengdu 610041, China ()
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Pierre K, Molina V, Shukla S, Avila A, Fong N, Nguyen J, Lucke-Wold B. Chronic traumatic encephalopathy: Diagnostic updates and advances. AIMS Neurosci 2022; 9:519-535. [PMID: 36660076 PMCID: PMC9826753 DOI: 10.3934/neuroscience.2022030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs secondary to repetitive mild traumatic brain injury. Current clinical diagnosis relies on symptomatology and structural imaging findings which often vary widely among those with the disease. The gold standard of diagnosis is post-mortem pathological examination. In this review article, we provide a brief introduction to CTE, current diagnostic workup and the promising research on imaging and fluid biomarker diagnostic techniques. For imaging, we discuss quantitative structural analyses, DTI, fMRI, MRS, SWI and PET CT. For fluid biomarkers, we discuss p-tau, TREM2, CCL11, NfL and GFAP.
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Affiliation(s)
- Kevin Pierre
- University of Florida Department of Radiology, Gainesville 32603, Florida, USA
| | - Vanessa Molina
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Shil Shukla
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Anthony Avila
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Nicholas Fong
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Jessica Nguyen
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Brandon Lucke-Wold
- University of Florida Department of Neurosurgery, Gainesville 32603, Florida, USA,* Correspondence:
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Giannatos V, Panagopoulos A, Antzoulas P, I Giakoumakis S, Lakoumentas J, Kouzelis A. Functional performance of the upper limb and the most common boxing-related injuries in male boxers: a retrospective, observational, comparative study with non-boxing population. BMC Sports Sci Med Rehabil 2022; 14:162. [PMID: 36050792 PMCID: PMC9434859 DOI: 10.1186/s13102-022-00558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/26/2022] [Indexed: 12/04/2022]
Abstract
Background To investigate the functional status and recording the most common injuries of the upper limb in male Greek boxing squad in comparison to the general population. Methods A retrospective injury surveillance study using an electronic questionnaire was performed in 2021. The questionnaire was sent to male members of the Greek Boxing Federation and consisted of three parts. Demographic data, functional status scales, training conditions, hours of training, the location and description of upper limb injuries and whether the injury occurred during competition or training and also whether it was a new or a recurrent one were gathered. The same questionnaire was sent to non-boxer males (military recruits), but without asking them to report any training parameters. Inclusion criteria were age < 35 years-old for all participants and no involvement in martial arts for the control group. Also, all participants (boxers and non-boxers) completed the Patient Rated Wrist Evaluation (PRWE) scale and the Quick Disabilities of Arm, Shoulder and Hand (quick-DASH) score. Results The final study cohort was consisted of 62 elite or amateur boxers and 75 non-boxer males, less than 35 years old. The quick-DASH score was found to be significantly lower (better) in boxers in comparison to the general population (15.65 ± 10.25 vs. 12.55 ± 8.62; p = 0.020) whereas the PRWE score was similar in both groups (9.25 ± 14.96 vs. 8.61 ± 13.05; p = 0.843). Physical therapy sessions, thumb injuries and boxer’s knuckle were also found to be significantly higher in the boxers group. On the other hand, upper limb surgeries were significantly less in the boxers group. Finally, the size of boxing gloves was associated to the number of finger fractures, thumb injuries and ulnar sided wrist pain in boxers. Conclusions Although a controversial sport, boxing appears to have no long-term consequences to the upper limb function, especially regarding hand performance. The size of gloves during heavy bag training was found to be an aggravating factor for hand injuries. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00558-3.
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Affiliation(s)
- Vasileios Giannatos
- Department of Shoulder and Elbow, Orthopaedic Clinic, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patra, Greece
| | - Andreas Panagopoulos
- Department of Shoulder and Elbow, Orthopaedic Clinic, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patra, Greece.
| | - Panagiotis Antzoulas
- Department of Shoulder and Elbow, Orthopaedic Clinic, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patra, Greece
| | - Savvas I Giakoumakis
- Special Clinic of Orthopaedic Rehabilitation, Koenig Ludwig, Schwangau, Bavaria, Germany
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, Patras University, Patras, Greece
| | - Antonis Kouzelis
- Department of Shoulder and Elbow, Orthopaedic Clinic, Patras University Hospital, Papanikolaou 1, 26504, Rio-Patra, Greece
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Gallacher J, Pickering J, Bayer A, Heslop L, Morgan G, Watkins A, Martin R, Elwood P. Amateur Boxing and Dementia: Cognitive Impairment Within the 35-Year Caerphilly Cohort Study. Clin J Sport Med 2022; 32:329-333. [PMID: 35470341 DOI: 10.1097/jsm.0000000000000976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term effects of amateur boxing in a representative population sample of men. DESIGN The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently through medical records. SETTING AND ASSESSMENT OF RICK FACTORS The Caerphilly Prospective Study investigates risk factors for a range of chronic diseases of diseases. These include life style and behavior, together with biological factors relevant to vascular disease. PARTICIPANTS 1123 adult men aged 45 to 59 years at baseline, followed for 35 years. MAIN OUTCOME MEASURES Cognitive impairment. RESULTS A report by a subject of having boxed "seriously" when younger was associated with a 2-fold increase in cognitive impairment [odds ratio (OR) = 2.27; 95% confidence intervals = 1.18-4.38]. For amnestic (Alzheimer-like) impairment, this rises to OR = 2.78 (95% confidence limits 1.37-5.65). Having boxed is associated with an "advancement" in the onset of the dementia (4.8 years; 95% confidence limits 0.9-8.8 years). CONCLUSIONS Amateur boxing is associated with an increased risk and an earlier onset of cognitive impairment and dementia.
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Affiliation(s)
- John Gallacher
- Department of Psychiatry, University of Oxford, England, United Kingdom
| | - Janet Pickering
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Anthony Bayer
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Luke Heslop
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Gareth Morgan
- Hywel Dda Health Board, Cardiff, Wales, United Kingdom ; and
| | - Angela Watkins
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhodri Martin
- Cwm Taf University Health Board, Cardiff, Wales, United Kingdom
| | - Peter Elwood
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
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Mavroudis I, Kazis D, Chowdhury R, Petridis F, Costa V, Balmus IM, Ciobica A, Luca AC, Radu I, Dobrin RP, Baloyannis S. Post-Concussion Syndrome and Chronic Traumatic Encephalopathy: Narrative Review on the Neuropathology, Neuroimaging and Fluid Biomarkers. Diagnostics (Basel) 2022; 12:diagnostics12030740. [PMID: 35328293 PMCID: PMC8947595 DOI: 10.3390/diagnostics12030740] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Rumana Chowdhury
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Vasiliki Costa
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, “Alexandru Ioan Cuza” University of Iași, 700057 Iași, Romania;
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700506 Iași, Romania
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Alina-Costina Luca
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Iulian Radu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Romeo Petru Dobrin
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Stavros Baloyannis
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
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Mahamane Salissou MT, Razak MYA, Wang X, Magaji RA. The role of protein phosphatase 2A tau axis in traumatic brain injury therapy. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traumatic brain injury (TBI) is a debilitating disorder due to trauma caused by an external mechanical force eventually leading to disruption in the normal function of the brain, with possible outcomes including permanent or temporary dysfunction of cognitive, physical, and psychosocial abilities. There have been several studies focusing on the search and innovation of neuroprotective agents that could have therapeutic relevance in TBI management. Due to its complexity, TBI is divided into two major components. The first initial event is known as the primary injury; it is a result of the mechanical insult itself and is known to be irreversible and resistant to a vast variety of therapeutics. The secondary event or secondary brain injury is viewed as a cellular injury that does not manifest immediately after the trauma but evolved after a delay period of hours or several days. This category of injury is known to respond favorably to different pharmacological treatment approaches.
Main body
Due to the complexity in the pathophysiology of the secondary injury, the therapeutic strategy needs to be in a multi-facets model and to have the ability to simultaneously regulate different cellular changes. Several studies have investigated in deep the possible approaches relying on natural compounds as an alternative therapeutic strategy for the management of TBI. In addition, many natural compounds have the potential to target numerous different components of the secondary injury including neuroinflammation, apoptosis, PP2A, tau, and Aβ among others. Here, we review past and current strategies in the therapeutic management of TBI, focusing on the PP2A-tau axis both in animal and human subjects. This review uncovers, in addition, a variety of compounds used in TBI therapy.
Conclusion
Despite beneficial therapeutic effects observed in animals for many compounds, studies are still needed to be conducted on human subjects to validate their therapeutic virtues. Furthermore, potential therapeutic virtues observed among studies might likely be dependent on the TBI animal model used and the type of induced injury. In addition, specificity and side effects are challenges in TBI therapy specifically which site of PP2A dysfunction to be targeted.
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11
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Lee J. Adverse Health and Psychosocial Repercussions in Retirees from Sports Involving Head Trauma: Looking at the Sport of Boxing. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1077632ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.
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Affiliation(s)
- Joseph Lee
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, Australia
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12
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Iacono D, Raiciulescu S, Olsen C, Perl DP. Traumatic Brain Injury Exposure Lowers Age of Cognitive Decline in AD and Non-AD Conditions. Front Neurol 2021; 12:573401. [PMID: 34054681 PMCID: PMC8153372 DOI: 10.3389/fneur.2021.573401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to detect the possible accelerating role of previous traumatic brain injury (TBI) exposures on the onset of later cognitive decline assessed across different brain diseases. We analyzed data from the National Alzheimer's Coordinating Center (NACC), which provide information on history of TBI and longitudinal data on cognitive and non-cognitive domains for each available subject. At the time of this investigation, a total of 609 NACC subjects resulted to have a documented history of TBI. We compared subjects with and without a history of previous TBI (of any type) at the time of their first cognitive decline assessment, and termed them, respectively, TBI+ and TBI- subjects. Three hundred and sixty-one TBI+ subjects (229 male/132 female) and 248 TBI- subjects (156 male/92 female) were available. The analyses included TBI+ and TBI- subjects with a clinical diagnosis of Mild Cognitive Impairment, Alzheimer's disease, Dementia with Lewy bodies, Progressive supranuclear palsy, Corticobasal degeneration, Frontotemporal dementia, Vascular dementia, non-AD Impairment, and Parkinson's disease. The data showed that the mean age of TBI+ subjects was lower than TBI- subjects at the time of their first cognitive decline assessment (71.6 ± 11.2 vs. 74.8 ± 9.5 year; p < 0.001). Moreover, the earlier onset of cognitive decline in TBI+ vs. TBI- subjects was independent of sex, race, attained education, APOE genotype, and importantly, clinical diagnoses. As for specific cognitive aspects, MMSE, Trail Making Test part B and WAIS-R scores did not differ between TBI+ and TBI- subjects, whereas Trail Making Test part A (p = 0.013) and Boston Naming test (p = 0.008) did. In addition, data showed that neuropsychiatric symptoms [based on Neuropsychiatry Inventory (NPI)] were much more frequent in TBI+ vs. TBI- subjects, including AD and non-AD neurodegenerative conditions such as PD. These cross-sectional analyses outcomes from longitudinally-assessed cohorts of TBI+ subjects that is, subjects with TBI exposure before the onset of cognitive decline in the contest of different neurodegenerative disorders and associated pathogenetic mechanisms, are novel, and indicate that a previous TBI exposure may act as a significant "age-lowering" factor on the onset of cognitive decline in either AD and non-AD conditions independently of demographic factors, education, APOE genotype, and current or upcoming clinical conditions.
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Affiliation(s)
- Diego Iacono
- Department of Defense/Uniformed Services University (DoD/USU) Brain Tissue Repository & Neuropathology Program, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, United States
- Complex Neurodegenerative Disorders, Neurodegenerative Disorders Clinic, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, United States
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
| | - Daniel P Perl
- Department of Defense/Uniformed Services University (DoD/USU) Brain Tissue Repository & Neuropathology Program, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
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13
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Chosy EJ, Gross N, Meyer M, Liu CY, Edland SD, Launer LJ, White LR. Brain Injury and Later-Life Cognitive Impairment and Neuropathology: The Honolulu-Asia Aging Study. J Alzheimers Dis 2021; 73:317-325. [PMID: 31771050 DOI: 10.3233/jad-190053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Findings are inconsistent regarding the role of traumatic head injury in the subsequent development of neurologic outcomes. OBJECTIVE Examine the relationship between head injury and later cognitive impairment. METHODS A sample of 3,123 Japanese-American men was assessed for history of head injury and evaluated for cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). For a subsample of 676 respondents, neuropathologic results from those with and without head injury were compared. RESULTS Although the crude model showed an association between history of head injury and later severe cognitive impairment, the relationship lost significance in the adjusted model (OR = 1.320, CI: 0.90-1.93), regardless of time between injury and impairment. Similar to cognitive impairment, hippocampal sclerosis was observed significantly more in the brains of respondents with a history of head injury in the crude model, but the relationship weakened in the adjusted model (OR = 1.462, CI: 0.68-3.12). After adjustment, decedents with a head injury demonstrated marginally higher brain weight (OR = 1.003, CI: 1.00-1.01). CONCLUSION We did not find a relationship between head injury and subsequent cognitive decline in this cohort. The neuropathology results also displayed no strong association between history of head injury and specific brain lesions and characteristics. These results support other findings in prospective cohorts. However, they could be influenced by the demographic make-up of the sample (male Japanese-Americans) or by the observation that the majority reported only a single head injury.
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Affiliation(s)
- E Julia Chosy
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Noele Gross
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Marnie Meyer
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Catherine Y Liu
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | | | - Lenore J Launer
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lon R White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
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14
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Quarta E, Cohen EJ, Bravi R, Minciacchi D. Future Portrait of the Athletic Brain: Mechanistic Understanding of Human Sport Performance Via Animal Neurophysiology of Motor Behavior. Front Syst Neurosci 2020; 14:596200. [PMID: 33281568 PMCID: PMC7705174 DOI: 10.3389/fnsys.2020.596200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
Sport performances are often showcases of skilled motor control. Efforts to understand the neural processes subserving such movements may teach us about general principles of behavior, similarly to how studies on neurological patients have guided early work in cognitive neuroscience. While investigations on non-human animal models offer valuable information on the neural dynamics of skilled motor control that is still difficult to obtain from humans, sport sciences have paid relatively little attention to these mechanisms. Similarly, knowledge emerging from the study of sport performance could inspire innovative experiments in animal neurophysiology, but the latter has been only partially applied. Here, we advocate that fostering interactions between these two seemingly distant fields, i.e., animal neurophysiology and sport sciences, may lead to mutual benefits. For instance, recording and manipulating the activity from neurons of behaving animals offer a unique viewpoint on the computations for motor control, with potentially untapped relevance for motor skills development in athletes. To stimulate such transdisciplinary dialog, in the present article, we also discuss steps for the reverse translation of sport sciences findings to animal models and the evaluation of comparability between animal models of a given sport and athletes. In the final section of the article, we envision that some approaches developed for animal neurophysiology could translate to sport sciences anytime soon (e.g., advanced tracking methods) or in the future (e.g., novel brain stimulation techniques) and could be used to monitor and manipulate motor skills, with implications for human performance extending well beyond sport.
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Affiliation(s)
| | | | | | - Diego Minciacchi
- Physiological Sciences Section, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Alyenbaawi H, Allison WT, Mok SA. Prion-Like Propagation Mechanisms in Tauopathies and Traumatic Brain Injury: Challenges and Prospects. Biomolecules 2020; 10:E1487. [PMID: 33121065 PMCID: PMC7692808 DOI: 10.3390/biom10111487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022] Open
Abstract
The accumulation of tau protein in the form of filamentous aggregates is a hallmark of many neurodegenerative diseases such as Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE). These dementias share traumatic brain injury (TBI) as a prominent risk factor. Tau aggregates can transfer between cells and tissues in a "prion-like" manner, where they initiate the templated misfolding of normal tau molecules. This enables the spread of tau pathology to distinct parts of the brain. The evidence that tauopathies spread via prion-like mechanisms is considerable, but work detailing the mechanisms of spread has mostly used in vitro platforms that cannot fully reveal the tissue-level vectors or etiology of progression. We review these issues and then briefly use TBI and CTE as a case study to illustrate aspects of tauopathy that warrant further attention in vivo. These include seizures and sleep/wake disturbances, emphasizing the urgent need for improved animal models. Dissecting these mechanisms of tauopathy progression continues to provide fresh inspiration for the design of diagnostic and therapeutic approaches.
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Affiliation(s)
- Hadeel Alyenbaawi
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada; (H.A.); (W.T.A.)
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Department of Medical Laboratories, Majmaah University, Majmaah 11952, Saudi Arabia
| | - W. Ted Allison
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada; (H.A.); (W.T.A.)
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Sue-Ann Mok
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada; (H.A.); (W.T.A.)
- Department of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
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16
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Yang C, Nag S, Xing G, Aggarwal NT, Schneider JA. A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology. Front Neurol 2020; 11:42. [PMID: 32117011 PMCID: PMC7028767 DOI: 10.3389/fneur.2020.00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) was recently recognized as a new tauopathy in which multifocal perivascular phosphorylated tau aggregates accumulate in neurons, astrocytes, and neurites at the depths of the cortical sulci. Traumatic brain injury (TBI) in early or mid-life is known to be associated with an increased risk of dementia in late life. This case report describes a 93-year-old former street boxer with a premortem diagnosis of severe dementia, who showed pathological evidence of the coexistence of Alzheimer's disease, CTE, dementia with Lewy bodies, and hippocampal sclerosis with TDP-43 pathology. These findings suggest that TBI may trigger a variety of misfolded proteins leading to dementia. Currently, clear clinical diagnostic criteria for CTE have not been established. Therefore, clinicians should be aware that TBI is a risk factor for dementia and that CTE can overlap with other neurodegenerative diseases.
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Affiliation(s)
- Chunhui Yang
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Sukriti Nag
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, United States
| | - Guoqiang Xing
- The Affiliated Hospital of the North Sichuan Medical College, Nanchong, China
| | - Neelum T Aggarwal
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Julie A Schneider
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, United States.,Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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17
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Filley CM, Arciniegas DB, Brenner LA, Anderson CA, Kelly JP. Chronic Traumatic Encephalopathy: A Clinical Perspective. J Neuropsychiatry Clin Neurosci 2019; 31:170-172. [PMID: 31012827 DOI: 10.1176/appi.neuropsych.18100223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Filley
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - David B Arciniegas
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - Lisa A Brenner
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - C Alan Anderson
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - James P Kelly
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
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18
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VanItallie TB. Traumatic brain injury (TBI) in collision sports: Possible mechanisms of transformation into chronic traumatic encephalopathy (CTE). Metabolism 2019; 100S:153943. [PMID: 31610856 DOI: 10.1016/j.metabol.2019.07.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/06/2019] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability, contributing to ~30% of all injury-related deaths in the US. TBI occurs when a force transmitted to the head causes neuropathologic damage and impairment of brain function. TBI doubles risk of suicide and is the major determinant of acquired seizure disorders. TBI arising from closed head trauma (CHT) significantly increases the risk of developing Alzheimer's disease (AD), Parkinson's disease (PD) and chronic traumatic encephalopathy (CTE). Evidence for a possible role of TBI as a risk factor for sporadic amyotrophic lateral sclerosis (sALS) has been provided by studies of professional players of European football. Depending on age, genetic make-up (in particular, being a carrier of one or two ApoE4 alleles), the number of TBIs sustained, their severity, the time periods involved, and many other factors that affect vulnerability, decades may pass after occurrence of one or more TBIs before sequelae such as AD, PD, sALS or CTE become clinically evident. Among college and professional football players who experience repeated concussions and sub-concussive blows to the head, the risk of developing CTE increases with the number of years actively devoted to the sport, and the degree of exposure to physical impacts inherent in the position played. Following a moderate or severe concussion, or a series of mild blows to the head, the brain may undergo subtle pathophysiological changes that are unlikely to be detected with confidence using available diagnostic methods. Biomarkers are being sought that can help the attending physician infer the likely presence of an ongoing occult neurodegenerative process. One example of the adverse effect of collision on the brain is "heading" the soccer ball-a feat that, repeated over years of competition, has been found to produce severe brain damage in veteran players. CTE has attracted increasing national attention because of its devastating effects in a high proportion of retired professional players of American football. In a study of brains from deceased former football players, contributed mostly by family members, CTE was neuropathologically diagnosed in 110 of 111 of National Football League (NFL) veterans. In the CTE-positive subjects, the authors observed extensive brain atrophy, astrogliosis, myelinated axonopathy, microvascular injury, perivascular neuroinflammation, and phosphorylated tau protein pathology. CTE's neuropathology has been formally defined as a tauopathy characterized by a distinct perivascular accumulation of hyperphosphorylated tau in neurons and astrocytes within cerebral sulci. Although the mechanism that underlies the unforeseen emergence of CTE long after the occurrence of one or more closed head traumas is unknown, an explanation proposed by Albayram and associates is persuasive. They discovered TBI-induced neuronal production of the toxic compound cis P-tau, an abnormal and destructive isomer of the normal and benign trans P-tau, in mouse models of CTE. Cis P-tau produced a CTE-like syndrome via a process they termed cistauosis. Cistauosis can be blocked in laboratory animals by cis P-tau monoclonal antibody, which prevents later development of tau tangles, brain atrophy and virtual CTE. In a subsequent study, the same group found in human samples obtained post-TBI from a variety of causes, that cis P-tau is induced in cortical axons and cerebrospinal fluid and positively correlates with axonal injury and clinical outcome. Thus, cis P-tau appears to contribute to short-term and long-term sequelae after TBI, but may be subject to neutralization by cis-antibody treatment.
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19
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Tripathy A, Shade A, Erskine B, Bailey K, Grande A, deLong JJ, Perry G, Castellani RJ. No Evidence of Increased Chronic Traumatic Encephalopathy Pathology or Neurodegenerative Proteinopathy in Former Military Service Members: A Preliminary Study. J Alzheimers Dis 2019; 67:1277-1289. [DOI: 10.3233/jad-181039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Arushi Tripathy
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Ashley Shade
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Brittany Erskine
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Kristi Bailey
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Abigail Grande
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Joyce J. deLong
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - George Perry
- College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rudy J. Castellani
- Center for Neuropathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
- Departments of Pathology and Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, USA
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20
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Tribett T, Erskine B, Bailey K, Brown T, Castellani RJ. Chronic Traumatic Encephalopathy Pathology After Shotgun Injury to the Brain. J Forensic Sci 2019; 64:1248-1252. [PMID: 30644555 DOI: 10.1111/1556-4029.14001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/27/2018] [Accepted: 12/28/2018] [Indexed: 12/12/2022]
Abstract
Chronic traumatic encephalopathy (CTE) was initially conceptualized in boxers, but has extended to other athletes in recent years, albeit with limited clinical correlations. It is often asserted that CTE pathology represents the substrate for progressive neurodegenerative disease. We report the case of a shotgun injury to the brain with 42-year survival and no neurological disease progression until shortly before death. The decedent had no other traumatic brain injury (TBI) exposure and did not play football or other high energy collision sport. Neuropathological examination confirmed tissue damage, but additionally demonstrated localized patterns of phosphorylated tau (p-tau) meeting criteria for CTE pathology. P-tau and TDP-43 deposits within marginal tissue of damaged brain were also present focally. No amyloid-β (Aβ) deposits were present. These findings indicate that CTE pathology may occur following a single, severe TBI.
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Affiliation(s)
- Taylor Tribett
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Brittany Erskine
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Kristi Bailey
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Theodore Brown
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Rudy J Castellani
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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21
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Castellani RJ, Perry G. Tau Biology, Tauopathy, Traumatic Brain Injury, and Diagnostic Challenges. J Alzheimers Dis 2019; 67:447-467. [PMID: 30584140 PMCID: PMC6398540 DOI: 10.3233/jad-180721] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
There is considerable interest in the pathobiology of tau protein, given its potential role in neurodegenerative diseases and aging. Tau is an important microtubule associated protein, required for the assembly of tubulin into microtubules and maintaining structural integrity of axons. Tau has other diverse cellular functions involving signal transduction, cellular proliferation, developmental neurobiology, neuroplasticity, and synaptic activity. Alternative splicing results in tau isoforms with differing microtubule binding affinity, differing representation in pathological inclusions in certain disease states, and differing roles in developmental biology and homeostasis. Tau haplotypes confer differing susceptibility to neurodegeneration. Tau phosphorylation is a normal metabolic process, critical in controlling tau's binding to microtubules, and is ongoing within the brain at all times. Tau may be hyperphosphorylated, and may aggregate as detectable fibrillar deposits in tissues, in both aging and neurodegenerative disease. The hypothesis that p-tau is neurotoxic has prompted constructs related to isomers, low-n assembly intermediates or oligomers, and the "tau prion". Human postmortem studies have elucidated broad patterns of tauopathy, with tendencies for those patterns to differ as a function of disease phenotype. However, there is extensive overlap, not only between genuine neurodegenerative diseases, but also between aging and disease. Recent studies highlight uniqueness to pathological patterns, including a pattern attributed to repetitive head trauma, although clinical correlations have been elusive. The diagnostic process for tauopathies and neurodegenerative diseases in general is challenging in many respects, and may be particularly problematic for postmortem evaluation of former athletes and military service members.
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Affiliation(s)
- Rudy J. Castellani
- Departments of Pathology and Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | - George Perry
- College of Sciences, University of Texas, San Antonio, San Antonio, TX, USA
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22
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Filley CM, Kelly JP. White Matter and Cognition in Traumatic Brain Injury. J Alzheimers Dis 2018; 65:345-362. [DOI: 10.3233/jad-180287] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher M. Filley
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - James P. Kelly
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, USA
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23
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Al-Dahhak R, Khoury R, Qazi E, Grossberg GT. Traumatic Brain Injury, Chronic Traumatic Encephalopathy, and Alzheimer Disease. Clin Geriatr Med 2018; 34:617-635. [PMID: 30336991 DOI: 10.1016/j.cger.2018.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is a major health and economic burden. With increasing aging population, this issue is expected to continue to rise. Neurodegenerative disorders are more common with aging population in general regardless of history of TBI. Recent evidence continues to support a relation between a TBI and neurocognitive decline later in life (such as in athletes and military). This article summarizes the pathologic and clinical effects of TBI (regardless of severity) on the later development of dementia in individuals 65 years or older.
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Affiliation(s)
- Roula Al-Dahhak
- Department of Neurology, Saint Louis University, 1438 South Grand Boulevard, Suite 105, St Louis, MO 63104, USA.
| | - Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - Erum Qazi
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
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