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Schiffner E, Hilsmann F, Lakomek F, Beyersdorf C, Windolf J, Latz D. Degenerative changes of the wrist in mixed martial arts and boxing based on the three column theory. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 38700558 DOI: 10.1080/00913847.2024.2351357] [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: 02/05/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Mixed Martial Arts (MMA) is a relatively young combat sport. In contrast to classic boxing, MMA combines techniques of grappling and striking. However, characteristic long-term effects of MMA on the wrist are discussed controversially. Aim of this study was to elucidate characteristic degenerative changes of the wrist from MMA fighters in comparison to classic boxers. METHODS In this study, eleven professional MMA fighters and ten professional boxers with chronic wrist pain were examined and compared. Age, weight, number of fights and weekly hours of training were recorded. Wrist and hand of each fighter were examined using a 3T-MR scanner. Degenerations of the radial, central and ulnar column were analyzed according to Navarro's three-column theory and degenerative changes were categorized based on the classification of Fredericson. RESULTS There was no significant difference of age, weight and number of fights between MMA fighters and boxers (p > 0.15). However, MMA fighters practiced significantly more hours per week (19.5 (MMA) vs. 8.5 (boxing) hours/week, p < 0.001). No significant associations were found between different training times per Week in terms of degenerative changes of the wrist in MMA and boxing based on the three column theory. The comparison of degenerative changes in the columns between MMA and boxing showed no significant differences. The MRI showed a significantly higher degeneration in the radial column compared to the central column among MMA fighters for ligaments (p = 0.01) and bones (p = 0.03). CONCLUSION Due to different fighting techniques, different physical traumas, including falls, pattern of degenerations of the wrist between MMA fighters and boxers are different. MMA fighters suffer of a highly degenerative radial column and boxers suffer of a homogeneous degeneration of all three columns.
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Affiliation(s)
- Erik Schiffner
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Falk Hilsmann
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Lakomek
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christoph Beyersdorf
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Joachim Windolf
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Latz
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Lember LM, Ntikas M, Mondello S, Wilson L, Di Virgilio TG, Hunter AM, Kobeissy F, Mechref Y, Donaldson DI, Ietswaart M. The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review. SPORTS MEDICINE - OPEN 2024; 10:12. [PMID: 38270708 PMCID: PMC10811313 DOI: 10.1186/s40798-023-00665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. OBJECTIVE This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. METHODS PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. RESULTS Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers-such as NfL-appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. CONCLUSION Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers' utility.
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Affiliation(s)
- Liivia-Mari Lember
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Michail Ntikas
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
- The School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Stefania Mondello
- Biomedical and Dental Sciences and Morphofunctional Imaging, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - Lindsay Wilson
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Thomas G Di Virgilio
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Angus M Hunter
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Department of Sports Science, Nottingham Trent University, Nottingham, UK
| | - Firas Kobeissy
- Center for Neurotrauma, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine (MSM), Multiomics & Biomarkers, Atlanta, GA, 30310, USA
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, USA
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, UK
| | - Magdalena Ietswaart
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
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Rydzik Ł, Wąsacz W, Ambroży T, Pałka T, Sobiło-Rydzik E, Kopańska M. Comparison of Head Strike Incidence under K1 Rules of Kickboxing with and without Helmet Protection-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20064713. [PMID: 36981626 PMCID: PMC10048724 DOI: 10.3390/ijerph20064713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Kickboxing is a combat sport that encompasses various forms of competition. K1 kickboxing is conducted without any restrictions on the force of strikes, and the bout can end prematurely through a knockout. Headgear has been introduced in amateur kickboxing to safeguard the head. However, scientific studies have shown that despite their use, serious head injuries can still occur. The aim of this study was to evaluate the temporal structure of the bout by calculating the number of head strikes in K1 kickboxing bouts with and without headgear. METHODS Thirty K1 kickboxing bouts were analyzed, with 30 participants included in the study. The fights were conducted according to the World Association Kickboxing Organization (WAKO) rules. The bouts consisted of three rounds of 2 min each, with a 1 min break between rounds. Sparring pairs were arranged according to weight categories. The first bouts were conducted without headgear, and two weeks later, the fights were repeated with WAKO-approved headgear. The number of head strikes was assessed retrospectively by analyzing video recordings of the bouts, categorizing strikes as hand or foot strikes, and differentiating between strikes that hit the head directly or indirectly. RESULTS The results showed statistically significant differences between bouts with and without headgear in terms of the number of strikes to the head (p = 0.002), strikes directly to the head (p < 0.001), all hand strikes to the head (p = 0.001), hand strikes directly to the head (p = 0.003), and foot strikes directly to the head (p = 0.03). Higher values were observed in bouts with headgear. CONCLUSIONS Headgear increases the probability of direct strikes to the head. Therefore, it is important to familiarize kickboxers with the use of headgear in their sport to minimize head injuries.
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Affiliation(s)
- Łukasz Rydzik
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Wojciech Wąsacz
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tadeusz Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education, 31-571 Kraków, Poland
| | | | - Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland
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Johnstone DM, Mitrofanis J, Stone J. The brain's weakness in the face of trauma: How head trauma causes the destruction of the brain. Front Neurosci 2023; 17:1141568. [PMID: 36950132 PMCID: PMC10026135 DOI: 10.3389/fnins.2023.1141568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Of all our organs, the brain is perhaps the best protected from trauma. The skull has evolved to enclose it and, within the skull, the brain floats in a protective bath of cerebrospinal fluid. It is becoming evident, however, that head trauma experienced in young adult life can cause a dementia that appears decades later. The level of trauma that induces such destruction is still being assessed but includes levels well below that which cracks the skull or causes unconsciousness or concussion. Clinically this damage appears as dementia, in people who played body-contact sports in their youth or have survived accidents or the blasts of combat; and appears also, we argue, in old age, without a history of head trauma. The dementias have been given different names, including dementia pugilistica (affecting boxers), chronic traumatic encephalopathy (following certain sports, particularly football), traumatic brain injury (following accidents, combat) and Alzheimer's (following decades of life). They share common features of clinical presentation and neuropathology, and this conceptual analysis seeks to identify features common to these forms of brain injury and to identify where in the brain the damage common to them occurs; and how it occurs, despite the protection provided by the skull and cerebrospinal fluid. The analysis suggests that the brain's weak point in the face of trauma is its capillary bed, which is torn by the shock of trauma. This identification in turn allows discussion of ways of delaying, avoiding and even treating these trauma-induced degenerations.
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Affiliation(s)
- Daniel M. Johnstone
- School of Biomedical Sciences and Pharmacy, University of Newcastle and School of Medical Sciences, The University of Sydney, Darlington, NSW, Australia
| | - John Mitrofanis
- Fonds de Dotation Clinatec, Université Grenoble Alpes, France and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Jonathan Stone
- Honorary Associate, Centenary Institute and University of Sydney, Darlington, NSW, Australia
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Caixeta L, Dangoni I, de Sousa RD, Soares PPD, Mendonça ACR. Extending the range of differential diagnosis of chronic traumatic encephalopathy of the boxer: Insights from a case report. Dement Neuropsychol 2018; 12:92-96. [PMID: 29682240 PMCID: PMC5901256 DOI: 10.1590/1980-57642018dn12-010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Sports activities associated with repetitive cranial trauma have become a fad and are popular in gyms and even among children. It is important to consistently characterize the consequences of such sports activities in order to better advise society on the real risks to the central nervous system. We present the case of a former boxer reporting cognitive and behavioral symptoms that began six years after his retirement as a boxer, evolving progressively with parkinsonian and cerebellar features suggestive of probable chronic traumatic encephalopathy (CTE). Using our case as a paradigm, we extended the range of differential diagnosis of CTE, including corticobasal degeneration, multiple system atrophy, vitamin B12 deficiency, neurosyphilis, frontotemporal dementia and Alzheimer’s disease.
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Affiliation(s)
- Leonardo Caixeta
- Associate Professor of Neurology, Federal University of Goiás, Goiânia, GO, Brazil. Coordinator, Cognitive and Behavioral Neurology Unit, Department of Neurology, Hospital das Clínicas
| | - Iron Dangoni
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Hospital das Clínicas, Federal University of Goiás, Goiânia, GO, Brazil
| | - Rafael Dias de Sousa
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Hospital das Clínicas, Federal University of Goiás, Goiânia, GO, Brazil
| | - Pedro Paulo Dias Soares
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Hospital das Clínicas, Federal University of Goiás, Goiânia, GO, Brazil
| | - Andreia Costa Rabelo Mendonça
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Hospital das Clínicas, Federal University of Goiás, Goiânia, GO, Brazil
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Stuart S, Hickey A, Morris R, O'Donovan K, Godfrey A. Concussion in contact sport: A challenging area to tackle. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:299-301. [PMID: 30356612 PMCID: PMC6189016 DOI: 10.1016/j.jshs.2017.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 05/29/2023]
Affiliation(s)
- Samuel Stuart
- Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Aodhan Hickey
- Insight Centre for Data Analytics, University College Dublin, Dublin D04 V1W8, Ireland
| | - Rosie Morris
- Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Karol O'Donovan
- School of Medicine, University College Cork, Cork T12 EH31, Ireland
| | - Alan Godfrey
- Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne NE1 4SE, UK
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Herweh C, Hess K, Meyding-Lamadé U, Bartsch AJ, Stippich C, Jost J, Friedmann-Bette B, Heiland S, Bendszus M, Hähnel S. Reduced white matter integrity in amateur boxers. Neuroradiology 2016; 58:911-20. [PMID: 27230917 DOI: 10.1007/s00234-016-1705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing. METHODS DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ). RESULTS All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights. CONCLUSIONS TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.
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Affiliation(s)
- Christian Herweh
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Klaus Hess
- Department of Neurology, University of Heidelberg Medical School, Heidelberg, Germany
| | | | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Stippich
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Joachim Jost
- National Training Center for Boxing, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, University of Heidelberg Medical School, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Hähnel
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Bernick C, Banks SJ, Shin W, Obuchowski N, Butler S, Noback M, Phillips M, Lowe M, Jones S, Modic M. Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: the Professional Fighters' Brain Health Study. Br J Sports Med 2015; 49:1007-11. [PMID: 25633832 PMCID: PMC4518758 DOI: 10.1136/bjsports-2014-093877] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/22/2022]
Abstract
Objectives Cumulative head trauma may alter brain structure and function. We explored the relationship between exposure variables, cognition and MRI brain structural measures in a cohort of professional combatants. Methods 224 fighters (131 mixed martial arts fighters and 93 boxers) participating in the Professional Fighters Brain Health Study, a longitudinal cohort study of licensed professional combatants, were recruited, as were 22 controls. Each participant underwent computerised cognitive testing and volumetric brain MRI. Fighting history including years of fighting and fights per year was obtained from self-report and published records. Statistical analyses of the baseline evaluations were applied cross-sectionally to determine the relationship between fight exposure variables and volumes of the hippocampus, amygdala, thalamus, caudate, putamen. Moreover, the relationship between exposure and brain volumes with cognitive function was assessed. Results Increasing exposure to repetitive head trauma measured by number of professional fights, years of fighting, or a Fight Exposure Score (FES) was associated with lower brain volumes, particularly the thalamus and caudate. In addition, speed of processing decreased with decreased thalamic volumes and with increasing fight exposure. Higher scores on a FES used to reflect exposure to repetitive head trauma were associated with greater likelihood of having cognitive impairment. Conclusions Greater exposure to repetitive head trauma is associated with lower brain volumes and lower processing speed in active professional fighters.
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Affiliation(s)
- Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Sarah J Banks
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Wanyong Shin
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy Obuchowski
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sam Butler
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Noback
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | | | - Mark Lowe
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Jones
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Modic
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
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Stiller JW, Yu SS, Brenner LA, Langenberg P, Scrofani P, Pannella P, Hsu EB, Roberts DW, Monsell RMT, Binks SW, Guzman A, Postolache TT. Sparring and neurological function in professional boxers. Front Public Health 2014; 2:69. [PMID: 25101253 PMCID: PMC4104643 DOI: 10.3389/fpubh.2014.00069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/15/2014] [Indexed: 11/15/2022] Open
Abstract
Despite increased interest regarding the potentially long-term negative impact of chronic traumatic brain injury, limited research has been conducted regarding such injuries and neurological outcomes in real world settings. To increase understanding regarding the relationship between sparring (e.g., training under the tutelage of an experienced boxing coach for the purpose of improving skills and/or fitness) and neurological functioning, professional boxers (n = 237) who competed in Maryland between 2003 and 2008 completed measures regarding sparring exposure (Cumulative Sparring Index, CSI) and performance on tests of cognition (Symbol Digit Modalities Test, SDMT) and balance (Sharpened Romberg Test, SRT). Measures were completed prior to boxing matches. Higher scores on the CSI (increased sparring exposure) were associated with poorer performance on both tests of cognition (SDMT) and balance (SRT). A threshold effect was noted regarding performance on the SDMT, with those reporting CSI values greater than about 150 experiencing a decline in cognition. A history of frequent and/or intense sparring may pose a significant risk for developing boxing associated neurological sequelae. Implementing administration of clinically meaningful tests before bouts, such as the CSI, SDMT, and/or the SRT, as well as documentation of results into the boxer’s physicals or medical profiles may be an important step for improving boxing safety.
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Affiliation(s)
- John W Stiller
- Department of Behavioral Health, St. Elizabeth's Hospital , Washington, DC , USA ; Maryland State Athletic Commission , Baltimore, MD , USA ; Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine , Baltimore, MD , USA ; Institute of Sports Chronobiology , Washington, DC , USA
| | - Steven S Yu
- Department of Medicine, University of Southern California , Los Angeles, CA , USA
| | - Lisa A Brenner
- Veterans Integrated Service Network 19, Mental Illness Research Education and Clinical Center , Denver, CO , USA ; Department of Psychiatry, University of Colorado, Anschutz Medical Campus , Aurora, CO , USA ; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus , Aurora, CO , USA ; Department of Neurology, University of Colorado, Anschutz Medical Campus , Aurora, CO , USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, MD , USA
| | - Phillip Scrofani
- Department of Behavioral Health, St. Elizabeth's Hospital , Washington, DC , USA ; Institute for the Psychological Sciences , Arlington, VA , USA
| | | | - Edbert B Hsu
- Department of Emergency Medicine, Johns Hopkins University , Baltimore, MD , USA
| | | | | | - Sidney W Binks
- Department of Behavioral Health, St. Elizabeth's Hospital , Washington, DC , USA
| | - Alvaro Guzman
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine , Baltimore, MD , USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine , Baltimore, MD , USA ; Institute of Sports Chronobiology , Washington, DC , USA ; Veterans Integrated Service Network 19, Mental Illness Research Education and Clinical Center , Denver, CO , USA ; Tuning, Inc. , Silver Spring, MD , USA
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10
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Abner EL, Nelson PT, Schmitt FA, Browning SR, Fardo DW, Wan L, Jicha GA, Cooper GE, Smith CD, Caban-Holt AM, Van Eldik LJ, Kryscio RJ. Self-reported head injury and risk of late-life impairment and AD pathology in an AD center cohort. Dement Geriatr Cogn Disord 2014; 37:294-306. [PMID: 24401791 PMCID: PMC4057973 DOI: 10.1159/000355478] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS To evaluate the relationship between self-reported head injury and cognitive impairment, dementia, mortality, and Alzheimer's disease (AD)-type pathological changes. METHODS Clinical and neuropathological data from participants enrolled in a longitudinal study of aging and cognition (n = 649) were analyzed to assess the chronic effects of self-reported head injury. RESULTS The effect of self-reported head injury on the clinical state depended on the age at assessment: for a 1-year increase in age, the OR for the transition to clinical mild cognitive impairment (MCI) at the next visit for participants with a history of head injury was 1.21 and 1.34 for the transition from MCI to dementia. Without respect to age, head injury increased the odds of mortality (OR = 1.54). Moreover, it increased the odds of a pathological diagnosis of AD for men (OR = 1.47) but not women (OR = 1.18). Men with a head injury had higher mean amyloid plaque counts in the neocortex and entorhinal cortex than men without. CONCLUSIONS Self-reported head injury is associated with earlier onset, increased risk of cognitive impairment and dementia, increased risk of mortality, and AD-type pathological changes.
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Affiliation(s)
- Erin L. Abner
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging
| | - Peter T. Nelson
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Pathology, University of Kentucky
| | - Frederick A. Schmitt
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Neurology, University of Kentucky
| | | | - David W. Fardo
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Biostatistics, University of Kentucky
| | - L. Wan
- Department of Statistics, University of Kentucky
| | - Gregory A. Jicha
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Neurology, University of Kentucky
| | | | - Charles D. Smith
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Neurology, University of Kentucky
| | - Allison M. Caban-Holt
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Behavioral Sciences, University of Kentucky
| | - Linda J. Van Eldik
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Anatomy and Neurobiology, University of Kentucky
| | - Richard J. Kryscio
- University of Kentucky Alzheimer’s Disease Center, Sanders-Brown Center on Aging,Department of Biostatistics, University of Kentucky,Department of Statistics, University of Kentucky
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11
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Kokjohn TA, Maarouf CL, Daugs ID, Hunter JM, Whiteside CM, Malek-Ahmadi M, Rodriguez E, Kalback W, Jacobson SA, Sabbagh MN, Beach TG, Roher AE. Neurochemical profile of dementia pugilistica. J Neurotrauma 2013; 30:981-97. [PMID: 23268705 PMCID: PMC3684215 DOI: 10.1089/neu.2012.2699] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Dementia pugilistica (DP), a suite of neuropathological and cognitive function declines after chronic traumatic brain injury (TBI), is present in approximately 20% of retired boxers. Epidemiological studies indicate TBI is a risk factor for neurodegenerative disorders including Alzheimer disease (AD) and Parkinson disease (PD). Some biochemical alterations observed in AD and PD may be recapitulated in DP and other TBI persons. In this report, we investigate long-term biochemical changes in the brains of former boxers with neuropathologically confirmed DP. Our experiments revealed biochemical and cellular alterations in DP that are complementary to and extend information already provided by histological methods. ELISA and one-dimensional and two dimensional Western blot techniques revealed differential expression of select molecules between three patients with DP and three age-matched non-demented control (NDC) persons without a history of TBI. Structural changes such as disturbances in the expression and processing of glial fibrillary acidic protein, tau, and α-synuclein were evident. The levels of the Aβ-degrading enzyme neprilysin were reduced in the patients with DP. Amyloid-β levels were elevated in the DP participant with the concomitant diagnosis of AD. In addition, the levels of brain-derived neurotrophic factor and the axonal transport proteins kinesin and dynein were substantially decreased in DP relative to NDC participants. Traumatic brain injury is a risk factor for dementia development, and our findings are consistent with permanent structural and functional damage in the cerebral cortex and white matter of boxers. Understanding the precise threshold of damage needed for the induction of pathology in DP and TBI is vital.
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Affiliation(s)
- Tyler A. Kokjohn
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
- Department of Microbiology, Midwestern University School of Medicine, Glendale, Arizona
| | - Chera L. Maarouf
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Ian D. Daugs
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Jesse M. Hunter
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Charisse M. Whiteside
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Michael Malek-Ahmadi
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Emma Rodriguez
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
- National Institute of Cardiology, Mexico City, Mexico
| | - Walter Kalback
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Sandra A. Jacobson
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Marwan N. Sabbagh
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Alex E. Roher
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
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Saing T, Dick M, Nelson PT, Kim RC, Cribbs DH, Head E. Frontal cortex neuropathology in dementia pugilistica. J Neurotrauma 2012; 29:1054-70. [PMID: 22017610 PMCID: PMC3325552 DOI: 10.1089/neu.2011.1957] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dementia pugilistica (DP) is associated with chronic traumatic brain injury (CTBI), and leads to a "punch drunk" syndrome characterized by impairments in memory and executive function, behavioral changes, and motor signs. Microscopic features include the accumulation of neurofibrillary tangles (NFTs), beta-amyloid (Aβ), and TAR DNA binding protein 43 (TDP-43) pathology. Here we describe detailed clinical and neuropathological data about a 55-year-old retired boxer (ApoE3/4), who presented with executive dysfunction and behavioral impairments. At autopsy, significant Aβ pathology was seen, primarily in the form of diffuse plaques. Tau pathology was extensive and was determined to be of Braak and Braak stage VI. Frontal white matter showed evidence of glial tau inclusions (astrocytes and oligodendroglia). Cerebrovascular pathology was minimal with patchy amyloid angiopathy. Inflammation was another key feature, including microglial activation and significant C1q labeling of neurons, along with NFTs. TDP-43-positive pathology was also observed. Inflammation may be a key inciting as well as propagating feature of DP neuropathology.
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Affiliation(s)
- Tommy Saing
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
| | - Malcolm Dick
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
| | - Peter T. Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Ronald C. Kim
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Pathology, University of California–Irvine, Irvine, California
| | - David H. Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Elizabeth Head
- Institute for Memory Impairments and Neurological Disorders, University of California–Irvine, Irvine, California
- Department of Neurology, University of Kentucky, Lexington, Kentucky
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Department of Molecular and Biomedical Pharmacology, University of Kentucky, Lexington, Kentucky
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van Bregt DR, Thomas TC, Hinzman JM, Cao T, Liu M, Bing G, Gerhardt GA, Pauly JR, Lifshitz J. Substantia nigra vulnerability after a single moderate diffuse brain injury in the rat. Exp Neurol 2012; 234:8-19. [PMID: 22178300 PMCID: PMC3294202 DOI: 10.1016/j.expneurol.2011.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/28/2011] [Accepted: 12/01/2011] [Indexed: 11/25/2022]
Abstract
Dementia and parkinsonism are late-onset symptoms associated with repetitive head injury, as documented in multiple contact-sport athletes. Clinical symptomatology is the likely phenotype of chronic degeneration and circuit disruption in the substantia nigra (SN). To investigate the initiating neuropathology, we hypothesize that a single diffuse brain injury is sufficient to initiate SN neuropathology including neuronal loss, vascular disruption and microglial activation, contributing to neurodegeneration and altered dopamine regulation. Adult, male Sprague-Dawley rats were subjected to sham or moderate midline fluid percussion brain injury. Stereological estimates indicated a significant 44% loss of the estimated total neuron number in the SN at 28-days post-injury, without atrophy of neuronal nuclear volumes, including 25% loss of tyrosine hydroxylase positive neurons by 28-days post-injury. Multi-focal vascular compromise occurred 1-2 days post-injury, with ensuing microglial activation (significant 40% increase at 4-days). Neurodegeneration (silver-stain technique) encompassed on average 21% of the SN by 7-days post-injury and increased to 29% by 28-days compared to sham (1%). Whole tissue SN, but not striatum, dopamine metabolism was altered at 28-days post-injury, without appreciable gene or protein changes in dopamine synthesis or regulation elements. Together, single moderate diffuse brain injury resulted in SN neurovascular pathology potentially associated with neuroinflammation or dopamine dysregulation. Compensatory mechanisms may preserve dopamine signaling acutely, but subsequent SN damage with aging or additional injury may expose clinical symptomatology of motor ataxias and dementia.
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Affiliation(s)
- Daniel R. van Bregt
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - Theresa Currier Thomas
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jason M. Hinzman
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, University of Kentucky College of Medicine, Lexington, KY, USA
- Center for Microelectrode Technology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Tuoxin Cao
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Mei Liu
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Guoying Bing
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Greg A. Gerhardt
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, University of Kentucky College of Medicine, Lexington, KY, USA
- Center for Microelectrode Technology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - James R. Pauly
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Pharmaceutical Sciences University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Jonathan Lifshitz
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Physical Medicine & Rehabilitation, University of Kentucky College of Medicine, Lexington, KY, USA
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Kostka T, Furgal W, Gawronski W, Bugajski A, Czamara A, Klukowski K, Krysztofiak H, Lewicki R, Szygula Z, Tomaszewski W, Trzaska T, Widuchowski J, Ziemba A, Jegier A. Recommendations of the Polish Society of Sports Medicine on age criteria while qualifying children and youth for participation in various sports. Br J Sports Med 2012; 46:159-62. [PMID: 21948125 PMCID: PMC3277724 DOI: 10.1136/bjsports-2011-090043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/30/2011] [Indexed: 12/02/2022]
Affiliation(s)
- Tomasz Kostka
- Faculty of Health Sciences, Polish Society of Sports Medicine, Medical University of Lodz, Pl. Hallera 1, Łódź, Poland.
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15
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Etgen T, Sander D, Bickel H, Förstl H. Mild cognitive impairment and dementia: the importance of modifiable risk factors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:743-50. [PMID: 22163250 DOI: 10.3238/arztebl.2011.0743] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 06/27/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI), a common condition among the elderly, is defined as a deterioration of memory, attention, and cognitive function that exceeds what would be expected for the individual's age and level of education, yet does not interfere significantly with the activities of daily living. MCI may be a precursor of dementia; the rate of transition from MCI to dementia is 10% to 20% per year. The role of somatic diseases and modifiable risk factors in MCI and dementia needs further study. METHODS We analyzed pertinent original articles and reviews published 1990 up to December 2010 that were retrieved by a selective search in PubMed and the Cochrane Library. RESULTS MCI and dementia are associated with many somatic disorders and modifiable risk factors. MCI has biologically plausible associations with hypertension, diabetes mellitus, and hyperlipidemia, although the interventional trials performed to date have yielded negative results. Recently, chronic renal failure has also been recognized as a risk factor. Insufficient evidence supports a putative benefit on MCI from the substitution of vitamin B12, vitamin D, or testosterone (when these substances are deficient), the treatment of hyperhomocysteinemia or subclinical thyroid dysfunction, or hormone replacement therapy after menopause. Epidemiological data suggest that a Mediterranean diet, physical activity, and moderate alcohol consumption protect against MCI, while cigarette smoking promotes it and should be stopped. CONCLUSION Modifiable risk factors for MCI should be sought (at the very latest) in persons who already have MCI, as their optimal treatment may improve these patients' cognitive performance or keep the existing deficits from progressing.
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Affiliation(s)
- Thorleif Etgen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany.
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16
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Lindemann WB. Boxing—acute complications and late sequelae: from concussion to dementia: Chronic damage has been underestimated. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:145-146. [PMID: 21442068 PMCID: PMC3063376 DOI: 10.3238/arztebl.2011.0145c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Prange H. Boxing—acute complications and late sequelae: from concussion to dementia: When does long term damage develop? DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:145-146. [PMID: 21442069 PMCID: PMC3063375 DOI: 10.3238/arztebl.2011.0145b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Hilmar Prange
- *Konrad-Adenauer-Str. 40, 37075 Göttingen, Germany, und
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Löllgen H. Boxing—acute complications and late sequelae: from concussion to dementia: Fatal outcome cannot be ruled out. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:145; author reply 146. [PMID: 21442067 PMCID: PMC3063374 DOI: 10.3238/arztebl.2011.0145a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Herbert Löllgen
- *Internistische-Kardiologische Praxis, Bermesgasse 32 b, 42897 Remscheid, Germany,
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