Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project

BACKGROUND

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the "Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project." The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project.

METHODS

The targeted sample and sample size was 240 male participants, ages 45-74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined.

RESULTS

Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021.

CONCLUSIONS

Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE.

TRIAL REGISTRATION

NCT02798185.

Global and region-specific patient-reported outcomes pre and post a division I football season

OBJECTIVE

Determine the change in global and region-specific PROMs among athletes from one NCAA Division I football team during one season.

DESIGN

Prospective cross-sectional study.

SETTING

Athletic training facility.

PATIENTS OR OTHER PARTICIPANTS

Fifty-three Division I collegiate football athletes (n = 54) were eligible (20.1 ± 1.4 years, 187.7 ± 8.3 cm, and 113.5 ± 25.6 kg) for analyses. Participants completed five PROMs (Disablement in the Physically Active Scale [DPA], Epworth Sleep Score [ESS], Headache Impact Test [Hit-6], Disabilities of the Arm, Shoulder, and Hand [DASH], and the Lower Extremity Functional Scale [LEFS]) before the season and the same five PROMs after the season.

MAIN OUTCOME MEASURES

A multivariate repeated measure analysis of variance (ANOVA) was conducted for all dependent variables. Alpha level was set at ɑ = 0.05.

RESULTS

The overall multivariate repeated measures ANOVA was significant for time (p = 0.01). Follow up one-way ANOVA's indicated the DPA (p < 0.01, mean decrease/worse of 6.6 points) and LEFS (p = 0.01, mean decrease/worse of 4.1 points) were statistically significant between time points.

CONCLUSION

Division I football can be detrimental to the physical, mental, and emotional health of the athletes. From these data, global and one region-specific PROM decreased over one season in one NCAA Division I football team.

Identifying the Influence of Opponent Ranking and Game Characteristics on Alcohol-Related Stadium Ejections

Sporting events in the U.S., particularly college football games, provide an opportunity for high-risk alcohol consumption that can result in alcohol-related consequences and associated public safety issues. Policy implication and predicting alcohol-related misconduct at college football games has become a concern for university administrators. To address this issue, we explored the extent to which the profile of a game or opponent-whether that be operationalized by classification (e.g., in-state opponent, conference opponent) or opponent quality (e.g., top-25 status, ranking average)-influences the reported stadium ejections of a college football venue, and whether these associations existed beyond the influence of several noteworthy covariates (e.g., time of kickoff, attendance, temperature). We suggest that time of kickoff and opponent quality measures predicted increases of ejections from college football stadiums. We conclude by discussing policy implications for college athletic departments and university stakeholders.