The clinical spectrum of sport-related traumatic brain injury

Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, New York, 10605 NY, USA. .
Nature Reviews Neurology (Impact Factor: 15.36). 03/2013; 9(4). DOI: 10.1038/nrneurol.2013.33
Source: PubMed


Acute and chronic sports-related traumatic brain injuries (TBIs) are a substantial public health concern. Various types of acute TBI can occur in sport, but detection and management of cerebral concussion is of greatest importance as mismanagement of this syndrome can lead to persistent or chronic postconcussion syndrome (CPCS) or diffuse cerebral swelling. Chronic TBI encompasses a spectrum of disorders that are associated with long-term consequences of brain injury, including chronic traumatic encephalopathy (CTE), dementia pugilistica, post-traumatic parkinsonism, post-traumatic dementia and CPCS. CTE is the prototype of chronic TBI, but can only be definitively diagnosed at autopsy as no reliable biomarkers of this disorder are available. Whether CTE shares neuropathological features with CPCS is unknown. Evidence suggests that participation in contact-collision sports may increase the risk of neurodegenerative disorders such as Alzheimer disease, but the data are conflicting. In this Review, the spectrum of acute and chronic sport-related TBI is discussed, highlighting how examination of athletes involved in high-impact sports has advanced our understanding of pathology of brain injury and enabled improvements in detection and diagnosis of sport-related TBI.

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    • "Dissociated and hyperphoshorylated tau exert a neurotoxic effect through misfolding and aggregation. The tau isoform profile, phosphorylation, and immunoreactivity state in CTE is similar to that found in Alzheimer's disease (Jordan, 2013; McKee et al., 2009). Evidence on the association between APOE ε4 allele and CTE is to date not conclusive (Jordan, 2013; Jordan et al., 1997; Kutner et al., 2000). "
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    ABSTRACT: A number of small studies and anecdotal reports have been suggested that sports involving repeated head trauma may have long-term risks of neurodegenerative disease. There are now plausible mechanisms for these effects, and a recognition that these problems do not just occur in former boxers, but in a variety of sports involving repeated concussions, and possibly also in sports in which low-level head trauma is common. These neurodegenerative effects potentially include increased risks of impaired cognitive function and dementia, Parkinson's disease, and amyotrophic lateral sclerosis. Many would argue for taking a precautionary approach and immediately banning or restricting sports such as boxing. However, there are important public health issues in terms of how wide the net should be cast in terms of other sports, and what remedial measures could be taken? This in turn requires a major research effort involving both clinical and basic research to understand the underlying mechanisms, leading from head trauma to neurodegenerative disease and epidemiologic studies to assess the long-term consequences. Copyright © 2015 Elsevier Inc. All rights reserved.
    Neurobiology of Aging 03/2015; 36(3). DOI:10.1016/j.neurobiolaging.2014.12.024 · 5.01 Impact Factor
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    • "Considering that more than 200 million Americans are involved in organized sports (Daneshvar et al. 2011a), the long-term consequences of sports-related concussive and subconcussive brain trauma may represent a major public health concern. Though a spectrum of chronic neurological injuries may occur, a primary concern involves the neurodegenerative disease known as chronic traumatic encephalopathy (CTE) ( Jordan 2013). CTE is considered one of the tauopathies, neurodegenerative diseases marked by an accumulation of hyperphosphorylated tau protein, leading to neuronal destruction and accompanying symptoms. "
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    ABSTRACT: Free access to article: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is most often identified in postmortem autopsies of individuals exposed to repetitive head impacts, such as boxers and football players. The neuropathology of CTE is characterized by the accumulation of hyperphosphorylated tau protein in a pattern that is unique from that of other neurodegenerative diseases, including Alzheimer's disease. The clinical features of CTE are often progressive, leading to dramatic changes in mood, behavior, and cognition, frequently resulting in debilitating dementia. In some cases, motor features, including parkinsonism, can also be present. In this review, the historical origins of CTE are revealed for the first time and an overview of the current state of knowledge of CTE is provided, including the neuropathology, clinical features, proposed clinical and pathological diagnostic criteria, potential in vivo biomarkers, known risk factors, and treatment options.
    Annual Review of Clinical Psychology 01/2015; 11(1). DOI:10.1146/annurev-clinpsy-032814-112814 · 12.67 Impact Factor
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    • "c o m / l o c a t e / y n b d i signs (e.g., slurred speech, parkinsonism). Concurrently, autopsy studies of a limited number of athletes (including football players) who have suffered from TBI have led some researchers to diagnose chronic traumatic encephalopathy (CTE), a putative tauopathy characterized by global brain atrophy with a thinned corpus callosum, enlarged ventricles , and cavum septum pellucidum (Jordan, 2013). The prevalence of CTE among former athletes who have suffered from TBI is unknown, as is the prevalence of other injury-associated brain pathologies, for example those associated with Alzheimer's disease or frontotemporal degeneration . "
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    ABSTRACT: There are growing concerns about potential delayed, neuropsychiatric consequences (e.g, cognitive decline, mood or anxiety disorders) of sports-related traumatic brain injury (TBI). Autopsy studies of brains from a limited number of former athletes have described characteristic, pathologic changes of chronic traumatic encephalopathy (CTE) leading to questions about the relationship between these pathologic and the neuropsychiatric disturbances seen in former athletes. Research in this area will depend on in vivo methods that characterize molecular changes in the brain, linking CTE and other sports-related pathologies with delayed emergence of neuropsychiatric symptoms. In this pilot project we studied former National Football League (NFL) players using new neuroimaging techniques and clinical measures of cognitive functioning. We hypothesized that former NFL players would show molecular and structural changes in medial temporal and parietal lobe structures as well as specific cognitive deficits, namely those of verbal learning and memory. We observed a significant increase in binding of [(11)C]DPA-713 to the translocator protein (TSPO), a marker of brain injury and repair, in several brain regions, such as the supramarginal gyrus and right amygdala, in 9 former NFL players compared to 9 age-matched, healthy controls. We also observed significant atrophy of the right hippocampus. Finally, we report that these same former players had varied performance on a test of verbal learning and memory, suggesting that these molecular and pathologic changes may play a role in cognitive decline. These results suggest that localized brain injury and repair, indicated by increased [(11)C]DPA-713 binding to TSPO, may be linked to history of NFL play. [(11)C]DPA-713 PET is a promising new tool that can be used in future study design to examine further the relationship between TSPO expression in brain injury and repair, selective regional brain atrophy, and the potential link to deficits in verbal learning and memory after NFL play. Copyright © 2014 Elsevier Inc. All rights reserved.
    Neurobiology of Disease 11/2014; 74C:58-65. DOI:10.1016/j.nbd.2014.10.019 · 5.08 Impact Factor
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