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Tan CO, Grashow R, Thorpe R, Miller KK, Nathan DM, Izzy S, Radmanesh F, Kim JH, Weisskopf MG, Taylor HA, Zafonte RD, Baggish AL. Concussion burden and later-life cardiovascular risk factors in former professional American-style football players. Ann Clin Transl Neurol 2024. [PMID: 38808967 DOI: 10.1002/acn3.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Mid-life cardiovascular risk factors are associated with later cognitive decline. Whether repetitive head injury among professional athletes impacts cardiovascular risk is unknown. We investigated associations between concussion burden and postcareer hypertension, high cholesterol, and diabetes among former professional American-style football (ASF) players. METHODS In a cross-sectional study of 4080 professional ASF players conducted between January 2015 and March 2022, we used an mulitsymptom concussion symptom score (CSS) and the number of loss-of-consciousness (LOC) episodes as a single severe symptom to quantify football-related concussion exposure. Primary outcomes were hypertension, dyslipidemia, and diabetes, defined by current or recommended prescription medication use. RESULTS The prevalence of hypertension, high cholesterol, and diabetes among former players (52 ± 14 years of age) was 37%, 34%, and 9%. Concussion burden was significantly associated with hypertension (lowest vs. highest CSS quartile, odds ratio (OR) = 1.99; 95%CI: 1.33-2.98; p < 0.01) and high cholesterol (lowest vs. moderate CSS, OR = 1.46, 95%CI, 1.11-1.91; p < 0.01), but not diabetes. In fully adjusted models, the prevalence of multiple CVD was associated with CSS. These results were driven by younger former players (≤ 40 year of age) in which the odds of hypertension were over three times higher in those in the highest CSS quartile (OR = 3.29, 95%CI: 1.39-7.61; p = 0.01). Results were similar for LOC analyses. INTERPRETATION Prior concussion burden is associated with postcareer atherogenic cardiovascular risk profiles among former professional American football players.
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Affiliation(s)
- Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Roland Thorpe
- Program of Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, Maryland, USA
| | - Karen K Miller
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, Massachusetts, USA
| | - David M Nathan
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Diabetes Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, Massachusetts, USA
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Farid Radmanesh
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neurocritical Care, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ross D Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiology, University of Lausanne, Lausanne, Switzerland
- Department of Sports Science, University of Lausanne, Lausanne, Switzerland
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Hodzic A, Gendron P, Baron E, Éthier A, Bonnefous O, Saloux E, Milliez P, Normand H, Tournoux F. Inter-season training effects on cardiovascular health in American-style football players. BMC Sports Sci Med Rehabil 2024; 16:108. [PMID: 38741116 DOI: 10.1186/s13102-024-00888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Recent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players. METHODS A prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen). RESULTS Fifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions. CONCLUSIONS Our study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France.
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France.
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France.
| | - Patrick Gendron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Emmanuelle Baron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Amélie Éthier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
| | - Odile Bonnefous
- Philips Research, Medical Imaging (Medisys), Suresnes, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - Hervé Normand
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - François Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
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Banks SJ, Yhang E, Tripodis Y, Su Y, Protas H, Adler CH, Balcer LJ, Bernick C, Mez JB, Palmisano J, Barr WB, Wethe JV, Dodick DW, Mcclean MD, Martin B, Hartlage K, Turner A, Turner RW, Malhotra A, Colman M, Pasternak O, Lin AP, Koerte IK, Bouix S, Cummings JL, Shenton ME, Reiman EM, Stern RA, Alosco ML. Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea. Neurol Clin Pract 2024; 14:e200263. [PMID: 38425491 PMCID: PMC10900387 DOI: 10.1212/cpj.0000000000200263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024]
Abstract
Background and Objectives Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players. Methods The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested. Results Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup. Discussion Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.
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Affiliation(s)
- Sarah J Banks
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eukyung Yhang
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yorghos Tripodis
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Yi Su
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Hillary Protas
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles H Adler
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Laura J Balcer
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Charles Bernick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jesse B Mez
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Joseph Palmisano
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - William B Barr
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jennifer V Wethe
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - David W Dodick
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael D Mcclean
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Brett Martin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Kaitlin Hartlage
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Arlener Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert W Turner
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Atul Malhotra
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael Colman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Ofer Pasternak
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Alexander P Lin
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Inga K Koerte
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Sylvain Bouix
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jeffrey L Cummings
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Martha E Shenton
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Eric M Reiman
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Robert A Stern
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Michael L Alosco
- Departments of Neuroscience and Psychiatry (SJB), University of California, San Diego; Department of Biostatistics (EY, YT), Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (YT, JBM, RAS, MLA), Boston University CTE Center, Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, MA; Banner Alzheimer's Institute (YS), Arizona State University,; Banner Alzheimer's Institute (HP), Arizona Alzheimer's Consortium, Phoenix; Department of Neurology (CHA, DWD), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Departments of Neurology (LJB), Population Health and Ophthalmology, NYU Grossman School of Medicine, New York; Cleveland Clinic Lou Ruvo Center for Brain Health (CB), Las Vegas, NV; Biostatistics and Epidemiology Data Analytics Center (BEDAC) (JP, BM, KH), Boston University School of Public Health, MA; Department of Neurology (WBB), NYU Grossman School of Medicine, New York; Department of Psychiatry and Psychology (JVW), Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale; Department of Environmental Health (MDM), Boston University School of Public Health, MA; Department of Psychiatry and Behavioral Sciences (AT), University of Miami; Department of Clinical Research and Leadership (RWT), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Medicine (AM), UCSD, San Diego, CA; Psychiatry Neuroimaging Laboratory (MC, OP, APL, IKK, SB), Department of Psychiatry, Brigham and Women's Hospital; Massachusetts General Hospital (IKK), Boston, MA; cBRAIN (IKK), Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Graduate School of Systemic Neurosciences (IKK); NICUM (NeuroImaging Core Unit Munich) (IKK), Ludwig Maximilians University, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas; Psychiatry Neuroimaging Laboratory (MES), Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Montreal, QC; Banner Alzheimer's Institute (EMR), University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix; Department of Anatomy and Neurobiology (RAS); and Department of Neurosurgery (RAS), Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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Teixeira E, Silva C, Vicente A. Development and validation of an interview guide for examining the effects of sports careers on the quality of life of retired Portuguese football players. Front Psychol 2024; 15:1374784. [PMID: 38533209 PMCID: PMC10963604 DOI: 10.3389/fpsyg.2024.1374784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Considering the importance of assessing the impacts resulting from a sport career, this study aimed at developing and validating a semi-structure interview guide suitable for quantifying the sociodemographic and epidemiological profile of former professional football players. Methods Based on the theoretical frameworks and several methodological procedures, an interview guide was developed, consisting of 3 areas of conceptual organization (A1. Biographical data; A2. Professional Career; and A3. Post-Career Transition) and 8 data collection categories (C1. Personal data; C2. Professional data; C3. Sociodemographic background; C4. Epidemiological pathway; C5. Moment of career retirement (career transition); C6. Post-career sociodemographic pathway; C7. Post-career epidemiological pathway; and C8. Perceptions of post-career planning). Thus, in procedural terms, four stages were considered for the construction and validation of the interview guide, namely the Ad hoc construction of the interview guide (i), the review of the in-terview guide by a panel of experts (ii), definition of procedures and protocol for the application of the interview (iii), and the application of the pilot study for the face validation of the interview guide (iv). The sample consisted of two former Portuguese professional players. Results and discussion To analyze and discuss the data, a content analysis was carried out on all the answers given to each question in the script by the interviewees. From them, matrices were created with the response references to each subcategory. In this way, it was possible to analyse the type of answers given by the interviewees and relate them to the theoretical perspectives of the topic being investigated. The results showed that the interview guide for the study of the impacts of the sports careers on the quality of life of Portuguese former football players shows reliability for the collection of qualitative and quantitative information from the respective content analysis. The use of the interview guide characterizes the path of former player, providing information and knowledge on the sociodemographic and epidemiological impact factors resulting from their post-career.
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Affiliation(s)
- Eduardo Teixeira
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Life Quality Research Centre, Polytechnic Institute of Santarem, Santarém, Portugal
| | - Carlos Silva
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Life Quality Research Centre, Polytechnic Institute of Santarem, Santarém, Portugal
| | - António Vicente
- Faculty of Human and Social Sciences, University of Beira Interior, Covilhã, Portugal
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Sisk M, Medawar N, McClure M, Cooke B, Cannon R, Kufner D, D'Almeida S, Jardaly A, Asif I, Momaya A, Ponce B. Cardiovascular disease in retired NFL players: a systematic review. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 38318675 DOI: 10.1080/00913847.2024.2315929] [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: 10/16/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Despite robust research endeavors exploring post-play health implications in former NFL players, the impact of former-player status on long-term cardiovascular health has not yet been elucidated. The purpose of this systematic review is to describe the available research on the cardiovascular health in former NFL players. METHODS Relevant studies were included from the PubMed, Scopus, and Embase databases. Studies were evaluated in accordance with PRISMA guidelines. Two independent reviewers conducted the title/abstract screenings and risk of bias determinations. The results of the studies were extracted for inclusion in the review. RESULTS Sixteen studies met inclusion criteria. Though evidence was discordant among studies, former NFL players appeared to possess more favorable metabolic profiles and decreased mortality compared to community controls. Of note, 90% of former players were found to be overweight or obese. CONCLUSION Though cardiovascular disease is the leading cause of death among former NFL players, they possess comparable metabolic and cardiovascular profiles to community controls. Further research is necessary to ascertain the impact of NFL play on cardiovascular health and develop tailored preventative care strategies for former players.
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Affiliation(s)
- Morgan Sisk
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Nicholas Medawar
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Mark McClure
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Brett Cooke
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Reily Cannon
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - David Kufner
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Stacey D'Almeida
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Achraf Jardaly
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Irfan Asif
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit Momaya
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent Ponce
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
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6
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Lynch SM. Playing professional American football does not increase longevity. Proc Natl Acad Sci U S A 2023; 120:e2317215120. [PMID: 37991936 PMCID: PMC10710026 DOI: 10.1073/pnas.2317215120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Affiliation(s)
- Scott M. Lynch
- Department of Sociology, Duke University, Durham, NC2708
- Duke University Population Research Institute, Duke University, Durham, NC2708
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Warren JR, Rumore G. The association between playing professional American football and longevity. Proc Natl Acad Sci U S A 2023; 120:e2308867120. [PMID: 37903248 PMCID: PMC10636321 DOI: 10.1073/pnas.2308867120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023] Open
Abstract
Recent research concludes that professional American football players (hereafter, "football players") live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s-906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).
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Affiliation(s)
- John Robert Warren
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
| | - Gina Rumore
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
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McHugh C, Hind K, Kelly A, Fearon U, Wasfy M, Floudas A, Barad Z, Dane K, Farrell G, Wilson F. Cardiovascular risk and systemic inflammation in male professional rugby: a cross-sectional study. BMJ Open Sport Exerc Med 2023; 9:e001636. [PMID: 37937309 PMCID: PMC10626771 DOI: 10.1136/bmjsem-2023-001636] [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] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To investigate cardiovascular risk factors' prevalence and association with systemic inflammation in professional male rugby players (RP). Methods A cross-sectional investigation of 46 professional male RP (26.1±4.1 years) cardiovascular risk factors were compared by position. Inflammatory markers were compared with healthy controls (n=13) and patients with rheumatoid arthritis (RA) (n=10). Results Twenty-six per cent of RP had no risk factors, 49% had 1-2 cardiovascular risk factors and 25% had 3-4 risk factors. Forwards had greater body fat (p<0.001), visceral fat (p<0.001), glucose (p=0.025), and C reactive protein (CRP) (p=0.023) compared with backs. RP demonstrated more favourable lipid and glucose profiles than reference values for the general population. Most RP (n=28, 61%) had elevated blood pressure (≥140/90 mm Hg). RP had higher vascular adhesion molecule-1 (VCAM-1) (p=0.004) and intracellular adhesion molecule-1 (ICAM-1) (p=0.002) than healthy controls. RP had lower CRP than patients with RA (p=0.009), while one-third (n=15) displayed equivalent ICAM-1 and VCAM-1 levels. Multivariate clustering and principal component analysis biplots revealed higher triglycerides, inflammatory markers, and worse body composition were associated with forwards. Conclusions Despite athletic status, most of this rugby cohort had at least one cardiovascular risk factor. Concomitantly, these RP demonstrated increased levels of inflammation, with one-third, primarily forwards, displaying equivalent levels to patients with inflammatory disease. Further studies are needed to unravel the prognostic implications of increased inflammation in RP because unchecked, chronic inflammation may lead to increased cardiovascular disease risk.
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Affiliation(s)
- Clíodhna McHugh
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Karen Hind
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Aine Kelly
- Department of Physiology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
| | - Ursula Fearon
- Department Molecular Rheumatology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
| | - Meagan Wasfy
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Achilleas Floudas
- Department Molecular Rheumatology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
| | - Zsuzsanna Barad
- Department of Physiology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
| | - Kathryn Dane
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | | | - Fiona Wilson
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
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9
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Street JH, Boos ZP, Fial A, Lennon SL, Smith CS, Creasy SA, Hunter SK, Farquhar WB, Capin JJ. Long-term function, body composition and cardiometabolic health in midlife former athletes: a scoping review. BMJ Open Sport Exerc Med 2023; 9:e001605. [PMID: 37920279 PMCID: PMC10619025 DOI: 10.1136/bmjsem-2023-001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 11/04/2023] Open
Abstract
While sports medicine has traditionally focused on recovering from injury and returning athletes to sport safely after injury, there is a growing interest in the long-term health of athletes. The purpose of this scoping review was to (1) summarise the literature (methodologies and findings) on physical function, body composition and cardiometabolic health in midlife (age 40-65 years) former competitive athletes compared with non-athlete controls, (2) identify areas for future study in long-term health in athletes and (3) determine outcomes that could be evaluated in a future systematic review(s). We searched PubMed, CINAHL, Web of Science and SPORTDiscus for studies published between 2000 and 2022 evaluating former athletes and controls on physical function, body composition and/or cardiometabolic measures using MeSH terms. We identified 20 articles that met our criteria. Outcomes varied considerably across studies, most of which were cross-sectional and evaluated only males. Limited data suggest that former endurance athletes have leaner body compositions, higher aerobic capacity and better cardiometabolic indicators than controls; former athletes who maintain higher physical activity (ie, self-reported exercise) are healthier than those who do not; and former team sport athletes, who have higher injury prevalence, may have poorer functional performance than controls who were recreationally active in college. Studies rarely evaluated functional performance, did not control for prior injury or diet and seldom assessed current physical activity levels. Future research should include females and evaluate sex differences, control for prior sports-related injury(ies), quantify physical activity, use standardised outcome measures including performance-based functional assessments and incorporate longitudinal designs.
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Affiliation(s)
- Jena Heck Street
- Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Zebadiah P Boos
- Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Alissa Fial
- Research, Teaching & Learning, Raynor Memorial Libraries, Marquette University, Milwaukee, Wisconsin, USA
| | - Shannon L Lennon
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Carolyn S Smith
- Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Seth A Creasy
- Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sandra K Hunter
- Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - William B Farquhar
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Jacob John Capin
- Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Iverson GL, Kissinger-Knox A, Huebschmann NA, Castellani RJ, Gardner AJ. A narrative review of psychiatric features of traumatic encephalopathy syndrome as conceptualized in the 20th century. Front Neurol 2023; 14:1214814. [PMID: 37545715 PMCID: PMC10401603 DOI: 10.3389/fneur.2023.1214814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Some ultra-high exposure boxers from the 20th century suffered from neurological problems characterized by slurred speech, personality changes (e.g., childishness or aggressiveness), and frank gait and coordination problems, with some noted to have progressive Parkinsonian-like signs. Varying degrees of cognitive impairment were also described, with some experiencing moderate to severe dementia. The onset of the neurological problems often began while they were young men and still actively fighting. More recently, traumatic encephalopathy syndrome (TES) has been proposed to be present in athletes who have a history of contact (e.g., soccer) and collision sport participation (e.g., American-style football). The characterization of TES has incorporated a much broader description than the neurological problems described in boxers from the 20th century. Some have considered TES to include depression, suicidality, anxiety, and substance abuse. Purpose We carefully re-examined the published clinical literature of boxing cases from the 20th century to determine whether there is evidence to support conceptualizing psychiatric problems as being diagnostic clinical features of TES. Methods We reviewed clinical descriptions from 155 current and former boxers described in 21 articles published between 1928 and 1999. Results More than one third of cases (34.8%) had a psychiatric, neuropsychiatric, or neurobehavioral problem described in their case histories. However, only 6.5% of the cases were described as primarily psychiatric or neuropsychiatric in nature. The percentages documented as having specific psychiatric problems were as follows: depression = 11.0%, suicidality = 0.6%, anxiety = 3.9%, anger control problems = 20.0%, paranoia/suspiciousness = 11.6%, and personality change = 25.2%. Discussion We conclude that depression, suicidality (i.e., suicidal ideation, intent, or planning), and anxiety were not considered to be clinical features of TES during the 20th century. The present review supports the decision of the consensus group to remove mood and anxiety disorders, and suicidality, from the new 2021 consensus core diagnostic criteria for TES. More research is needed to determine if anger dyscontrol is a core feature of TES with a clear clinicopathological association. The present findings, combined with a recently published large clinicopathological association study, suggest that mood and anxiety disorders are not characteristic of TES and they are not associated with chronic traumatic encephalopathy neuropathologic change.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | | | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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11
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Kuenze C, Pietrosimone B, Currie KD, Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, McCrea M, Guskiewicz KM, Meehan WP. Joint Injury, Osteoarthritis, and Cardiovascular Disease Risk Factors in Former National Football League Athletes: An NFL-LONG Study. J Athl Train 2023; 58:528-535. [PMID: 36645831 PMCID: PMC10496448 DOI: 10.4085/1062-6050-0437.22] [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: 01/18/2023]
Abstract
CONTEXT Individuals with lower extremity osteoarthritis (OA) have a 25% greater risk of cardiovascular disease (CVD) than those without OA. The prevalence of traumatic joint injuries among National Football League (NFL) players exposes these athletes to an elevated risk for OA and potentially a greater risk of cardiovascular risk factors (CRFs) and CVD. OBJECTIVES To examine the associations between a history of lower extremity joint injury, lower extremity OA, and the prevalence of CRFs and CVD among former NFL athletes. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Former NFL players completed a comprehensive health questionnaire that was used in an ongoing study, the Neurologic Function Across the Lifespan: A Prospective, Longitudinal, and Translational Study for Former NFL Players (NFL-LONG). A subsample of 1738 former players reported lifetime medical diagnoses including CVD or CRFs. MAIN OUTCOME MEASURE(S) Crude and adjusted prevalence ratios (PRsadj) characterized the associations between CVD or CRFs and injury, OA diagnosis, or both among athletes who reported (1) no history of lower extremity joint injury or surgery and no diagnosed OA, (2) a history of lower extremity joint injury or surgery and no diagnosed OA, and (3) a history of lower extremity joint injury or surgery and diagnosed OA. RESULTS Neither a history of lower extremity joint injury (PRadj = 1.34; 95% CI = 0.86, 2.07) nor a history of lower extremity joint injury and diagnosed OA (PRadj = 1.41; 95% CI = 0.89, 2.25) was significantly associated with CVD. However, CRFs were 30% and 53% more prevalent in former players with lower extremity joint injury and no diagnosed OA (PRadj = 1.30; 95% CI = 1.12, 1.50) and those with lower extremity joint injury and diagnosed OA (PRadj = 1.53; 95% CI = 1.31, 1.78), respectively, versus athletes with no history of either condition. CONCLUSIONS The prevalence of CRFs was highest among former NFL athletes with a history of lower extremity joint injury and diagnosed OA. These findings provide insight regarding the potential pathways to chronic diseases that may be initiated by joint injury early in life.
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Affiliation(s)
| | - Brian Pietrosimone
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Samuel R. Walton
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y. Kerr
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Avinash Chandran
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - J. D. DeFreese
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Ruben J. Echemendia
- University of Missouri–Kansas City
- University Orthopedics Center Concussion Clinic, State College, PA
| | | | - Kevin M. Guskiewicz
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
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12
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Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
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Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
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13
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Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC, Guskiewicz KM, Hainline B, Iverson GL, Kutcher JS, Leddy JJ, Maddocks D, Manley G, McCrea M, Purcell LK, Putukian M, Sato H, Tuominen MP, Turner M, Yeates KO, Herring SA, Meeuwisse W. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med 2023; 57:695-711. [PMID: 37316210 DOI: 10.1136/bjsports-2023-106898] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, Staffordshire, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation, Boston, Massachusetts, USA
| | - Robert C Cantu
- CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Medicine, Swansea University, Swansea, UK
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nina Feddermann-Demont
- University Hospital Zurich, Zurich, Switzerland
- Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicne, SUNY Buffalo, Buffalo, New York, USA
| | - David Maddocks
- Melbourne Neuropsychology Services & Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Geoff Manley
- Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Haruhiko Sato
- Neurosurgery, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | | | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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14
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Kerr ZY, Chandran A, Brett BL, Walton SR, DeFreese JD, Mannix R, Echemendia RJ, McCrea MA, Guskiewicz KM, Meehan WP. The stability of self-reported professional football concussion history among former players: A longitudinal NFL-LONG study. Brain Inj 2022; 36:968-976. [PMID: 35971311 DOI: 10.1080/02699052.2022.2109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To examine the stability of former National Football League (NFL) players' recall of professional football concussion. METHODS Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 … 10, >10). Participants were categorized into four 'recall stability' groups, based upon concussion recall [e.g., 'Same' (same number recalled), 'Increased' (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. 'Recall stability group' functioning scores were compared. RESULTS Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the 'Same' vs 'Increased' groups. CONCLUSIONS Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Columbia, Pennsylvania, USA.,Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael A McCrea
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William P Meehan
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Huang B, Wang Q, Wang X, Wang L, Ma P, Wang F, Du C. Associations of specific types of physical activities with 10-year risk of cardiovascular disease among adults: Data from the national health and nutrition examination survey 1999–2006. Front Public Health 2022; 10:964862. [PMID: 35958867 PMCID: PMC9358206 DOI: 10.3389/fpubh.2022.964862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity plays a key role in the prevention of cardiovascular disease (CVD). However, previous studies focused predominantly on the associations of the total amount of physical activity with CVD. There were few evidences on the associations of specific sport disciplines with CVD. Furthermore, little was known on the interactions between the different types of sports on CVD risk. Therefore, this study aimed to examine the independent associations of specific types of physical activities with the 10-year risk of CVD, and further evaluate the interactions between specific types of physical activities on the 10-year risk of CVD in US adults. Methods This study used the data of the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Participants aged ≥ 30 years and with free of CVD were eligible. The physical activity questionnaire is used to collect general information on leisure-time activities in the past 30 days, including the frequency, duration, and intensity of participation in each activity. The exposures of interest included cycling, swimming, aerobics, running, American Football, basketball, and racquet sports. The Framingham risk score algorithm was used to assess 10-year CVD risk based on age, high density lipoprotein, total cholesterol, systolic blood pressure, smoking status, and diabetes. A higher total score reflects a greater risk of CVD. Results This study included 10829 participants. Compared to no participation, participation in cycling (β = −0.890, 95% CI:−1.278,−0.502, P < 0.001), running (β = −1.466, 95% CI:−1.837,−1.095, P < 0.001), American Football (β = −2.934, 95% CI:−3.750,−2.119, P < 0.001), basketball (β = −1.968, 95% CI:−2.645,−1.291, P < 0.001), and aerobics (β = −0.980, 95% CI:−1.352,−0.608, P < 0.001) was associated with a lower CVD risk. Furthermore, cycling was antagonistic with basketball and racquet sports in the associations with CVD risk. An antagonistic action between swimming and aerobics was also observed. Nevertheless, running was synergistic with cycling, aerobics, and racquet sports in the associations with CVD risk. Conclusions There were inverse associations of specific types of physical activities with CVD risk. Furthermore, there might be synergistic and antagonistic associations of multiple types of physical activities with CVD risk.
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Affiliation(s)
- Bingsen Huang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Qian Wang
- Women and Infants Hospital of Zhengzhou, Zhengzhou, China
| | - Xin Wang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Lei Wang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Peiyao Ma
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Fengling Wang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Changchun Du
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
- *Correspondence: Changchun Du
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16
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Buckland ME, Affleck AJ, Pearce AJ, Suter CM. Chronic Traumatic Encephalopathy as a Preventable Environmental Disease. Front Neurol 2022; 13:880905. [PMID: 35769361 PMCID: PMC9234108 DOI: 10.3389/fneur.2022.880905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
In this Perspective we explore the evolution of our understanding of chronic traumatic encephalopathy (CTE) and its relationship with repetitive head injury. As with many neurodegenerative conditions, there is an imperfect correspondence between neuropathology and clinical phenotype, but unlike other neurodegenerative diseases, CTE has a discrete and easily modifiable risk factor: exposure to repetitive head injury. Consequently, evaluation of the evidence regarding exposure to repetitive head injury and CTE risk should be undertaken using public or occupational health frameworks of medical knowledge. The current debate over the existence of CTE as a disease of concern is fuelled in part by immediate medico-legal considerations, and the involvement of high-profile athletes, with inevitable media interest. Moving beyond this debate has significant potential to address and reduce disease impact in the near future, and provide novel insights into mechanisms underlying abnormal protein accumulation in CTE and other neurodegenerative diseases.
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Affiliation(s)
- Michael E. Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- *Correspondence: Michael E. Buckland
| | - Andrew J. Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Catherine M. Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
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17
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Wichmann TK, Wolfson J, Roelofs EJ, Bosch TA, Bach CW, Oliver JM, Carbuhn A, Stanforth PR, Dengel DR. Longitudinal Assessment of NCAA Division I Football Body Composition by Season and Player Age. J Strength Cond Res 2022; 36:1682-1690. [PMID: 35333212 DOI: 10.1519/jsc.0000000000004256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Julian Wolfson
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Erica J Roelofs
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Tyler A Bosch
- Performance and Data Analytics, Athlete Performance Center, Santa Monica, California
| | - Christopher W Bach
- Nebraska Athletic Performance Laboratory, University of Nebraska, Lincoln, Nebraska
| | - Jonathan M Oliver
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas
| | - Aaron Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas; and
| | - Philip R Stanforth
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
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18
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Cortez B, Valdivia C, Keating D, Marengi D, Bates T, Brown C, Dairi I, Doyle M, Keske R, Connor A, Grashow R, Tenforde A, Wasfy MM, Weisskopf MG, Speizer F, Zafonte R, Baggish A. Multi-modality human phenotyping to examine subjective and objective health afflictions in former professional American-style football players: The In-Person Assessment (IPA) protocol. PLoS One 2022; 17:e0265737. [PMID: 35358242 PMCID: PMC8970522 DOI: 10.1371/journal.pone.0265737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation.
Objective
To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Methods
The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol.
Results
This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Conclusion
The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.
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Affiliation(s)
- Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dylan Keating
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dean Marengi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trevor Bates
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Berenson Allen Center and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Adam Tenforde
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Meagan M. Wasfy
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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19
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Iverson GL, Merz ZC, Terry DP. High-School Football and Midlife Brain Health Problems. Clin J Sport Med 2022; 32:86-94. [PMID: 35234740 PMCID: PMC8868212 DOI: 10.1097/jsm.0000000000000898] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine whether middle-aged men who played high-school football experience worse mental health or cognitive functioning than men who did not play high-school football. DESIGN Cross-sectional cohort study. SETTING Online survey completed remotely. PARTICIPANTS A total of 435 men between the ages of 35 and 55 completed the study, of whom 407 were included in the analyses after excluding participants who answered embedded validity items incorrectly (n = 16), played semiprofessional football (n = 2), or experienced a recent concussion (n = 10). ASSESSMENT OF RISK FACTORS Self-reported high school football participation, compared with those who played contact sports, noncontact sports, and no sports. MAIN OUTCOME MEASURES A lifetime history of depression or anxiety; mental health or cognitive problems in the past year; current depression symptoms, and post-concussion-like symptoms. RESULTS Middle-aged men who played high-school football did not have a higher prevalence of being prescribed medication for anxiety or depression or receiving treatment from a mental health professional. Similarly, there were no significant differences between groups on the rates in which they endorsed depression, anxiety, anger, concentration problems, memory problems, headaches, migraines, neck or back pain, or chronic pain over the past year. A greater proportion of those who played football reported sleep problems over the past year and reported being prescribed medication for chronic pain and for headaches. CONCLUSIONS Men who played high-school football did not report worse brain health compared with those who played other contact sports, noncontact sports, or did not participate in sports during high school.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts and
| | - Zachary C. Merz
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, UNC Memorial Hospital, Chapel Hill, North Carolina
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts and
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20
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Tso JV, Turner CG, Liu C, Ahmad S, Ali A, Selvaraj S, Galante A, Gilson CR, Clark C, Williams BR, Quyyumi AA, Baggish AL, Kim JH. Hypertension and Ventricular-Arterial Uncoupling in Collegiate American Football Athletes. J Am Heart Assoc 2022; 11:e023430. [PMID: 35199554 PMCID: PMC9075286 DOI: 10.1161/jaha.121.023430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular–arterial (VA) coupling is defined as the ratio between arterial elastance (EA) and left ventricular elastance (ELV). VA uncoupling, as occurs in hypertensive heart disease, is associated with adverse outcomes. This study sought to determine the relationship between American football (AF)–associated hypertension and VA uncoupling. Methods and Results This was a multicenter, longitudinal, and repeated measures observational study of collegiate AF athletes across 3 years of AF participation. Of 200 freshman athletes initially enrolled, 142 (67 Black [47%]/75 White [53%], 58 linemen [41%]/84 nonlinemen [59%]) were prospectively studied with echocardiography and applanation tonometry. Primary echocardiographic VA coupling outcome measures were EA/ELV and ΔEA/ELV, with increased EA/ELV indicating VA uncoupling. Adjusting for race and player position, AF athletes demonstrated increased EA/ELV (mean [95% CI]Δ, 0.10 [0.04–0.15]; P=0.001) and systolic blood pressure (SBP) (mean [95% CI]Δ, 11.4 [8.3–14.5] mm Hg, P<0.001) over their collegiate AF careers. In combination with longitudinal VA uncoupling, hypertension prevalence (including both stage 1 and 2) increased from 54% at baseline to 77% (44% stage 2) at the end of the study period (P<0.001). In multivariable mixed‐effects linear regression analysis, higher SBP (β=0.021, P=0.02), lower E′ (β=−0.010, P=0.03), and worse global longitudinal strain (β=0.036, P<0.001) were associated with higher EA/ELV. Increased SBP (ΔSBP, β=0.029, P=0.02) and worsened global longitudinal strain (Δglobal longitudinal strain, β=0.045, P<0.001) also predicted increased ΔEA/ELV. Conclusions VA uncoupling is associated with pathologically increased SBP and subclinical impairments in left ventricular systolic function in collegiate AF athletes, indicating a key mechanism underlying maladaptive cardiovascular phenotypes observed in this population. Future studies analyzing whether targeted clinical interventions improve VA coupling and health outcomes are warranted.
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Affiliation(s)
- Jason V Tso
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Casey G Turner
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Chang Liu
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Syed Ahmad
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Abbas Ali
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Steve Selvaraj
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Angelo Galante
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Carla R Gilson
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Craig Clark
- Sports Medicine Furman University Greenville SC
| | - B Robinson Williams
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Arshed A Quyyumi
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Aaron L Baggish
- Cardiovascular Performance Program Massachusetts General Hospital Boston MA
| | - Jonathan H Kim
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA.,Sports Medicine Georgia Institute of Technology Atlanta GA
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21
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Iverson GL, Terry DP. High School Football and Risk for Depression and Suicidality in Adulthood: Findings From a National Longitudinal Study. Front Neurol 2022; 12:812604. [PMID: 35222232 PMCID: PMC8865514 DOI: 10.3389/fneur.2021.812604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022] Open
Abstract
BackgroundThere is growing public concern regarding the potential long-term effects of playing football on brain health, specifically that playing football before and during high school might cause damage to the brain that manifests years or decades later as depression or suicidality. This study examined if playing high school football was associated with increased lifetime risk for depression, suicidality over the past year, or depressed mood in the past week in men aged between their middle 30 s to early 40 s.MethodsPublicly available data from the National Longitudinal Study of Adolescent to Adult Health were analyzed. This longitudinal, prospective cohort study sampled nationally representative U.S. youth starting in 1994–1995 (Wave I) and most recently in 2016–2018 (Wave V). A total of 3,147 boys participated in Wave I (median age = 15), of whom 1,805 were re-assessed during Wave V (median age = 38).ResultsOf the 1,762 men included in the study, 307 (17.4%) men reported being diagnosed with depression and 275 (15.6%) reported being diagnosed with an anxiety disorder or panic disorder at some point in their life. When comparing men who played high school football to those who did not, there were no differences in the proportions of the sample who had a lifetime diagnosis of depression, lifetime diagnosis of anxiety/panic disorders, suicidal ideation in the past year, psychological counseling in the past year, or current depressed mood. However, men who received psychological counseling and/or experienced suicidal ideation during adolescence were significantly more likely to report a lifetime history of depression, suicidal ideation in the past year, and current depressed mood.ConclusionIndividuals who reported playing football during adolescence did not have an increased risk of depression or suicidal ideation when they were in their middle 30 s to early 40 s, but mental health problems during adolescence were associated with an increased risk for psychological health difficulties more than 20 years later.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
- *Correspondence: Grant L. Iverson
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
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22
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Left ventricular hypertrophy in athletes, a case-control analysis of interindividual variability. Int J Cardiol 2021; 348:157-162. [PMID: 34896409 DOI: 10.1016/j.ijcard.2021.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND A variability in cardiac remodeling is observed in athletes regardless of age, sex, body size and sport participated. We sought to investigate whether other individual characteristics could affect the extent of Left ventricular hypertrophy (LVH). METHODS From 2120 consecutive Olympic athletes, those with LVH (defined as LV Wall thickness ≥ 13 mm) were matched 1:1 by age, gender, body surface area and type of sport with non-LVH Athletes. Clinical and Echocardiographic variables were compared. RESULTS 48 athletes with LVH (2.3%) and 48 matched non-LVH athletes were identified. LVH Athletes had higher body weight (90 ± 18 vs 81 ± 11Kg; p = 0.006) body mass index (26 ± 2 vs 24 ± 2 Kg/m2; p < 0.001) and body fat percentage (15 ± 7% vs 12 ± 4%; p = 0.016) compared to non-LVH Athletes. They also had higher systolic (123 ± 1 vs 116 ± 11 mmHg; p = 0.002) and diastolic blood pressure (76 ± 8 vs 71 ± 9 mmHg; p = 0.002). On exercise testing, LVH Athletes reached a lower index workload (3.7 ± 0.9 vs 4.1 ± 0.8 W/Kg; p = 0.013) and a higher peak diastolic blood pressure (79 ± 10 vs 74 ± 11 mmHg; p = 0.012) than those without LVH. Binary logistic regression analysis showed that diastolic blood pressure (OR 1.052; 95% CI from 1.011 to 1.130; p = 0.020) and BMI (OR 1.220; 95% CI from 1.016 to 1.465; p = 0.033) had the strongest association with LVH as categorical variable. CONCLUSIONS Our study showed that increased blood pressure at rest and during exercise, together with larger body weight, body mass and fat percentage are associated with a higher degree of LVH, which is not associated with a greater physical performance and therefore possibly disproportionate to the sport activity.
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23
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Iverson GL, Deep-Soboslay A, Hyde TM, Kleinman JE, Erskine B, Fisher-Hubbard A, deJong JL, Castellani RJ. Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football. Front Neurol 2021; 12:745824. [PMID: 34899570 PMCID: PMC8662809 DOI: 10.3389/fneur.2021.745824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: It is reasonable to estimate that tens of millions of men in the United States played high school football. There is societal concern that participation in football confers risk for later-in-life mental health problems. The purpose of this study is to examine whether there is an association between a personal history of playing high school football and death by suicide. Methods: The subjects were obtained from the Lieber Institute for Brain Development (LIBD) brain donation program in collaboration with the Office of the Medical Examiner at Western Michigan University Homer Stryker MD School of Medicine. Donor history was documented via medical records, mental health records, and telephone interviews with the next-of-kin. Results: The sample included 198 men aged 50 or older (median = 65.0 years, interquartile range = 57-75). There were 34.8% who participated in contact sports during high school (including football), and 29.8% participated in high school football. Approximately one-third of the sample had suicide as their manner of death (34.8%). There was no statistically significant difference in the proportions of suicide as a manner of death among those men with a personal history of playing football compared to men who did not play football or who did not play sports (p = 0.070, Odds Ratio, OR = 0.537). Those who played football were significantly less likely to have a lifetime history of a suicide attempt (p = 0.012, OR = 0.352). Men with mood disorders (p < 0.001, OR = 10.712), substance use disorders (p < 0.020, OR = 2.075), and those with a history of suicide ideation (p < 0.001, OR = 8.038) or attempts (p < 0.001, OR = 40.634) were more likely to have suicide as a manner of death. Moreover, those men with a family history of suicide were more likely to have prior suicide attempts (p = 0.031, OR = 2.153) and to have completed suicide (p = 0.001, OR = 2.927). Discussion: Suicide was related to well-established risk factors such as a personal history of a mood disorder, substance abuse disorder, prior suicide ideation, suicide attempts, and a family history of suicide attempts. This study adds to a steadily growing body of evidence suggesting that playing high school football is not associated with increased risk for suicidality or suicide during adulthood.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Amy Deep-Soboslay
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
| | - Thomas M. Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joel E. Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brittany Erskine
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Amanda Fisher-Hubbard
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Joyce L. deJong
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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24
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Iverson GL, Merz ZC, Terry DP. Playing High School Football Is Not Associated With an Increased Risk for Suicidality in Early Adulthood. Clin J Sport Med 2021; 31:469-474. [PMID: 34704972 DOI: 10.1097/jsm.0000000000000890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if playing high school football is associated with suicide ideation between the ages of 24 and 32 years. DESIGN Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health. This prospective cohort study sampled nationally representative US participants at 4 time points from 1994 to 2008. SETTING In-home assessment. PARTICIPANTS There were 3147 boys (age: median = 14.9, SD = 1.8) who participated during adolescence in 1994 to 1995 (wave I), of whom 2353 were reinterviewed in 2008 (wave IV, age: median = 29.1, SD = 1.8). ASSESSMENT OF RISK FACTORS Football participation, history of psychological counseling, suicide ideation, and a suicide attempt in the past year during high school. MAIN OUTCOME MEASURES Lifetime history of depression, suicide ideation within the past year, and feeling depressed in the past 7 days at wave IV. RESULTS Men who played high school football, compared with those who did not, reported similar rates of lifetime diagnosis of depression, suicide ideation in the past year, and feeling depressed in the past 7 days. Those who played football reported similar rates of suicide ideation in the past year when they were in their early 20s. Individuals who underwent psychological counseling during adolescence were more likely to report a lifetime history of depression and suicide ideation in the past year. CONCLUSIONS Young men who played high school football are not at an increased risk for suicide ideation during both their early 20s and late 20s. By contrast, those who experienced mental health problems in high school were much more likely to experience suicide ideation during their 20s.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Rehabilitation Hospital; Spaulding Research Institute
- MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
- Center for Health and Rehabilitation Research, Charlestown, Massachusetts; and
| | - Zachary C Merz
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, UNC Memorial Hospital, Chapel Hill, North Carolina
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
- Center for Health and Rehabilitation Research, Charlestown, Massachusetts; and
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Iverson GL, Büttner F, Caccese JB. Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review. Front Neurol 2021; 12:727089. [PMID: 34659092 PMCID: PMC8511696 DOI: 10.3389/fneur.2021.727089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
A controversial theory proposes that playing tackle football before the age of 12 causes later in life brain health problems. This theory arose from a small study of 42 retired National Football League (NFL) players, which reported that those who started playing tackle football at a younger age performed worse on selected neuropsychological tests and a word reading test. The authors concluded that these differences were likely due to greater exposure to repetitive neurotrauma during a developmentally sensitive maturational period in their lives. Several subsequent studies of current high school and collegiate contact/collision sports athletes, and former high school, collegiate, and professional tackle football players have not replicated these findings. This narrative review aims to (i) discuss the fundamental concepts, issues, and controversies surrounding existing research on age of first exposure (AFE) to contact/collision sport, and (ii) provide a balanced interpretation, including risk of bias assessment findings, of this body of evidence. Among 21 studies, 11 studies examined former athletes, 8 studies examined current athletes, and 2 studies examined both former and current athletes. Although the literature on whether younger AFE to tackle football is associated with later in life cognitive, neurobehavioral, or mental health problems in former NFL players is mixed, the largest study of retired NFL players (N = 3,506) suggested there was not a significant association between earlier AFE to organized tackle football and worse subjectively experienced cognitive functioning, depression, or anxiety. Furthermore, no published studies of current athletes show a significant association between playing tackle football (or other contact/collision sports) before the age of 12 and cognitive, neurobehavioral, or mental health problems. It is important to note that all studies were judged to be at high overall risk of bias, indicating that more methodologically rigorous research is needed to understand whether there is an association between AFE to contact/collision sports and later in life brain health. The accumulated research to date suggests that earlier AFE to contact/collision sports is not associated with worse cognitive functioning or mental health in (i) current high school athletes, (ii) current collegiate athletes, or (iii) middle-aged men who played high school football. The literature on former NFL players is mixed and does not, at present, clearly support the theory that exposure to tackle football before age 12 is associated with later in life cognitive impairment or mental health problems.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jaclyn B. Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, United States
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26
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Morales JS, Castillo-García A, Valenzuela PL, Saco-Ledo G, Mañas A, Santos-Lozano A, Lucia A. Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis. Scand J Med Sci Sports 2021; 31:2241-2248. [PMID: 34416791 DOI: 10.1111/sms.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.
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Affiliation(s)
- Javier S Morales
- Department of Physical Education, MOVE-IT Research Group, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | | | | | - Gonzalo Saco-Ledo
- Bioenergy and Motion Analysis Laboratory, National Research Center on Human Evolution (CENIEH), Burgos, Spain
| | - Asier Mañas
- GENUD Toledo Research Group, University of Castilla-La Mancha Toledo, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Alejandro Santos-Lozano
- Department of Health Sciences, i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain.,Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital, 12 de Octubre' ('imas12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital, 12 de Octubre' ('imas12'), Madrid, Spain
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27
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Tso JV, Turner CG, Liu C, Galante A, Gilson CR, Clark C, Taylor HA, Quyyumi AA, Baggish AL, Kim JH. Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes. Br J Sports Med 2021; 56:151-157. [PMID: 34389546 DOI: 10.1136/bjsports-2021-104333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES American-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes. METHODS Collegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate acquired C-LVH in black versus white athletes controlling for playing position (linemen (LM) and non-linemen (NLM)), family income, body weight and blood pressure. RESULTS At baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048). CONCLUSIONS Independent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.
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Affiliation(s)
- Jason V Tso
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Casey G Turner
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Carla R Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, South Carolina, USA
| | - Herman A Taylor
- Department of Medicine, Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan H Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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28
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Grashow R, Weisskopf MG, Miller KK, Nathan DM, Zafonte R, Speizer FE, Courtney TK, Baggish A, Taylor HA, Pascual-Leone A, Nadler LM, Roberts AL. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol 2021; 76:1428-1438. [PMID: 31449296 PMCID: PMC6714010 DOI: 10.1001/jamaneurol.2019.2664] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question Are professional US-style football players with a history of multiple concussion symptoms more likely to report indicators of low testosterone levels or erectile dysfunction (ED)? Findings In this cross-sectional study of 3409 former players, a monotonically increasing association was found between the number of concussion symptoms and the odds of reporting an indicator of low testosterone level and ED. Meaning Concussion symptoms among former football players were associated with low testosterone levels and ED indicators, suggesting that men with a history of head injury may benefit from discussions with their health care clinicians regarding these treatable outcomes. Importance Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown. Objective To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED. Design, Setting, and Participants This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures, demographic factors, and current health conditions were sent via electronic and postal mail to participants within and outside of the United States. Analyses were conducted in Boston, Massachusetts; the data analysis began in March 2018 and additional analyses were performed through June 2019. Of the 13 720 male former players eligible to enroll who were contacted, 3506 (25.6%) responded. Exposures Concussion symptom score was calculated by summing the frequency with which participants reported 10 symptoms, such as loss of consciousness, disorientation, nausea, memory problems, and dizziness, at the time of football-related head injury. Main Outcomes and Measures Self-reported recommendations or prescriptions for low testosterone or ED medication served as indicators for testosterone insufficiency and ED. Results In 3409 former players (mean [SD] age, 52.5 [14.1] years), the prevalence of indicators of low testosterone levels and ED was 18.3% and 22.7%, respectively. The odds of reporting low testosterone levels or ED indicators were elevated for previously established risk factors (eg, diabetes, sleep apnea, and mood disorders). Models adjusted for demographic characteristics, football exposures, and current health factors showed a significant monotonically increasing association of concussion symptom score with the odds of reporting the low testosterone indicator (highest vs lowest quartile, odds ratio, 2.39; 95% CI, 1.79-3.19; P < .001). The ED indicator showed a similar association (highest quartile vs lowest, odds ratio, 1.72; 95% CI, 1.30-2.27; P < .001). Conclusions and Relevance Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Karen K Miller
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - David M Nathan
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Diabetes Center, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Herman A Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Tenforde AS, Cortez B, Coughlan-Gifford E, Grashow R, Baker J, Baggish AL, Pascual-Leone A, Nadler LM, Speizer FE, Taylor HA, Weisskopf MG, Zafonte R. Individual and cumulative health afflictions are associated with greater impairment in physical and mental function in former professional American style football players. PM R 2021; 14:30-39. [PMID: 33644969 PMCID: PMC9292914 DOI: 10.1002/pmrj.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Former American style football players (ASF players) have recognized health concerns associated with prior sport participation. It remains unknown whether categorizations of current health conditions, referred to in this report as afflictions (conceptually framed as neurocognitive, cardiovascular, cardiometabolic, sleep apnea, and chronic pain) are associated with physical and mental function. OBJECTIVE To evaluate the association of afflictions to physical and mental function. It was hypothesized that former National Football League players with any affliction would have worse function compared to unafflicted participants. It was anticipated that multiple afflictions would result in cumulative loss of function. DESIGN Cross-sectional retrospective design. SETTING Academic medical multisite hospital system. PARTICIPANTS A total of 3913 of 15,611 former ASF players who played professionally from 1960 to 2019 (response rate 25%). Assessment of Risk Factors Self-report survey. MAIN OUTCOME MEASURES Each participant completed the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale and Physical Function questionnaires. Responses were used to generate two physical function and one mental function subscale scores. Raw scores were converted to T-scores categorized as impaired (T-score < 40) or unimpaired (T-score ≥ 40). Primary analyses measured the association of affliction to function (impaired or unimpaired). RESULTS After adjusting for confounders (age, race, position, number of seasons, age of first exposure to football, alcohol use, smoking history, and current body mass index), each affliction was associated with reduced physical function on the Global physical function subscale (risk ratio [RR] = 1.23-2.45, all P < .005), physical function scale (RR = 1.24-2.75, all P < .01), and mental function scale (RR = 1.34-2.87, all P < .001), except that cardiovascular affliction was not associated with mental function (RR = 1.15, P = .15). The lowest functional measures were observed in those afflicted by chronic pain. Cumulative afflictions were associated with worse function. CONCLUSIONS Afflictions are associated with cumulative reduction of function. Research evaluating how afflictions interact may help elucidate mechanisms for illness and develop interventions to optimize function.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Elaine Coughlan-Gifford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.,Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Camí de Can Ruti, Barcelona, Spain
| | - Lee M Nadler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Frank E Speizer
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Herman A Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
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30
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Takeuchi T, Kitamura Y, Ishizuka S, Yamada S, Aono H, Kawahara T, Sobue T. Mortality of Japanese Olympic athletes in 1964 Tokyo Olympic Games. BMJ Open Sport Exerc Med 2021; 7:e000896. [PMID: 33520254 PMCID: PMC7816928 DOI: 10.1136/bmjsem-2020-000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives To compare the mortality of Japanese athletes in the 1964 Tokyo Olympic Games with that of the Japanese population, and to elucidate factors associated with their mortality. Methods We obtained from the Japan Sport Association study subjects’ biographical information, information on lifestyles and medical data. Missing data were obtained from online databases. Standardised mortality ratio (SMR) was calculated to compare athletes’ mortality with the Japanese population. Cox proportional hazards model was applied to estimate the HR for each category of body mass index (BMI), smoking history and handgrip strength. This analysis was limited to male athletes due to the small number of female athletes. Results Among 342 (283 men, 59 women) athletes, deaths were confirmed for 70 (64 men, 6 women) athletes between September 1964 and December 2017. Total person years was 15 974.8, and the SMR was 0.64 (95% CI 0.50 to 0.81). Multivariate analysis performed on 181 male athletes. Mortality was significantly higher for BMI≥25 kg/m2 than for 21–23 kg/m2 (HR: 3.03, 95% CI 1.01 to 9.07). We found no statistically significant associations between smoking history and mortality; the HR (95% CI) for occasional and daily smokers were 0.82 (0.26 to 2.57) and 1.30 (0.55 to 3.03) compared with never smokers. We also found no statistically significant associations between handgrip strength and mortality (P for trend: 0.51). Conclusion Japanese athletes in the 1964 Tokyo Olympic Games lived longer than the Japanese population. BMI≥25 kg/m2 was associated with higher mortality, but smoking history and handgrip strength were not associated with mortality.
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Affiliation(s)
- Taro Takeuchi
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuri Kitamura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Soya Ishizuka
- Sport Sciences Laboratory, Japan Sport Association, Shinjuku-ku, Japan
| | - Sachiko Yamada
- Sport Sciences Laboratory, Japan Sport Association, Shinjuku-ku, Japan
| | - Hiroshi Aono
- Sport Sciences Laboratory, Japan Sport Association, Shinjuku-ku, Japan
| | - Takashi Kawahara
- Sport Medicine and Science Research Committee, Japan Sport Association, Shinjuku-ku, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Runacres A, Mackintosh KA, McNarry MA. Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes. Sports Med 2021; 51:289-301. [PMID: 33368029 PMCID: PMC7846545 DOI: 10.1007/s40279-020-01379-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Exercise is widely accepted to improve health, reducing the risk of premature mortality, cardiovascular disease (CVD) and cancer. However, several epidemiological studies suggest that the exercise-longevity relationship may be 'J' shaped; with elite athlete's likely training above these intensity and volume thresholds. Therefore, the aim of this meta-analysis was to examine this relationship in former elite athletes. METHODS 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 and 24 were included in the systematic review and meta-analysis, respectively. Athletes were split into three groups depending on primary sport: Endurance (END), Mixed/Team, or power (POW). Standard mortality ratio's (SMR) and standard proportionate mortality ratio (SPMR) were obtained, or calculated, and combined for the meta-analysis. RESULTS Athletes lived significantly longer than the general population (male SMR 0.69 [95% CI 0.61-0.78]; female SMR 0.51 [95% CI 0.40-0.65]; both p < 0.01). There was no survival benefit for male POW athletes compared to the general population (SMR 1.04 [95% CI 0.91-1.12]). Although male athlete's CVD (SMR 0.73 [95% CI 0.62-0.85]) and cancer mortality (SMR 0.75 [95% CI 0.63-0.89]), were significantly reduced compared to the general population, there was no risk-reduction for POW athletes CVD mortality (SMR 1.10 [0.86-1.40]) or END athletes cancer mortality (SMR 0.73 [0.50-1.07]). There was insufficient data to calculate female sport-specific SMR's. DISCUSSION Overall, athletes live longer and have a reduced incidence of both CVD and cancer mortality compared to the general population, refuting the 'J' shape hypothesis. However, different health risks may be apparent according to sports classification, and between sexes, warranting further investigation. Trial registration PROSPERO (registration number: CRD42019130688).
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Affiliation(s)
- Adam Runacres
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK.
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
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Iverson GL, Gardner AJ. Risk of Misdiagnosing Chronic Traumatic Encephalopathy in Men With Depression. J Neuropsychiatry Clin Neurosci 2020; 32:139-146. [PMID: 31587629 DOI: 10.1176/appi.neuropsych.19010021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In recent years, it has been proposed that depression represents one clinical subtype of chronic traumatic encephalopathy (CTE). This is the first study to examine the specificity of the research criteria for the clinical diagnosis of CTE in men with depression from the general population. METHODS Data from the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were used for this study. Men diagnosed as having a major depressive episode in the past 30 days were included (N=101; mean age=39.4 years, SD=12.9, range=18-71). They were deemed to meet research criteriafor CTE if they presented with the purported supportive clinical features of CTE (e.g., impulsivity and substance abuse, anxiety, apathy, suicidality, and headache). RESULTS Approximately half of the sample (52.5%) met the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one accepts the delayed-onset criterion as being present, meaning that the men in the sample were presenting with depression years after retirement from sports or the military, then 83.2% of this sample would meet the research criteria for diagnosis. CONCLUSIONS The clinical problems attributed to CTE, such as depression, suicidality, anxiety, anger control problems, and headaches, co-occurred in this sample of men with depression from the general population-illustrating that these problems are not specific or unique to CTE. More research is needed to determine whether depression is, in fact, a clinical subtype of CTE.
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Affiliation(s)
- Grant L Iverson
- The Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston (Iverson); Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston (Iverson); the Sports Concussion Program, MassGeneral Hospital for Children, Boston (Iverson); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston (Iverson); the Sports Concussion Program, Hunter New England Local Health District, New South Wales, Australia (Gardner); and the Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia (Gardner)
| | - Andrew J Gardner
- The Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston (Iverson); Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston (Iverson); the Sports Concussion Program, MassGeneral Hospital for Children, Boston (Iverson); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston (Iverson); the Sports Concussion Program, Hunter New England Local Health District, New South Wales, Australia (Gardner); and the Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia (Gardner)
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Ehrlich J, Kmush B, Walia B, Sanders S. Mortality risk factors among National Football League players: An analysis using player career data. F1000Res 2020; 8:2022. [PMID: 32789001 PMCID: PMC7406953 DOI: 10.12688/f1000research.21235.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/05/2022] Open
Abstract
In general, National Football League (NFL) players tend to live longer than the general population. However, little information exists about the long-term mortality risk in this population. Frequent, yet mild, head trauma may be associated with early mortality in this group of elite athletes. Therefore, career playing statistics can be used as a proxy for frequent head trauma. Using data from Pro Football Reference, we analyzed the association between age-at-death, position, and NFL seasons-played among 6,408 NFL players that were deceased as of July 1, 2018. The linear regression model allowing for a healthy worker effect demonstrated the best fit statistics (F-statistic = 9.95, p-value = 0.0016). The overall association of age-at-death and seasons-played is positive beginning at the 10.75 and 10.64 seasons-played point in our two models that feature seasons-played and seasons-played squared as explanatory variables. Previous research that does not account for this survivorship bias/healthy worker effect may not adequately describe mortality risk among NFL players.
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Affiliation(s)
- Justin Ehrlich
- Sport Analytics, Syracuse University, Syracuse, NY, 13244, USA
| | - Brittany Kmush
- Public Health, Syracuse University, Syracuse, NY, 13244, USA
| | - Bhavneet Walia
- Public Health, Syracuse University, Syracuse, NY, 13244, USA
| | - Shane Sanders
- Sport Analytics, Syracuse University, Syracuse, NY, 13244, USA
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Iverson GL. Retired National Football League Players are Not at Greater Risk for Suicide. Arch Clin Neuropsychol 2020; 35:332-341. [PMID: 31665203 PMCID: PMC7297280 DOI: 10.1093/arclin/acz023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Some researchers have claimed that former National Football League (NFL) players are at increased risk for suicide as a clinical feature of chronic traumatic encephalopathy (CTE). This review examines the literature on risk for suicide in former professional football players, and the association between suicide and CTE. Method A narrative review of the literature published between 1928 and 2018. Results Between 1928 and 2009, suicide was not considered to be a clinical feature of CTE in the literature. The best available evidence from epidemiological studies suggests that former NFL football players are at lesser risk for suicide, not greater risk, compared to men in the general population. However, surveys have revealed that a substantial minority of former NFL players have depression and other mental health problems, chronic pain and opioid use is relatively common, and those with depression and chronic pain also have greater life stress and financial difficulties. That minority would be at increased risk for suicidal thoughts and behaviors. Conclusions Researchers and clinicians are encouraged to be cautious and circumspect when considering the clinical presentation of former athletes, and to not assume that depression and suicidality are caused by specific types of neuropathology. This represents a reductionistic and Procrustean view. Some former football players have mental health problems, but it should not be assumed uncritically that the underlying cause is an inexorably progressive neurodegenerative disease. Providing evidence-informed and evidence-supported treatments for depression and suicidality might reduce suffering and improve their functioning.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sport Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
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Abstract
With age, the presence of multiple neuropathologies in a single individual becomes increasingly common. Given that traumatic brain injury and the repetitive head impacts (RHIs) that occur in contact sports have been associated with the development of many neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), Alzheimer's disease, Lewy body disease, and amyotrophic lateral sclerosis, it is becoming critical to understand the relationship and interactions between these pathologies. In fact, comorbid pathology is common in CTE and likely influenced by both age and the severity and type of exposure to RHI as well as underlying genetic predisposition. Here, we review the major comorbid pathologies seen with CTE and in former contact sports athletes and discuss what is known about the associations between RHI, age, and the development of neuropathologies. In addition, we examine the distinction between CTE and age-related pathology including primary age-related tauopathy and age-related tau astrogliopathy.
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Affiliation(s)
- Thor D. Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts,Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts,Departments of Research and Pathology & Laboratory Medicine, VA Boston Healthcare System, Boston, Massachusetts,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - John F. Crary
- Department of Pathology, Neuropathology Brain Bank & Research Core, Ronald M. Loeb Center for Alzheimer’s Disease, Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York
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Kim JH, Hollowed C, Liu C, Al-Badri A, Alkhoder A, Dommisse M, Gowani Z, Miller A, Nguyen P, Prabakaran G, Sidoti A, Wehbe M, Galante A, Gilson CL, Clark C, Ko YA, Quyyumi AA, Baggish AL. Weight Gain, Hypertension, and the Emergence of a Maladaptive Cardiovascular Phenotype Among US Football Players. JAMA Cardiol 2020; 4:1221-1229. [PMID: 31617867 DOI: 10.1001/jamacardio.2019.3909] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Former US football athletes are at increased risk of cardiovascular (CV) morbidity and mortality compared with the general population and other professional athletes. However, responsible maladaptive CV phenotypes have not been fully characterized. Objective To address the emergence and progression of multiple independent factors associated with CV risk across serial years of collegiate US football participation. Design, Setting, and Participants Collegiate US football athletes from 2 National Collegiate Athletic Association Division I programs were recruited as freshmen between June 2014 and June 2017 and analyzed at multiple points throughout 3 complete years of collegiate US football participation (until January 2019). Excluded athletes were those who did not complete any season of US football training because of injury, illness, or leaving the team. Factors associated with CV risk assessed clinically, by transthoracic echocardiography, and by vascular applanation tonometry were recorded. Exposures The exposure of interest was seasonal US football exposure, including training, competition, and the training environment. Main Outcomes and Measures Primary outcome measures were left ventricular mass index and geometry (cardiac structure), early diastolic myocardial relaxation velocity (E'; diastolic function), and pulse-wave velocity (arterial stiffness). Results Of 186 individuals recruited as freshmen, 126 athletes were included in analyzed data. Collegiate US football athletes (62 white individuals [49%]; 63 black individuals [50%]; 77 nonlinemen [61%]; 49 linemen [39%]; 126 male individuals [100%]) weighed a mean (SD) of 101.1 (21.0) kg, with a mean systolic blood pressure of 129.1 (11.6) mm Hg at baseline of the freshman season. Adjusting for race, height, and player position, there were significant increases in weight (mean [SE] Δ, 4.74 [0.6] kg; P < .001), systolic blood pressure (mean [SE] Δ, 11.6 [1.6] mm Hg; P < .001), and pulse-wave velocity (mean [SE] Δ, 0.24 [0.09] m/s; P = .007), and significant declines in E' (mean [SE] Δ, -1.7 [0.3] cm/s; P < .001) across 3 years of US football participation. Weight gain was associated with both arterial stiffening (increased pulse-wave velocity, β = 0.01 [SE, 0.004]; P = .003) and the development of concentric left ventricular hypertrophy (odds ratio, 1.09 [95% CI, 1.05-1.14]; P < .001); increased systolic blood pressure was also associated with arterial stiffening (β = 0.01 [SE, 0.003]; P = .007) and the development of concentric left ventricular hypertrophy (odds ratio, 1.04 [95% CI, 1.01-1.07]; P = .02). Conclusions and Relevance Collegiate US football athletes who gain weight and develop increased systolic blood pressure levels are at risk for the development of a pathologic CV phenotype characterized by concentric left ventricular hypertrophy, arterial stiffening, and reduced left ventricular diastolic function. Future work aimed at optimizing CV health in this population, who are young but uniquely at risk, is warranted.
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Affiliation(s)
- Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia.,Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Casey Hollowed
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Chang Liu
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ahmed Al-Badri
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Morgan Dommisse
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Zaina Gowani
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arthur Miller
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Parker Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ganesh Prabakaran
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arianna Sidoti
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Mohamad Wehbe
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Carla L Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, South Carolina
| | - Yi-An Ko
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
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Tso J, Hollowed C, Liu C, Alkhoder A, Dommisse M, Gowani Z, Miller A, Nguyen G, Nguyen P, Prabakaran G, Wehbe M, Galante A, Gilson CR, Clark C, Marshall T, Patterson G, Quyyumi AA, Baggish AL, Kim JH. Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Risk in American Football. Med Sci Sports Exerc 2020; 52:2522-2528. [PMID: 32520869 DOI: 10.1249/mss.0000000000002404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse cardiovascular outcomes and reportedly overused in American-style football (ASF). However, assessment of ASF NSAID use in the context of cardiovascular risk has not been performed. We sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes. METHODS A total of 226 ASF athletes, 60 endurance athletes, and 63 nonathletic controls were studied pre- and postseason with echocardiography, vascular applanation tonometry, and clinical data assessment. Qualitative NSAID use throughout the season was recorded at postseason. RESULTS ASF athletes gained weight (Δ0.86 ± 3.9 kg, P < 0.001), increased systolic blood pressure (SBP, Δ3.1 ± 12 mm Hg, P < 0.001) and pulse wave velocity (Δ0.2 ± 0.6 m·s, P < 0.001), and decreased E' (Δ-1.4 ± 2.8 cm·s, P < 0.001) across one athletic season. Seventy-seven percent (n = 173) of ASF athletes reported that sport-specific NSAID use began in middle school. ASF NSAID use was more frequent with "weekly" (n = 42.19%) and "daily" (n = 32.14%) use compared with endurance athletes (P < 0.001) and controls (P = 0.02). ASF NSAID use increased in parallel with postseason SBP and weights. "Daily" ASF NSAID users demonstrated the highest postseason SBP (137 ± 13 vs 128 ± 13 mm Hg, P = 0.002) and weight (109.0 ± 18.6 vs 95.8 ± 20.5 kg, P = 0.002) compared with "never/rare" users. Adjusting for player position, SBP, pulse wave velocity, and E', increased weight (odds ratio = 1.04, 95% confidence interval = 1.0-1.08, P = 0.037) was associated with more frequent NSAID use. CONCLUSIONS Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in ASF athletes. NSAID use frequency should be considered when risk stratifying high-risk ASF athletes.
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Affiliation(s)
- Jason Tso
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Casey Hollowed
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Chang Liu
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Morgan Dommisse
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Zaina Gowani
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Arthur Miller
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Grace Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Parker Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Ganesh Prabakaran
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Mohamad Wehbe
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta, GA
| | - Carla R Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta, GA
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, SC
| | | | | | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
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Kmush BL, Mackowski M, Ehrlich J, Walia B, Owora A, Sanders S. Association of Professional Football Cumulative Head Impact Index Scores With All-Cause Mortality Among National Football League Players. JAMA Netw Open 2020; 3:e204442. [PMID: 32391891 PMCID: PMC7215260 DOI: 10.1001/jamanetworkopen.2020.4442] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/05/2020] [Indexed: 01/16/2023] Open
Abstract
Importance Long-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada. Objective To assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality. Design, Setting, and Participants This retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference. Exposures The main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies. Main Outcomes and Measures Demographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height. Results Among 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased. Conclusions and Relevance The findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.
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Affiliation(s)
- Brittany L. Kmush
- Department of Public Health, Syracuse University, Syracuse, New York
| | | | - Justin Ehrlich
- Department of Sport Analytics, Syracuse University, Syracuse, New York
| | - Bhavneet Walia
- Department of Public Health, Syracuse University, Syracuse, New York
| | - Arthur Owora
- Department of Public Health, Syracuse University, Syracuse, New York
- Currently with Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington
| | - Shane Sanders
- Department of Sport Analytics, Syracuse University, Syracuse, New York
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Wolfson DI, Kuhn AW, Kerr ZY, Brett BL, Yengo-Kahn AM, Solomon GS, Zuckerman SL. Chronic traumatic encephalopathy research viewed in the public domain: What makes headlines? Brain Inj 2020; 34:528-534. [PMID: 32064946 DOI: 10.1080/02699052.2020.1725843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To determine chronic traumatic encephalopathy (CTE)-related publication characteristics associated with higher Altmetric scores.Methods: A systematic review of the CTE literature was conducted using PubMed. Publications were coded for: journal impact factor (JIF); publication type (primary versus non-primary data collection); discussion of American football; contact sport-CTE association conclusion (yes versus no/neutral); and Altmetric score. Multivariable ordinal logistic regression identified predictors of higher Altmetric scores.Results: Most of the 270 CTE-related publications did not include primary data collection (60%). The median Altmetric score was 12 (range = 0-3745). Higher Altmetric scores were associated with primary data collection [Odds ratio (OR)Adjusted = 2.29; 95% confidence interval (CI) = 1.35-3.89] and discussing American football (ORAdjusted = 2.11; 95%CI = 1.24-3.59). Among publications concluding contact sport-CTE associations, higher Altmetric scores were associated with higher JIF (3-point-JIF-increase ORAdjusted = 2.11; 95%CI = 1.24-3.59); however, the association of higher Altmetric scores with higher JIF was not found among neutral publications or those concluding no contact sport-CTE associations (3-point-JIF-increase ORAdjusted = 1.07; 95%CI = 0.94-1.22).Conclusions: Most CTE-related publications (60%) did not involve primary data collection. Publication characteristics such as higher JIF and concluding contact sport-CTE associations were associated with higher Altmetric scores. It is important for the academic community to consider strategies to counter publication and promotion bias in the presentation of CTE literature.
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Affiliation(s)
- Daniel I Wolfson
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew W Kuhn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Health and Safety Department, National Football League, New York, NY, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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LA Fountaine MF, Hohn AN, Testa AJ, Weir JP. Attenuation of Spontaneous Baroreceptor Sensitivity after Concussion. Med Sci Sports Exerc 2019; 51:792-797. [PMID: 30407273 DOI: 10.1249/mss.0000000000001833] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cardiovascular autonomic nervous system (CV-ANS) function is negatively impacted after concussion. The arterial baroreflex buffers pressor and depressor challenges through efferent modulation of cardiac chronotropism and inotropism, and peripheral vascular tone. Baroreceptor sensitivity (BRS) reflects the capacity of the CV-ANS to accommodate dynamic metabolic demands in the periphery. The impact of concussion on BRS has yet to be defined. METHODS Cardiovascular autonomic nervous system assessment (e.g., electrocardiogram and beat-to-beat systolic blood pressure [SBP]) was performed the seated upright position at rest within 48 h (V1) of concussion and 1 wk later (V2) in 10 intercollegiate male athletes with concussion and 10 noninjured male athletes. Changes in HR, SBP, high- and low-frequency HR variabilities (HF-HRV and LF-HRV, respectively), LF-SBP variability and BRS for increasing (BRSn-Up) and decreasing (BRSn-Dn) SBP excursions, and overall BRS (BRSn-Avg) were assessed for differences at V1 and V2. RESULTS The concussion (age, 20 ± 1 yr; height, 1.79 ± 0.14 m; weight, 83 ± 10 kg) and control (age, 20 ± 1 yr; height, 1.78 ± 0.10 m; weight, 79 ± 13 kg) groups were matched for demographics. Concussed athletes had a significantly reduced BRSn-Up, BRSn-Dn, and BRSn-Avg compared with controls at V1 or V2; these changes occurred without differences in conventional markers of CV-ANS function (e.g., HF-HRV, LF-HRV, LF-SBP), HR, or SBP at either visit. CONCLUSIONS Reduced BRS is a postconcussive consequence of CV-ANS dysfunction during the first postinjury week. Because SBP was similar between groups, it may be speculated that reduced BRS was not afferent in origin, but represents a postinjury consequence of the central nervous system after injury.
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Affiliation(s)
- Michael F LA Fountaine
- School of Health and Medical Sciences, Seton Hall University, South Orange, NJ.,The Institute for Advanced Study of Rehabilitation and Sports Science, Seton Hall University, South Orange, NJ.,Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ
| | - Asante N Hohn
- School of Health and Medical Sciences, Seton Hall University, South Orange, NJ
| | - Anthony J Testa
- Center for Sports Medicine, Seton Hall University, South Orange, NJ
| | - Joseph P Weir
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, KS
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Ehrlich J, Kmush B, Walia B, Sanders S. Mortality risk factors among National Football League players: An analysis using player career data. F1000Res 2019; 8:2022. [PMID: 32789001 PMCID: PMC7406953 DOI: 10.12688/f1000research.21235.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/01/2023] Open
Abstract
In general, National Football League (NFL) players tend to live longer than the general population. However, little information exists about the long-term mortality risk in this population. Frequent, yet mild, head trauma may be associated with early mortality in this group of elite athletes. Therefore, career playing statistics can be used as a proxy for frequent head trauma. Using data from Pro Football Reference, we analyzed the association between age-at-death, position, and NFL seasons-played among 6,408 NFL players that were deceased as of July 1, 2018. The linear regression model allowing for a healthy worker effect demonstrated the best fit statistics (F-statistic = 9.95, p-value = 0.0016). The overall association of age-at-death and seasons-played is positive beginning at the 10.75 and 10.64 seasons-played point in our two models that feature seasons-played and seasons-played squared as explanatory variables. Previous research that does not account for this survivorship bias/healthy worker effect may not adequately describe mortality risk among NFL players.
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Affiliation(s)
- Justin Ehrlich
- Sport Analytics, Syracuse University, Syracuse, NY, 13244, USA
| | - Brittany Kmush
- Public Health, Syracuse University, Syracuse, NY, 13244, USA
| | - Bhavneet Walia
- Public Health, Syracuse University, Syracuse, NY, 13244, USA
| | - Shane Sanders
- Sport Analytics, Syracuse University, Syracuse, NY, 13244, USA
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Alosco ML, Stein TD, Tripodis Y, Chua AS, Kowall NW, Huber BR, Goldstein LE, Cantu RC, Katz DI, Palmisano JN, Martin B, Cherry JD, Mahar I, Killiany RJ, McClean MD, Au R, Alvarez V, Stern RA, Mez J, McKee AC. Association of White Matter Rarefaction, Arteriolosclerosis, and Tau With Dementia in Chronic Traumatic Encephalopathy. JAMA Neurol 2019; 76:1298-1308. [PMID: 31380975 PMCID: PMC6686769 DOI: 10.1001/jamaneurol.2019.2244] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with cognitive and neuropsychiatric disturbances that can progress to dementia. Pathways to dementia in CTE are unclear and likely involve tau and nontau pathologic conditions. OBJECTIVE To investigate the association of white matter rarefaction and cerebrovascular disease with dementia in deceased men older than 40 years who played football and had CTE. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involves analyses of data from the ongoing Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study, which is conducted via and included brain donors from the Veterans Affairs-Boston University-Concussion Legacy Foundation brain bank between 2008 and 2017. An original sample of 224 men who had played football and were neuropathologically diagnosed with CTE was reduced after exclusion of those younger than 40 years and those missing data. EXPOSURES The number of years of football play as a proxy for repetitive head impacts. MAIN OUTCOMES AND MEASURES Neuropathological assessment of white matter rarefaction and arteriolosclerosis severity (on a scale of 0-3, where 3 is severe); number of infarcts, microinfarcts, and microbleeds; and phosphorylated tau accumulation determined by CTE stage and semiquantitative rating of dorsolateral frontal cortex (DLFC) neurofibrillary tangles (NFTs) (none or mild vs moderate or severe). Informant-based retrospective clinical interviews determined dementia diagnoses via diagnostic consensus conferences. RESULTS A total of 180 men were included. The mean (SD) age of the sample at death was 67.9 (12.7) years. Of 180, 120 [66.7%]) were found to have had dementia prior to death. Moderate to severe white matter rarefaction (84 of 180 [46.6%]) and arteriolosclerosis (85 of 180 [47.2%]) were common; infarcts, microinfarcts, and microbleeds were not. A simultaneous equations regression model controlling for age and race showed that more years of play was associated with more severe white matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and greater phosphorylated tau accumulation (DLFC NFTs: β, 0.15 [95% CI, 0.004-0.30]; P = .04; CTE stage: β, 0.27 [95% CI, 0.14-0.41]; P < .001). White matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and DLFC NFTs (β, 0.16 [95% CI, 0.03-0.28]; P = .01) were associated with dementia. Arteriolosclerosis and years of play were not associated, but arteriolosclerosis was independently associated with dementia (β, 0.21 [95% CI, 0.07-0.35]; P = .003). CONCLUSIONS AND RELEVANCE Among older men who had played football and had CTE, more years of football play were associated with more severe white matter rarefaction and greater DLFC NFT burden. White matter rarefaction, arteriolosclerosis, and DLFC NFTs were independently associated with dementia. Dementia in CTE is likely a result of neuropathologic changes, including white matter rarefaction and phosphorylated tau, associated with repetitive head impact and pathologic changes not associated with head trauma, such as arteriolosclerosis.
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Affiliation(s)
- Michael L. Alosco
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Alicia S. Chua
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Neil W. Kowall
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Bertrand Russell Huber
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare, Boston, Massachusetts
| | - Lee E. Goldstein
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Electrical & Computer Engineering, Boston University College of Engineering, Boston, Massachusetts
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts
| | - Robert C. Cantu
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
- Concussion Legacy Foundation, Boston, Massachusetts
- Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts
| | - Douglas I. Katz
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Joseph N. Palmisano
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Brett Martin
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan D. Cherry
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Ian Mahar
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ronald J. Killiany
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Center for Biomedical Imaging, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rhoda Au
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Victor Alvarez
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Robert A. Stern
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Center and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
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Bohr AD, Boardman JD, McQueen MB. Association of Adolescent Sport Participation With Cognition and Depressive Symptoms in Early Adulthood. Orthop J Sports Med 2019; 7:2325967119868658. [PMID: 31598525 PMCID: PMC6764154 DOI: 10.1177/2325967119868658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Recent studies have associated sport-related concussion with depression and
impaired cognitive ability later in life in former professional football
players. However, population studies with two 1950s-era cohorts did not find
an association between high school football participation and impaired
cognition or depressive symptoms in late adulthood. Purpose/Hypothesis: This study assessed whether actual/intended participation in contact sports
during adolescence had an adverse effect on participants’ cognition or
depressive symptoms in early adulthood. We hypothesized that there would not
be an association. Study Design: Cohort study; Level of evidence, 2. Methods: This study used a subsample (n = 10,951) from the National Longitudinal Study
of Adolescent to Adult Health (Add Health), a nationally (United States)
representative prospective cohort study following participants through 4
waves of data collection from 1994 through 2008. Participants were
categorized as actual/intended participation in no sports, noncontact sports
only, and contact sports. We constructed 6 multivariate and logistic
regression models predicting word recall, number recall, modified Center for
Epidemiologic Studies Depression Scale, depression diagnosis, suicide
ideation, and suicide attempts at wave IV as a function of sport
participation during wave I. Sport participation was treated as a factor
with the referent category noncontact sports. This analysis was repeated on
a males-only sample (n = 5008). In the males-only analysis, participants
were classified as actual/intended participation in no sports, noncontact
sports, contact sports other than American football, and American football.
The referent category remained noncontact sports. Results: Intention to participate in contact sports was not significantly associated
with any of the outcomes in the full-sample analysis. Intention to
participate in football was significantly associated with a reduced odds of
depression diagnosis in adulthood (odds ratio, 0.70; P =
.02) when compared with noncontact sports participation in the males-only
sample. Football was not significantly associated with impaired cognitive
ability, increased depressive symptoms, or increased suicide ideation. Conclusion: Actual/intended participation in contact sports during adolescence did not
adversely affect Add Health participants’ cognition or depressive symptoms
in young adulthood.
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Affiliation(s)
- Adam D Bohr
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jason D Boardman
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Matthew B McQueen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
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Zuckerman SL, Brett BL, Jeckell A, Yengo-Kahn AM, Solomon GS. Chronic Traumatic Encephalopathy and Neurodegeneration in Contact Sports and American Football. J Alzheimers Dis 2019; 66:37-55. [PMID: 30223396 DOI: 10.3233/jad-180218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by the presence of abnormally phosphorylated tau protein in the depths of one or more cortical sulci. Controversy over the risk of CTE and neurologic disorders later in life among contact sport athletes has taken hold in the public spotlight, most notably in American football. Players, parents, coaches, and legislators have taken action based on the commonly held notion that contact sports invariably lead to neurodegenerative disorders. However, to fully understand the science behind this assumed association, a critical appraisal of the evidence is warranted. With regards to CTE in sports, the objectives of the current report are to: 1) describe the history of CTE, 2) review current CTE definitions, 3) critically evaluate the empiric data, divided into all contact sports and exclusively American football, and 4) summarize notable themes for future research.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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47
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Bosch TA, Carbuhn AF, Stanforth PR, Oliver JM, Keller KA, Dengel DR. Body Composition and Bone Mineral Density of Division 1 Collegiate Football Players: A Consortium of College Athlete Research Study. J Strength Cond Res 2019; 33:1339-1346. [PMID: 28277428 DOI: 10.1519/jsc.0000000000001888] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Bosch, TA, Carbuhn, AF, Stanforth, PR, Oliver, JM, Keller, KA, and Dengel, DR. Body composition and bone mineral density of Division 1 collegiate football players: a consortium of college athlete research study. J Strength Cond Res 33(5): 1339-1346, 2019-The purpose of this study was to generate normative data for total and regional body composition in Division 1 collegiate football players using dual-energy x-ray absorptiometry (DXA) and examine positional differences in total and regional measurements. Data were used from the Consortium of College Athlete Research (C-CAR) group. Four hundred sixty-seven players were included in this study. Height, body mass, total and regional fat mass, lean mass, and bone mineral density were measured in each athlete in the preseason (June-August). Players were categorized by their offensive or defensive position for comparisons. Linemen tended to have the higher fat and lean mass measures (p ≤ 0.05 for all) compared with other positions. Positions that mirror each other (e.g. linemen) had similar body composition and body ratios. All positions were classified as overweight or obese based on body mass index (BMI) (>25 kg·m), yet other than offensive and defensive linemen, all positions had healthy percent body fat (13-20%) and low visceral fat mass (<500 g). The data presented here provide normative positional data for total and regional fat mass, lean mass, and bone density in Division 1 collegiate football players. Player position had a significant effect on body composition measures and is likely associated with on-field positional requirements. From a player's health perspective, although all positions had relatively high BMI values, most positions had relatively low body fat and visceral fat, which is important for the health of players during and after their playing career. The increased accuracy and reliability of DXA provides greater information, regarding positional differences in college football players compared with other methods.
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Affiliation(s)
- Tyler A Bosch
- College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | - Aaron F Carbuhn
- Kansas Athletics, Inc, University of Kansas, Lawrence, Kansas
| | - Philip R Stanforth
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas
| | - Jonathan M Oliver
- Department of Kinesiology, Texas Christian University, Fort Worth, Texas
| | - Kathryn A Keller
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
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48
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Van Ommeren R, Hazrati LN. Pathological Assessment of Chronic Traumatic Encephalopathy: Review of Concepts and Methodology. Acad Forensic Pathol 2019; 8:555-564. [PMID: 31240059 DOI: 10.1177/1925362118797729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/01/2018] [Indexed: 11/17/2022]
Abstract
Chronic traumatic encephalopathy (CTE) has become a topic of considerable interest in recent years, with wide-ranging implications for athletes, military members, and other groups exposed to frequent concussive or subconcussive head trauma. The condition has been subject to intensive neuropathological characterization by various groups, with assessment methodologies and staging criteria proposed. Clinical characterization of symptoms has also been performed, but has not yet been definitively formalized. While efforts are underway to develop in vivo markers of tauopathies including CTE, these remain experimental at this time, necessitating postmortem analysis for definitive diagnosis. The putative link between development of cognitive and behavioral dysfunction and neuropathological findings of CTE may prompt requests for postmortem assessment in the forensic setting. Here, we review current concepts in CTE research, describe histopathological findings in CTE, and describe methodologies for pathological assessment of CTE which may be useful to the forensic pathologist.
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49
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Randolph C. Chronic traumatic encephalopathy is not a real disease. Arch Clin Neuropsychol 2019; 33:644-648. [PMID: 30169776 DOI: 10.1093/arclin/acy063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/16/2018] [Indexed: 12/14/2022] Open
Abstract
There was a long-lasting debate during the first half of the 1900s about whether boxers suffered from a condition called "dementia pugilistica". This included arguments as to whether there was such a distinct clinical condition, whether it was static or progressive, and whether boxers were actually at any increased risk of any neurological issues at all. The debate was never resolved, but was resuscitated in 2005 with the speculation that a similar condition, dubbed "chronic traumatic encephalopathy (CTE)" existed in retired National Football League (NFL) players. A specific pattern of p-tau deposition has been identified in the brains of NFL retirees, and also identifiable in the brains of at least a percentage of individuals exposed to contact sports in general. Advocates of CTE as a disease describe it as presenting with behavioral disturbance, increased suicidality and neurodegeneration leading to dementia. The evidence to date, however, does not rise to the level of a verifiable disease, and remains at the level of case report. To assume that CTE pathology represents a neurodegenerative disease flies in the face of a number of facts, including that traumatic brain injury does not cause neurodegeneration, protein deposits in the brain are a poor predictor of behavioral symptoms, p-tau is not necessarily toxic or self-propagating, and retired NFL players are actually much physically and mentally healthier than men of their demographic background. They have an all-cause mortality rate that is 50% of that expected, and a suicide rate that is 40% of that expected. The most parsimonious explanation of the evidence to date is that repetitive head trauma may result in p-tau deposition, but that this isoform of p-tau is inert and has no toxic or self-propagating effects.
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50
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Niebauer J, Börjesson M, Carre F, Caselli S, Palatini P, Quattrini F, Serratosa L, Adami PE, Biffi A, Pressler A, Rasmusen HK, Schmied C, van Buuren F, Panhuyzen-Goedkoop N, Solberg EE, Halle M, Gerche AL, Papadakis M, Sharma S, Pelliccia A. Brief recommendations for participation in competitive sports of athletes with arterial hypertension: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:1549-1555. [DOI: 10.1177/2047487319852807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Owing to its undisputed multitude of beneficial effects, European Society of Cardiology guidelines advocate regular physical activity as a class IA recommendation for the prevention and treatment of cardiovascular disease. Nonetheless, competitive athletes with arterial hypertension may be exposed to an increased risk of cardiovascular events. Guidance to physicians will be given in this summary of our recently published recommendations for participation in competitive sports of athletes with arterial hypertension.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martin Halle
- Paracelsus Medical University, Salzburg, Austria
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