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Lepage C, Muehlmann M, Tripodis Y, Hufschmidt J, Stamm J, Green K, Wrobel P, Schultz V, Weir I, Alosco ML, Baugh CM, Fritts NG, Martin BM, Chaisson C, Coleman MJ, Lin AP, Pasternak O, Makris N, Stern RA, Shenton ME, Koerte IK. Limbic system structure volumes and associated neurocognitive functioning in former NFL players. Brain Imaging Behav 2019; 13:725-734. [PMID: 29779184 PMCID: PMC6854905 DOI: 10.1007/s11682-018-9895-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts. CTE has been linked to disruptions in cognition, mood, and behavior. Unfortunately, the diagnosis of CTE can only be made post-mortem. Neuropathological evidence suggests limbic structures may provide an opportunity to characterize CTE in the living. Using 3 T magnetic resonance imaging, we compared select limbic brain regional volumes - the amygdala, hippocampus, and cingulate gyrus - between symptomatic former National Football League (NFL) players (n = 86) and controls (n = 22). Moreover, within the group of former NFL players, we examined the relationship between those limbic structures and neurobehavioral functioning (n = 75). The former NFL group comprised eighty-six men (mean age = 55.2 ± 8.0 years) with at least 12 years of organized football experience, at least 2 years of active participation in the NFL, and self-reported declines in cognition, mood, and behavior within the last 6 months. The control group consisted of men (mean age = 57.0 ± 6.6 years) with no history of contact-sport involvement or traumatic brain injury. All control participants provided neurobehavioral data. Compared to controls, former NFL players exhibited reduced volumes of the amygdala, hippocampus, and cingulate gyrus. Within the NFL group, reduced bilateral cingulate gyrus volume was associated with worse attention and psychomotor speed (r = 0.4 (right), r = 0.42 (left); both p < 0.001), while decreased right hippocampal volume was associated with worse visual memory (r = 0.25, p = 0.027). Reduced volumes of limbic system structures in former NFL players are associated with neurocognitive features of CTE. Volume reductions in the amygdala, hippocampus, and cingulate gyrus may be potential biomarkers of neurodegeneration in those at risk for CTE.
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Affiliation(s)
- Christian Lepage
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Marc Muehlmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Yorghos Tripodis
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jakob Hufschmidt
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Julie Stamm
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA
| | - Katie Green
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pawel Wrobel
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Isabelle Weir
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Alosco
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Baugh
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA
| | - Nathan G Fritts
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
| | - Brett M Martin
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Christine Chaisson
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikos Makris
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neural Systems Investigations, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A Stern
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
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Stewart W, Allinson K, Al-Sarraj S, Bachmeier C, Barlow K, Belli A, Burns MP, Carson A, Crawford F, Dams-O'Connor K, Diaz-Arrastia R, Dixon CE, Edlow BL, Ferguson S, Fischl B, Folkerth RD, Gentleman S, Giza CC, Grady MS, Helmy A, Herceg M, Holton JL, Howell D, Hutchinson PJ, Iacono D, Iglesias JE, Ikonomovic MD, Johnson VE, Keene CD, Kofler JK, Koliatsos VE, Lee EB, Levin H, Lifshitz J, Ling H, Loane DJ, Love S, Maas AI, Marklund N, Master CL, McElvenny DM, Meaney DF, Menon DK, Montine TJ, Mouzon B, Mufson EJ, Ojo JO, Prins M, Revesz T, Ritchie CW, Smith C, Sylvester R, Tang CY, Trojanowski JQ, Urankar K, Vink R, Wellington C, Wilde EA, Wilson L, Yeates K, Smith DH. Primum non nocere: a call for balance when reporting on CTE. Lancet Neurol 2019; 18:231-233. [PMID: 30784550 PMCID: PMC6594011 DOI: 10.1016/s1474-4422(19)30020-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Safa Al-Sarraj
- The Institute of Psychiatry Psychology and Neurosciences, King's College London, London, UK
| | - Corbin Bachmeier
- Roskamp Institute, Sarasota, Florida, USA; The Open University, Milton Keynes, UK; Bay Pines VA Healthcare System, Bay Pines, Florida, USA
| | - Karen Barlow
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mark P Burns
- Georgetown University Medical Center, Washington DC, DC, USA
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fiona Crawford
- Roskamp Institute, Sarasota, Florida, USA; The Open University, Milton Keynes, UK; James A Haley Veterans' Hospital, Tampa, FL, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, USA
| | - C Edward Dixon
- Department of Neurological Surgery, Brain Trauma Research Center, University of Pittsburgh, Pittsburgh, PA, USA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Scott Ferguson
- Roskamp Institute, Sarasota, Florida, USA; Roskamp Institute, Sarasota, Florida, USA; James A Haley Veterans' Hospital, Tampa, FL, USA
| | - Bruce Fischl
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Rebecca D Folkerth
- City of New York Office of the Chief Medical Examiner, and New York University School of Medicine, New York NY, USA
| | - Steve Gentleman
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA; Departments of Pediatrics and Neurosurgery, David Geffen School of Medicine and UCLA Mattel Children's Hospital, University of California, Los Angeles, CA, USA
| | - M Sean Grady
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Mark Herceg
- Department of Physical Medicine and Rehabilitation, Phelps Hospital Northwell Health, New York, NY, USA; School of Public Health, New York Medical College, New York, NY, USA
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - David Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Diego Iacono
- Neuropathology Research, Biomedical Research Institute of New Jersey, Cedar Knolls, NJ, USA; Atlantic Neuroscience Institute, Atlantic Health System, Morristown, NJ, USA
| | - Juan E Iglesias
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Milos D Ikonomovic
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victoria E Johnson
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Julia K Kofler
- Department of Pathology, Division of Neuropathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vassilis E Koliatsos
- Departments of Pathology, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Neuropsychiatry Program, Sheppard and Enoch Pratt Hospital, Baltimore, MD, USA
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; University of Arizona College of Medicine Phoenix, Child Health, Phoenix, AZ, USA; Phoenix Veteran Affairs Healthcare System, Phoenix, AZ, USA
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - David J Loane
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA; Shock Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD, USA; School of Biochemistry and Immunology and Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Seth Love
- Dementia Research Group, Institute of Clinical Neurosciences, Medical School, University of Bristol, Bristol, UK
| | - Andrew Ir Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Niklas Marklund
- Skane University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
| | - Christina L Master
- Center for Injury Research and Prevention and Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - David F Meaney
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - David K Menon
- NIHR Global Health Research Group on Neurotrauma, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK; Division of Anaesthesia, Department of Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | | | - Benoit Mouzon
- Roskamp Institute, Sarasota, Florida, USA; The Open University, Milton Keynes, UK; James A Haley Veterans' Hospital, Tampa, FL, USA
| | - Elliott J Mufson
- Barrow Neurological Institute, Departments of Neurobiology and Neurology, Phoenix, AZ, USA
| | - Joseph O Ojo
- Roskamp Institute, Sarasota, Florida, USA; The Open University, Milton Keynes, UK; James A Haley Veterans' Hospital, Tampa, FL, USA
| | - Mayumi Prins
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Colin Smith
- Academic Neuropathology, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard Sylvester
- Homerton University Hospital NHS Trust, National Hospital of Neurology and Neurosurgery, University College London, London, UK
| | - Cheuk Y Tang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA; Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn Urankar
- Dementia Research Group, Institute of Clinical Neurosciences, Medical School, University of Bristol, Bristol, UK
| | - Robert Vink
- Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, International Collaboration on Repair Discoveries, School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; Michael DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Keith Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, AB, Canada
| | - Douglas H Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, USA
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