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Bryant BR, Esagoff AI, Young L, Kosyakova N, Bray MJC, Richey LN, Vohra V, Shan G, Schneider ALC, Peters ME, Bernick CB, Narapareddy BR. Association of Win-Loss Record With Neuropsychiatric Symptoms and Brain Health Among Professional Fighters. J Neuropsychiatry Clin Neurosci 2024; 36:118-124. [PMID: 38258377 DOI: 10.1176/appi.neuropsych.20230108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Repetitive head impacts in professional fighting commonly lead to head injuries. Increased exposure to repetitive head trauma, measured by the number of professional fights and years of fighting, has been associated with slower processing speed and smaller brain volumes. The impact of win-loss outcomes has been investigated in other sports, with several studies suggesting that individuals on losing teams experience more head injuries. Here, the authors hypothesized that fighters with a worse fight record would exhibit poorer brain health outcomes. METHODS The Professional Fighters Brain Health Study examined changes in neuropsychiatric symptoms, regional brain volume, and cognition among professional boxers and mixed martial arts fighters. These data were used to evaluate the relationship between win-loss ratios and brain health outcomes among professional fighters (N=212) by using validated neuropsychiatric symptom and cognitive measures and MRI data. RESULTS Retired fighters with a better record demonstrated more impulsiveness (B=0.21, df=48) and slower processing speed (B=-0.42, df=31). More successful fighters did not perform better than fighters with worse records on any neuropsychiatric or cognitive test. Retired fighters with better fight records had smaller brain volumes in the subcortical gray matter, anterior corpus callosum, left and right hippocampi, left and right amygdala, and left thalamus. More successful active fighters had a smaller left amygdala volume. CONCLUSIONS These findings suggest that among retired fighters, a better fight record was associated with greater impulsiveness, slower processing speed, and smaller brain volume in certain regions. This study shows that even successful fighters experience adverse effects on brain health.
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Affiliation(s)
- Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Aaron I Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Lisa Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Natalia Kosyakova
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Varun Vohra
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Guogen Shan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Andrea L C Schneider
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Charles B Bernick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Bryant, Esagoff, Young, Bray, Richey, Vohra, Peters); Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Kosyakova); Department of Biostatistics, University of Florida, Gainesville (Shan); Department of Neurology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia (Schneider); Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas (Bernick); Institute of Living, Hartford Hospital, Hartford, Conn. (Narapareddy)
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Young L, Esagoff AI, Reisch A, Bernick CB, Peters ME, Narapareddy BR. Cocaine history and impulsiveness in professional boxers and mixed martial arts fighters. Am J Addict 2024; 33:92-95. [PMID: 37670433 DOI: 10.1111/ajad.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND/OBJECTIVES Impulsiveness is linked to cocaine history (CH) in the general population and greater fight exposure in professional fighters. Among fighters, no previous studies have quantified CH or investigated its relationship with impulsiveness. METHODS Adjusted multivariable regressions were utilized to examine the relationship between CH and impulsiveness in 335 fighters from the Professional Fighters Brain Health Study. RESULTS Twenty percent of fighters reported CH. CH was significantly associated with impulsiveness overall and on three subscales. DISCUSSION/CONCLUSION Cocaine's prevalence and significant association with impulsiveness in fighters merit further study. SCIENTIFIC SIGNIFICANCE We quantify CH and demonstrate its significant association with impulsiveness in professional fighters for the first time.
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Affiliation(s)
- Lisa Young
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron I Esagoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne Reisch
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Charles B Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Matthew E Peters
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bharat R Narapareddy
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Institute of Living, Hartford Hospital, Hartford, Connecticut, USA
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Esagoff AI, Heckenlaible NJ, Bray MJC, Pasuizaca A, Bryant BR, Shan G, Peters ME, Bernick CB, Narapareddy BR. Sparring and the Brain: The Associations between Sparring and Regional Brain Volumes in Professional Mixed Martial Arts Fighters. Sports Med 2023; 53:1641-1649. [PMID: 36972014 DOI: 10.1007/s40279-023-01838-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Mixed martial arts (MMA) fighters, due to exposure to repetitive head impacts, are at risk for brain atrophy and neurodegenerative sequelae. Simultaneously, motor skills training and cognition-rich activities have been linked with larger regional brain volumes. The majority of an MMA fighter's sporting activity occurs during practice (e.g., sparring) rather than formal competition. This study, therefore, aims to be the first to explore regional brain volumes associated with sparring in MMA fighters. METHODS Ninety-four active, professional MMA fighters from the Professional Fighters Brain Health Study met inclusion criteria for this cross-sectional analysis. Adjusted multivariable regression analyses were utilized to examine the relationship between the number of sparring practice rounds per week during typical training and a select number of regional brain volumes (i.e., caudate, thalamus, putamen, hippocampus, amygdala). RESULTS A higher number of weekly sparring rounds during training was significantly associated with larger left (beta = 13.5 µL/round, 95% CI 2.26-24.8) and right (beta = 14.9 µL/round, 95% CI 3.64-26.2) caudate volumes. Sparring was not significantly associated with left or right thalamus, putamen, hippocampus, or amygdala volumes. CONCLUSIONS More weekly rounds of sparring was not significantly associated with smaller volumes in any of the brain regions studied in active, professional MMA fighters. Sparring's significant association with larger caudate volume raises questions about whether fighters who spar more experience attenuated trauma-related decreases in caudate volume relative to fighters who spar less, whether fighters who spar more experience minimal or even positive changes to caudate volume, whether baseline differences in caudate size may have mediated results, or whether some other mechanism may be at play. Given limitations inherent to the cross-sectional study design, more research is needed to further explore the brain effects of sparring in MMA.
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Affiliation(s)
- Aaron I Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA.
| | - Nicolas J Heckenlaible
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Andres Pasuizaca
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Guogen Shan
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Charles B Bernick
- Department of Neurology, University of Washington, Seattle, WA, USA
- Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
- Institute of Living, Hartford Hospital, Hartford, CT, USA
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4
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Protas HD, Su Y, Luo J, Chen K, Alosco ML, Adler C, Balcer L, Bernick CB, Au R, Banks SJ, Barr W, Coleman MJ, Dodick DW, Katz DI, Marek K, Mariani M, McClean MD, McKee AC, Mez JB, Palmisano J, Peskind ER, Turner RW, Wethe J, Rabinovici GD, Johnson KA, Tripodis Y, Cummings J, Shenton ME, Stern RA, Reiman EM. A new flortaucipir PET biomarker based on graph theory for early detection of CTE in former American football players. Alzheimers Dement 2022. [DOI: 10.1002/alz.068936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hillary D. Protas
- Banner Alzheimer's Institute Phoenix AZ USA
- Arizona Alzheimer's Consortium Phoenix AZ USA
| | - Yi Su
- Banner Alzheimer's Institute Phoenix AZ USA
- Arizona Alzheimer's Consortium Phoenix AZ USA
- Arizona State University Tempe AZ USA
| | - Ji Luo
- Banner Alzheimer's Institute Phoenix AZ USA
- Arizona Alzheimer's Consortium Phoenix AZ USA
| | - Kewei Chen
- Banner Alzheimer's Institute Phoenix AZ USA
- Arizona Alzheimer's Consortium Phoenix AZ USA
| | - Michael L Alosco
- Department of Neurology, Boston University School of Medicine Boston MA USA
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | - Charles B. Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas NV USA
- University of Washington Seattle WA USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University School of Medicine; Boston University School of Public Health Boston MA USA
| | | | | | | | | | | | - Ken Marek
- Institute for Neurodegenerative Disorders, Invicro,LLC New Haven CT USA
| | | | | | - Ann C. McKee
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | - Elaine R Peskind
- VA Puget Sound Health Care System Seattle WA USA
- University of Washington School of Medicine Seattle WA USA
| | | | | | | | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Boston University School of Public Health Boston MA USA
| | | | - Martha E Shenton
- Harvard Medical School Boston MA USA
- Brigham and Women's Hospital Boston MA USA
| | - Robert A Stern
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Eric M. Reiman
- Banner Alzheimer's Institute Phoenix AZ USA
- Arizona Alzheimer's Consortium Phoenix AZ USA
- Arizona State University Tempe AZ USA
- University of Arizona Tucson AZ USA
- Translational Genomics Research Institute Phoenix AZ USA
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Esagoff AI, Bray MJ, Shan G, Narapareddy L, Bernick CB, Peters ME, Narapareddy BR. Symptomatic Concussions, Depression, and Impulsivity in Fighters with a Family History of Dementia. Alzheimers Dement 2022. [DOI: 10.1002/alz.061121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Guogen Shan
- University of Florida, College of Public Health and Health Professions and College of Medicine Gainesville FL USA
| | - Laren Narapareddy
- Emory University, Nell Hodgson Woodruff School of Nursing Atlanta GA USA
| | - Charles B. Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas NV USA
- University of Washington Seattle WA USA
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Moebius HJ, Bernick CB, Winner P, Maalouf J, Ooi K, Dickson SP, Hendrix SB, Church K, Olichney JM. ACT‐AD: Fosgonimeton in mild‐to‐moderate Alzheimer’s disease – first results of a randomized, placebo‐controlled, 26‐week Phase 2 proof‐of‐concept trial. Alzheimers Dement 2022. [DOI: 10.1002/alz.061572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Paul Winner
- Premiere Research Institute West Palm Beach FL USA
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Culhane JE, Barr W, Wethe J, Banks SJ, Miller JB, Adler C, Balcer L, Bernick CB, Palmisano J, Tripodis Y, Cummings JL, Reiman EM, Shenton ME, Stern RA, Alosco ML. Neuropsychological test performance in former college and professional American football players. Alzheimers Dement 2021. [DOI: 10.1002/alz.054455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Julia E Culhane
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | | | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas NV USA
| | | | | | | | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | | | - Robert A Stern
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | - Michael L Alosco
- Boston University Alzheimer’s Disease Research Center Boston MA USA
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Alosco ML, Adler C, Dodick DW, Balcer L, Bernick CB, Palmisano J, Tripodis Y, Cummings JL, Reiman EM, Shenton ME, Stern RA, Banks SJ. Sleep disruption and disorders in former college and professional American football players. Alzheimers Dement 2021. [DOI: 10.1002/alz.056137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michael L. Alosco
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | | | - Charles B. Bernick
- Lou Ruvo Center for Brain Health Cleveland Clinic Las Vegas NV USA
- University of Washington Seattle WA USA
| | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease Research Center Boston MA USA
- Boston University School of Public Health Boston MA USA
- Boston University Boston MA USA
| | - Jeffrey L. Cummings
- Center for Transformative Neuroscience Department of Brain Health School of Integrated Health Sciences University of Nevada Las Vegas (UNLV) Las Vegas NV USA
| | | | - Martha E. Shenton
- Brigham and Women's Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - Robert A. Stern
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
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9
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Bray MJC, Tsai J, Bryant BR, Narapareddy BR, Richey LN, Krieg A, Tobolowsky W, Jahed S, Shan G, Bernick CB, Peters ME. Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters. Neurotrauma Rep 2021; 2:169-179. [PMID: 34223552 PMCID: PMC8240832 DOI: 10.1089/neur.2020.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (≤139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.
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Affiliation(s)
- Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jerry Tsai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry, Institute of Living, Hartford Hospital, Hartford, Connecticut, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William Tobolowsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sahar Jahed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Guogen Shan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Charles B Bernick
- Department of Neurology, University of Washington, Seattle, Washington, USA.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Bryant BR, Narapareddy BR, Bray MJC, Richey LN, Krieg A, Shan G, Peters ME, Bernick CB. The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume. Int Rev Psychiatry 2020; 32:89-95. [PMID: 31587599 DOI: 10.1080/09540261.2019.1665501] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has long been established that fighting sports such as boxing and mixed martial arts can lead to head injury. Prior work from this group on the Professional Fighters Brain Health Study found that exposure to repetitive head impacts is associated with lower brain volumes and decreased processing speed in fighters. Current and previously licensed professional fighters were recruited, divided into active and retired cohorts, and matched with a control group that had no prior experience in sports with likely head trauma. This study examined the relationship between age of first exposure (AFE) to fighting sports and brain structure (MRI regional volume), cognitive performance (CNS Vital Signs, iComet C3), and clinical neuropsychiatric symptoms (PHQ-9, Barratt Impulsiveness Scale). Brain MRI data showed significant correlations between earlier AFE and smaller bilateral hippocampal and posterior corpus callosum volumes for both retired and active fighters. Earlier AFE in active fighters was correlated with decreased processing speed and decreased psychomotor speed. Retired fighters showed a correlation between earlier AFE and higher measures of depression and impulsivity. Overall, the results help to inform clinicians, governing bodies, parents, and athletes of the risks associated with beginning to compete in fighting sports at a young age.
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Affiliation(s)
- Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guogen Shan
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles B Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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11
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Lee BG, Leavitt MJ, Bernick CB, Leger GC, Rabinovici G, Banks SJ. A Systematic Review of Positron Emission Tomography of Tau, Amyloid Beta, and Neuroinflammation in Chronic Traumatic Encephalopathy: The Evidence To Date. J Neurotrauma 2018; 35:2015-2024. [PMID: 29609516 PMCID: PMC6421996 DOI: 10.1089/neu.2017.5558] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 02/06/2023] Open
Abstract
Chronic traumatic encephalopathy (CTE) is associated with pathological changes, yet detecting these changes during life has proven elusive. Positron emission tomography (PET) offers the potential for identifying such pathology. Few studies have been completed to date and their approaches and results have been diverse. It was the objective of this review to systematically examine relevant research using ligands for PET that bind to identified pathology in CTE. We focused on identification of patterns of binding and addressing gaps in knowledge of PET imaging for CTE. A comprehensive literature search was conducted. Data used were published on or before May 22, 2017. As the extant literature is limited, any peer-reviewed article assessing military, contact sports athletes, or professional fighters was considered for inclusion. The main outcomes were regional binding to brain regions identified through control comparisons or through clinical metrics (e.g., standardized uptake volume ratios). A total of 1207 papers were identified for review, of which six met inclusion criteria. Meta-analyses were planned but were deemed inappropriate given the small number of studies identified. Methodological concerns in these initial papers included small sample sizes, lack of a control comparison, use of nonstandard statistical procedures to quantify data, and interpretation of potentially off-target binding areas. Across studies, the hippocampi, amygdalae, and midbrain had reasonably consistent increased uptake. Evidence for increased uptake in cortical regions was less consistent. The evidence suggests that the field of PET imaging in those at risk for CTE remains nascent. As the field evolves to include more stringent studies, ligands for PET may prove an important tool in identifying CTE in vivo.
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Affiliation(s)
- Bern G. Lee
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
- University of Nevada, Las Vegas, Las Vegas, Nevada
| | - MacKenzie J. Leavitt
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Charles B. Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Gabriel C. Leger
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
| | - Gil Rabinovici
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Sarah J. Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health and Lerner College of Medicine, Las Vegas, Nevada
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Banks SJ, Miller JB, Rissman RA, Bernick CB. Lack of Influence of Apolipoprotein E Status on Cognition or Brain Structure in Professional Fighters. J Neurotrauma 2016; 34:380-384. [PMID: 27245878 DOI: 10.1089/neu.2016.4453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The role of the apolipoprotein e4 allele in moderating cognitive and neuroanatomical degeneration following repeated traumatic brain injury is controversial. Here we sought to establish the presence or absence of such a moderating relationship in a prospective study of active and retired boxers and mixed martial arts fighters. Fighters (n = 193) underwent cognitive evaluations, interviews regarding fight history, MRI of the brain, and genetic testing. We used a series of moderator analyses to test for any relationship of apolipoprotein genotype on structural volumes of brain regions previously established to be smaller in those with the most fight exposure, and on cognitive abilities also established to be sensitive to fight exposure. No moderating relationship was detected in any of the analyses. The results of this study suggest that there is no impact of apolipoprotein genotype on the apparent negative association between exposure to professional fighting and brain structure volume or aspects of cognition.
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Affiliation(s)
- Sarah J Banks
- 1 Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas, Nevada
| | - Justin B Miller
- 1 Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas, Nevada
| | - Robert A Rissman
- 2 Department of Neuroscience, University of California San Diego , San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Charles B Bernick
- 1 Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas, Nevada
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Raji CA, Lopez OL, Kuller LH, Carmichael OT, Longstreth WT, Gach HM, Boardman J, Bernick CB, Thompson PM, Becker JT. White matter lesions and brain gray matter volume in cognitively normal elders. Neurobiol Aging 2011; 33:834.e7-16. [PMID: 21943959 DOI: 10.1016/j.neurobiolaging.2011.08.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 08/03/2011] [Accepted: 08/12/2011] [Indexed: 01/18/2023]
Abstract
Cerebral white matter lesions (WMLs) reflect small vessel disease, are common in elderly individuals, and are associated with cognitive impairment. We sought to determine the relationships between WMLs, age, gray matter (GM) volume, and cognition in the Cardiovascular Health Study (CHS). From the Cardiovascular Health Study we selected 740 cognitively normal controls with a 1.5 T magnetic resonance imaging (MRI) scan of the brain and a detailed diagnostic evaluation. WML severity was determined using a standardized visual rating system. GM volumes were analyzed using voxel-based morphometry implemented in the Statistical Parametric Mapping software. WMLs were inversely correlated with GM volume, with the greatest volume loss in the frontal cortex. Age-related atrophy was observed in the hippocampus and posterior cingulate cortex. Regression analyses revealed links among age, APOE*4 allele, hypertension, WMLs, GM volume, and digit symbol substitution test scores. Both advancing age and hypertension predict higher WML load, which is itself associated with GM atrophy. Longitudinal data are needed to confirm the temporal sequence of events leading to a decline in cognitive function.
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Affiliation(s)
- Cyrus A Raji
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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Bernick CB, Kuller LH, Longstreth WT, Dulberg C, Manolio TA, Beauchamp NJ, Price TR. Silent Brain MRI Infarcts and Subsequent Stroke Type In the Cardiovascular health Study. Stroke 2001. [DOI: 10.1161/str.32.suppl_1.363-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
P136
Objective:
Silent infarcts seen on cranial MRI scans are a risk factor for subsequent clinical stroke in the elderly. This study examines the type of clinical strokes seen in those with silent infarcts.
Methods:
Cranial MRI examination was completed on 3324 Cardiovascular Health Study (CHS) participants aged 65+ who were without a prior history of clinical stroke. Incident strokes were identified over an average follow-up of 4 years and classified as hemorrhagic or ischemic. Ischemic strokes were further subdivided into lacunar, cardioembolic, atherosclerotic or other/unknown.
Results:
Silent MRI infarcts >3mm were found in approximately 28% (n=923). Of these, 7% (n=67) subsequently had a clinically evident stroke. The characteristics of the silent MRI infarcts in those who sustained an incident stroke were as folows: 56 had only subcortical infarcts, of which 55 were <20mm; 4 had only cortical infarcts; and 7 had both cortical and subcortical infarcts. Of those with only subcortical silent MRI infarcts, 16% (n=9) went on to a hemorrhagic stroke and 84% (n=47) sustained an ischemic stroke. The ischemic strokes were subtyped as 12 cardioembolic, 3 lacunar, 2 atherosclerotic and 30 unknown/other. Considering only those with cortical silent infarcts, either alone or in combination with subcortical infarcts, there was 1 hemorrhagic stroke and 10 ischemic strokes. Half of the ischemic strokes were cardioembolic and half were unknown type.
Conclusion:
Elderly individuals with silent subcortical infarcts who go onto subsequent stroke may be at risk not only for lacunar infarcts but also cardioembolic or hemorrhagic strokes.
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Affiliation(s)
- Charles B Bernick
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Lewis H Kuller
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Will T Longstreth
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Corinne Dulberg
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Teri A Manolio
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Norman J Beauchamp
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
| | - Thomas R Price
- Univ of Nevada Sch of Medicine, Las Vegas, NV; Univ of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA; National Institute of Health, Bethesda, MD; Johns Hopkins Univ, Baltimore, MD; Univ of Maryland, Baltimore, MD
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