Concussion, dementia and CTE: are we getting it very wrong?

Carson, Alan

doi:10.1136/jnnp-2016-315510

Cited by 18 publications

(8 citation statements)

References 25 publications

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“…While there is now a stronger understanding of the potential mechanisms involved in the processes underlying concussion, the epidemiological evidence and the strength of this evidence, to support the long-term effects on cognition remains unclear 17. A recent systematic review aimed at assessing the long-term neurological sequelae of sport-related concussion concluded that there might be an association with repeated concussion and later cognitive impairment 18.…”

Section: Introductionmentioning

confidence: 99%

Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review

Gallo¹,

Motley

Kemp

et al. 2020

J Neurol Neurosurg Psychiatry

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IntroductionUnderstanding whether concussion in sport is associated with worsening cognitive function in later life will likely have immediate repercussion on sports concussion prevention and management policy and sporting rules and regulations. This systematic review aims to summarise the evidence on the association between concussion sustained by professional/elite athletes and long-term cognitive impairment.MethodsEmbase, PubMed and Web of Science were used to search for eligible studies. Studies including professional/elite athletes from any sport were considered. Three comparison groups were considered: internal comparison (concussed vs non-concussed athletes within the same sample); between-sport comparison (contact sport athletes vs non-contact sports ones); external comparison (athletes vs samples of the general population or population norms).Results14 studies were included (rugby, American football, ice hockey players, boxers and marital art fighters). The general quality of the evidence was poor. The overall evidence, weighted for type of comparison and study quality, points towards an association between sustaining a sport-related concussion and poorer cognitive function later in life in rugby, American football and boxing, although it is unclear to what extent this is clinically relevant. Data on ice hockey and martial arts were too sparse to allow conclusions to be drawn.ConclusionHigh-quality, appropriately designed and powered epidemiological studies are urgently needed to assess the association between sustaining a sport-related concussion and cognitive impairment later in life. Particular emphasis should be put on the clinical translational value of findings.

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Section: Introductionmentioning

confidence: 99%

Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review

Gallo¹,

Motley

Kemp

et al. 2020

J Neurol Neurosurg Psychiatry

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show abstract

“…Although several sources conclude no connection between exposure to a single mTBI and incidence of neurodegenerative disease (Guskiewicz et al, 2005;Carson, 2017;Manley et al, 2017;McCrory et al, 2017;Lobue et al, 2020), other studies suggest that repeated mTBIs, without full recovery time between events, could increase the risk for neurodegenerative disease decades later (Guskiewicz et al, 2005;Cruz-Haces et al, 2017). Repetitive injuries are known to increase the risk for future injury and are associated with slower recovery after an mTBI including the persistence of PCS (Daneshvar et al, 2011).…”

Section: Concussion and Neurodegenerative Diseasesmentioning

confidence: 99%

Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers

et al. 2020

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“…Our own review of the RHI !CTE !symptoms links has no pretense of being comprehensive. Instead, we have profited from several narrative reviews, [30][31][32][33][34][35] along with a selective reading of the studies that were consistently highlighted in those narrative reviews as being particularly formative. In relation to evidence informing the CTE !symptoms link, we paid particular attention to the case and case-series data, [36][37][38] the brain bank convenience sample, 39 the consensus criteria for identifying CTE, 40 and the animal model evidence suggesting plausibility.…”

Section: Seminars In Neurologymentioning

confidence: 99%

A Decision-Analytic Approach to Addressing the Evidence About Football and Chronic Traumatic Encephalopathy

Brand

Finkel

2019

Semin Neurol

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Doubts can be raised about almost any assertion that a particular exposure can lead to an increase in a given adverse health effect. Even some of the most well-accepted causal associations in public health, such as that linking cigarette smoking to increased lung cancer risk, have intriguing research questions remaining to be answered. The inquiry whether an exposure causes a disease is never wholly a yes/no question but ought to follow from an appraisal of the weight of evidence supporting the positive conclusion in light of any coherent theories casting doubt on this evidence and the data supporting these. More importantly, such an appraisal cannot be made sensibly without considering the relative consequences to public health and economic welfare of specific actions based on unwarranted credulity (false positives) versus unwarranted skepticism (false negatives). Here we appraise the weight of evidence for the premise that repeated head impacts (RHIs) in professional football can increase the incidence of chronic traumatic encephalopathy (CTE) and, in turn, cause a variety of cognitive and behavioral symptoms. We first dismiss four logical fallacies that should not affect the appraisal of the weight of evidence. We then examine four alternative hypotheses in which RHI is not associated with CTE or symptoms (or both), and we conclude that the chances are small that the RHI→ CTE→ symptoms link is coincidental or artifactual. In particular, we observe that there are many specific interventions for which, even under a skeptical appraisal of the weight of evidence, the costs of a false positive are smaller than the false negative costs of refusing to intervene.

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Concussion, dementia and CTE: are we getting it very wrong?

Cited by 18 publications

References 25 publications

Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review

Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review

Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers

A Decision-Analytic Approach to Addressing the Evidence About Football and Chronic Traumatic Encephalopathy

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