Cumulative Effects of Prior Concussion and Primary Sport Participation on Brain Morphometry in Collegiate Athletes: A Study From the NCAA–DoD CARE Consortium

Brett, Benjamin L.; Bobholz, Samuel; España, Lezlie Y.; Huber, Daniel L.; Mayer, Andrew R.; Harezlak, Jaroslaw; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael; Meier, Timothy B.

doi:10.3389/fneur.2020.00673

Cited by 20 publications

(15 citation statements)

References 56 publications

(98 reference statements)

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“…The Concussion Assessment, Research, and Education (CARE) Consortium is a national multi-site study of sport-related head trauma (concussion and repetitive asymptomatic exposure) [ 52 ] that has produced several recent reports on structural brain changes in active collegiate athletes [ 53 – 55 ]. Brett and colleagues found that active, healthy collision sport athletes showed an association of more years of sport participation—a proxy for cumulative head trauma exposure—with lower thalamic volumes [ 56 ]. This effect was not observed in non-contact sport athletes.…”

Section: Structural Mrimentioning

confidence: 99%

Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review

Asken

Rabinovici

2021

acta neuropathol commun

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Background and Scope of Review Varying severities and frequencies of head trauma may result in dynamic acute and chronic pathophysiologic responses in the brain. Heightened attention to long-term effects of head trauma, particularly repetitive head trauma, has sparked recent efforts to identify neuroimaging biomarkers of underlying disease processes. Imaging modalities like structural magnetic resonance imaging (MRI) and positron emission tomography (PET) are the most clinically applicable given their use in neurodegenerative disease diagnosis and differentiation. In recent years, researchers have targeted repetitive head trauma cohorts in hopes of identifying in vivo biomarkers for underlying biologic changes that might ultimately improve diagnosis of chronic traumatic encephalopathy (CTE) in living persons. These populations most often include collision sport athletes (e.g., American football, boxing) and military veterans with repetitive low-level blast exposure. We provide a clinically-oriented review of neuroimaging data from repetitive head trauma cohorts based on structural MRI, FDG-PET, Aβ-PET, and tau-PET. We supplement the review with two patient reports of neuropathology-confirmed, clinically impaired adults with prior repetitive head trauma who underwent structural MRI, FDG-PET, Aβ-PET, and tau-PET in addition to comprehensive clinical examinations before death. Review Conclusions Group-level comparisons to controls without known head trauma have revealed inconsistent regional volume differences, with possible propensity for medial temporal, limbic, and subcortical (thalamus, corpus callosum) structures. Greater frequency and severity (i.e., length) of cavum septum pellucidum (CSP) is observed in repetitive head trauma cohorts compared to unexposed controls. It remains unclear whether CSP predicts a particular neurodegenerative process, but CSP presence should increase suspicion that clinical impairment is at least partly attributable to the individual’s head trauma exposure (regardless of underlying disease). PET imaging similarly has not revealed a prototypical metabolic or molecular pattern associated with repetitive head trauma or predictive of CTE based on the most widely studied radiotracers. Given the range of clinical syndromes and neurodegenerative pathologies observed in a subset of adults with prior repetitive head trauma, structural MRI and PET imaging may still be useful for differential diagnosis (e.g., assessing suspected Alzheimer’s disease).

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Section: Structural Mrimentioning

confidence: 99%

Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review

Asken

Rabinovici

2021

acta neuropathol commun

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“…Consistent with numerous prior studies across all levels of development within active athletes, including youth, high school, and collegiate levels, we found a significant positive association between concussion history and both psychological distress and concussionlike symptom severity. [5][6][7][8][9][10] The presence of multiple comorbidities (eg, depression) and factors (eg, decreased sleep quality) known to influence symptoms has often obscured the association between concussion history and symptom severity in athletes with remote concussion. For example, one alternative explanation for the previously reported associations between the number of self-reported prior concussions and symptom severity is that they reflect underlying health or health behavior differences (ie, sleep).…”

Section: Concussion History Psychological Distress and Concussion-lik...mentioning

confidence: 99%

The Association Between Concussion History and Increased Symptom Severity Reporting Is Independent of Common Medical Comorbidities, Personality Factors, and Sleep Quality in Collegiate Athletes

Brett

Nelson

Meier

2021

Journal of Head Trauma Rehabilitation

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Objective: We investigated the degree to which the association between history of concussion with psychological distress and general symptom severity is independent of several factors commonly associated with elevated symptom severity. We also examined whether symptom severity endorsement was associated with concussion injury specifically or response to injury in general. Setting: Academic medical center. Participants: Collegiate athletes (N = 106; age: M = 21.37 ± 1.69 years; 33 female) were enrolled on the basis of strict medical/psychiatric exclusion criteria. Design: Cross-sectional single-visit study. Comprehensive assessment, including semistructured interviews to retrospectively diagnose the number of previous concussions, was completed. Single-predictor and stepwise regression models were fit to examine the predictive value of prior concussion and orthopedic injuries on symptom severity, both individually and controlling for confounding factors. Main Outcome Measures: Psychological distress was operationalized as Brief Symptom Inventory-18 Global Severity Index (BSI-GSI) ratings; concussionrelated symptom severity was measured using the Sport Concussion Assessment Tool. Results: Controlling for baseline factors associated with the symptom outcomes (agreeableness, neuroticism, negative emotionality, and sleep quality), concussion history was significantly associated with psychological distress (B = 1.25 [0.55]; P = .025, R 2 = 0.034) and concussion-like symptom severity (B = 0.22 [0.08]; P = .005, R 2 = 0.064) and accounted for a statistically significant amount of unique variance in symptom outcomes. Orthopedic injury history was not individually predictive of psychological distress (B = −0.06 [0.53]; P = .905) or general symptom severity (B = 0.06 [0.08]; P = .427) and did not explain the relationship between concussion history and symptom outcomes.

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“…There is growing concern and ongoing debate among the public and health care professionals regarding the safety of contact and collision sports for athletes across the life span. Numerous scientific efforts across the world are underway to better understand the potential short-term and long-term consequences of repetitive head trauma . Within motorsport, historical emphasis has been placed on reducing catastrophic injuries, with the study of concussion and subconcussive impact exposure lagging behind contact and collision sport counterparts .…”

Section: Discussionmentioning

confidence: 99%

“…Numerous scientific efforts across the world are underway to better understand the potential short-term and long-term consequences of repetitive head trauma. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Within motorsport, historical emphasis has been placed on reducing catastrophic injuries, with the study of concussion and subconcussive impact exposure lagging behind contact and collision sport counterparts. 10 Innovations in vehicle and track engineering have led to greatly reduced injuries of all severity, such as the reduced frequency of reported concussions in the last decade in comparison to the 1980s, even with substantial changes in concussion diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Efforts are under way to characterize neurobehavioral sequelae and long-term consequences of impact-related acceleration and deceleration and rotational force exposure in athletes across all levels and sports. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Motorsport is no exception, with recent public and professional concern shifting primary focus from severe traumatic brain injuries to mild traumatic brain injuries or concussion and subconcussive force exposure. This effort has been aided by medical and engineering innovations to improve driver safety.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers

et al. 2023

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ImportanceProfessional motorsport drivers are regularly exposed to biomechanical forces comparable with those experienced by contact and collision sport athletes, and little is known about the potential short-term and long-term neurologic sequelae.ObjectiveTo determine whether cumulative impact exposure is associated with oculomotor functioning in motorsport drivers from the INDYCAR professional open-wheel automobile racing series.Design, Setting, and ParticipantsThis is a longitudinal retrospective cohort study conducted across 3 racing seasons (2017-2019). Statistical analyses were conducted in November 2021. Data were retrieved from a secondary care setting associated with the INDYCAR series. INDYCAR series drivers who participated in 3 professional level racing seasons and were involved in at least 1 contact incident (ie, crash) in 2 of the 3 seasons were included in the study.ExposureCumulative acceleration and deceleration forces and total contact incidents (ie, crashes) measured via accident data recorder third generation chassis and ear accelerometers.Main Outcomes and MeasuresPostseries oculomotor performance, including predictive saccades, vergence smooth pursuit, and optokinetic nystagmus, was measured annually with a head-mounted, clinical eye tracking system (Neurolign Dx 100).ResultsThirteen drivers (mean [SD] age, 29.36 [7.82] years; all men) sustained median resultant acceleration forces of 38.15 g (observed range, 12.01-93.05 g; 95% CI, 30.62-65.81 g) across 81 crashes. A 2-way multivariate analysis of variance did not reveal a statistically significant association between ear and chassis average resultant g forces, total number of contact incidents, and racing season assessed (F9,12 = 0.955; P = .54; Wilks Λ = 0.44).Conclusions and RelevanceIn this cohort study of professional drivers from the INDYCAR series, there were no statistically significant associations among cumulative impact exposure, racing season assessed, and oculomotor performance. Longitudinal studies across racing seasons using multidimensional examination modalities (eg, neurocognitive testing, advanced imaging, biomarkers, and physical examination) are critical to understand potential neurological and neurobehavioral sequelae and long-term consequences of cumulative impact exposure.

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Cumulative Effects of Prior Concussion and Primary Sport Participation on Brain Morphometry in Collegiate Athletes: A Study From the NCAA–DoD CARE Consortium

Cited by 20 publications

References 56 publications

Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review

Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review

The Association Between Concussion History and Increased Symptom Severity Reporting Is Independent of Common Medical Comorbidities, Personality Factors, and Sleep Quality in Collegiate Athletes

Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers

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