The accumulation of subconcussive impacts on cognitive, imaging, and biomarker outcomes in child and college-aged athletes: a systematic review

Walter, Alexa E; Wilkes, James R.; Arnett, Peter A.; Miller, Sharon; Sebastianelli, Wayne J.; Seidenberg, Peter H.; Slobounov, Semyon

doi:10.1007/s11682-021-00489-6

Cited by 15 publications

(9 citation statements)

References 83 publications

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“…This conflicting evidence, combined with the absence of symptoms, has created uncertainty regarding the short-term clinical importance of RHIs. While several systematic reviews on the topic of RHI have been conducted, none have specifically addressed the acute neurologic effects of RHI exposure in these 3 categories (cognitive, vestibular, and oculomotor) 17,18. This scoping review was undertaken to summarize the evidence linking contact sports–related RHIs to short-term declines in neurologic function.…”

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confidence: 99%

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Stephen

Hasman

Goldenberg

et al. 2022

Journal of Head Trauma Rehabilitation

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Objective: To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function. Methods: A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure. Results: Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate (n = 23) or high school (n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history. Conclusion:The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.

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confidence: 99%

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Stephen

Hasman

Goldenberg

et al. 2022

Journal of Head Trauma Rehabilitation

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“…‘Stars’ are awarded to each item deemed ‘low risk’ (Wells et al., n.d.). The NOS has previously been adapted to assess RoB in studies of subconcussive impacts and neuroimaging (Tarnutzer et al., 2017; Walter et al., 2022). The criteria were further adapted for this review to better suit the broad range of sports accepted and provide further clarity of the definitions (File S2).…”

Section: Methodsmentioning

confidence: 99%

“…The criteria were further adapted for this review to better suit the broad range of sports accepted and provide further clarity of the definitions (File S2). Study quality was rated according to established thresholds (Tarnutzer et al., 2017; Walter et al., 2022): ‘good’ (≥7 stars), ‘fair’ (3–6 stars), ‘poor’ (≤2 stars).…”

Section: Methodsmentioning

confidence: 99%

The effect of contact/collision sport participation without concussion on neurometabolites: A systematic review and meta‐analysis of magnetic resonance spectroscopy studies

Delang,

Irwin,

Peek

et al. 2023

Journal of Neurochemistry

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The aim of this study was to systematically review prior research investigating the effects of contact/collision sport participation on neurometabolite levels in the absence of concussion. Four online databases were searched to identify studies that measured neurometabolite levels in contact/collision sport athletes (without concussion) using proton (1H) or phosphorus (31P) magnetic resonance spectroscopy (MRS). All study designs were acceptable for inclusion. Meta‐analytic procedures were used to quantify the effect of contact/collision sport participation on neurometabolite levels and explore the impact of specific moderating factors (where sufficient data were available). Narrative synthesis was used to describe outcomes that could not be meta‐analysed. Nine observational studies involving 300 contact/collision sport athletes were identified. Six studies (providing 112 effect estimates) employed longitudinal (cohort) designs and three (that could not be meta‐analysed) employed case–control designs. N‐acetylaspartate (NAA; g = −0.331, p = 0.013) and total creatine (tCr; creatine + phosphocreatine; g = −0.524, p = 0.029), but not glutamate–glutamine (Glx), myo‐inositol (mI) or total choline (tCho; choline‐containing compounds; p's > 0.05), decreased between the pre‐season and mid−/post‐season period. Several moderators were statistically significant, including: sex (Glx: 6 female/23 male, g = −0.549, p = 0.013), sport played (Glx: 22 American football/4 association football [soccer], g = 0.724, p = 0.031), brain region (mI: 2 corpus callosum/9 motor cortex, g = −0.804, p = 0.015), and the MRS quantification approach (mI: 18 absolute/3 tCr‐referenced, g = 0.619, p = 0.003; and tCho: 18 absolute/3 tCr‐referenced, g = 0.554, p = 0.005). In case–control studies, contact/collision sport athletes had higher levels of mI, but not NAA or tCr compared to non‐contact sport athletes and non‐athlete controls. Overall, this review suggests that contact/collision sport participation has the potential to alter neurometabolites measured via 1H MRS in the absence of concussion. However, further research employing more rigorous and consistent methodologies (e.g. interventional studies with consistent 1H MRS pulse sequences and quantifications) is required to confirm and better understand the clinical relevance of observed effects.image

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“…Football players also are more likely to experience concussions than youth participating in other sports ( 5 , 6 ). Researchers have reported that playing a single season of high school football is associated with changes in the brain measurable with structural and functional experimental neuroimaging ( 7 , 8 ), as well as changes in cognition ( 9 ) and other clinical metrics, though results have been mixed Walter et al ( 10 ). Concerns about long-term brain health have likely been fueled by extensive media coverage of research relating to chronic traumatic encephalopathy (CTE) in former National Football League (NFL) players ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

High School Football and Risk for Depression and Suicidality in Adulthood: Findings From a National Longitudinal Study

Iverson

Terry

2022

Front. Neurol.

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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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The accumulation of subconcussive impacts on cognitive, imaging, and biomarker outcomes in child and college-aged athletes: a systematic review

Cited by 15 publications

References 83 publications

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review

The effect of contact/collision sport participation without concussion on neurometabolites: A systematic review and meta‐analysis of magnetic resonance spectroscopy studies

High School Football and Risk for Depression and Suicidality in Adulthood: Findings From a National Longitudinal Study

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