White matter signal abnormalities in former National Football League players

Alosco, Michael L.; Koerte, Inga K.; Tripodis, Yorghos; Mariani, Megan; Chua, Alicia; Jarnagin, Johnny; Rahimpour, Yashar; Puzo, Christian; Healy, Rose C.; Martin, Brett; Chaisson, Christine E.; Cantu, Robert C.; Au, Rhoda; McClean, Michael D.; McKee, Ann C.; Lin, Alexander P.; Shenton, Martha E.; Killiany, Ronald; Stern, Robert

doi:10.1016/j.dadm.2017.10.003

Cited by 62 publications

(73 citation statements)

References 60 publications

(117 reference statements)

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“…Ten studies based on chronic TBI individuals examined a mixed gender experimental group and one did not provide information on the sex of study participants . All studies focusing on contact sports athletes investigated solely male experimental groups, and the two ex vivo studies did not provide any information on gender . Contact sports athletes included soccer players, boxers, American football players, baseball players, and wrestlers.…”

Section: Resultsmentioning

confidence: 99%

“…The age range of all studies was from school level to retirement age (13.5–74 years). Of all included in vivo studies, 22 used an age‐matched control group . All articles were published between 1994 and 2018.…”

Section: Resultsmentioning

confidence: 99%

“…From the 25 included studies, 14 used diverse MR techniques . Twenty‐one studies applied structural MRI, including T 1 ‐weighted (T 1 ‐w), T 2 ‐weighted (T 2 ‐w), fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), and proton‐density weighted (PD‐w) imaging . Thirteen studies used diffusion MRI, specifically diffusion tensor imaging (DTI), generalized q‐sampling imaging (GQI), diffusion kurtosis imaging (DKI), and diffusion weighted imaging (DWI) .…”

Section: Resultsmentioning

confidence: 99%

“…Of the studies using contact sports athletes as the experimental group, 10 applied structural MRI sequences . Two, however, did not perform structural MRI group comparisons .…”

Section: Resultsmentioning

confidence: 99%

“…Five studies analyzed American football players . Koerte et al focused on imaging features of the CSP in former male football players .…”

Section: Resultsmentioning

confidence: 99%

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Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS

Ruprecht

Scheurer

Lenz

2018

Magnetic Resonance Imaging

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Of the studies using contact sports athletes as the experimental group, 10 applied structural MRI sequences . Two, however, did not perform structural MRI group comparisons .…”

Section: Resultsmentioning

confidence: 99%

“…Five studies analyzed American football players . Koerte et al focused on imaging features of the CSP in former male football players .…”

Section: Resultsmentioning

confidence: 99%

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Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS

Ruprecht

Scheurer

Lenz

2018

Magnetic Resonance Imaging

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Association of Playing College American Football With Long-term Health Outcomes and Mortality

et al. 2022

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Association of White Matter Rarefaction, Arteriolosclerosis, and Tau With Dementia in Chronic Traumatic Encephalopathy

et al. 2019

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IMPORTANCE Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with cognitive and neuropsychiatric disturbances that can progress to dementia. Pathways to dementia in CTE are unclear and likely involve tau and nontau pathologic conditions.OBJECTIVE To investigate the association of white matter rarefaction and cerebrovascular disease with dementia in deceased men older than 40 years who played football and had CTE. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study involves analyses of data from the ongoing Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study, which is conducted via and included brain donors from the Veterans Affairs-Boston University-Concussion Legacy Foundation brain bank between 2008 and 2017. An original sample of 224 men who had played football and were neuropathologically diagnosed with CTE was reduced after exclusion of those younger than 40 years and those missing data.EXPOSURES The number of years of football play as a proxy for repetitive head impacts. MAIN OUTCOMES AND MEASURESNeuropathological assessment of white matter rarefaction and arteriolosclerosis severity (on a scale of 0-3, where 3 is severe); number of infarcts, microinfarcts, and microbleeds; and phosphorylated tau accumulation determined by CTE stage and semiquantitative rating of dorsolateral frontal cortex (DLFC) neurofibrillary tangles (NFTs) (none or mild vs moderate or severe). Informant-based retrospective clinical interviews determined dementia diagnoses via diagnostic consensus conferences.RESULTS A total of 180 men were included. The mean (SD) age of the sample at death was 67.9 (12.7) years. Of 180, 120 [66.7%]) were found to have had dementia prior to death. Moderate to severe white matter rarefaction (84 of 180 [46.6%]) and arteriolosclerosis (85 of 180 [47.2%]) were common; infarcts, microinfarcts, and microbleeds were not. A simultaneous equations regression model controlling for age and race showed that more years of play was associated with more severe white matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and greater phosphorylated tau accumulation (DLFC NFTs: β, 0.15 [95% CI, 0.004-0.30]; P = .04; CTE stage: β, 0.27 [95% CI, 0.14-0.41]; P < .001). White matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and DLFC NFTs (β, 0.16 [95% CI, 0.03-0.28]; P = .01) were associated with dementia. Arteriolosclerosis and years of play were not associated, but arteriolosclerosis was independently associated with dementia (β, 0.21 [95% CI, 0.07-0.35]; P = .003).CONCLUSIONS AND RELEVANCE Among older men who had played football and had CTE, more years of football play were associated with more severe white matter rarefaction and greater DLFC NFT burden. White matter rarefaction, arteriolosclerosis, and DLFC NFTs were independently associated with dementia. Dementia in CTE is likely a result of neuropathologic changes, including white matter rarefaction and phosphorylated...

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White matter signal abnormalities in former National Football League players

Cited by 62 publications

References 60 publications

Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS

Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS

Association of Playing College American Football With Long-term Health Outcomes and Mortality

Association of White Matter Rarefaction, Arteriolosclerosis, and Tau With Dementia in Chronic Traumatic Encephalopathy

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