The objective of this knowledge overview of the project “Service provision and access to services in Nordic rural areas – secure, trusted and for all ages” is to analyse how essential service needs for different types of societal groups and ruralities can be understood and defined, and how solutions to rural service provision challenges can be organised.

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Background: Considering the wide range of outcomes following sport-related concussions, biomarkers are needed to detect underlying pathological changes. The objective was to analyze the use of plasma phosphorylated tau 181 (pTau181) as a non-invasive measure of underlying brain changes in a cohort of retired contact sports athletes at risk of neurodegeneration.Methods: This study included 54 retired contact sport athletes and 27 healthy controls whose blood plasma was analyzed for pTau181. A portion (N=21) of retired athletes came for a 2-year follow-up visit. All participants had completed a neuropsychological battery and MRI imaging.Results: Plasma pTau181 was significantly higher in retired athletes compared to healthy controls (8.945.08 pg/mL vs. 6.002.53 pg/mL; 95% CI 0.87-5.01; p=.02). When the retired athletes cohort was divided into high vs. normal pTau181 groups, the corpus callosum (CC) and entorhinal volumes were significantly lower in high pTau181 compared to older healthy controls (1.570.19 vs. 2.020.32, p=.002; and 2.070.35 vs. 2.820.51, p=.003, respectively). Lower white matter integrity was observed in the high pTau181 group in comparison to healthy controls (CC medial diffusivity: 0.960.04 x10 -3 mm 2 /s vs. 0.900.03 x10 -3 mm 2 /s, p=.003; CC axial diffusivity: 1.490.04 x10 -3 mm 2 /s vs. 1.410.02 x10 -3 mm 2 /s, p<.001, respectively). Conclusions:Although high plasma pTau181 levels was associated with lower regional brain volumes and decreased white matter integrity, baseline pTau181 did not predict longitudinal changes in regional brain volumes or white matter integrity in retired contact sport athletes. pTau181 may be useful for identifying those with brain abnormalities related to repeated concussion but not for predicting progression.