Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

Alosco, Michael L.; Kasimis, A B; Stamm, Julie; Chua, Alicia; Baugh, Christine M.; Daneshvar, Daniel H.; Robbins, Clifford A.; Mariani, Megan; Hayden, Juliana; Conneely, Shannon E; Au, Rhoda; Torres, Alcy; McClean, Michael D.; McKee, Ann C.; Cantu, Robert C.; Mez, Jesse; Nowinski, Christopher J.; Martin, Brett; Chaisson, Christine E.; Tripodis, Yorghos; Stern, Robert

doi:10.1038/tp.2017.197

Cited by 159 publications

(134 citation statements)

References 83 publications

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“…3,39 In contrast, our findings that show a relationship between AFE and age of symptom onset are consistent with previous research in living former amateur and professional tackle football players that linked younger AFE to tackle football, before age 12 in particular, with worse cognitive, behavior, and mood outcomes. 11,14 The clinical presentation of CTE seems to involve early-life behavioral/mood symptoms and/or later-life cognitive impairment. Nearly all reported cases of CTE have exhibited cognitive dysfunction at some point during their life, and those that present with cognitive impairment as an initial symptom tend to develop dementia.…”

Section: Discussionmentioning

confidence: 99%

Age of first exposure to tackle football and chronic traumatic encephalopathy

Alosco

Mez

Tripodis

et al. 2018

Annals of Neurology

121

136

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In this sample of deceased tackle football players, younger age of exposure to tackle football was not associated with CTE pathological severity, but predicted earlier neurobehavioral symptom onset. Youth exposure to tackle football may reduce resiliency to late-life neuropathology. These findings may not generalize to the broader tackle football population, and informant-report may have affected the accuracy of the estimated effects. Ann Neurol 2018;83:886-901.

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Section: Discussionmentioning

confidence: 99%

Age of first exposure to tackle football and chronic traumatic encephalopathy

Alosco

Mez

Tripodis

et al. 2018

Annals of Neurology

121

136

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“…If a participant played more than one position at the highest level (including playing both offensive and defensive positions), the position played most was used. Age of first exposure (AFE) to football was defined as the age that the participant first played organized American football …”

Section: Methodsmentioning

confidence: 99%

“…Age of first exposure (AFE) to football was defined as the age that the participant first played organized American football. [38][39][40][41]…”

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confidence: 99%

Duration of American Football Play and Chronic Traumatic Encephalopathy

Mez

Daneshvar

Abdolmohammadi

et al. 2019

Annals of Neurology

177

166

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Objective Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to contact and collision sports, including American football. We hypothesized a dose–response relationship between duration of football played and CTE risk and severity. Methods In a convenience sample of 266 deceased American football players from the Veterans Affairs–Boston University–Concussion Legacy Foundation and Framingham Heart Study Brain Banks, we estimated the association of years of football played with CTE pathological status and severity. We evaluated the ability of years played to classify CTE status using receiver operating characteristic curve analysis. Simulation analyses quantified conditions that might lead to selection bias. Results In total, 223 of 266 participants met neuropathological diagnostic criteria for CTE. More years of football played were associated with having CTE (odds ratio [OR] = 1.30 per year played, 95% confidence interval [CI] = 1.19–1.41; p = 3.8 × 10−9) and with CTE severity (severe vs mild; OR = 1.14 per year played, 95% CI = 1.07–1.22; p = 3.1 × 10−4). Participants with CTE were 1/10th as likely to have played <4.5 years (negative likelihood ratio [LR] = 0.102, 95% CI = 0.100–0.105) and were 10 times as likely to have played >14.5 years (positive LR = 10.2, 95% CI = 9.8–10.7) compared with participants without CTE. Sensitivity and specificity were maximized at 11 years played. Simulation demonstrated that years played remained adversely associated with CTE status when years played and CTE status were both related to brain bank selection across widely ranging scenarios. Interpretation The odds of CTE double every 2.6 years of football played. After accounting for brain bank selection, the magnitude of the relationship between years played and CTE status remained consistent. ANN NEUROL 2020;87:116–131

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“…The scientific debate regarding head injury in ASF has progressed from how concussion is managed, to how a person's cumulative history of neurotrauma, inclusive of sub-concussive impacts, should be managed.Not only are a large percentage of concussions 9,10 unrecognized or underreported, but a number of modalities have been used to show changes in brain function, connectivity, activation and cognition, following sub-concussive RHI [11][12][13][14] . Many deficits associated with the long-term consequences of RHI are not clinically apparent until years after the impacts are experienced 15,16 . This has raised awareness of the link between cumulative RHI and the development and/or initiation of neurological disorders, including chronic traumatic open Scientific RepoRtS | (2020) 10:1200 | https://doi.org/10.1038/s41598-019-54874-9www.nature.com/scientificreports www.nature.com/scientificreports/ encephalopathy (CTE).…”

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confidence: 99%

“…Head contact is integral to ASF, resulting in hundreds of RHI throughout a season [36][37][38][39] . Biomechanical assessment of RHI that incorporate multiple event characteristics have predominantly been derived from self-reported histories and head impact sensors to estimate exposure 5,15 . Innovations designed to measure the dynamic response of the head resulting from impacts report RHI estimates for youth, high school and collegiate level ASF, however exposure at the professional level has not been documented [38][39][40][41][42] .…”

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confidence: 99%

A novel repetitive head impact exposure measurement tool differentiates player position in National Football League

Karton

Hoshizaki

Gilchrist

2020

Sci Rep

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American-style football participation poses a high risk of repetitive head impact (RHI) exposure leading to acute and chronic brain injury. The complex nature of symptom expression, human predisposition, and neurological consequences of RHI limits our understanding of what constitutes as an injurious impact affecting the integrity of brain tissue. Video footage of professional football games was reviewed and documentation made of all head contact. Frequency of impact, tissue strain magnitude, and time interval between impacts was used to quantify RHI exposure, specific to player field position. Differences in exposure characteristics were found between eight different positions; where three unique profiles can be observed. Exposure profiles provide interpretation of the relationship between the traumatic event(s) and how tissue injury is manifested and expressed. This study illustrates and captures an objective measurement of RHI on the field, a critical component in guiding public policy and guidelines for managing exposure.Various levels of impact severity associated with head injury have been studied for over a century where knowledge and reporting reflected current periods' public concern and environmental context 1 . The scientific community, medical sectors and regulatory authorities have been working for decades to unravel the complexity of head injury in sport, most predominantly the definition, identification, and treatment of concussions. There were obvious challenges associated with the ambiguous nature and presentation of what is regarded as a tissue 'injury' 2,3 . Inconsistencies in symptom expression and prediction, and human variability in predisposition limit the precision in defining the relationship between the traumatic event(s) and injury. Despite numerous reports describing the implications of the acute and chronic effects of single and repeated sub-concussive and concussive blows to the head 1 , only recently have exposure to repetitive head impacts (RHI) in contact sports become a real concern, and this concern has become relevant to researchers, neurologists, clinicians and athletic professionals alike. The high profile sport, American-style football (ASF), has received increasing attention amongst researchers who believe that this population will help establish a better understanding of the consequences and management of RHI.Measuring head injury in ASF solely on the basis of immediate signs and symptoms has proven to be insufficient in capturing the spectrum of tissue injury 4,5 . Moreover, as individuals recover from the clinical expression of symptoms, the assumption that neurobiological recovery has also occurred is also likely to be inaccurate 6,7 . A more sophisticated understanding that now prevails considers the time course of neurobiological recovery and the mental health consequences of being exposed to RHI. Oliver and colleagues 8 report that blood concentrations of axonal injury biomarkers in college football starters remain elevated even 9 weeks post season. The scientific de...

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Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

Cited by 159 publications

References 83 publications

Age of first exposure to tackle football and chronic traumatic encephalopathy

Age of first exposure to tackle football and chronic traumatic encephalopathy

Duration of American Football Play and Chronic Traumatic Encephalopathy

A novel repetitive head impact exposure measurement tool differentiates player position in National Football League

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