Cerebral Cortical Surface Structure and Neural Activation Pattern Among Adolescent Football Players

Abstract

ImportanceRecurring exposure to head impacts in American football has garnered public and scientific attention, yet neurobiological associations in adolescent football players remain unclear.ObjectiveTo examine cortical structure and neurophysiological characteristics in adolescent football players.Design, Setting, and ParticipantsThis cohort study included adolescent football players and control athletes (swimming, cross country, and tennis) from 5 high school athletic programs, who were matched with age, sex (male), and school. Neuroimaging assessments were conducted May to July of the 2021 and 2022 seasons. Data were analyzed from February to November 2023.ExposurePlaying tackle football or noncontact sports.Main Outcomes and MeasuresStructural magnetic resonance imaging (MRI) data were analyzed for cortical thickness, sulcal depth, and gyrification, and cortical surface-based resting state (RS)–functional MRI analyses examined the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and RS-functional connectivity (RS-FC).ResultsTwo-hundred seventy-five male participants (205 football players; mean [SD] age, 15.8 [1.2] years; 5 Asian [2.4%], 8 Black or African American [3.9%], and 189 White [92.2%]; 70 control participants; mean [SD] age 15.8 [1.2] years, 4 Asian [5.7], 1 Black or African American [1.4%], and 64 White [91.5%]) were included in this study. Relative to the control group, the football group showed significant cortical thinning, especially in fronto-occipital regions (eg, right precentral gyrus: t = −2.24; P = .01; left superior frontal gyrus: −2.42; P = .002). Elevated cortical thickness in football players was observed in the anterior and posterior cingulate cortex (eg, left posterior cingulate cortex: t = 2.28; P = .01; right caudal anterior cingulate cortex 3.01; P = .001). The football group had greater and deeper sulcal depth than the control groups in the cingulate cortex, precuneus, and precentral gyrus (eg, right inferior parietal lobule: t = 2.20; P = .004; right caudal anterior cingulate cortex: 4.30; P < .001). Significantly lower ALFF was detected in the frontal lobe and cingulate cortex of the football group (t = −3.66 to −4.92; P < .01), whereas elevated ALFF was observed in the occipital regions (calcarine and lingual gyrus, t = 3.20; P < .01). Similar to ALFF, football players exhibited lower ReHo in the precentral gyrus and medial aspects of the brain, such as precuneus, insula, and cingulum, whereas elevated ReHo was clustered in the occipitotemporal regions (t = 3.17; P < .001; to 4.32; P < .01). There was no group difference in RS-FC measures.Conclusions and RelevanceIn this study of adolescent athletes, there was evidence of discernible structural and physiological differences in the brains of adolescent football players compared with their noncontact controls. Many of the affected brain regions were associated with mental health well-being.

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes

“…One line of research reinforces the notion that participating in tackle football during adolescence does not correlate with negative outcomes in depression, anxiety, alcohol use, and suicidality during young adulthood ( 32 – 34 ). However, opposing research suggests that despite the absence of clinically discernible psychiatric symptoms, adolescent football players displayed alterations in cortical morphology and neural activation patterns in brain regions vital for mental well-being, including the cingulate cortex, precuneus, and prefrontal cortex ( 9 ). A study published in 2023 by McKee et al.…”

“…Notably, individuals with CTE often exhibit significant changes in mental health conditions during their 40s and 50s ( 6 – 8 ). Despite this knowledge, the inquiry of the interactive effects of mental health and RHI is still in its early stages, with a predominant focus on male professional athletes, particularly in football ( 4 , 9 ). Given the larger population of amateur athletes susceptible to mental health declines, it becomes imperative to characterize the midlife mental health integrity in those who participated in RHI-prone contact sports at the amateur level for both males and females.…”