Chronic traumatic encephalopathy in Australia: the first three years of the Australian Sports Brain Bank

Suter, Catherine M.; Affleck, Andrew J.; Lee, Maggie; Pearce, Alan J.; Iles, Linda; Buckland, Michael E.

doi:10.5694/mja2.51420

Cited by 17 publications

(18 citation statements)

References 5 publications

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“…We excluded studies (24,25,(46)(47)(48) that did not provide the necessary raw data to estimate an odds ratio-either lacking any subjects without CTE, lacking any subjects with no exposure to RHI, or both. While it is possible to estimate an incidence of CTE in a population exposed to RHI and compare it to "historical control rates" for unexposed populations studied elsewhere, the studies referenced above were self-contained case-control investigations and hence a more reliable subset.…”

Section: Strength Of Associationmentioning

confidence: 99%

“…Similarly, investigators at other North American institutions have published studies that describe the presence of CTE pathology in military veterans (60) and former athletes in American football (10,23,24,(61)(62)(63)(64), amateur and professional wrestling (23,65), and ice hockey (24). Investigators have also reported CTE pathology in Scotland (Glasgow TBI Brain Bank) (28,48,66), England (Queen Square Brain Bank for Neurological Disorders, University College London) (29,67,68), Ireland (Dublin Brain Bank) (27,69), France (GIE Neuro-CEB Brain Bank) (30), Australia (Australian Sports Brain Bank) (25,70,71), Brazil (Biobank for Aging Studies at the University of São Paulo) (26), and South Korea (72). In these reports, CTE pathology was described in the brains of former soccer, rugby, Australian rules football, and boxing athletes as well as a young individual who exhibited head-banging behavior (72).…”

Section: Consistencymentioning

confidence: 99%

“…While CTE has been known in the literature for nearly a century, most of the research on CTE has occurred only in the last decade. McKee et al (18) noted that prior to 2009, there were only 48 cases of CTE in the literature, in contrast to the hundreds of cases of CTE since (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Introductionmentioning

confidence: 99%

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Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

Nowinski¹,

Bureau²,

Buckland

et al. 2022

Front. Neurol.

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Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with a history of repetitive head impacts (RHI). CTE was described in boxers as early as the 1920s and by the 1950s it was widely accepted that hits to the head caused some boxers to become “punch drunk.” However, the recent discovery of CTE in American and Australian-rules football, soccer, rugby, ice hockey, and other sports has resulted in renewed debate on whether the relationship between RHI and CTE is causal. Identifying the strength of the evidential relationship between CTE and RHI has implications for public health and medico-legal issues. From a public health perspective, environmentally caused diseases can be mitigated or prevented. Medico-legally, millions of children are exposed to RHI through sports participation; this demographic is too young to legally consent to any potential long-term risks associated with this exposure. To better understand the strength of evidence underlying the possible causal relationship between RHI and CTE, we examined the medical literature through the Bradford Hill criteria for causation. The Bradford Hill criteria, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework to determine if one can justifiably move from an observed association to a verdict of causation. The Bradford Hill criteria include nine viewpoints by which to evaluate human epidemiologic evidence to determine if causation can be deduced: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy. We explored the question of causation by evaluating studies on CTE as it relates to RHI exposure. Through this lens, we found convincing evidence of a causal relationship between RHI and CTE, as well as an absence of evidence-based alternative explanations. By organizing the CTE literature through this framework, we hope to advance the global conversation on CTE mitigation efforts.

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Section: Strength Of Associationmentioning

confidence: 99%

Section: Consistencymentioning

confidence: 99%

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Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

Nowinski¹,

Bureau²,

Buckland

et al. 2022

Front. Neurol.

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“…However, professional American footballers are not the only demographic at risk of CTE: any person who is exposed to repetitive brain injury, via any means, is at increased risk. With recent case studies reporting CTE pathology in sports outside of American football ( 60 – 63 ), and where community contact sports participation is high, there is a pressing need to quantify risk and then implement strategies that can best modify the risk. There is also a need to be alert to the potential for CTE in non-sports scenarios associated with RHI, particularly those that may not be so easily modifiable (such as domestic violence, combat military service, and medical conditions (such as epilepsy) associated with frequent head impacts.…”

Section: Moving Forward: Cte Recognition and Researchmentioning

confidence: 99%

Chronic Traumatic Encephalopathy as a Preventable Environmental Disease

et al. 2022

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In this Perspective we explore the evolution of our understanding of chronic traumatic encephalopathy (CTE) and its relationship with repetitive head injury. As with many neurodegenerative conditions, there is an imperfect correspondence between neuropathology and clinical phenotype, but unlike other neurodegenerative diseases, CTE has a discrete and easily modifiable risk factor: exposure to repetitive head injury. Consequently, evaluation of the evidence regarding exposure to repetitive head injury and CTE risk should be undertaken using public or occupational health frameworks of medical knowledge. The current debate over the existence of CTE as a disease of concern is fuelled in part by immediate medico-legal considerations, and the involvement of high-profile athletes, with inevitable media interest. Moving beyond this debate has significant potential to address and reduce disease impact in the near future, and provide novel insights into mechanisms underlying abnormal protein accumulation in CTE and other neurodegenerative diseases.

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“…While epidemiological studies only describe the risk, observational studies have suggested that increased risk appears to be due to continuing neurological and neuromuscular impairments post-concussion [5][6][7]. It has been suggested that experiencing numerous concussions, or exposure to repetitive subconcussive head trauma, could be associated with longterm consequences such as persistent post-concussive symptoms [8] or increasing risk of neurodegenerative disorders such as chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease and motor neuron disease [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review

Daly

Pearce

Finnegan

et al. 2022

BMC Sports Sci Med Rehabil

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Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies.

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Chronic traumatic encephalopathy in Australia: the first three years of the Australian Sports Brain Bank

Cited by 17 publications

References 5 publications

Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy as a Preventable Environmental Disease

An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review

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