Chronic traumatic encephalopathy in two former Australian National Rugby League players

Buckland, Michael E.; Sy, Joanne; Szentmariay, Istvan; Kullen, Alexandra; Lee, Maggie; Harding, Anthony John; Halliday, Glenda M.; Suter, Catherine M.

doi:10.1186/s40478-019-0751-1

Cited by 35 publications

(31 citation statements)

References 11 publications

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“…While CTE can be suspected clinically, at present, the definitive diagnosis of CTE can only be made following neuropathological examination of the brain (11,(15)(16)(17). CTE pathology contributes to the clinical presentation, and its interaction with comorbid neurodegenerative pathologies is unclear (9,13,18).…”

Section: Introductionmentioning

confidence: 99%

A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology

et al. 2020

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Chronic traumatic encephalopathy (CTE) was recently recognized as a new tauopathy in which multifocal perivascular phosphorylated tau aggregates accumulate in neurons, astrocytes, and neurites at the depths of the cortical sulci. Traumatic brain injury (TBI) in early or mid-life is known to be associated with an increased risk of dementia in late life. This case report describes a 93-year-old former street boxer with a premortem diagnosis of severe dementia, who showed pathological evidence of the coexistence of Alzheimer's disease, CTE, dementia with Lewy bodies, and hippocampal sclerosis with TDP-43 pathology. These findings suggest that TBI may trigger a variety of misfolded proteins leading to dementia. Currently, clear clinical diagnostic criteria for CTE have not been established. Therefore, clinicians should be aware that TBI is a risk factor for dementia and that CTE can overlap with other neurodegenerative diseases.

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Section: Introductionmentioning

confidence: 99%

A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology

et al. 2020

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“…The first case report of chronic traumatic encephalopathy (CTE) in a National Football League player in 2005 [9] opened the floodgates for the identification of CTE in American football. CTE is now reported in ex-players of other contact sports, including ice hockey, soccer, rugby union, and most recently in Australian rugby league [2]. To date, repetitive head injury remains the only known risk factor for the development of CTE [3].…”

Section: To the Editormentioning

confidence: 99%

“…The boxed area is represented at high power in the inset. All immunohistochemistry performed on 4 μm sections from standard-sized blocks of formalin-fixed (10% neutral buffered formalin), paraffin-embedded tissue on a Leica BOND-MAX™ autostainer using the Leica BOND Polymer Refine detection system as per the manufacturer's recommendations pathology is something we have not encountered in our busy clinical practice outside of ex-contact sports players [2]. That it exists at all should serve as a call to action to recognise and research CTE, and the very clear association with repetitive head injury.…”

Section: To the Editormentioning

confidence: 99%

Chronic traumatic encephalopathy in a former Australian rules football player diagnosed with Alzheimer’s disease

Pearce

Lee

et al. 2020

acta neuropathol commun

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“…Resultantly, there have been increased investigations studying the underlying neurological mechanisms to inform the development of diagnostic, monitoring, and treatment protocols (Koerte et al, 2015 ; Lefebvre et al, 2015 ; Kamins et al, 2017 ). While much of this culture shift has been catalyzed by the publishing of neuropathological and long-term neurological impairment studies in retired professional athletes (Pearce et al, 2014 , 2018 , 2020b ; Koerte et al, 2015 ; Buckland et al, 2019 ; Mez et al, 2019 ), there is a push to elicit explanations of the shorter-term impacts and underlying pathophysiology (Lefebvre et al, 2015 ) that can determine long-term sequelae.…”

Section: Introductionmentioning

confidence: 99%

The Neurophysiological Responses of Concussive Impacts: A Systematic Review and Meta-Analysis of Transcranial Magnetic Stimulation Studies

Scott

Kidgell

Frazer

et al. 2020

Front. Hum. Neurosci.

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This systematic review and meta-analysis investigated neurophysiological responses using transcranial magnetic stimulation (TMS) following a concussion or sub-concussion. Methods: A systematic searching of relevant databases for peer-reviewed literature quantifying motor evoked potentials from TMS between 1999 and 2019 was performed. A meta-analysis quantified pooled data for measures including motor threshold, motor latency, and motor evoked potential amplitude and for inhibitory measures such as cortical silent period duration, short-interval intracortical inhibition (SICI), and long-interval intracortical inhibition (LICI) ratios. Results: Fifteen articles met the inclusion criteria. The studies were arbitrarily classified into the groups, based on time post-concussion, "acute" (subjects 0-3 months post-injury, n = 8) and "post-acute" (3 months−2 years post-concussion, n = 7). A TMS quality of study checklist rated studies from moderate to high in methodological quality; however, the risk of bias analysis found that the included studies were categorised as high risk of bias, particularly for a lack of allocation concealment and blinding of participants in the methodologies. A meta-analysis showed no differences in excitability measures, apart from a decreased motor threshold that was observed in the concussed group (SMD −0.28, 95% CI −0.51 to −0.04; P = 0.02) for the post-acute time frame. Conversely, all inhibitory measures showed differences between groups. Cortical silent period duration was found to be significantly increased in the acute (SMD 1.19, 95% CI 0.58-1.81; P < 0.001) and post-acute (SMD 0.55, 95% CI 0.12-0.98; P = 0.01) time frames. The SICI (SMD −1.15, 95% CI −1.95 to −0.34; P = 0.005) and LICI (SMD −1.95, 95% CI −3.04 to −0.85; P = 0.005) ratios were reduced, inferring increased inhibition, for the post-acute time frame. Conclusion: This systematic review and meta-analysis demonstrates that inhibitory pathways are affected in the acute period post-concussion. However, persistent alterations in cortical excitability remain, with increased intracortical inhibition. While TMS Scott et al. Neurophysiology of Concussion Injury should be considered as a reliable technique to measure the functional integrity of the central nervous system, the high risk of bias and heterogeneity in data suggest that future studies should aim to incorporate standardised methodological techniques, particularly with threshold determination and stimulus intervals for paired-pulse measures.

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Chronic traumatic encephalopathy in two former Australian National Rugby League players

Cited by 35 publications

References 11 publications

A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology

A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer's Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology

Chronic traumatic encephalopathy in a former Australian rules football player diagnosed with Alzheimer’s disease

The Neurophysiological Responses of Concussive Impacts: A Systematic Review and Meta-Analysis of Transcranial Magnetic Stimulation Studies

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