Neuropsychological dysfunction following repeat concussions in jockeys

Wall, Sarah E.; Williams, W. Huw; Cartwright‐Hatton, Sam; Kelly, Toby; Murray, J. T.; Murray, M; Owen, Andrew; Turner, Michael S.

doi:10.1136/jnnp.2004.061044

Cited by 134 publications

(80 citation statements)

References 20 publications

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“…Moreover, confirmation of the likely residual pathology from concussion is clearly demonstrated in the secondinjury circumstance, where a prior concussion increases the likelihood of a second concussion and greater morbidity of the second concussion in both human and animal studies (Huh et al, 2007;Longhi et al, 2005;Manville et Wall et al, 2006). The most straight forward explanation of the pathology of the second injury concussion is that the first concussion is simply not benign, but that the brain adapts quickly to the injury in most cases.…”

Section: Pathophysiology Of Concussionmentioning

confidence: 95%

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Bigler

2007

J Int Neuropsychol Soc

363

248

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On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion. (JINS, 2008, 14, 1-22.)

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Section: Pathophysiology Of Concussionmentioning

confidence: 95%

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Bigler

2007

J Int Neuropsychol Soc

363

248

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“…Several studies have been conducted in sports medicine to evaluate the differences between groups of athletes who experienced single or repeat mTBI (10,17,38,46,57). These reports described cumulative effect of multiple concussions, highlighting the possible occurrence of the second impact syndrome (7,8,10).…”

Section: Discussionmentioning

confidence: 99%

Temporal Window of Metabolic Brain Vulnerability to Concussions

et al. 2007

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OBJECTIVE:In the present study, we investigate the existence of a temporal window of brain vulnerability in rats undergoing repeat mild traumatic brain injury (mTBI) delivered at increasing time intervals. METHODS: Rats were subjected to two diffuse mTBIs (450 g/1 m height) with the second mTBI delivered after 1 (n ϭ 6), 2 (n ϭ 6), 3 (n ϭ 6), 4 (n ϭ 6), and 5 days (n ϭ 6) and sacrificed 48 hours after the last impact. Sham-operated animals were used as controls (n ϭ 6). Two further groups of six rats each received a second mTBI after 3 days and were sacrificed at 120 and 168 hours postinjury. Concentrations of adenine nucleotides, N-acetylated amino acids, oxypurines, nucleosides, free coenzyme A, acetyl CoA, and oxidized and reduced nicotinamide adenine dinucleotides, oxidized nicotinamide adenine dinucleotide phosphate, and reduced nicotinamide adenine dinucleotide, reduced nicotinamide adenine dinucleotide phosphate nicotinic coenzymes were measured in deproteinized cerebral tissue extracts (three right and three left hemispheres), whereas the gene expression of N-acetylaspartate acylase, the enzyme responsible for N-acetylaspartate (NAA) degradation, was evaluated in extracts of three left and three right hemispheres. RESULTS: A decrease of adenosine triphosphate, adenosine triphosphate /adenosine diphosphate ratio, NAA, N-acetylaspartylglutamate, oxidized and reduced nicotinamide adenine dinucleotide, reduced nicotinamide adenine dinucleotide, and acetyl CoA and increase of N-acetylaspartate acylase expression were related to the interval between impacts with maximal changes recorded when mTBIs were spaced by 3 days. In these animals, protracting the time of sacrifice after the second mTBI up to 1 week failed to show cerebral metabolic recovery, indicating that this type of damage is difficult to reverse. A metabolic pattern similar to controls was observed only in animals receiving mTBIs 5 days apart. CONCLUSION: This study shows the existence of a temporal window of brain vulnerability after mTBI. A second concussive event falling within this time range had profound consequences on mitochondrial-related metabolism. Furthermore, because NAA recovery coincided with normalization of all other metabolites, it is conceivable to hypothesize that NAA measurement by 1 H-NMR spectroscopy might be a valid tool in assessing full cerebral metabolic recovery in the clinical setting and with particular reference to sports medicine in establishing when to return mTBI-affected athletes to play. This study also shows, for the first time, the influence of TBI on acetyl-CoA, N-acetylaspartate acylase gene expression, and N-acetylaspartylglutamate, thus providing novel data on cerebral biochemical changes occurring in head injury.

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“…When studied independently, experiencing multiple blast and nonblast injuries resulted in the greatest likelihood of reporting MSI symptoms. Given the cumulative effect of multiple head injuries, as suggested by the sports concussion literature [69][70][71], experiencing blast and nonblast injury only once may allow for a better recovery from each injury compared with individuals with multiple injury events. Experiencing the same injury type more than once may have cumulative effects, because the previous injury symptoms may not have fully resolved [72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Neuropsychological dysfunction following repeat concussions in jockeys

Abstract: Repeated concussion is associated with reliable decrements in cognitive performance--even after a three month window for recent recovery.

Cited by 134 publications

References 20 publications

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Temporal Window of Metabolic Brain Vulnerability to Concussions

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

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