Recurrent Concussion and Risk of Depression in Retired Professional Football Players

Guskiewicz, Kevin M.; Marshall, Stephen W.; Bailes, Julian E.; McCrea, Michael; Harding, Herndon P.; Matthews, Amy; Mihalik, Johna Register; Cantu, Robert C.

doi:10.1249/mss.0b013e3180383da5

Cited by 798 publications

(609 citation statements)

References 37 publications

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“…38 This study focuses on only one cognitive domain; however, other tests of cognition were significant as described by Hart and coworkers, 35 and we adjusted our p value to compensate (Bonferonni correction p < 0.02). Age was regressed from the imaging data prior to the execution of Randomise to make the imaging data comparable to the BNT T-scores that were already stratified for age.…”

Section: Image Analysismentioning

confidence: 99%

White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes

Strain

Didehbani

Spence

et al. 2017

Journal of Neurotrauma

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Using diffusion tensor imaging (DTI), we assessed the relationship of white matter integrity and performance on the Boston Naming Test (BNT) in a group of retired professional football players and a control group. We examined correlations between fractional anisotropy (FA) and mean diffusivity (MD) with BNT T-scores in an unbiased voxelwise analysis processed with tract-based spatial statistics (TBSS). We also analyzed the DTI data by grouping voxels together as white matter tracts and testing each tract's association with BNT T-scores. Significant voxelwise correlations between FA and BNT performance were only seen in the retired football players ( p < 0.02). Two tracts had mean FA values that significantly correlated with BNT performance: forceps minor and forceps major. White matter integrity is important for distributed cognitive processes, and disruption correlates with diminished performance in athletes exposed to concussive and subconcussive brain injuries, but not in controls without such exposure.

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Section: Image Analysismentioning

confidence: 99%

White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes

Strain

Didehbani

Spence

et al. 2017

Journal of Neurotrauma

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“…From this database of over 2800 retirees, 430 retired NFL players were identified who meet the following criteria: 1) age 30-65 who played at least 1 year in the NFL; 2) completed the CSRA Health Survey of Retired NFL Players questionnaire 5,6,24 the Short Form 36 (SF-36) quality-of-life assessment and the International Index of Erectile Function (IIEF) survey; and 3) had poor QoL based on an SF-36 Mental Component Score (MCS) of < 49 ( Fig. 1).…”

Section: Initial Screening Eligibility and Exclusion Criteriamentioning

confidence: 99%

“…Recurrent concussion in the NFL has been associated with development of depression, cognitive impairment, and poor quality of life (QoL) in retirees. 5,6 Another potential sequelae of repetitive mTBI is pituitary hormonal dysfunction which is known to occur in 20-40% of moderate and severe TBI (sTBI) patients. [7][8][9][10][11][12][13][14][15][16][17][18] Prospective cohort studies published since 2000 in moderate and sTBI patients show that growth hormone (GH) and gonadotropin deficiencies are the most common endocrinopathies, whereas hypothyroidism, adrenal insufficiency, and diabetes insipidus are less common.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

Kelly

Chaloner

Evans

et al. 2014

Journal of Neurotrauma

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Hypopituitarism is common after moderate and severe traumatic brain injury (TBI). Herein, we address the association between mild TBI (mTBI) and pituitary and metabolic function in retired football players. Retirees 30-65 years of age, with one or more years of National Football League (NFL) play and poor quality of life (QoL) based on Short Form 36 (SF-36) Mental Component Score (MCS) were prospectively enrolled. Pituitary hormonal and metabolic syndrome (MetS) testing was performed. Using a glucagon stimulation test, growth hormone deficiency (GHD) was defined with a standard cut point of 3 ng/mL and with a more stringent body mass index (BMI)-adjusted cut point. Subjects with and without hormonal deficiency (HD) were compared in terms of QoL, International Index of Erectile Function (IIEF) scores, metabolic parameters, and football career data. Of 74 subjects, 6 were excluded because of significant non-football-related TBIs. Of the remaining 68 subjects (mean age, 47.3 -10.2 years; median NFL years, 5; median NFL concussions, 3; mean BMI, 33.8 -6.0), 28 (41.2%) were GHD using a peak GH cutoff of < 3 ng/mL. However, with a BMI-adjusted definition of GHD, 13 of 68 (19.1%) were GHD. Using this BMI-adjusted definition, overall HD was found in 16 (23.5%) subjects: 10 (14.7%) with isolated GHD; 3 (4.4%) with isolated hypogonadism; and 3 (4.4%) with both GHD and hypogonadism. Subjects with HD had lower mean scores on the IIEF survey ( p = 0.016) and trended toward lower scores on the SF-36 MCS ( p = 0.113). MetS was present in 50% of subjects, including 5 of 6 (83%) with hypogonadism, and 29 of 62 (46.8%) without hypogonadism ( p = 0.087). Age, BMI, median years in NFL, games played, number of concussions, and acknowledged use of performance-enhancing steroids were similar between HD and non-HD groups. In summary, in this cohort of retired NFL players with poor QoL, 23.5% had HD, including 19% with GHD (using a BMI-adjusted definition), 9% with hypogonadism, and 50% had MetS. Although the cause of HD is unclear, these results suggest that GHD and hypogonadism may contribute to poor QoL, erectile dysfunction, and MetS in this population. Further study of pituitary function is warranted in athletes sustaining repetitive mTBI.

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“…It should be noted that there is some controversy over the second injury hypothesis (Iverson et al, 2006b;Schnadower et al, 2007) and much more animal and human research is needed to fully understand this phenomena (Laurer et al, 2001). From a clinical management standpoint, repeated concussions are the basis for recommendations to retire from sports (Cantu, 2003) and reported to be related to the presence of neuropsychiatric symptoms in professional North American Football players (Guskiewicz et al, 2007).…”

Section: Pathophysiology Of Concussionmentioning

confidence: 99%

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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Recurrent Concussion and Risk of Depression in Retired Professional Football Players

Abstract: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.

Cited by 798 publications

References 37 publications

White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes

White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes

Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

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