Rachel Grashow1,2, Marc G Weisskopf1,2, Aaron Baggish1,3, Frank E Speizer1,2,4, Alicia J Whittington1, Lee Nadler1,5, Ann Connor1,6, Robyn Keske1, Herman Taylor1,7, Ross Zafonte1,8, Alvaro Pascual-Leone1,6,9,10. 1. Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA. 2. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA. 4. Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 5. Dana Farber Cancer Institute, Boston, MA. 6. Department of Neurology, Harvard Medical School, Boston, MA. 7. Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA. 8. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School Boston, Boston, MA. 9. Center for Memory Health and Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA. 10. Institut Guttmann, Universitat Autónoma, Barcelona, Spain.
Abstract
OBJECTIVE: American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. METHODS: A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. RESULTS: Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE. INTERPRETATION: Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
OBJECTIVE: American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. METHODS: A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. RESULTS: Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE. INTERPRETATION: Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
Authors: Andrea L Roberts; Ross Zafonte; Lori B Chibnik; Aaron Baggish; Herman Taylor; Jillian Baker; Alicia J Whittington; Marc G Weisskopf Journal: JAMA Netw Open Date: 2022-03-01
Authors: Douglas I Katz; Charles Bernick; David W Dodick; Jesse Mez; Megan L Mariani; Charles H Adler; Michael L Alosco; Laura J Balcer; Sarah J Banks; William B Barr; David L Brody; Robert C Cantu; Kristen Dams-O'Connor; Yonas E Geda; Barry D Jordan; Thomas W McAllister; Elaine R Peskind; Ronald C Petersen; Jennifer V Wethe; Ross D Zafonte; Éimear M Foley; Debra J Babcock; Walter J Koroshetz; Yorghos Tripodis; Ann C McKee; Martha E Shenton; Jeffrey L Cummings; Eric M Reiman; Robert A Stern Journal: Neurology Date: 2021-03-15 Impact factor: 11.800