The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy

2019 ◽  
pp. 337-355 ◽  
Author(s):  
Michael L. Alosco ◽  
Robert A. Stern
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Long Term Consequences

scholarly journals Detecting a History of Repetitive Head Impacts from a Short Voice Recording

2021 ◽  
Author(s):  
Michael G. Tauro ◽  
Mirco Ravanelli ◽  
Cristian A. Droppelmann
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Control Group ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Potential Biomarker ◽  
Increased Risk ◽  
Clinical Diagnoses ◽  
History Of ◽  
Brain Changes ◽  
Fine Tune

Repetitive head impacts (RHI) are associated with an increased risk of developing various neurodegenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), and most notably, chronic traumatic encephalopathy (CTE). While the clinical presentation of AD and PD is well established, CTE can only be diagnosed post-mortem. Therefore, a distinction can be made between the pathologically defined CTE and RHI-related functional or structural brain changes (RHI-BC) which may result in CTE. Unfortunately, there are currently no accepted biomarkers of CTE nor RHI-BC, a major hurdle to achieving clinical diagnoses. Interestingly, speech has shown promise as a potential biomarker of both AD and PD, being used to accurately classify individuals with AD and PD from those without. Given the overlapping symptoms between CTE, RHI-BC, PD and AD, we aimed to determine if speech could be used to identify individuals with a history of RHI from those without. We therefore created the Verus dataset, consisting of 13 second voice recordings from 605 professional fighters (RHI group) and 605 professional athletes in non-contact sports (control group) for a total of 1210 recordings. Using a deep learning approach, we achieved 85% accuracy in detecting individuals with a history of RHI from those without. We then used our model trained on the Verus dataset to fine-tune on publicly available AD and PD speech datasets and achieved new state-of-the-art accuracies of 84.99% on the AD dataset and 89% on the PD dataset. Finding a biomarker of CTE and RHI-BC that presents early in disease progression is critical to improve risk management and patient outcome. Our study is the first we are aware of to investigate speech as such a candidate biomarker of RHI-BC.

scholarly journals Long‐term effects of repetitive head impacts on gray matter cortical thickness

2021 ◽  
Vol 17 (S6) ◽  
Author(s):  
Bailee Brekke ◽  
Renee DeVivo ◽  
Ann C. McKee ◽  
Thor D. Stein ◽  
Yorghos Tripodis ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Gray Matter ◽  
Long Term Effects ◽  
Head Impacts ◽  
Repetitive Head Impacts

scholarly journals Improving the translational potential of rodent models to study the behavioral and pathophysiological effects of repetitive mild traumatic brain injury

2018 ◽  
Vol 120 (1) ◽  
pp. 1-3
Author(s):  
Megan E. Huibregtse
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Outcome Measures ◽  
Mild Traumatic Brain Injury ◽  
Chronic Traumatic Encephalopathy ◽  
Rodent Models ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
The Impact

Chronic traumatic encephalopathy (CTE) is thought to be caused by repetitive head impacts. Consequently, there is a need to develop rodent models to better understand the behavioral and pathophysiological changes of repetitive mild traumatic brain injury (rmTBI) and to determine the link between rmTBI and CTE. This Neuro Forum article reviews recent rodent rmTBI models, comparing the impact methods and outcome measures in terms of translational potential.

scholarly journals High-frequency head impact causes chronic synaptic adaptation and long-term cognitive impairment in mice

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Stephanie S. Sloley ◽  
Bevan S. Main ◽  
Charisse N. Winston ◽  
Alex C. Harvey ◽  
Alice Kaganovich ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
High Frequency ◽  
Chronic Traumatic Encephalopathy ◽  
Glutamate Release ◽  
Head Impact ◽  
Physiological Adaptation ◽  
Head Impacts ◽  
Behavioral Impairments ◽  
Human And Mouse

AbstractRepeated head impact exposure can cause memory and behavioral impairments. Here, we report that exposure to non-damaging, but high frequency, head impacts can alter brain function in mice through synaptic adaptation. High frequency head impact mice develop chronic cognitive impairments in the absence of traditional brain trauma pathology, and transcriptomic profiling of mouse and human chronic traumatic encephalopathy brain reveal that synapses are strongly affected by head impact. Electrophysiological analysis shows that high frequency head impacts cause chronic modification of the AMPA/NMDA ratio in neurons that underlie the changes to cognition. To demonstrate that synaptic adaptation is caused by head impact-induced glutamate release, we pretreated mice with memantine prior to head impact. Memantine prevents the development of the key transcriptomic and electrophysiological signatures of high frequency head impact, and averts cognitive dysfunction. These data reveal synapses as a target of high frequency head impact in human and mouse brain, and that this physiological adaptation in response to head impact is sufficient to induce chronic cognitive impairment in mice.

scholarly journals Persistent, Long-term Cerebral White Matter Changes after Sports-Related Repetitive Head Impacts

PLoS ONE ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. e94734 ◽  
Author(s):  
Jeffrey J. Bazarian ◽  
Tong Zhu ◽  
Jianhui Zhong ◽  
Damir Janigro ◽  
Eric Rozen ◽  
...  
Keyword(s):  
White Matter ◽  
Cerebral White Matter ◽  
White Matter Changes ◽  
Head Impacts ◽  
Repetitive Head Impacts

Chronic Traumatic Encephalopathy and Neuropathological Comorbidities

2020 ◽  
Vol 40 (04) ◽  
pp. 384-393
Author(s):  
Thor D. Stein ◽  
John F. Crary
Keyword(s):  
Traumatic Brain Injury ◽  
Chronic Traumatic Encephalopathy ◽  
Lewy Body Disease ◽  
Single Individual ◽  
Contact Sports ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Age Related ◽  
The Relationship ◽  
Lateral Sclerosis

AbstractWith age, the presence of multiple neuropathologies in a single individual becomes increasingly common. Given that traumatic brain injury and the repetitive head impacts (RHIs) that occur in contact sports have been associated with the development of many neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), Alzheimer's disease, Lewy body disease, and amyotrophic lateral sclerosis, it is becoming critical to understand the relationship and interactions between these pathologies. In fact, comorbid pathology is common in CTE and likely influenced by both age and the severity and type of exposure to RHI as well as underlying genetic predisposition. Here, we review the major comorbid pathologies seen with CTE and in former contact sports athletes and discuss what is known about the associations between RHI, age, and the development of neuropathologies. In addition, we examine the distinction between CTE and age-related pathology including primary age-related tauopathy and age-related tau astrogliopathy.

scholarly journals COllaborative Neuropathology NEtwork Characterizing ouTcomes of TBI (CONNECT-TBI)

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Douglas H. Smith ◽  
Jean-Pierre Dollé ◽  
Kamar E. Ameen-Ali ◽  
Abigail Bretzin ◽  
Etty Cortes ◽  
...  
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Clinical Information ◽  
Illustrative Case ◽  
Contact Sports ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Dementia Risk ◽  
Stroke Center ◽  
Tissue Specimens ◽  
Multiple Experts

AbstractEfforts to characterize the late effects of traumatic brain injury (TBI) have been in progress for some time. In recent years much of this activity has been directed towards reporting of chronic traumatic encephalopathy (CTE) in former contact sports athletes and others exposed to repetitive head impacts. However, the association between TBI and dementia risk has long been acknowledged outside of contact sports. Further, growing experience suggests a complex of neurodegenerative pathologies in those surviving TBI, which extends beyond CTE. Nevertheless, despite extensive research, we have scant knowledge of the mechanisms underlying TBI-related neurodegeneration (TReND) and its link to dementia. In part, this is due to the limited number of human brain samples linked to robust demographic and clinical information available for research. Here we detail a National Institutes for Neurological Disease and Stroke Center Without Walls project, the COllaborative Neuropathology NEtwork Characterizing ouTcomes of TBI (CONNECT-TBI), designed to address current limitations in tissue and research access and to advance understanding of the neuropathologies of TReND. As an international, multidisciplinary collaboration CONNECT-TBI brings together multiple experts across 13 institutions. In so doing, CONNECT-TBI unites the existing, comprehensive clinical and neuropathological datasets of multiple established research brain archives in TBI, with survivals ranging minutes to many decades and spanning diverse injury exposures. These existing tissue specimens will be supplemented by prospective brain banking and contribute to a centralized route of access to human tissue for research for investigators. Importantly, each new case will be subject to consensus neuropathology review by the CONNECT-TBI Expert Pathology Group. Herein we set out the CONNECT-TBI program structure and aims and, by way of an illustrative case, the approach to consensus evaluation of new case donations.

Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware)

2020 ◽  
pp. bjsports-2020-102108
Author(s):  
Michael Turner ◽  
David Maddocks ◽  
Majid Hassan ◽  
Adrian Anderson ◽  
Paul McCrory
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Return To Sport ◽  
Executive Dysfunction ◽  
Return To Play ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
School Sports ◽  
Long Term Consequences ◽  
Prospective Longitudinal

While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a cause and effect relationship has not yet been demonstrated between CTE and concussions or between CTE and exposure to contact sports, as no prospective longitudinal studies have been performed to address that question. Studies of high-school sports exposure and long-term outcomes have not demonstrated consistent findings.Medical advice regarding return to play and the risk of acute and/or long-term consequences is therefore problematic. It is important that the individual’s right to make their own choices regarding their health is respected. Team, coach, parental, peer or financial pressures should not influence this decision. The choice to return to play after a concussion or mild TBI injury is the athlete’s decision once they have (1) recovered from their injury and have the legal capacity to make an informed decision; (2) been medically assessed and (3) been informed of any possible long-term risks in a language that they can understand.Given the current lack of certainty in relation to long-term outcomes from concussion, is it possible to provide a framework to inform players of current evidence, as part of a consent process, even if the information upon which the decision to return to sport is based remains uncertain and evolving?

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