Citation

Stewart W, Buckland ME, Abdolmohammadi B, Affleck AJ, Alvarez VE, Gilchrist S, Huber BR, Lee EB, Lyall DM, Nowinski CJ, Russell ER, Stein TD, Suter CM, McKee AC. Acta Neuropathol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00401-023-02644-3

PMID

37872234

Abstract

There is concern over late, adverse brain health outcomes associated with contact sports participation, with high neurodegenerative disease risk reported in studies of former American football [3, 8], soccer [9, 16] and rugby union players [15]. In parallel, autopsy studies of former athletes from a range of contact sports describe a frequent finding of chronic traumatic encephalopathy (CTE), a neuropathology uniquely associated with prior history of traumatic brain injury (TBI) and repetitive head impact (RHI) exposure [7, 12,13,14]. Among contact sports, rugby union (hereafter 'rugby') is documented as having high risk of concussion/mild TBI, with reported injury rates ranging 4.1 concussions/1000 player hours at community level [2] to 22.2 concussions/1000 player hours in professional rugby [4]. Nevertheless, despite its popularity, with a reported 8.46 million active participants globally [20], there have been relatively few case descriptions of CTE in former rugby players [7, 17, 18]. To address this, we collated and analyzed neuropathological data from autopsy brain examinations on individuals with rugby as primary sport exposure submitted to three international brain banks with specific interest in contact sport and brain health.

Case records of the Understanding Neurologic Injury and Traumatic Encephalopathy Brain Bank (UNITE; Boston University School of Medicine, US), the Glasgow TBI Archive (GTBI; University of Glasgow, UK) and the Australian Sports Brain Bank (ASBB; Royal Prince Alfred Hospital and University of Sydney, Australia) were surveyed to identify case donations in which primary sport exposure was recorded as 'rugby union'. Each archive employs standardized procedures for case accrual, clinical history acquisition and tissue processing, with neuropathological evaluations conducted blind to demographic and clinical information and employing established, consensus protocols for assessment of neurodegenerative disease pathologies, including CTE [1, 11, 13]. For the purposes of this study, existing archive datasets were interrogated to extract relevant demographic information (age at death, sex), sports exposure history (years duration of rugby participation, position played [dichotomized as forward or back], highest level of participation [dichotomized as amateur or elite (encompassing representative international and/or professional)], other contact sport exposure) and principal neuropathological findings...

Language: en