@article{ref1,
title="Neuropathologic and clinical findings in young contact sport athletes exposed to repetitive head impacts",
journal="JAMA neurology",
year="2023",
author="McKee, Ann C. and Mez, Jesse and Abdolmohammadi, Bobak and Butler, Morgane and Huber, Bertrand Russell and Uretsky, Madeline and Babcock, Katharine and Cherry, Jonathan D. and Alvarez, Victor E. and Martin, Brett and Tripodis, Yorghos and Palmisano, Joseph N. and Cormier, Kerry A. and Kubilus, Caroline A. and Nicks, Raymond and Kirsch, Daniel and Mahar, Ian and McHale, Lisa and Nowinski, Christopher and Cantu, Robert C. and Stern, Robert A. and Daneshvar, Daniel and Goldstein, Lee E. and Katz, Douglas I. and Kowall, Neil W. and Dwyer, Brigid and Stein, Thor D. and Alosco, Michael L.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="IMPORTANCE: Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). <br><br>OBJECTIVE: To characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes. DESIGN, SETTING, AND PARTICIPANTS: This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022. Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023. EXPOSURES: Repetitive head impacts from contact sports. MAIN OUTCOMES AND MEASURES: Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation. <br><br>RESULTS: Among the 152 deceased contact sports participants (mean [SD] age, 22.97 [4.31] years; 141 [92.8%] male) included in the study, CTE was diagnosed in 63 (41.4%; median [IQR] age, 26 [24-27] years). Of the 63 brain donors diagnosed with CTE, 60 (95.2%) were diagnosed with mild CTE (stages I or II). Brain donors who had CTE were more likely to be older (mean difference, 3.92 years; 95% CI, 2.74-5.10 years) Of the 63 athletes with CTE, 45 (71.4%) were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer. For those who played football, duration of playing career was significantly longer in those with vs without CTE (mean difference, 2.81 years; 95% CI, 1.15-4.48 years). Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. Cognitive and neurobehavioral symptoms were frequent among all brain donors. Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status. <br><br>CONCLUSIONS AND RELEVANCE: This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. Future studies that include young brain donors unexposed to repetitive head impacts are needed to clarify the association among exposure, white matter and microvascular pathologic findings, CTE, and clinical symptoms.<p /> <p>Language: en</p>",
language="en",
issn="2168-6149",
doi="10.1001/jamaneurol.2023.2907",
url="http://dx.doi.org/10.1001/jamaneurol.2023.2907"
}