Manley Geoff, Gardner Andrew J, Schneider Kathryn J, Guskiewicz Kevin M, Bailes Julian, Cantu Robert C, Castellani Rudolph J, Turner Michael, Jordan Barry D, Randolph Christopher, Dvořák Jiří, Hayden K Alix, Tator Charles H, McCrory Paul, Iverson Grant L
Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, USA.
Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, Australia.
Br J Sports Med. 2017 Jun;51(12):969-977. doi: 10.1136/bjsports-2017-097791. Epub 2017 Apr 28.
Systematic review of possible long-term effects of sports-related concussion in retired athletes.
Ten electronic databases.
Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as 10 years after the injury.
Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors.
Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes.
Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
系统评价退役运动员中与运动相关的脑震荡可能产生的长期影响。
十个电子数据库。
原始研究；与长期心理健康或神经问题相关的发病率、危险因素或病因；遭受过脑震荡的个体；以退役运动员为研究对象，将受伤后10年定义为可能的长期后遗症。
研究人群、暴露/结局测量、临床数据、神经学检查结果、认知评估、神经影像学检查结果和神经病理学结果。由两位作者评估偏倚风险和证据水平。
在对3819项研究进行综述后，47项符合纳入标准。一些前运动员在晚年出现抑郁和认知缺陷，这些缺陷与多次先前的脑震荡之间存在关联。前运动员自杀死亡风险并未增加（两项研究）。前美国高中橄榄球运动员患晚年神经退行性疾病的风险似乎并未增加（两项研究）。一些退役的美国职业橄榄球运动员认知功能减退或轻度认知障碍（多项研究）以及神经退行性疾病（一项研究）的风险可能增加。神经影像学研究显示，部分运动员存在宏观结构、微观结构、功能和神经化学变化的适度证据。
多次脑震荡似乎是某些个体认知障碍和心理健康问题的危险因素。需要更多研究来更好地了解慢性创伤性脑病和其他神经疾病的患病率，以及它们与运动中遭受的脑震荡和/或重复性神经创伤的相关程度。
