Mez Jesse, Daneshvar Daniel H, Kiernan Patrick T, Abdolmohammadi Bobak, Alvarez Victor E, Huber Bertrand R, Alosco Michael L, Solomon Todd M, Nowinski Christopher J, McHale Lisa, Cormier Kerry A, Kubilus Caroline A, Martin Brett M, Murphy Lauren, Baugh Christine M, Montenigro Phillip H, Chaisson Christine E, Tripodis Yorghos, Kowall Neil W, Weuve Jennifer, McClean Michael D, Cantu Robert C, Goldstein Lee E, Katz Douglas I, Stern Robert A, Stein Thor D, McKee Ann C
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts3Department of Orthopaedic Surgery, Stanford University, Stanford, California.
JAMA. 2017 Jul 25;318(4):360-370. doi: 10.1001/jama.2017.8334.
Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE).
To determine the neuropathological and clinical features of deceased football players with CTE.
DESIGN, SETTING, AND PARTICIPANTS: Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history.
Participation in American football at any level of play.
Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia.
Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre-high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia.
In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.
美式橄榄球运动员可能面临长期神经疾病风险增加，尤其是慢性创伤性脑病（CTE）。
确定患有CTE的已故橄榄球运动员的神经病理学和临床特征。
设计、地点和参与者：202名橄榄球运动员的病例系列，其大脑被捐赠用于研究。对神经病理学评估和与 informant 进行的回顾性电话临床评估（包括头部创伤史）进行了盲法操作。通过在线问卷确定运动和军事历史。
参与任何水平的美式橄榄球运动。
根据既定诊断标准对神经退行性疾病（包括CTE）进行神经病理学诊断；CTE神经病理学严重程度（I至IV期或分为轻度[I和II期]和重度[III和IV期]）； informant报告的运动历史，以及对于2014年或之后去世的运动员，临床表现，包括行为、情绪、认知症状和痴呆。
在202名已故前橄榄球运动员中（死亡时中位年龄66岁[四分位间距，47 - 76岁]），177名运动员（87%）经神经病理学诊断患有CTE（死亡时中位年龄67岁[四分位间距，52 - 77岁]；平均橄榄球参与年限15.1[标准差，5.2]），包括2名高中前球员中的0名，14名高中球员中的3名（21%），53名大学球员中的48名（91%），14名半职业球员中的9名（64%），8名加拿大橄榄球联盟球员中的7名（88%），以及111名国家橄榄球联盟球员中的110名（99%）。CTE的神经病理学严重程度在最高水平的比赛中均有分布，所有3名前高中球员均有轻度病变，而大多数前大学（27名[56%]）、半职业（5名[56%]）和职业（101名[86%]）球员有重度病变。在27名患有轻度CTE病变的参与者中，26名（96%）有行为或情绪症状或两者皆有，23名（85%）有认知症状，9名（33%）有痴呆迹象。在84名患有重度CTE病变的参与者中，75名（89%）有行为或情绪症状或两者皆有，80名（95%）有认知症状，71名（85%）有痴呆迹象。
在一个为研究而捐赠大脑的已故橄榄球运动员便利样本中，很大比例有CTE的神经病理学证据，表明CTE可能与先前参与橄榄球运动有关。
