Randolph Christopher
Neurology, Loyola University Medical Center, Maywood, IL, USA.
Arch Clin Neuropsychol. 2018 Aug 1;33(5):644-648. doi: 10.1093/arclin/acy063.
There was a long-lasting debate during the first half of the 1900s about whether boxers suffered from a condition called "dementia pugilistica". This included arguments as to whether there was such a distinct clinical condition, whether it was static or progressive, and whether boxers were actually at any increased risk of any neurological issues at all. The debate was never resolved, but was resuscitated in 2005 with the speculation that a similar condition, dubbed "chronic traumatic encephalopathy (CTE)" existed in retired National Football League (NFL) players. A specific pattern of p-tau deposition has been identified in the brains of NFL retirees, and also identifiable in the brains of at least a percentage of individuals exposed to contact sports in general. Advocates of CTE as a disease describe it as presenting with behavioral disturbance, increased suicidality and neurodegeneration leading to dementia. The evidence to date, however, does not rise to the level of a verifiable disease, and remains at the level of case report. To assume that CTE pathology represents a neurodegenerative disease flies in the face of a number of facts, including that traumatic brain injury does not cause neurodegeneration, protein deposits in the brain are a poor predictor of behavioral symptoms, p-tau is not necessarily toxic or self-propagating, and retired NFL players are actually much physically and mentally healthier than men of their demographic background. They have an all-cause mortality rate that is 50% of that expected, and a suicide rate that is 40% of that expected. The most parsimonious explanation of the evidence to date is that repetitive head trauma may result in p-tau deposition, but that this isoform of p-tau is inert and has no toxic or self-propagating effects.
在20世纪上半叶,关于拳击运动员是否患有“拳击性痴呆”这一病症存在着长期的争论。这包括关于是否存在这样一种独特的临床病症、它是静止的还是进行性的,以及拳击运动员实际上是否真的有任何神经系统问题的风险增加等争论。这场争论从未得到解决,但在2005年又被重新提起,当时有人猜测,一种类似的病症,被称为“慢性创伤性脑病(CTE)”,存在于退役的美国国家橄榄球联盟(NFL)球员中。在NFL退休人员的大脑中已经发现了一种特定的p- tau蛋白沉积模式,并且在至少一部分从事接触性运动的人的大脑中也可以识别出来。CTE作为一种疾病的支持者将其描述为表现为行为障碍、自杀倾向增加以及导致痴呆的神经退行性变。然而,迄今为止的证据并未达到可证实疾病的水平,仍然停留在病例报告的层面。假设CTE病理学代表一种神经退行性疾病,这与许多事实相悖,包括创伤性脑损伤不会导致神经退行性变、大脑中的蛋白质沉积并不能很好地预测行为症状、p- tau蛋白不一定有毒或具有自我传播性,而且退役的NFL球员实际上在身体和精神上比同年龄段背景的男性要健康得多。他们的全因死亡率仅为预期的50%,自杀率为预期的40%。对迄今为止证据的最简洁解释是,重复性头部创伤可能导致p- tau蛋白沉积,但这种p- tau蛋白异构体是惰性的,没有毒性或自我传播作用。