Department of Neuroscience, Mayo Clinic, Jacksonville, FL.
Department of Pathology and Laboratory Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, TX.
Brain Pathol. 2020 Jan;30(1):63-74. doi: 10.1111/bpa.12757. Epub 2019 Jul 4.
Chronic traumatic encephalopathy is a debilitating neurodegenerative disorder associated with repetitive traumatic brain injuries often sustained through prior contact sport participation. The frequency of this disorder in a diverse population, including amateur athletes, is unknown. Primary historical obituary and yearbook records were queried for 2566 autopsy cases in the Mayo Clinic Tissue Registry resulting in identification of 300 former athletes and 450 non-athletes. In these cases, neocortical tissue was screened for tau pathology with immunohistochemistry, including pathology consistent with chronic traumatic encephalopathy, blinded to exposure or demographic information. Using research infrastructure of the Rochester Epidemiology Project, a comprehensive and established medical records-linkage system of care providers in southern Minnesota and western Wisconsin, medical diagnostic billing codes pertaining to head trauma, dementia, movement disorders, substance abuse disorders and psychiatric disorders were recorded for cases and controls in a blinded manner. A total of 42 individuals had pathology consistent with, or features of, chronic traumatic encephalopathy. It was more frequent in athletes compared to non-athletes (27 cases versus 15 cases) and was largely observed in men (except for one woman). For contact sports, American football had the highest frequency of chronic traumatic encephalopathy pathology (15% of cases) and an odds ratio of 2.62 (P-value = 0.005). Cases with chronic traumatic encephalopathy pathology had higher frequencies of antemortem clinical features of dementia, psychosis, movement disorders and alcohol abuse compared to cases without chronic traumatic encephalopathy pathology. Understanding the frequency of chronic traumatic encephalopathy pathology in a large autopsy cohort with diverse exposure backgrounds provides a baseline for future prospective studies assessing the epidemiology and public health impact of chronic traumatic encephalopathy and sports-related repetitive head trauma.
慢性创伤性脑病是一种与重复性创伤性脑损伤相关的进行性神经退行性疾病，这种损伤通常源于之前参与的接触性运动。这种疾病在不同人群中的发病率，包括业余运动员，尚不清楚。通过查询 Mayo 诊所组织库的 2566 例尸检病例的原始讣告和年鉴记录，确定了 300 名前运动员和 450 名非运动员。在这些病例中，使用免疫组织化学方法对新皮质组织进行 tau 病理学筛查，包括与慢性创伤性脑病一致的病理学表现，该筛查过程对暴露或人口统计学信息设盲。利用罗切斯特流行病学项目的研究基础设施，这是一个明尼苏达州南部和威斯康星州西部医疗保健提供者的全面且成熟的医疗记录链接系统，以盲法记录了病例和对照的与头部创伤、痴呆、运动障碍、物质滥用障碍和精神障碍相关的医疗诊断计费代码。共有 42 人具有慢性创伤性脑病一致或具有特征性的病理学表现。与非运动员相比，运动员中更为常见（27 例比 15 例），且主要为男性（除了一名女性）。在接触性运动中，美式橄榄球中慢性创伤性脑病病理学的发病率最高（15%的病例），其比值比为 2.62（P 值=0.005）。与没有慢性创伤性脑病病理学表现的病例相比，具有慢性创伤性脑病病理学表现的病例在生前有更高频率的痴呆、精神病、运动障碍和酒精滥用的临床特征。在具有不同暴露背景的大型尸检队列中了解慢性创伤性脑病病理学的频率为未来评估慢性创伤性脑病和与运动相关的重复性头部创伤的流行病学和公共卫生影响的前瞻性研究提供了基线。
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