Terpstra Alex R, Vasquez Brandon P, Colella Brenda, Tartaglia Maria Carmela, Tator Charles H, Mikulis David, Davis Karen D, Wennberg Richard, Green Robin E A
Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute, Toronto, ON, Canada.
Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
Front Neurol. 2019 Aug 7;10:712. doi: 10.3389/fneur.2019.00712. eCollection 2019.
To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms. Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports. Between-groups analyses. . Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). . Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task). (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions ( ), but not former players with ≤ 3 concussions ( ), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task. Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.
(1)全面描述前职业橄榄球运动员的神经精神和认知功能，重点关注执行功能；(2)区分与脑震荡相关的发现和职业橄榄球运动员的病前/队列特征；以及(3)探索执行功能与神经精神症状之间的关系。61名功能良好的前职业橄榄球运动员和31名年龄及性别匹配、无脑震荡病史或未参与接触性运动的对照参与者。进行组间分析。使用人格评估量表(PAI)临床量表加攻击治疗考虑量表；迷你国际神经精神访谈(MINI)。采用综合临床神经心理测验组合评估言语和视觉空间注意力领域；加工速度和记忆；当前和估计的病前智商；以及执行功能，包括两项针对该人群新颖的实验测量指标(即反应抑制和在go/no-go任务中反应的不一致性)。(1)与对照参与者相比，前职业橄榄球运动员在PAI抑郁、躁狂和攻击量表上得分显著更高，而在反应抑制方面得分显著更低。(2)相对于对照组，有超过3次脑震荡的前运动员( )，而非脑震荡次数≤3次的前运动员( )，表现出：(i)在PAI抑郁量表上得分显著更高，(ii)总体上MINI临床诊断显著更多，特别是躁狂/轻躁狂发作，以及(iii)执行功能显著更差。(3)中介分析显示，脑震荡暴露通过在go/no-go任务中反应的不一致性对PAI抑郁、躁狂和攻击有显著间接影响。观察到神经精神功能有明显损害，并且在执行功能的一项敏感实验测量指标上表现更差；这些与脑震荡病史和病前(队列)因素均有关。因此，对于有多次脑震荡既往史的人群，应仔细评估其神经精神和执行功能。此外，前运动员的神经精神症状与反应的不一致性有关；这表明针对反应不一致性的治疗可能有助于减轻神经精神功能障碍。
