职业足球运动员的生前慢性创伤性脑病诊断。
Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football.
机构信息
Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.
出版信息
Ann Neurol. 2020 Jul;88(1):106-112. doi: 10.1002/ana.25747. Epub 2020 May 4.
OBJECTIVE
American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE.
METHODS
A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019.
RESULTS
Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE.
INTERPRETATION
Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
目的
美式橄榄球（ASF）因与重复性头部损伤和神经退行性疾病之间的可能联系而受到关注。尽管在 ASF 运动员中已经报道了与慢性创伤性脑病（CTE）一致的死后病理变化，但目前尚无用于 CTE 的既定生前诊断标准。尽管存在认知障碍的症状，治疗前运动员的临床医生可能倾向于在没有彻底探讨表现出与假定 CTE 相似临床表型的共病因素的情况下建议 CTE。
方法
对截至 2019 年 3 月通过回复调查的 24 至 89 岁的 3913 名前 ASF 运动员进行了调查。
结果
尽管这是一种死后诊断，但有 108 名（2.8%）运动员自我报告了临床诊断的 CTE。年龄在 60 岁以下的运动员报告 CTE 诊断的比例为 2.3%，而年龄在 60 岁或以上的参与者为 3.7%。自我报告 CTE 的参与者的共病明显更为常见，包括睡眠呼吸暂停、高胆固醇血症、肥胖、过去或现在的抑郁、高血压、处方止痛药使用、心脏疾病和低睾酮的指标，与非 CTE 受访者相比。肥胖、高血压、心脏疾病或高胆固醇血症的报告模式在年龄较大和较小的参与者之间有所不同。自我报告 CTE 的参与者的认知障碍症状明显更高。
结论
一些前职业足球运动员已被临床诊断患有 CTE，这是一种死后病症。可影响认知的共病与年龄较大和较小的运动员中的 CTE 诊断有关。尽管不能排除潜在的神经病理学，但应在表现出与 CTE 相关的临床表型或症状的前运动员中探索可治疗的病症，以作为改善这些患者认知健康的一种手段。ANN NEUROL 2020 ANN NEUROL 2020；88：106-112。
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