Schaffert Jeff, Didehbani Nyaz, LoBue Christian, Hart John, Rossetti Heidi, Lacritz Laura, Cullum C Munro
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Front Neurol. 2021 Feb 23;12:617526. doi: 10.3389/fneur.2021.617526. eCollection 2021.
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white ( = 62) or African-American ( = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, = 0.087), number of concussions (OR = 1.020, = 0.532), number of concussions with loss of consciousness (OR = 1.141 = 0.188), and years playing professionally (OR = 0.976, = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.
创伤性脑病综合征（TES）被认为是重复性头部损伤暴露的长期影响以及慢性创伤性脑病（CTE）的临床表现。本研究旨在评估一组退休职业接触性运动运动员中TES的发生率，将TES的发生率与临床共识诊断结果进行比较，并确定增加TES诊断可能性的预测因素。研究对象是来自德克萨斯大学西南医学中心和德克萨斯大学达拉斯分校前瞻性队列的85名退休职业接触性运动运动员。参与者年龄在23岁至79岁之间（M = 55.95，标准差 = 13.82），接受教育年限为7年至19年（M = 16.08，标准差 = 1.03）。退休人员为非西班牙裔白人（n = 62）或非裔美国人（n = 23）。退休运动员接受了标准的临床评估，包括临床访谈、神经检查、神经影像学检查、神经心理学测试以及正常、轻度认知障碍或痴呆的共识诊断。将TES标准应用于所有85名运动员，并比较诊断频率。使用二元逻辑回归评估了14个TES诊断的预测因素，包括人口统计学、神经心理学、抑郁症状和头部损伤暴露变量。在这组退休运动员中观察到较高的TES发生率（56%），但通过共识诊断，符合TES标准的运动员中有54%被诊断为认知正常。在美国国家橄榄球联盟比赛的场次（比值比 = 0.993，P = 0.087）、脑震荡次数（比值比 = 1.020，P = 0.532）、伴有意识丧失的脑震荡次数（比值比 = 1.141，P = 0.188）以及职业运动年限（比值比 = 0.976，P = 0.627）与TES诊断无关。通过贝克抑郁量表-II总分衡量的抑郁症状严重程度是TES诊断的唯一预测因素（比值比 = 1.297，P < 0.001）。我们的研究结果补充了先前强调假阳性诊断风险的研究发现，突出了TES标准在临床和研究环境中的局限性，并对TES与头部损伤暴露之间的关系提出了质疑。未来需要开展研究以调查退休职业运动员中的抑郁症情况。
