Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and.
Saxion University of Applied Sciences, Enschede, the Netherlands.
Clin J Sport Med. 2024 Jan 1;34(1):69-80. doi: 10.1097/JSM.0000000000001174. Epub 2023 Jul 4.
Exposure to repetitive sports-related concussions or (sub)concussive head trauma may lead to chronic traumatic encephalopathy (CTE). Which impact (heading or concussion) poses the greatest risk of CTE development in soccer players?
Narrative review.
Teaching hospital and University of Applied sciences.
A literature search (PubMed) was conducted for neuropathologic studies in the period 2005-December 2022, investigating soccer players with dementia and a CTE diagnosis, limited to English language publications. 210 papers were selected for final inclusion, of which 7 papers described 14 soccer players.
Magnetic resonance imaging studies in soccer players show that lifetime estimates of heading numbers are inversely correlated with cortical thickness, grey matter volume, and density of the anterior temporal cortex. Using diffusion tensor imaging-magnetic resonance imaging, higher frequency of headings-particularly with rotational accelerations-are associated with impaired white matter integrity. Serum neurofilament light protein is elevated after heading.
Chronic traumatic encephalopathy pathology, history of concussion, heading frequency.
In 10 of 14 soccer players, CTE was the primary diagnosis. In 4 cases, other dementia types formed the primary diagnosis and CTE pathology was a concomitant finding. Remarkably, 6 of the 14 cases had no history of concussion, suggesting that frequent heading may be a risk for CTE in patients without symptomatic concussion. Rule changes in heading duels, management of concussion during the game, and limiting the number of high force headers during training are discussed.
Data suggest that heading frequency and concussions are associated with higher risk of developing CTE in (retired) soccer players. However based on this review of only 14 players, questions persist as to whether or not heading is a risk factor for CTE or long-term cognitive decline.
反复发生与运动相关的脑震荡或（亚）脑震荡性头部创伤可能导致慢性创伤性脑病（CTE）。在足球运动员中，哪种撞击（头部撞击或脑震荡）造成 CTE 发展的风险最大？
叙述性综述。
教学医院和应用科学大学。
对 2005 年 12 月至 2022 年期间进行的与患有痴呆症和 CTE 诊断的足球运动员相关的神经病理学研究进行了文献检索（PubMed），仅限于英语出版物。选择了 210 篇论文进行最终纳入，其中 7 篇论文描述了 14 名足球运动员。
磁共振成像研究显示，足球运动员一生中的头部撞击次数估计与皮质厚度、灰质体积和前颞叶皮质密度呈负相关。使用弥散张量成像磁共振成像，头部撞击频率较高 - 特别是具有旋转加速度 - 与白质完整性受损有关。头部撞击后血清神经丝轻蛋白升高。
慢性创伤性脑病病理、脑震荡史、头部撞击频率。
在 14 名足球运动员中，有 10 名运动员的主要诊断为 CTE。在 4 例中，其他痴呆类型构成了主要诊断，而 CTE 病理学是伴随发现。值得注意的是，14 例中有 6 例没有脑震荡史，这表明频繁的头部撞击可能是无症状脑震荡患者发生 CTE 的危险因素。讨论了头部撞击决斗规则的改变、比赛中脑震荡的管理以及训练中高力量头部撞击次数的限制。
数据表明，头部撞击频率和脑震荡与（退役）足球运动员发生 CTE 的风险增加有关。然而，基于对仅 14 名运动员的回顾，仍然存在疑问，即头部撞击是否是 CTE 或长期认知能力下降的危险因素。
