Veterans Affairs (VA) Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts.
Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts.
JAMA Neurol. 2023 Oct 1;80(10):1037-1050. doi: 10.1001/jamaneurol.2023.2907.
Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE).
To characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes.
DESIGN, SETTING, AND PARTICIPANTS: This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022. Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023.
Repetitive head impacts from contact sports.
Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation.
Among the 152 deceased contact sports participants (mean [SD] age, 22.97 [4.31] years; 141 [92.8%] male) included in the study, CTE was diagnosed in 63 (41.4%; median [IQR] age, 26 [24-27] years). Of the 63 brain donors diagnosed with CTE, 60 (95.2%) were diagnosed with mild CTE (stages I or II). Brain donors who had CTE were more likely to be older (mean difference, 3.92 years; 95% CI, 2.74-5.10 years) Of the 63 athletes with CTE, 45 (71.4%) were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer. For those who played football, duration of playing career was significantly longer in those with vs without CTE (mean difference, 2.81 years; 95% CI, 1.15-4.48 years). Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. Cognitive and neurobehavioral symptoms were frequent among all brain donors. Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status.
This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. Future studies that include young brain donors unexposed to repetitive head impacts are needed to clarify the association among exposure, white matter and microvascular pathologic findings, CTE, and clinical symptoms.
年轻的接触性运动运动员可能面临长期神经病理障碍的风险，包括慢性创伤性脑病（CTE）。
描述接触性运动运动员年轻脑捐献者的神经病理学和临床症状。
设计、设置和参与者：本病例系列分析了通过理解神经损伤和创伤性脑病（UNITE）脑库从 2008 年 2 月 1 日至 2022 年 9 月 31 日期间确定的 156 名 30 岁以下年轻脑捐献者中的 152 名的发现，这些捐献者捐献了他们的大脑。进行了神经病理学评估、回顾性电话临床评估和在线问卷，调查对象为知情人。数据分析于 2021 年 8 月至 2023 年 6 月进行。
接触性运动导致的反复头部撞击。
根据定义的诊断标准进行大体和微观神经病理学评估，包括 CTE 的诊断；以及知情人报告的运动史和知情人完成的评估认知症状、情绪障碍和神经行为失调的量表。
在纳入研究的 152 名已故接触性运动参与者（平均[SD]年龄，22.97[4.31]岁；141[92.8%]男性）中，63 名（41.4%；中位数[IQR]年龄，26[24-27]岁）被诊断为 CTE。在 63 名被诊断为 CTE 的脑捐献者中，有 60 名（95.2%）被诊断为轻度 CTE（I 期或 II 期）。患有 CTE 的脑捐献者更可能年龄较大（平均差异 3.92 岁；95%CI，2.74-5.10 岁）。在 63 名患有 CTE 的运动员中，有 45 名（71.4%）是从事业余运动的男性，包括美式足球、冰球、足球、橄榄球和摔跤；1 名患有 CTE 的女性从事大学足球运动。对于那些从事足球运动的人来说，职业生涯的持续时间在患有 CTE 与不患有 CTE 的人中明显更长（平均差异 2.81 年；95%CI，1.15-4.48 年）。患有 CTE 的运动员在前额白质中出现更多的脑室扩张、透明隔腔、丘脑凹陷和血管周围含色素的巨噬细胞。所有脑捐献者都有认知和神经行为症状。自杀是最常见的死因，其次是意外药物过量；根据 CTE 状态，死因或临床症状没有差异。
本病例系列研究发现，接触性头部反复撞击的年轻脑捐献者症状明显，无论 CTE 状态如何，而该样本中的症状原因可能是多因素的。需要进行包括未接触过反复头部撞击的年轻脑捐献者的未来研究，以阐明暴露、白质和微血管病理发现、CTE 和临床症状之间的关联。
