Neuropathologic and psychological changes present in young athletes with repetitive head impacts

1. Young amateur and professional contact sport athletes are at risk of developing long-term neurodegenerative disorders, such as chronic traumatic encephalopathy.

2. Young athletes exposed to repetitive head impacts frequently exhibit significant clinical symptoms, including executive dysfunction, behavioral dysregulation, and depression.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Frequent head injuries can lead to both obvious concussions and subtle, asymptomatic injuries. Over time, individuals may experience cognitive and neuropsychiatric problems, along with a progressive brain condition called chronic traumatic encephalopathy (CTE). This study focused on understanding the clinical and brain-related characteristics of young athletes who donated their brains for research. Researchers found that CTE was diagnosed in 41% of the donors, mostly men engaged in amateur sports like American football, ice hockey, soccer, rugby, and wrestling. Individuals with CTE had longer sports careers and more brain-related changes compared to those without the diagnosis. Cognitive and behavioral issues were common across all brain donors. One limitation of this study is that it mainly relied on brain donors whose families sought post-mortem brain examinations, primarily white male football players. This could introduce bias, as individuals with symptoms during their lives, regardless of their history of head injuries or CTE diagnosis, were more likely to donate their brains for study. Nonetheless, this research ultimately revealed that young athletes exposed to frequent head impacts often exhibited significant neuropsychological symptoms, regardless of CTE status. This highlights the need for future prospective research that follows living athletes who have been exposed to repetitive head injuries and their clinical symptoms in order to identify and treat them appropriately.

Click to read the study in JAMA Neurology

Relevant Reading:  Disparate associations of years of football participation and a metric of head impact exposure with neurobehavioral outcomes in former collegiate football players

In-Depth [case series]: This case series examined data from 152 brain donors under the age of 30 at the time of their passing, with analysis spanning from August 2021 to June 2023. The majority of participants were male (93%) and white (73%). Diagnosis of CTE was determined using established criteria, and further outcomes were assessed through gross and microscopic neuropathological analysis, as well as informant-provided details on athletic history and cognitive, mood, and neurobehavioral symptoms. Among young athletes with CTE, notable differences included increased ventricular dilatation, cavum septum pellucidum, thalamic notching, p-tau pathological findings, and perivascular pigment-laden macrophages in the frontal white matter compared to those without CTE. Clinical symptoms, reported retrospectively by their close relatives, were prevalent in young donors exposed to repetitive head impacts (RHI). Approximately 50% had clinically meaningful symptoms of executive dysfunction, 60% had symptoms of behavioral dysregulation, and 70% had symptoms of depression and apathy. In summary, a substantial proportion of young athletes exposed to RHI had CTE and most displayed clinically significant symptoms.

Image: PD

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