Acta Neuropathologica

, Volume 127, Issue 1, pp 29–51 | Cite as

The neuropathology of sport

  • Ann C. McKeeEmail author
  • Daniel H. Daneshvar
  • Victor E. Alvarez
  • Thor D. Stein


The benefits of regular exercise, physical fitness and sports participation on cardiovascular and brain health are undeniable. Physical activity reduces the risk for cardiovascular disease, type 2 diabetes, hypertension, obesity, and stroke, and produces beneficial effects on cholesterol levels, antioxidant systems, inflammation, and vascular function. Exercise also enhances psychological health, reduces age-related loss of brain volume, improves cognition, reduces the risk of developing dementia, and impedes neurodegeneration. Nonetheless, the play of sports is associated with risks, including a risk for mild TBI (mTBI) and, rarely, catastrophic traumatic injury and death. There is also growing awareness that repetitive mTBIs, such as concussion and subconcussion, can occasionally produce persistent cognitive, behavioral, and psychiatric problems as well as lead to the development of a neurodegeneration, chronic traumatic encephalopathy (CTE). In this review, we summarize the beneficial aspects of sports participation on psychological, emotional, physical and cognitive health, and specifically analyze some of the less common adverse neuropathological outcomes, including concussion, second-impact syndrome, juvenile head trauma syndrome, catastrophic sudden death, and CTE. CTE is a latent neurodegeneration clinically associated with behavioral changes, executive dysfunction and cognitive impairments, and pathologically characterized by frontal and temporal lobe atrophy, neuronal and axonal loss, and abnormal deposits of paired helical filament (PHF)-tau and 43 kDa TAR deoxyribonucleic acid (DNA)-binding protein (TDP-43). CTE often occurs as a sole diagnosis, but may be associated with other neurodegenerative disorders, including motor neuron disease (CTE-MND). Although the incidence and prevalence of CTE are not known, CTE has been reported most frequently in American football players and boxers. Other sports associated with CTE include ice hockey, professional wrestling, soccer, rugby, and baseball.


Amyotrophic Lateral Sclerosis Diffusion Tensor Imaging Soccer Player Sport Participation Motor Neuron Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We gratefully acknowledge the extraordinary help of Christopher Nowinski, Lisa McHale, Dr. Robert Stern, Dr. Robert Cantu, and all other members of the Center for the Study of Traumatic Encephalopathy at Boston University and Boston VA, as well as the individuals and families whose participation and contributions made this work possible. We also gratefully acknowledge the use of resources and facilities at the Edith Nourse Rogers Memorial Veterans Hospital (Bedford, MA) and Dr. Peter Davies for antibodies. This work was supported by the Department of Veterans Affairs; Veterans Affairs Biorepository (CSP 501); Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS); Veterans Affairs Rehabilitation Research and Development Traumatic Brain Injury Center of Excellence (B6796-C); Sports Legacy Institute; National Institute of Aging Boston University Alzheimer’s Disease Center [P30AG13846; supplement 0572063345-5; National Institute of Aging Boston University Framingham Heart Study R01 [AG1649]; National Operating Committee on Standards for Athletic Equipment. This work was also supported by unrestricted gifts from the National Football League, the Andlinger Foundation, and Worldwide Wrestling Entertainment.


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Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2013

Authors and Affiliations

  • Ann C. McKee
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Daniel H. Daneshvar
    • 3
    • 5
  • Victor E. Alvarez
    • 3
    • 5
  • Thor D. Stein
    • 1
    • 2
    • 4
    • 5
  1. 1.VA Boston HealthCare SystemBostonUSA
  2. 2.Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonUSA
  3. 3.Departments of NeurologyBoston University School of MedicineBostonUSA
  4. 4.Alzheimer Disease CenterBoston University School of MedicineBostonUSA
  5. 5.Center for the Study of Traumatic EncephalopathyBoston University School of MedicineBostonUSA

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