Repeated mild traumatic brain injuries is not associated with volumetric differences in former high school football players
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We investigated potential brain volumetric differences in a sample of former high school football players many years after these injuries. Forty community-dwelling males ages 40–65 who played high school football, but not college or professional sports, were recruited. The experimental group (n = 20) endorsed experiencing two or more mTBIs on an empirically validated mTBI assessment tool (median = 3, range = 2–15). The control group (n = 20) denied ever experiencing an mTBI. Participants completed a self-report index of current mTBI symptomatology and underwent high-resolution T1-weighted MRI scanning, which were analyzed using the Freesurfer software package. A priori regions of interest (ROIs) included total intracranial volume (ICV), total gray matter, total white matter, bilateral anterior cingulate cortex, bilateral hippocampi, and lateral ventricles. ROIs were corrected for head size using a normalization method that took ICV into account. Despite an adequate sample size and being matched on age, education, estimated premorbid IQ, current concussive symptomatology, there were no statistically significant volumetric group differences across all of the ROIs. These data suggest that multiple mTBIs from high school football may not be associated with measurable brain atrophy later in life. Accounting for the severity of injury and chronicity of sport exposure may be especially important when measuring long-term neuroanatomical differences.
KeywordsConcussion Mild traumatic brain injury MRI Brain volume Atrophy Cognition
This research was made possible by the charitable contributions of the John & Mary Franklin Foundation and the BioImaging Research Center at the University of Georgia. There are no other funding agencies or conflicts of interest to declare.
Compliance with ethical standards
This study was funded by partial support to D.P. Terry by the John and Mary Franklin Foundation and the University of Georgia BioImaging Research Center.
Conflict of interest
D.P. Terry and L.S. Miller declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Georgia Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.
- Blennow, K., Hardy, J., Zetterberg, H. (2012). The neuropathology and neurobiology of traumatic brain injury. Neuron, 6,(76), 886–899.Google Scholar
- Buckner, R. L., Head, D., Parker, J., Fotenos, A. F., Marcus, D., Morris, J. C., & Synder, A. Z. (2004). A unified approach for morphometric and functional data analysis in young, old, and demented adults using automated atlas-based head size normalization: Reliability and validation against manual of total intracranial volume. NeuroImage, 23, 724–738. doi: 10.1016/j.neuroimage.2004.06.018.CrossRefPubMedGoogle Scholar
- Canu, E., McLaren, D. G., Fitzgerald, M. E., Bendlin, B. B., Zoccatelli, G., Alessandrini, F., et al. (2010). Microstructural diffusion changes are independent of macrostructural volume loss in moderate to severe Alzheimer’s disease. Journal of Alzheimer’s Disease, 19, 963–976. doi: 10.3233/JAD-2010-1295.CrossRefPubMedPubMedCentralGoogle Scholar
- Cassidy, J. D., Carroll, L. J., Peloso, P. M., Borg, J., von Holst, H., Holm, L., Kraus, J., Coronado, VG.; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43(suppl), 28–60.Google Scholar
- CDC (2010). Injury, prevention, & control: Traumatic brain injury. Center for Disease Control and Prevention. Retrieved from http://www.cdc.gov/traumaticbraininjury/statistics.html.
- Faul, M. D., Xu, L., Wald, M. M., & Coronado, V. G., (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths 2002–2006. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, pp. 2–70.Google Scholar
- Gale, S. D., Johnson, S. C., Bigler, E. D., & Blatter, D. D. (1995). Trauma-induced degenerative changes in brain injury: A morphometric analysis of three patients with preinjury and postinjury MR scans. Journal of Neurotrauma, 12(2), 151–158. doi: 10.1089/neu.1995.12.151.CrossRefPubMedGoogle Scholar
- Gioia, G. A., & Collins, M. W. (2006) Acute concussion evaluation (ace): physician/clinician version. Available at: http://ww.cdc.gov/ncipc/tbi/PhysiciansToolKit.htm.
- Gioia, G. A., Collins, M. W., & Isquith, P. K. (2008). Improving identification and diagnosis of mild traumatic brain injury with evidence: Psychometric support for the acute concussion evaluation. The Journal of Head Trauma Rehabilitation, 23, 230–242. doi: 10.1097/01.HTR.0000327255.38881.ca.CrossRefPubMedGoogle Scholar
- Hart Jr., J., Kraut, M. A., Womack, K. B., Strain, J., Didehbani, N., Bartz, E., et al. (2013). Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players: A cross-sectional study. JAMA Neurology, 70, 326–335. doi: 10.1001/2013.jamaneurol.340.CrossRefPubMedPubMedCentralGoogle Scholar
- Henry, L. C., Tremblay, S., & De Beaumont, L. (2016). Long-term effects of sports Concussions: Bridging the Neurocognitive Repercussions of the Injury with the Newest Neuroimaging Data. Neuroscientist. doi: 10.1177/1073858416651034
- Hughes, D. G., Jackson, A., Mason, D. L., Berry, E., Hollis, S., & Yates, D. W. (2004). Abnormalities on magnetic resonance imaging seen acutely following mild traumatic brain injury: Correlation with neuropsychological tests and delayed recovery. Neuroradiology, 46(7), 550–558. doi: 10.1007/s00234-004-1227-x.CrossRefPubMedGoogle Scholar
- Jarrett, M., Tam, R., Hernández-Torres, E., Martin, N., Perera, W., Zhao, Y., et al. (2016). A prospective pilot investigation of brain volume, white matter Hyperintensities, and hemorrhagic lesions after mild traumatic brain injury. Frontiers in Neurology, 7, 11. doi: 10.3389/fneur.2016.00011.CrossRefPubMedPubMedCentralGoogle Scholar
- Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007). Depression and generalized anxiety disorder: Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64, 651–660. doi: 10.1001/archpsyc.64.6.651.CrossRefPubMedGoogle Scholar
- Monti, J. M., Voss, M. W., Pence, A., McAuley, E., Kramer, A. F., & Cohen, N. J. (2013). History of mild traumatic brain injury is associated with deficits in relational memory, reduced hippocampal volume, and less neural activity later in life. Frontiers in Aging Neuroscience, 5, 41. doi: 10.3389/fnagi.2013.00041.CrossRefPubMedPubMedCentralGoogle Scholar
- Ross, D. E., Ochs, A. L., Seabaugh, J. M., DeMark, M. F., Shrader, C. R., Marwitz, J. H., & Havranek, M. D. (2012). Progressive brain atrophy in patients with chronic neuropsychiatric symptoms after mild traumatic brain injury: A preliminary study. Brain Injury, 26, 1500–1509. doi: 10.3109/02699052.2012.694570.CrossRefPubMedGoogle Scholar
- Singh, R., Meier, T. B., Kuplicki, R., Savitz, J., Mukai, I., Cavanagh, L., Allen, T., Teague, T. K., et al. (2014). Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA, 311, 1883–1888. doi: 10.1001/jama.2014.3313.CrossRefPubMedGoogle Scholar
- Tate, D. F., York, G. E., Reid, M. W., Cooper, D. B., Jones, L., Robin, D. A., Kennedy, J. E., & Lewis, J. (2014). Preliminary findings of cortical thickness abnormalities in blast injured service members and their relationship to clinical findings. Brain, Imaging, and Behavior, 8, 102–109. doi: 10.1007/s11682-013-9257-9.CrossRefGoogle Scholar
- Terribilli, D., Schaufelberger, M. S., Duran, F. L. S., Zanetti, M. V., Curiati, P. K., Menezes, P. R., et al. (2011). Age-related gray matter volume changes in the brain during non-elderly adulthood. Neurobiology of Aging, 32(2–6), 354–368. doi: 10.1016/j.neurobiolaging.2009.02.008.CrossRefPubMedPubMedCentralGoogle Scholar
- Terry, D. P., & Miller, L. S. (2016). Microstructural white matter differences in former high school football players with a history of multiple concussions. In Paper presented at the National Academy of Neuropsychology annual conference, October 2016. Seattle, WA.Google Scholar
- Tremblay, S., Henry, L. C., Bedetti, C., Larson-Dupuis, C., Gagnon, J. F., Evans, A. C., et al. (2014). Diffuse white matter tract abnormalities in clinically normal ageing retired athletes with a history of sports-related concussions. Brain, 137, 2997–3011. doi: 10.1093/brain/awu236.CrossRefPubMedPubMedCentralGoogle Scholar
- Wilde, E. A., Bigler, E. D., Huff, T., Wang, H., Black, G. M., Christensen, Z. P., et al. (2016). Quantitative structural neuroimaging of mild traumatic brain injury in the chronic effects of Neurotrauma consortium (CENC): Comparison of volumetric data within and across scanners. Brain Injury, 30, 1442–1451. doi: 10.1080/02699052.2016.1219063.CrossRefPubMedGoogle Scholar