Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players.
Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players.
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DOI：
10.1007/s00401-017-1680-3
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发表时间：
2017-03
影响因子：
12.7
通讯作者：
Williams DD
中科院分区：
文献类型：
--
作者：
Ling H;Morris HR;Neal JW;Lees AJ;Hardy J;Holton JL;Revesz T;Williams DD
在具有重复头部撞击历史的退休职业足球（足球）运动员中，慢性创伤性脑病（CTE）是痴呆和运动障碍的潜在神经退行性原因。从1980年到2010年，14名患有痴呆症的退役足球运动员接受了定期随访，直到死亡。前瞻性收集他们的临床资料、职业生涯和脑震荡史。最近的亲属同意六人进行死后脑部检查。在14名男性参与者中，13人是专业人士，1人是业余爱好者。他们都是熟练的头球手，平均踢了26年足球。在六个案例中，脑震荡的发生率被限制在他们职业生涯中的一次发作。所有病例均发生进行性认知功能障碍，平均发病年龄为63.6岁，病程为10年。神经病理学检查显示，间隔异常，在所有六个死后的情况下，支持的历史，慢性重复头部撞击。4例病例有病理学证实的CTE;伴随病理学包括阿尔茨海默病（N = 6）、TDP-43（N = 6）、脑淀粉样血管病（N = 5）、海马硬化（N = 2）、皮质基底节变性（N = 1）、路易体痴呆（N = 1）和血管病理学（N = 1）;所有这些都会协同作用导致临床表现。根据最新的共识诊断标准，在四个个体中建立了CTE的病理诊断。这一发现可能与他们过去长期暴露于头部与球员碰撞的重复头部撞击以及在他们的职业生涯中数千次头球有关。阿尔茨海默病和TDP-43病理是CTE中常见的伴随发现，这两者越来越多地被认为是老年个体中CTE病理实体的一部分。足球是世界上最受欢迎的运动，我们的研究结果表明，踢足球和CTE的重复头部撞击之间的潜在联系具有相当大的公共卫生利益。显然，在这个临床病理系列中不能建立明确的联系，但我们的研究结果支持需要进一步的系统调查，包括大规模的病例对照研究，以确定足球运动员的风险群体，这将证明实施保护策略是合理的。
In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case–control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.