Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players
Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players
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DOI：
10.1089/neu.2016.4413
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发表时间：
2017-01-15
影响因子：
4.2
通讯作者：
Tripodis, Yorghos
中科院分区：
文献类型：
--
作者：
Montenigro, Philip H.;Alosco, Michael L.;Tripodis, Yorghos
“重复性头部撞击”(RHI) 一词是指对脑震荡和亚脑震荡事件的累积暴露。尽管 RHI 被认为会增加晚年神经系统后果（包括慢性创伤性脑病）的风险，但由于缺乏量化终生 RHI 暴露的有效工具，因此尚未对这种关系进行定量分析。本研究的目标是：1) 制定一个衡量标准 量化足球累积的 RHI 暴露，我们称之为“累积头部影响指数”(CHII)； 2) 使用 CHII 来检查 RHI 暴露与长期临床结果之间的关联； 3) 评估其相对于其他暴露指标（即比赛持续时间、首次暴露年龄、脑震荡历史）的预测特性。参与者包括 93 名前高中和大学橄榄球运动员，他们完成了客观认知和自我报告的行为/情绪测试，作为正在进行的更大纵向研究的一部分。使用既定的截止分数，我们将连续结果转化为二分变量（正常与受损）。 CHII 是针对每个参与者计算的，并根据自我报告的运动历史（即赛季数、位置、比赛水平）和头盔加速计研究中报告的冲击频率相结合得出。双变量概率工具变量模型揭示了 CHII 与晚年认知障碍 (p < 0.0001)、自我报告的执行功能障碍 (p < 0.0001)、抑郁 (p < 0.0001)、冷漠 (p = 0.0161) 和行为失调 (p < 0.0001) 风险之间的阈值剂量反应关系。最终，CHII 表现出比其他个人暴露指标更高的预测有效性。
The term "repetitive head impacts'' (RHI) refers to the cumulative exposure to concussive and subconcussive events. Although RHI are believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined because of the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, which we term the "cumulative head impact index'' (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and 3) to evaluate its predictive properties relative to other exposure metrics (i.e., duration of play, age of first exposure, concussion history). Participants included 93 former high school and collegiate football players who completed objective cognitive and self-reported behavioral/mood tests as part of a larger ongoing longitudinal study. Using established cutoff scores, we transformed continuous outcomes into dichotomous variables (normal vs. impaired). The CHII was computed for each participant and derived from a combination of self-reported athletic history (i.e., number of seasons, position[s], levels played), and impact frequencies reported in helmet accelerometer studies. A bivariate probit, instrumental variable model revealed a threshold dose-response relationship between the CHII and risk for later-life cognitive impairment (p < 0.0001), self-reported executive dysfunction (p < 0.0001), depression (p < 0.0001), apathy (p = 0.0161), and behavioral dysregulation (p < 0.0001). Ultimately, the CHII demonstrated greater predictive validity than other individual exposure metrics.