Brain injury due to soccer heading and opportunities for its mitigation

描述(由申请者提供)：运动员的创伤性脑损伤(TBI)是一个日益被认识的重大公共卫生问题。损伤的病理基础可能是多灶性微结构创伤性轴索损伤(TAI)，这种损伤可以通过弥散张量磁共振成像(DTI)在体内检测到。这些结构性变化既有短期的，也有长期的认知后果。我们的初步研究表明，业余足球运动员确实经常头球，每年高达5000英镑，那些每年头球超过1000-1500次的人，结构(TAI)和功能(认知表现较差)变化的风险更高。头晕会使大脑暴露在反复的低水平(“亚脑震荡”)创伤中。众所周知，接连发生的多处头部损伤与较差的预后有关。还需要开展更多的工作，以确定足球头球的暴露-反应关系、这些结构和功能影响以及特别脆弱人群的发病和恢复的时间进程。在这里，我们使用3个综合研究设计来确定标题对大脑结构和功能的影响。在一项横断面研究(目标1)中，我们在大样本(n=400)业余足球运动员中评估了前一年的头部与结构性(TAI)和功能性(认知和脑震荡后症状(PCS))测量的关系。为了评估因果关系，我们建议进行一项纵向研究，以调查在两年的随访中，标题对TAI、认知和PCS变化的增量影响(目标2)。为了评估航向与认知功能和PCS的日常变异性之间的短期关系以及密集测量的预测价值，我们将每3个月使用手持设备对100名玩家进行为期14天的每日航向、认知和PCS的评估。我们还将评估一些潜在的头球与脑结构和功能之间的联系的修饰物(例如，载脂蛋白E4基因)。具体目的：目的I(横断面)：确定头部暴露于创伤性轴索损伤(TAI)的MRI证据与认知功能和脑震荡后症状(PCS)的关系。目标II(纵向)：在一项前瞻性研究中，确定航向与TAI、认知功能和PCS的增量变化之间的纵向关系。目标III(密集测量)：使用密集测量设计，确定日常认知功能和PCS的短期影响和变异性。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) in athletes is a major and increasingly recognized public health problem. The presumed pathologic basis of the injury is multifocal microstructural traumatic axonal injury (TAI), which can be detected in vivo using diffusion tensor MRI (DTI). These structural changes have both short-term and long-term cognitive consequences. Our preliminary studies show that amateur soccer players do head the ball frequently, up to > 5,000 per year, and those who head more than 1,000- 1,500 times per year are at increased risk for structural (TAI) and functional (poorer cognitive performance) changes. Heading exposes the brain to repeated low-level ("subconcussive") trauma. It is known that multiple head injuries in close succession are associated with worse outcomes. Additional work is needed to define exposure-response relationships for soccer heading, the time course for the onset and recovery from these structural and functional effects and particularly vulnerable populations. Herein, we use 3 integrated study designs to determine the influence of heading on brain structure and function. In a cross-sectional study (Aim 1), we assess the relationship of heading over the previous year to structural (TAI) and functional (cognition and post-concussion symptoms (PCS)) measures in a large sample (n=400) of amateur soccer players. To assess causality, we propose a longitudinal study to investigate the incremental effects of heading on changes in TAI, cognition and PCS over 2 years of follow-up (Aim 2). To assess the short-term relationship between heading and day-to-day variability in cognitive function and PCS as well as the predictive value of intensive measurement, we will assess heading, cognition and PCS on a daily basis for 14 days every 3 months using a hand-held device in a substudy of 100 players. We will also assess a number of potential modifiers of the association between heading and brain structure and function (e.g., Apolipoprotein E4 genotype). Specific Aims: Aim I (Cross-sectional): Determine the relationship of heading exposure to MRI evidence of traumatic axonal injury (TAI), cognitive function and post concussion symptoms (PCS). Aim II (Longitudinal): Determine the longitudinal relationships between heading and incremental changes in TAI, cognitive function, and PCS in a prospective study. Aim III (Intensive measurement): Determine the short-term effects on and variability in day-to-day cognitive function and PCS using an intensive measurement design.