Brain injury due to soccer heading and opportunities for its mitigation

描述（由申请人提供）：运动员的创伤性脑损伤（TBI）是一个主要的和日益认识到的公共卫生问题。损伤的假定病理基础是多灶性微结构创伤性轴索损伤（TAI），其可以使用扩散张量MRI（DTI）在体内检测。这些结构性变化对认知有短期和长期的影响。我们的初步研究表明，业余足球运动员确实经常头球，每年多达5,000次，而那些每年头球超过1,000- 1,500次的人发生结构（TAI）和功能（认知表现较差）变化的风险增加。头部暴露大脑反复低水平（“亚震荡”）创伤。众所周知，连续多次头部受伤会导致更糟糕的结果。还需要开展更多的工作，以确定足球头球的安全性-反应关系，从这些结构和功能影响以及特别是弱势群体中发病和恢复的时间进程。在此，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，我们在一个大样本（n=400）的业余足球运动员中评估了前一年的标题与结构（TAI）和功能（认知和脑震荡后症状（PCS））措施的关系。为了评估因果关系，我们提出了一项纵向研究，以调查在2年的随访（目标2）中，航向对TAI、认知和PCS变化的增量影响。为了评估航向与认知功能和PCS的日常变化之间的短期关系以及强化测量的预测价值，我们将在100名球员的子研究中使用手持设备每3个月每天评估航向，认知和PCS，持续14天。我们还将评估标题与大脑结构和功能之间关联的一些潜在修饰符（例如，载脂蛋白E4基因型）。具体目标：目标I（横截面）：确定头部暴露与创伤性轴索损伤（TAI）、认知功能和脑震荡后症状（PCS）的MRI证据之间的关系。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增量变化之间的纵向关系。目的III（强化测量）：使用强化测量设计确定对日常认知功能和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.