Heading and Soccer: understanding cognitive risks, benefits, and the potential mediating role of white matter

项目摘要/摘要 《健康人2030》的一个关键目标是通过有氧体育活动提高成年人的健康水平。足球， 这项地球上最受欢迎的运动是2500多万美国人的有氧出口。潜在的好处 由足球头部重复的亚震荡头部撞击(RSHI)抵消了足球运动的影响。RSHI关联 与暴露相关的对神经成像和认知表现的不良影响，独立于 碰撞和脑震荡。有氧运动的益处和RSHI相关的危害之间的权衡尚不清楚。这个 这项建议的主要目的是研究足球运动对有氧运动的益处，以及与RSHI危害有关的问题。 对大脑结构和功能的影响，并探索改变这种风险-收益权衡的个人因素。 神经成像可以检测RSHI对有氧能力的有利影响和不良亚临床影响 白质。然而，关于它们对白质的共同影响以及白质是如何 特征对认知功能的影响起中介作用。RSHI风险-收益平衡的基本知识可以 告知我们对RSHI发病率及其缓解的理解，超越了足球的特定背景，例如 其他运动和格斗。以前关于RSHI效应的工作还没有具体测量有氧能力，而且几乎没有 了解白质是否以及如何调节暴露-结果关联。我们建议的两年制 280名青壮年纵向随访研究，包括高低组足球运动员各70名 暴露于RSHI，非碰撞运动员(n=70)和非运动员对照组(n=70)，将检验这一假设 有氧能力带来的益处混淆和改变了RSHI对脑白质的不利影响 这反过来又是不利认知影响的中介因素。我们将测量有氧能力(VO2max)和 RSHI超过2年，并进行髓鞘水和脑白质微结构MRI以及认知 评估，在注册时和两年后。我们将处理以下具体目标：目标1：评估 VO2max和RSHI对脑白质髓鞘形成和显微结构的联合作用目标2：通过以下方式评估调解 已知的VO2max和RSHI与认知表现相关的白质。目标3：探索 BDNFVal66Met和ApoE-ε4基因变异体作为VO2max和rHSI介导效应权衡的修饰物 关于白质的。描述足球对认知表现的风险和益处可以改变人们对足球的认知 由利益相关者承担风险，促进对足球参与和头球的选择和指导。有影响的选择 年轻的成年球员，有很高的RSHI暴露和几十年的未来需求，有可能影响他们的 几十年来的福祉、医疗足迹和生产率。

PROJECT SUMMARY/ABSTRACT A key goal of “Healthy People 2030” is to improve the health of adults through aerobic physical activity. Soccer, the most popular sport on earth, is an aerobic outlet for more than 25 million Americans. The potential benefits of soccer are offset by repetitive subconcussive head impacts (RSHI) from soccer heading. RSHI are associated with exposure-dependent adverse effects on neuroimaging and on cognitive performance, independent of collisions and concussion. The tradeoffs between aerobic benefits and RSHI-related harms are not known. The central aim of this proposal is to examine the aerobic benefits of soccer play, in relation to RSHI harms, for brain structure and function, and to explore person-level factors that modify this risk-benefit tradeoff. Beneficial effects of aerobic capacity and adverse subclinical effects of RSHI can be detected with neuroimaging of white matter. However, little is known about their joint impact on white matter and, in turn, how white matter features mediate effects on cognitive function. Fundamental knowledge on the RSHI risk-benefit balance can inform our understanding of RSHI morbidity and its mitigation beyond the specific context of soccer, such as other sports and combat. Prior work on RSHI effects has not specifically measured aerobic capacity, and little is known about whether and how white matter mediates exposure-outcome associations. Our proposed 2-year longitudinal follow up study of 280 young adults, including soccer players with high (n=70) and low (n=70) exposure to RSHI, non-collision athletes (n=70) and non-athlete controls (n=70), will test the hypothesis that aerobic capacity-engendered benefits confound and modify the adverse effects of RSHI on white matter that, in turn, is a mediator of adverse cognitive effects. We will measure aerobic capacity (VO2max) and RSHI over 2 years and perform Myelin Water and Microstructure MRI of white matter as well as cognitive assessments, at enrollment and 2 years later. We will address the following specific aims: Aim 1: Evaluate the joint effects of VO2max and RSHI on white matter myelination and microstructure. Aim 2: Assess mediation by white matter of the known associations of VO2max and RSHI with cognitive performance. Aim 3: Explore the BDNF-Val66met and ApoE-ε4 gene variants as modifiers of the tradeoff of VO2max and RHSI-mediated effects on white matter. Delineating risk vs. benefit to cognitive performance from soccer can transform perception of risk by stakeholders, facilitate choice and guidance on soccer participation and heading. Choices that impact young adult players, with high RSHI exposure and decades of future needs, have the potential to impact their wellbeing, healthcare footprint and productivity for decades.