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PLoS One. 2014 Apr 16;9(4):e94734. doi: 10.1371/journal.pone.0094734. eCollection 2014.

Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts.

Author information

1
Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America.
2
Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America.
3
Imaging Sciences, Biomedical Engineering, and Physics, University of Rochester, Rochester, New York, United States of America.
4
Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States of America.
5
Athletics and Recreation, University of Rochester, Rochester, New York, United States of America.
6
University of Rochester, Rochester, New York, United States of America.
7
Hamilton College, Clinton, New York, United States of America.
8
Physics and Astronomy, University of Rochester, Rochester, New York, United States of America.

Abstract

INTRODUCTION:

Repetitive head impacts (RHI) sustained in contact sports are thought to be necessary for the long-term development of chronic traumatic encephalopathy (CTE). Our objectives were to: 1) characterize the magnitude and persistence of RHI-induced white matter (WM) changes; 2) determine their relationship to kinematic measures of RHI; and 3) explore their clinical relevance.

METHODS:

Prospective, observational study of 10 Division III college football players and 5 non-athlete controls during the 2011-12 season. All subjects underwent diffusion tensor imaging (DTI), physiologic, cognitive, and balance testing at pre-season (Time 1), post-season (Time 2), and after 6-months of no-contact rest (Time 3). Head impact measures were recorded using helmet-mounted accelerometers. The percentage of whole-brain WM voxels with significant changes in fractional anisotropy (FA) and mean diffusivity (MD) from Time 1 to 2, and Time 1 to 3 was determined for each subject and correlated to head impacts and clinical measures.

RESULTS:

Total head impacts for the season ranged from 431-1,850. No athlete suffered a clinically evident concussion. Compared to controls, athletes experienced greater changes in FA and MD from Time 1 to 2 as well as Time 1 to 3; most differences at Time 2 persisted to Time 3. Among athletes, the percentage of voxels with decreased FA from Time 1 to 2 was positively correlated with several helmet impact measures. The persistence of WM changes from Time 1 to 3 was also associated with changes in serum ApoA1 and S100B autoantibodies. WM changes were not consistently associated with cognition or balance.

CONCLUSIONS:

A single football season of RHIs without clinically-evident concussion resulted in WM changes that correlated with multiple helmet impact measures and persisted following 6 months of no-contact rest. This lack of WM recovery could potentially contribute to cumulative WM changes with subsequent RHI exposures.

PMID:
24740265
PMCID:
PMC3989251
DOI:
10.1371/journal.pone.0094734
[Indexed for MEDLINE]
Free PMC Article
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