Stern, R A; Tripodis, Y; Baugh, C M; Fritts, N G; Martin, B M; Chaisson, C; Cantu, R C; Joyce, J A; Shah, S; Ikezu, T; Zhang, J; Gercel-Taylor, C; Taylor, D D
Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy Journal Article
In: Journal of Alzheimer's Disease, vol. 51, no. 4, pp. 1099–1109, 2016.
Abstract | BibTeX | Tags: *Chronic Traumatic Encephalopathy/bl [Blood], *Extracellular Vesicles/me [Metabolism], *Plasma/cy [Cytology], *tau Proteins/me [Metabolism], 0 (tau Proteins), adult, aged, ANALYSIS of variance, Case-Control Studies, Humans, Male, middle aged
@article{Stern2016,
title = {Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy},
author = {Stern, R A and Tripodis, Y and Baugh, C M and Fritts, N G and Martin, B M and Chaisson, C and Cantu, R C and Joyce, J A and Shah, S and Ikezu, T and Zhang, J and Gercel-Taylor, C and Taylor, D D},
year = {2016},
date = {2016-01-01},
journal = {Journal of Alzheimer's Disease},
volume = {51},
number = {4},
pages = {1099--1109},
abstract = {BACKGROUND: Chronic traumatic encephalopathy (CTE) is a tauopathy associated with prior exposure to repetitive head impacts, such as those incurred through American football and other collision sports. Diagnosis is made through neuropathological examination. Many of the clinical features of CTE are common in the general population, with and without a history of head impact exposure, making clinical diagnosis difficult. As is now common in the diagnosis of other neurodegenerative disorders, such as Alzheimer's disease, there is a need for methods to diagnose CTE during life through objective biomarkers. OBJECTIVE: The aim of this study was to examine tau-positive exosomes in plasma as a potential CTE biomarker. METHODS: Subjects were 78 former National Football League (NFL) players and 16 controls. Extracellular vesicles were isolated from plasma. Fluorescent nanoparticle tracking analysis was used to determine the number of vesicles staining positive for tau. RESULTS: The NFL group had higher exosomal tau than the control group (p \< 0.0001). Exosomal tau discriminated between the groups, with 82% sensitivity, 100% specificity, 100% positive predictive value, and 53% negative predictive value. Within the NFL group, higher exosomal tau was associated with worse performance on tests of memory (p = 0.0126) and psychomotor speed (p = 0.0093). CONCLUSION: These preliminary findings suggest that exosomal tau in plasma may be an accurate, noninvasive CTE biomarker.},
keywords = {*Chronic Traumatic Encephalopathy/bl [Blood], *Extracellular Vesicles/me [Metabolism], *Plasma/cy [Cytology], *tau Proteins/me [Metabolism], 0 (tau Proteins), adult, aged, ANALYSIS of variance, Case-Control Studies, Humans, Male, middle aged},
pubstate = {published},
tppubtype = {article}
}
Hilz, M J; Liu, M; Koehn, J; Wang, R; Ammon, F; Flanagan, S R; Hosl, K M
Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury Journal Article
In: BMC Neurology, vol. 16, pp. 61, 2016.
Abstract | BibTeX | Tags: *Autonomic Nervous System Diseases/pp [Physiopatho, *Baroreflex, *Blood Pressure, *Brain Concussion/pp [Physiopathology], *Valsalva Maneuver, adult, Case-Control Studies, Female, Heart Rate/ph [Physiology], Humans, Male, Respiration
@article{Hilz2016,
title = {Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury},
author = {Hilz, M J and Liu, M and Koehn, J and Wang, R and Ammon, F and Flanagan, S R and Hosl, K M},
year = {2016},
date = {2016-01-01},
journal = {BMC Neurology},
volume = {16},
pages = {61},
abstract = {BACKGROUND: Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. METHODS: In 29 healthy persons (31.3+/-12.2 years; 9 women) and 25 post-mTBI-patients (35.0+/-13.2 years, 7 women, 4-98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P\<0.05). RESULTS: At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P\<0.05). CONCLUSIONS: Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.},
keywords = {*Autonomic Nervous System Diseases/pp [Physiopatho, *Baroreflex, *Blood Pressure, *Brain Concussion/pp [Physiopathology], *Valsalva Maneuver, adult, Case-Control Studies, Female, Heart Rate/ph [Physiology], Humans, Male, Respiration},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors},
pubstate = {published},
tppubtype = {article}
}
Kurowski, B G; Pomerantz, W J; Schaiper, C; Ho, M; Gittelman, M A
Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 3 Suppl 1, pp. S21–8, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pc [Prevention & Control], *Brain Concussion/pc [Prevention & Control], *Health Education, *Health Knowledge, Adolescent, Attitudes, Case-Control Studies, Educational Measurement, Female, Humans, Male, Practice, Prospective Studies, Surveys and Questionnaires
@article{Kurowski2015,
title = {Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes},
author = {Kurowski, B G and Pomerantz, W J and Schaiper, C and Ho, M and Gittelman, M A},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {3 Suppl 1},
pages = {S21--8},
abstract = {BACKGROUND: The benefit of preseason concussion education on athletes' knowledge, attitudes, and behaviors is unclear. The purpose of the study was to determine the influence of preseason concussion education on knowledge and self-reported attitudes and reporting behaviors. We hypothesized that preseason education would lead to better knowledge and self-reported attitudes and better reporting of concussion symptoms during the season. METHODS: This study involved a prospective cohort comparing the benefits of a preseason lectured-based concussion education session at one high school with a control school. Participants included males and females age 13 years to 18 years from two community high schools who were participating in higher concussion risk, fall or winter sports (football, soccer, wrestling, and basketball). The education school and control school included 234 and 262 participants, respectively. Outcomes were a preseason and postseason survey assessing knowledge and self-reported attitudes about concussions and an end-of-season questionnaire assessing concussion reporting behaviors during the season. RESULTS: Total scores on the combined (p \< 0.0001), knowledge-based (p = 0.016), and behavioral-based (p \< 0.0001) questions demonstrated statistically significant improvement in the education group. Scores peaked immediately after education but dissipated at the end of the season. There was a lower proportion in the education school (72%) compared with the control school (88%) that reported continued play despite having concussion symptoms during the season (p = 0.025). A similar proportion of athletes diagnosed with concussion during the season in the education (27%) and control schools (23%) reported returning to play before symptoms resolved (p = 0.81). CONCLUSION: These findings suggest that a didactic-based preseason concussion education likely has minimal benefits. Other factors besides knowledge are likely influencing student-athlete concussion reporting behavior. Future research focused on changing the culture of concussion reporting is needed. LEVEL OF EVIDENCE: Therapeutic study, level III.},
keywords = {*Athletic Injuries/pc [Prevention \& Control], *Brain Concussion/pc [Prevention \& Control], *Health Education, *Health Knowledge, Adolescent, Attitudes, Case-Control Studies, Educational Measurement, Female, Humans, Male, Practice, Prospective Studies, Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Barrio, J R; Small, G W; Wong, K P; Huang, S C; Liu, J; Merrill, D A; Giza, C C; Fitzsimmons, R P; Omalu, B; Bailes, J; Kepe, V
In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344] Journal Article
In: Proceedings of the National Academy of Sciences of the United States of America, vol. 112, no. 16, pp. E2039–47, 2015.
Abstract | BibTeX | Tags: *Brain Injury, *Brain/pa [Pathology], *Brain/ri [Radionuclide Imaging], *Nitriles, *Positron-Emission Tomography, 0 (2-(1-(6-((2-fluoroethyl)(methyl)amino)-2-naphth, 0 (Nitriles), 80 and over, adult, aged, Alzheimer Disease/ri [Radionuclide Imaging], Amygdala/mi [Microbiology], Amygdala/pa [Pathology], autopsy, Case-Control Studies, Chronic/ri [Radionuclide Imaging], Demography, Humans, Male, Mesencephalon/mi [Microbiology], Mesencephalon/pa [Pathology], middle aged
@article{Barrio2015,
title = {In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344]},
author = {Barrio, J R and Small, G W and Wong, K P and Huang, S C and Liu, J and Merrill, D A and Giza, C C and Fitzsimmons, R P and Omalu, B and Bailes, J and Kepe, V},
year = {2015},
date = {2015-01-01},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
volume = {112},
number = {16},
pages = {E2039--47},
abstract = {Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer's dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-beta] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.},
keywords = {*Brain Injury, *Brain/pa [Pathology], *Brain/ri [Radionuclide Imaging], *Nitriles, *Positron-Emission Tomography, 0 (2-(1-(6-((2-fluoroethyl)(methyl)amino)-2-naphth, 0 (Nitriles), 80 and over, adult, aged, Alzheimer Disease/ri [Radionuclide Imaging], Amygdala/mi [Microbiology], Amygdala/pa [Pathology], autopsy, Case-Control Studies, Chronic/ri [Radionuclide Imaging], Demography, Humans, Male, Mesencephalon/mi [Microbiology], Mesencephalon/pa [Pathology], middle aged},
pubstate = {published},
tppubtype = {article}
}
Gardner, A J; Tan, C O; Ainslie, P N; Van Donkelaar, P; Stanwell, P; Levi, C R; Iverson, G L
Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review Journal Article
In: British Journal of Sports Medicine, vol. 49, no. 16, pp. 1050–1055, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Athletic Injuries, brain circulation, brain concussion, case control study, Case-Control Studies, Cerebrovascular Circulation, Doppler, echography, Female, human, Humans, Male, Pathophysiology, PHYSIOLOGY, sport injury, Transcranial, transcranial Doppler ultrasonography, Ultrasonography, Young Adult
@article{Gardner2015bb,
title = {Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review},
author = {Gardner, A J and Tan, C O and Ainslie, P N and {Van Donkelaar}, P and Stanwell, P and Levi, C R and Iverson, G L},
doi = {10.1136/bjsports-2014-093901},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
number = {16},
pages = {1050--1055},
abstract = {Background: Traumatic brain injury influences regulation of cerebral blood flow in animal models and in human studies. We reviewed the use of transcranial Doppler ultrasound (US) to monitor cerebrovascular reactivity following sport-related concussion. Review method: A narrative and systematic review of articles published in the English language, from December 1982 to October 2013. Data sources: Articles were retrieved via numerous databases using relevant key terms. Observational, cohort, correlational, cross-sectional and longitudinal studies were included. Results: Three publications met the criteria for inclusion; these provided data from 42 athletes and 33 controls. All three studies reported reductions in cerebrovascular reactivity via transcranial Doppler US. Conclusions: These initial results support the use of cerebrovascular reactivity as a research tool for identifying altered neurophysiology and monitoring recovery in adult athletes. Larger cross-sectional, prospective and longitudinal studies are required to understand the sensitivity and prognostic value of cerebrovascular reactivity in sport-related concussion. © 2015, BMJ Publishing Group. All rights reserved.},
keywords = {Adolescent, adult, Athletic Injuries, brain circulation, brain concussion, case control study, Case-Control Studies, Cerebrovascular Circulation, Doppler, echography, Female, human, Humans, Male, Pathophysiology, PHYSIOLOGY, sport injury, Transcranial, transcranial Doppler ultrasonography, Ultrasonography, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Strand, S; Lechuga, D; Zachariah, T; Beaulieu, K
Relative risk for concussions in young female soccer players Journal Article
In: Applied Neuropsychology. Child, vol. 4, no. 1, pp. 58–64, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/ep [Epidemiology], *Soccer/in [Injuries], Adolescent, Case-Control Studies, Child, Female, Humans, Incidence, Risk Factors, United States/ep [Epidemiology]
@article{Strand2015,
title = {Relative risk for concussions in young female soccer players},
author = {Strand, S and Lechuga, D and Zachariah, T and Beaulieu, K},
year = {2015},
date = {2015-01-01},
journal = {Applied Neuropsychology. Child},
volume = {4},
number = {1},
pages = {58--64},
abstract = {The objective of this study was to determine the relative risk and reported symptoms of concussions in 11- to 13-year-old, female soccer players. For this, a survey to compare the reported incidence of concussion in age-matched female soccer players to nonsoccer players was performed. The survey included 342 girls between the ages of 11 and 13: 195 were involved in an organized soccer team and 147 were not involved in organized soccer but were allowed to participate in any other sport or activity. A total of 94 of the 195 soccer players, or 48%, reported at least one symptom consistent with a concussion. The most prevalent symptom for these girls was headache (84%). A total of 34 of the 147 nonsoccer players, or 23%, reported at least one symptom consistent with a concussion in the previous six months. These results determined that the relative risk of probable concussions among 11- to 13-year-old, female soccer players is 2.09 (p \< .001},
keywords = {*Brain Concussion/ep [Epidemiology], *Soccer/in [Injuries], Adolescent, Case-Control Studies, Child, Female, Humans, Incidence, Risk Factors, United States/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}
Stern, R A; Tripodis, Y; Baugh, C M; Fritts, N G; Martin, B M; Chaisson, C; Cantu, R C; Joyce, J A; Shah, S; Ikezu, T; Zhang, J; Gercel-Taylor, C; Taylor, D D
Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy Journal Article
In: Journal of Alzheimer's Disease, vol. 51, no. 4, pp. 1099–1109, 2016.
@article{Stern2016,
title = {Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy},
author = {Stern, R A and Tripodis, Y and Baugh, C M and Fritts, N G and Martin, B M and Chaisson, C and Cantu, R C and Joyce, J A and Shah, S and Ikezu, T and Zhang, J and Gercel-Taylor, C and Taylor, D D},
year = {2016},
date = {2016-01-01},
journal = {Journal of Alzheimer's Disease},
volume = {51},
number = {4},
pages = {1099--1109},
abstract = {BACKGROUND: Chronic traumatic encephalopathy (CTE) is a tauopathy associated with prior exposure to repetitive head impacts, such as those incurred through American football and other collision sports. Diagnosis is made through neuropathological examination. Many of the clinical features of CTE are common in the general population, with and without a history of head impact exposure, making clinical diagnosis difficult. As is now common in the diagnosis of other neurodegenerative disorders, such as Alzheimer's disease, there is a need for methods to diagnose CTE during life through objective biomarkers. OBJECTIVE: The aim of this study was to examine tau-positive exosomes in plasma as a potential CTE biomarker. METHODS: Subjects were 78 former National Football League (NFL) players and 16 controls. Extracellular vesicles were isolated from plasma. Fluorescent nanoparticle tracking analysis was used to determine the number of vesicles staining positive for tau. RESULTS: The NFL group had higher exosomal tau than the control group (p \< 0.0001). Exosomal tau discriminated between the groups, with 82% sensitivity, 100% specificity, 100% positive predictive value, and 53% negative predictive value. Within the NFL group, higher exosomal tau was associated with worse performance on tests of memory (p = 0.0126) and psychomotor speed (p = 0.0093). CONCLUSION: These preliminary findings suggest that exosomal tau in plasma may be an accurate, noninvasive CTE biomarker.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hilz, M J; Liu, M; Koehn, J; Wang, R; Ammon, F; Flanagan, S R; Hosl, K M
Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury Journal Article
In: BMC Neurology, vol. 16, pp. 61, 2016.
@article{Hilz2016,
title = {Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury},
author = {Hilz, M J and Liu, M and Koehn, J and Wang, R and Ammon, F and Flanagan, S R and Hosl, K M},
year = {2016},
date = {2016-01-01},
journal = {BMC Neurology},
volume = {16},
pages = {61},
abstract = {BACKGROUND: Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. METHODS: In 29 healthy persons (31.3+/-12.2 years; 9 women) and 25 post-mTBI-patients (35.0+/-13.2 years, 7 women, 4-98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P\<0.05). RESULTS: At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P\<0.05). CONCLUSIONS: Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kurowski, B G; Pomerantz, W J; Schaiper, C; Ho, M; Gittelman, M A
Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 3 Suppl 1, pp. S21–8, 2015.
@article{Kurowski2015,
title = {Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes},
author = {Kurowski, B G and Pomerantz, W J and Schaiper, C and Ho, M and Gittelman, M A},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {3 Suppl 1},
pages = {S21--8},
abstract = {BACKGROUND: The benefit of preseason concussion education on athletes' knowledge, attitudes, and behaviors is unclear. The purpose of the study was to determine the influence of preseason concussion education on knowledge and self-reported attitudes and reporting behaviors. We hypothesized that preseason education would lead to better knowledge and self-reported attitudes and better reporting of concussion symptoms during the season. METHODS: This study involved a prospective cohort comparing the benefits of a preseason lectured-based concussion education session at one high school with a control school. Participants included males and females age 13 years to 18 years from two community high schools who were participating in higher concussion risk, fall or winter sports (football, soccer, wrestling, and basketball). The education school and control school included 234 and 262 participants, respectively. Outcomes were a preseason and postseason survey assessing knowledge and self-reported attitudes about concussions and an end-of-season questionnaire assessing concussion reporting behaviors during the season. RESULTS: Total scores on the combined (p \< 0.0001), knowledge-based (p = 0.016), and behavioral-based (p \< 0.0001) questions demonstrated statistically significant improvement in the education group. Scores peaked immediately after education but dissipated at the end of the season. There was a lower proportion in the education school (72%) compared with the control school (88%) that reported continued play despite having concussion symptoms during the season (p = 0.025). A similar proportion of athletes diagnosed with concussion during the season in the education (27%) and control schools (23%) reported returning to play before symptoms resolved (p = 0.81). CONCLUSION: These findings suggest that a didactic-based preseason concussion education likely has minimal benefits. Other factors besides knowledge are likely influencing student-athlete concussion reporting behavior. Future research focused on changing the culture of concussion reporting is needed. LEVEL OF EVIDENCE: Therapeutic study, level III.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Barrio, J R; Small, G W; Wong, K P; Huang, S C; Liu, J; Merrill, D A; Giza, C C; Fitzsimmons, R P; Omalu, B; Bailes, J; Kepe, V
In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344] Journal Article
In: Proceedings of the National Academy of Sciences of the United States of America, vol. 112, no. 16, pp. E2039–47, 2015.
@article{Barrio2015,
title = {In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344]},
author = {Barrio, J R and Small, G W and Wong, K P and Huang, S C and Liu, J and Merrill, D A and Giza, C C and Fitzsimmons, R P and Omalu, B and Bailes, J and Kepe, V},
year = {2015},
date = {2015-01-01},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
volume = {112},
number = {16},
pages = {E2039--47},
abstract = {Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer's dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-beta] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gardner, A J; Tan, C O; Ainslie, P N; Van Donkelaar, P; Stanwell, P; Levi, C R; Iverson, G L
Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review Journal Article
In: British Journal of Sports Medicine, vol. 49, no. 16, pp. 1050–1055, 2015.
@article{Gardner2015bb,
title = {Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review},
author = {Gardner, A J and Tan, C O and Ainslie, P N and {Van Donkelaar}, P and Stanwell, P and Levi, C R and Iverson, G L},
doi = {10.1136/bjsports-2014-093901},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
number = {16},
pages = {1050--1055},
abstract = {Background: Traumatic brain injury influences regulation of cerebral blood flow in animal models and in human studies. We reviewed the use of transcranial Doppler ultrasound (US) to monitor cerebrovascular reactivity following sport-related concussion. Review method: A narrative and systematic review of articles published in the English language, from December 1982 to October 2013. Data sources: Articles were retrieved via numerous databases using relevant key terms. Observational, cohort, correlational, cross-sectional and longitudinal studies were included. Results: Three publications met the criteria for inclusion; these provided data from 42 athletes and 33 controls. All three studies reported reductions in cerebrovascular reactivity via transcranial Doppler US. Conclusions: These initial results support the use of cerebrovascular reactivity as a research tool for identifying altered neurophysiology and monitoring recovery in adult athletes. Larger cross-sectional, prospective and longitudinal studies are required to understand the sensitivity and prognostic value of cerebrovascular reactivity in sport-related concussion. © 2015, BMJ Publishing Group. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Strand, S; Lechuga, D; Zachariah, T; Beaulieu, K
Relative risk for concussions in young female soccer players Journal Article
In: Applied Neuropsychology. Child, vol. 4, no. 1, pp. 58–64, 2015.
@article{Strand2015,
title = {Relative risk for concussions in young female soccer players},
author = {Strand, S and Lechuga, D and Zachariah, T and Beaulieu, K},
year = {2015},
date = {2015-01-01},
journal = {Applied Neuropsychology. Child},
volume = {4},
number = {1},
pages = {58--64},
abstract = {The objective of this study was to determine the relative risk and reported symptoms of concussions in 11- to 13-year-old, female soccer players. For this, a survey to compare the reported incidence of concussion in age-matched female soccer players to nonsoccer players was performed. The survey included 342 girls between the ages of 11 and 13: 195 were involved in an organized soccer team and 147 were not involved in organized soccer but were allowed to participate in any other sport or activity. A total of 94 of the 195 soccer players, or 48%, reported at least one symptom consistent with a concussion. The most prevalent symptom for these girls was headache (84%). A total of 34 of the 147 nonsoccer players, or 23%, reported at least one symptom consistent with a concussion in the previous six months. These results determined that the relative risk of probable concussions among 11- to 13-year-old, female soccer players is 2.09 (p \< .001},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Stern, R A; Tripodis, Y; Baugh, C M; Fritts, N G; Martin, B M; Chaisson, C; Cantu, R C; Joyce, J A; Shah, S; Ikezu, T; Zhang, J; Gercel-Taylor, C; Taylor, D D
Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy Journal Article
In: Journal of Alzheimer's Disease, vol. 51, no. 4, pp. 1099–1109, 2016.
Abstract | BibTeX | Tags: *Chronic Traumatic Encephalopathy/bl [Blood], *Extracellular Vesicles/me [Metabolism], *Plasma/cy [Cytology], *tau Proteins/me [Metabolism], 0 (tau Proteins), adult, aged, ANALYSIS of variance, Case-Control Studies, Humans, Male, middle aged
@article{Stern2016,
title = {Preliminary Study of Plasma Exosomal Tau as a Potential Biomarker for Chronic Traumatic Encephalopathy},
author = {Stern, R A and Tripodis, Y and Baugh, C M and Fritts, N G and Martin, B M and Chaisson, C and Cantu, R C and Joyce, J A and Shah, S and Ikezu, T and Zhang, J and Gercel-Taylor, C and Taylor, D D},
year = {2016},
date = {2016-01-01},
journal = {Journal of Alzheimer's Disease},
volume = {51},
number = {4},
pages = {1099--1109},
abstract = {BACKGROUND: Chronic traumatic encephalopathy (CTE) is a tauopathy associated with prior exposure to repetitive head impacts, such as those incurred through American football and other collision sports. Diagnosis is made through neuropathological examination. Many of the clinical features of CTE are common in the general population, with and without a history of head impact exposure, making clinical diagnosis difficult. As is now common in the diagnosis of other neurodegenerative disorders, such as Alzheimer's disease, there is a need for methods to diagnose CTE during life through objective biomarkers. OBJECTIVE: The aim of this study was to examine tau-positive exosomes in plasma as a potential CTE biomarker. METHODS: Subjects were 78 former National Football League (NFL) players and 16 controls. Extracellular vesicles were isolated from plasma. Fluorescent nanoparticle tracking analysis was used to determine the number of vesicles staining positive for tau. RESULTS: The NFL group had higher exosomal tau than the control group (p \< 0.0001). Exosomal tau discriminated between the groups, with 82% sensitivity, 100% specificity, 100% positive predictive value, and 53% negative predictive value. Within the NFL group, higher exosomal tau was associated with worse performance on tests of memory (p = 0.0126) and psychomotor speed (p = 0.0093). CONCLUSION: These preliminary findings suggest that exosomal tau in plasma may be an accurate, noninvasive CTE biomarker.},
keywords = {*Chronic Traumatic Encephalopathy/bl [Blood], *Extracellular Vesicles/me [Metabolism], *Plasma/cy [Cytology], *tau Proteins/me [Metabolism], 0 (tau Proteins), adult, aged, ANALYSIS of variance, Case-Control Studies, Humans, Male, middle aged},
pubstate = {published},
tppubtype = {article}
}
Hilz, M J; Liu, M; Koehn, J; Wang, R; Ammon, F; Flanagan, S R; Hosl, K M
Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury Journal Article
In: BMC Neurology, vol. 16, pp. 61, 2016.
Abstract | BibTeX | Tags: *Autonomic Nervous System Diseases/pp [Physiopatho, *Baroreflex, *Blood Pressure, *Brain Concussion/pp [Physiopathology], *Valsalva Maneuver, adult, Case-Control Studies, Female, Heart Rate/ph [Physiology], Humans, Male, Respiration
@article{Hilz2016,
title = {Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury},
author = {Hilz, M J and Liu, M and Koehn, J and Wang, R and Ammon, F and Flanagan, S R and Hosl, K M},
year = {2016},
date = {2016-01-01},
journal = {BMC Neurology},
volume = {16},
pages = {61},
abstract = {BACKGROUND: Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. METHODS: In 29 healthy persons (31.3+/-12.2 years; 9 women) and 25 post-mTBI-patients (35.0+/-13.2 years, 7 women, 4-98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P\<0.05). RESULTS: At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P\<0.05). CONCLUSIONS: Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.},
keywords = {*Autonomic Nervous System Diseases/pp [Physiopatho, *Baroreflex, *Blood Pressure, *Brain Concussion/pp [Physiopathology], *Valsalva Maneuver, adult, Case-Control Studies, Female, Heart Rate/ph [Physiology], Humans, Male, Respiration},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors},
pubstate = {published},
tppubtype = {article}
}
Kurowski, B G; Pomerantz, W J; Schaiper, C; Ho, M; Gittelman, M A
Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 3 Suppl 1, pp. S21–8, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pc [Prevention & Control], *Brain Concussion/pc [Prevention & Control], *Health Education, *Health Knowledge, Adolescent, Attitudes, Case-Control Studies, Educational Measurement, Female, Humans, Male, Practice, Prospective Studies, Surveys and Questionnaires
@article{Kurowski2015,
title = {Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes},
author = {Kurowski, B G and Pomerantz, W J and Schaiper, C and Ho, M and Gittelman, M A},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {3 Suppl 1},
pages = {S21--8},
abstract = {BACKGROUND: The benefit of preseason concussion education on athletes' knowledge, attitudes, and behaviors is unclear. The purpose of the study was to determine the influence of preseason concussion education on knowledge and self-reported attitudes and reporting behaviors. We hypothesized that preseason education would lead to better knowledge and self-reported attitudes and better reporting of concussion symptoms during the season. METHODS: This study involved a prospective cohort comparing the benefits of a preseason lectured-based concussion education session at one high school with a control school. Participants included males and females age 13 years to 18 years from two community high schools who were participating in higher concussion risk, fall or winter sports (football, soccer, wrestling, and basketball). The education school and control school included 234 and 262 participants, respectively. Outcomes were a preseason and postseason survey assessing knowledge and self-reported attitudes about concussions and an end-of-season questionnaire assessing concussion reporting behaviors during the season. RESULTS: Total scores on the combined (p \< 0.0001), knowledge-based (p = 0.016), and behavioral-based (p \< 0.0001) questions demonstrated statistically significant improvement in the education group. Scores peaked immediately after education but dissipated at the end of the season. There was a lower proportion in the education school (72%) compared with the control school (88%) that reported continued play despite having concussion symptoms during the season (p = 0.025). A similar proportion of athletes diagnosed with concussion during the season in the education (27%) and control schools (23%) reported returning to play before symptoms resolved (p = 0.81). CONCLUSION: These findings suggest that a didactic-based preseason concussion education likely has minimal benefits. Other factors besides knowledge are likely influencing student-athlete concussion reporting behavior. Future research focused on changing the culture of concussion reporting is needed. LEVEL OF EVIDENCE: Therapeutic study, level III.},
keywords = {*Athletic Injuries/pc [Prevention \& Control], *Brain Concussion/pc [Prevention \& Control], *Health Education, *Health Knowledge, Adolescent, Attitudes, Case-Control Studies, Educational Measurement, Female, Humans, Male, Practice, Prospective Studies, Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Barrio, J R; Small, G W; Wong, K P; Huang, S C; Liu, J; Merrill, D A; Giza, C C; Fitzsimmons, R P; Omalu, B; Bailes, J; Kepe, V
In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344] Journal Article
In: Proceedings of the National Academy of Sciences of the United States of America, vol. 112, no. 16, pp. E2039–47, 2015.
Abstract | BibTeX | Tags: *Brain Injury, *Brain/pa [Pathology], *Brain/ri [Radionuclide Imaging], *Nitriles, *Positron-Emission Tomography, 0 (2-(1-(6-((2-fluoroethyl)(methyl)amino)-2-naphth, 0 (Nitriles), 80 and over, adult, aged, Alzheimer Disease/ri [Radionuclide Imaging], Amygdala/mi [Microbiology], Amygdala/pa [Pathology], autopsy, Case-Control Studies, Chronic/ri [Radionuclide Imaging], Demography, Humans, Male, Mesencephalon/mi [Microbiology], Mesencephalon/pa [Pathology], middle aged
@article{Barrio2015,
title = {In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging.[Erratum appears in Proc Natl Acad Sci U S A. 2015 Jun 2;112(22):E2981; PMID: 25964344]},
author = {Barrio, J R and Small, G W and Wong, K P and Huang, S C and Liu, J and Merrill, D A and Giza, C C and Fitzsimmons, R P and Omalu, B and Bailes, J and Kepe, V},
year = {2015},
date = {2015-01-01},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
volume = {112},
number = {16},
pages = {E2039--47},
abstract = {Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer's dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-beta] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.},
keywords = {*Brain Injury, *Brain/pa [Pathology], *Brain/ri [Radionuclide Imaging], *Nitriles, *Positron-Emission Tomography, 0 (2-(1-(6-((2-fluoroethyl)(methyl)amino)-2-naphth, 0 (Nitriles), 80 and over, adult, aged, Alzheimer Disease/ri [Radionuclide Imaging], Amygdala/mi [Microbiology], Amygdala/pa [Pathology], autopsy, Case-Control Studies, Chronic/ri [Radionuclide Imaging], Demography, Humans, Male, Mesencephalon/mi [Microbiology], Mesencephalon/pa [Pathology], middle aged},
pubstate = {published},
tppubtype = {article}
}
Gardner, A J; Tan, C O; Ainslie, P N; Van Donkelaar, P; Stanwell, P; Levi, C R; Iverson, G L
Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review Journal Article
In: British Journal of Sports Medicine, vol. 49, no. 16, pp. 1050–1055, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Athletic Injuries, brain circulation, brain concussion, case control study, Case-Control Studies, Cerebrovascular Circulation, Doppler, echography, Female, human, Humans, Male, Pathophysiology, PHYSIOLOGY, sport injury, Transcranial, transcranial Doppler ultrasonography, Ultrasonography, Young Adult
@article{Gardner2015bb,
title = {Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: A systematic review},
author = {Gardner, A J and Tan, C O and Ainslie, P N and {Van Donkelaar}, P and Stanwell, P and Levi, C R and Iverson, G L},
doi = {10.1136/bjsports-2014-093901},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
number = {16},
pages = {1050--1055},
abstract = {Background: Traumatic brain injury influences regulation of cerebral blood flow in animal models and in human studies. We reviewed the use of transcranial Doppler ultrasound (US) to monitor cerebrovascular reactivity following sport-related concussion. Review method: A narrative and systematic review of articles published in the English language, from December 1982 to October 2013. Data sources: Articles were retrieved via numerous databases using relevant key terms. Observational, cohort, correlational, cross-sectional and longitudinal studies were included. Results: Three publications met the criteria for inclusion; these provided data from 42 athletes and 33 controls. All three studies reported reductions in cerebrovascular reactivity via transcranial Doppler US. Conclusions: These initial results support the use of cerebrovascular reactivity as a research tool for identifying altered neurophysiology and monitoring recovery in adult athletes. Larger cross-sectional, prospective and longitudinal studies are required to understand the sensitivity and prognostic value of cerebrovascular reactivity in sport-related concussion. © 2015, BMJ Publishing Group. All rights reserved.},
keywords = {Adolescent, adult, Athletic Injuries, brain circulation, brain concussion, case control study, Case-Control Studies, Cerebrovascular Circulation, Doppler, echography, Female, human, Humans, Male, Pathophysiology, PHYSIOLOGY, sport injury, Transcranial, transcranial Doppler ultrasonography, Ultrasonography, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Strand, S; Lechuga, D; Zachariah, T; Beaulieu, K
Relative risk for concussions in young female soccer players Journal Article
In: Applied Neuropsychology. Child, vol. 4, no. 1, pp. 58–64, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/ep [Epidemiology], *Soccer/in [Injuries], Adolescent, Case-Control Studies, Child, Female, Humans, Incidence, Risk Factors, United States/ep [Epidemiology]
@article{Strand2015,
title = {Relative risk for concussions in young female soccer players},
author = {Strand, S and Lechuga, D and Zachariah, T and Beaulieu, K},
year = {2015},
date = {2015-01-01},
journal = {Applied Neuropsychology. Child},
volume = {4},
number = {1},
pages = {58--64},
abstract = {The objective of this study was to determine the relative risk and reported symptoms of concussions in 11- to 13-year-old, female soccer players. For this, a survey to compare the reported incidence of concussion in age-matched female soccer players to nonsoccer players was performed. The survey included 342 girls between the ages of 11 and 13: 195 were involved in an organized soccer team and 147 were not involved in organized soccer but were allowed to participate in any other sport or activity. A total of 94 of the 195 soccer players, or 48%, reported at least one symptom consistent with a concussion. The most prevalent symptom for these girls was headache (84%). A total of 34 of the 147 nonsoccer players, or 23%, reported at least one symptom consistent with a concussion in the previous six months. These results determined that the relative risk of probable concussions among 11- to 13-year-old, female soccer players is 2.09 (p \< .001},
keywords = {*Brain Concussion/ep [Epidemiology], *Soccer/in [Injuries], Adolescent, Case-Control Studies, Child, Female, Humans, Incidence, Risk Factors, United States/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}