International concern continues regarding the association between the long-term neurophysiologic changes from repetitive neurotrauma associated with contact and collision sports. This study describes ...corticomotor changes in retired contact/collision sport athletes and controls, between the ages of 30 and 70 years. Retired athletes (n = 152; 49.1 ± 8.5 years) and controls (n = 72; 47.8 ± 9.5 years) were assessed using single and paired-pulse transcranial magnetic stimulation (TMS) for active motor threshold (aMT), motor evoked potential and cortical silent period duration (expressed as MEP:cSP ratio), and short- and long-interval intracortical inhibition (SICI and LICI). Motor threshold, MEP:cSP, SICI and LICI for both groups were correlated across age. Controls showed significant moderate correlations for MEP:cSP ratios at 130% (rho = 0.48, p < 0.001), 150% (rho = 0.49, p < 0.001) and 170% aMT (rho = 0.42; p < 0.001) and significant small negative correlation for SICI (rho = −0.27; p = 0.030), and moderate negative correlation for LICI (rho = −0.43; p < 0.001). Group-wise correlation analysis comparisons showed significant correlation differences between groups for 130% (p = 0.016) and 150% aMT (p = 0.009), specifically showing retired athletes were displaying increased corticomotor inhibition. While previous studies have focussed studies on older athletes (>50 years), this study is the first to characterize corticomotor differences between retired athletes and controls across the lifespan. These results, demonstrating pathophysiological differences in retired athletes across the lifespan, provide a foundation to utilise evoked potentials as a prodromal marker in supplementing neurological assessment for traumatic encephalopathy syndrome associated with contact/collision sport athletes that is currently lacking physiological biomarkers.
•Repetitive head trauma has been shown to increase risk of neurodegenerative disease.•Corticomotor connections were assed in 152 athletes and 72 controls.•Athletes with head trauma showed reduced inhibitory response compared to controls.•TMS represents an approach exploring pathophysiology of repetitive head trauma.
Display omitted
•Previous concussions may alter prefrontal cortex oxygenation during a hypercapnic challenge.•Cellular mechanisms to respond to elevated CO2 may be impaired in individuals with ...previous concussions.•Unequal CO2 stress in right cerebral hemisphere vs left in those with previous concussions.
This exploratory study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a five-minute hypercapnic challenge using Near Infrared Spectroscopy (NIRS). 55 physically active retired contact sport male athletes with three or more previous concussions (mTBI) were recruited along with 29 physically active males with no concussions history (CTRL). Participants completed five minutes of seated rest prior to the five-minute hypercapnic challenge (20-second breath-hold, 40-second recovery breathing; five times). NIRS measured right and left side oxygenated (O2Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) with all parameters analysed through changes in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations. Right prefrontal cortex HbDiff ΔMAX was significantly higher in the mTBI compared to CTRL (p = 0.045) group. Left prefrontal cortex O2Hb ΔMAX (p = 0.040), HHb Z-Scores (p = 0.008), and HbDiff ΔMAX(p = 0.014) were significantly higher in the mTBI group. Within-group right vs left analyses demonstrated significantly lower left HbDiff ΔMAX (p = 0.048) and HbDiff Z-scores (p = 0.002) in the mTBI group, while the CTRL group had significantly lower left HHb Z-scores (p = 0.003) and left tHb Z-scores (p = 0.042). This study provides preliminary evidence that athletes with a history of three or more concussions may have impaired prefrontal cortex oxygenation parameters during a hypercapnic challenge.
This study investigated the long-term effects of multiple concussions on prefrontal cortex oxygenation using near-infrared spectroscopy (NIRS) during a squat-stand maneuver that activated dynamic ...cerebral autoregulation.
Active male retired contact sport athletes with a history of 3+ concussions (mTBI; n = 55), and active retired athletes with no concussion history (CTRL; n = 29) were recruited. Participants completed a 5-min squat-stand maneuve (10-s squat, 10-s stand, 0.05 Hz; 15 times). Oxygenated (O
2
Hb), deoxygenated (HHb), total (tHb) hemoglobin, and hemoglobin difference (HbDiff) were analyzed through the change in maximal and minimal values during the test (∆MAX), Z-scores, and standard deviations.
mTBI group showed left prefrontal cortex O
2
Hb ∆MAX (p = 0.046) and HbDiff ∆MAX (p = 0.018) were significantly higher. Within-group analyses showed significantly higher left HHb ∆MAX (p = 0.003) and lower left HbDiff Z-scores (p = 0.010) only in the mTBI group. The CTRL group demonstrated significantly lower left HbDiff SD (p = 0.039), tHb Z-scores (p = 0.030), and HbDiff ∆MAX (p = 0.037) compared to right prefrontal cortex response.
These preliminary results suggest changes in prefrontal cortex oxygenation potentially affecting the brain's ability to adapt to changing cerebral perfusion pressure after multiple previous concussions.
•Advanced MRI scans can detect long-term concussion-related brain damage.•Repetitive concussive events can result in lasting functional brain abnormalities.•Minimal microstructural damage was ...detected in the aging, retired athletes.•Pre-motor cortex, hippocampus dentate gyrus and visual cortex were commonly injured.•Impaired social functioning, emotional well-being, energy, and general health.
This brain imaging study examined subjects with a history of repetitive concussive and sub-concussive impacts sustained over the course of their careers in the Canadian Football League (CFL). We hypothesized that microstructural and functional abnormalities, assessed using diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (rsfMRI) respectively, would be present in these retired athletes, that are not present in matched controls. Seventeen aging, retired CFL players (aged 58.5±6.2y, ranged 45–66) completed three neuropsychological tests, and had anatomical, diffusion and functional MRI scans performed. Healthy age- and sex-matched control data (n = 2117) were used to develop a subject-specific and region-wise Z-scoring approach. Regional DTI fractional anisotropy (FA) and rsfMRI signal complexity (fractal dimension; FD) Z-score data was further analyzed as a subject-specific total, left, and right injury burden (IB) value for each MRI metric. Microstructural abnormality was detected in 6 of 17 subjects based on DTI FA. The rsfMRI data showed 4 subjects with higher total FDIB, and several regions had Z-score outliers detected in multiple subjects. The right pre-motor cortex, right hippocampus dentate gyrus, and right visual cortex were the most abnormally functioning grey matter brain regions. Total FAIB was negatively correlated with career length, social functioning, and significantly with emotional well-being, and positively correlated with physical health. Total FDIB was negatively correlated with energy and fatigue and general health, and positively correlated with age, career length, and education. This study provides evidence of brain changes years after professional athletes have retired.
This article presents results of a systematic review of the literature (2000-2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were ...selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.
The topic of potential long-term neurological consequences from having multiple concussions during a career in collision sports is controversial. We sought to investigate white matter microstructure ...using diffusion tensor imaging (DTI) in retired professional Australian National Rugby League (NRL) players (
= 11) with a history of multiple self-reported concussions compared with age- and education-matched controls (
= 13) who have had no history of brain trauma. Diffusion-weighted images were acquired with a Siemens 3T scanner. All participants completed a clinical interview. There were no significant differences between groups on measures of depression, anxiety, stress, or post-concussion symptoms; however, NRL players scored significantly higher on the alcohol use disorder identification test (AUDIT). Voxelwise analyses of DTI measures were performed using tract-based spatial statistics (TBSS) with age and AUDIT scores included as covariates. TBSS revealed significantly reduced fractional anisotropy (FA), and increased radial diffusivity (RD), axial diffusivity (AD), and trace (TR) in white matter regions of recently retired NRL players compared with controls. FA was significantly reduced in the right superior longitudinal fasciculus and right corticospinal tract while TR, RD, and AD were increased in these regions, as well as the corpus callosum, forceps major, right uncinate fasciculus, and left corticospinal tract. In summary, DTI in a small cohort of recently retired professional NRL players with a history of multiple concussions showed differences in white matter microstructure compared with age- and education-matched controls with no history of brain trauma.
There is considerable interest in determining whether later-in-life depression is associated with lifetime history of concussions or the duration of a career in professional contact and collision ...sports. Rugby league is a high-intensity collision sport involving a large number of tackles per game and a high rate of concussions. We examined predictors and correlates of depression in retired elite level rugby league players in Australia.
Retired elite level rugby league players (
= 141, age: M = 52.6, SD = 13.8; Range = 30-89 years) completed the Depression, Anxiety, and Stress Scale (DASS), Brief Pain Inventory, Connor-Davidson Resilience Scale (CD-RISC), and Epworth Sleepiness Scale; they also reported on lifetime history of concussions. The DASS depression score was regressed on age, total number of self-reported concussions, years played professionally, CD-RISC score, BPI pain interference score, and ESS score.
The retired players reported a median of 15 total lifetime concussions interquartile range (IQR) = 6-30, and a median of 8 years playing professional sports (IQR = 3.5-11). The proportion of the sample endorsing at least mild current depression was 29%. The DASS depression score was positively correlated with the DASS anxiety (
= 0.54) and DASS stress scores (
= 0.58). The CD-RISC score was negatively correlated with the depression score (
= -0.53). Depression scores were not significantly correlated with pain severity (
= 0.14), and were weakly correlated with life interference due to pain (
= 0.20) and years playing professional sports (
= -0.17). Depression scores were not significantly correlated with lifetime history of concussions (
= 0.14). A multiple regression model, with age, total number of self-reported concussions, years played professionally, the CD-RISC, Brief Pain Inventory-pain interference score, and Epworth Sleepiness Scale score as predictors was significant, with 35% of the variance in DASS depression accounted for. The two significant independent predictors of depression were lower resilience and greater life interference due to pain.
This is the first large study of depression in retired rugby league players. Depression in these retired players was not meaningfully associated with lifetime history of concussions or number of years playing elite level collision sport. Depression was associated with current anxiety, stress, resilience, and life interference due to chronic pain.
Rugby league is an international full-contact sport, with frequent concussive injuries. Participation in other full-contact sports such as American football has been considered to be a risk factor ...for neuropsychiatric sequelae later-in-life, but little research has addressed the mental and cognitive health of retired professional rugby league players. We examined predictors and correlates of perceived (self-reported) cognitive decline in retired National Rugby League (NRL) players.
Participants were 133 retired male elite level rugby league players in Australia. Participants completed clinical interviews, neuropsychological testing, and self-report measures. The Informant Questionnaire on Cognitive Decline in the Elderly, self-report (IQCODE-Self), measured perceived cognitive decline.
The median age of the sample was 55.0 (M = 53.1, SD = 13.9, range = 30-89) and the median years of education completed was 12.0 (M = 11.9, SD = 2.6, range = 7-18). The retired players reported a median of 15.0 total lifetime concussions (M = 28.0, SD = 36.6, range = 0-200). The mean IQCODE-Self score was 3.2 (SD = 0.5; Range = 1.3-5.0); 10/133 (7.5%) and 38/133 (28.6%) scored above conservative and liberal cutoffs for cognitive decline on the IQCODE-Self, respectively. Perceived cognitive decline was positively correlated with current depressive symptoms, negatively correlated with years of professional sport exposure and resilience, and unrelated to objective cognition and number of self-reported concussions. A multiple regression model with perceived cognitive decline regressed on age, concussion history, professional rugby league exposure, depression, resilience, objective cognitive functioning, daytime sleepiness, and pain severity showed depression as the only significant predictor.
This is the first large study examining subjectively experienced cognitive decline in retired professional rugby league players. Similar to studies from the general population and specialty clinics, no relationship was found between objective cognitive test performance and perceived cognitive decline. Depressive symptoms emerged as the strongest predictor of perceived cognitive decline, suggesting that subjective reports of worsening cognition in retired elite rugby league players might reflect psychological distress rather than current cognitive impairment.
: This study investigated cerebral hemodynamic responses to a neurovascular coupling (NVC) test in retired contact athletes with a history of repeated mild traumatic brain injury (mTBI) and in ...controls with no history of mTBI.
: Twenty-one retired rugby players (47.7 ± 12.9 year old; age at retirement: 38.5 ± 8.9 year; number of years playing rugby: 12.7 ± 3.7 year) with a history of three or more diagnosed concussions (8.9 ± 7.9 concussions per player) and 23 controls with no history of mTBI (46.5 ± 12.8 year old) performed a NVC test to detect task-orientated cerebral hemodynamic changes using functional near-infrared spectroscopy (fNIRS).
: The NVC showed a statistically significant reduction in the cerebral hemodynamic response in comparison to the control group which had a greater relative increase of oxyhemoglobin (O
Hb). There were reductions in left middle frontal gyrus (MFG) O
Hb (-0.015 ± 0.258 μM) and relative increases in deoxyhemoglobin (HHb; -0.004 ± 0.159 μM) in the same region for the mTBI group in comparison to the control group (-0.160 ± 0.311 μM; -0.121 ± 0.076 μM for O
Hb and HHb, respectively). The mTBI group induced a greater rate of oxygen extraction compared to the control group.
: This was the first study to examine cerebral hemodynamic changes in retired rugby players in response to a NVC test, and we found reduced cerebral hemodynamic responses in participants with a history of mTBI compared to controls. These results suggest altered cerebral metabolic demands in participants with a history of multiple head injuries. Further research is needed to ascertain an understanding of the changes in hemodynamics from playing into retirement.
PDF
