A magnetic resonance spectroscopy investigation in symptomatic former NFL players
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ORIGINAL RESEARCH
A magnetic resonance spectroscopy investigation in symptomatic former NFL players Michael L. Alosco 1 & Yorghos Tripodis 2 & Benjamin Rowland 3 & Alicia S. Chua 2 & Huijun Liao 3 & Brett Martin 4,5 & Johnny Jarnagin 1 & Christine E. Chaisson 1,2,5 & Ofer Pasternak 6 & Sarina Karmacharya 7 & Inga K. Koerte 7,8 & Robert C. Cantu 9,10 & Neil W. Kowall 11,12 & Ann C. McKee 11,13,14 & Martha E. Shenton 6,13 & Richard Greenwald 15,16 & Michael McClean 17 & Robert A. Stern 18 & Alexander Lin 3
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The long-term neurologic consequences of exposure to repetitive head impacts (RHI) are not well understood. This study used magnetic resonance spectroscopy (MRS) to examine later-life neurochemistry and its association with RHI and clinical function in former National Football League (NFL) players. The sample included 77 symptomatic former NFL players and 23 asymptomatic individuals without a head trauma history. Participants completed cognitive, behavior, and mood measures. N-acetyl aspartate, glutamate/glutamine, choline, myo-inositol, creatine, and glutathione were measured in the posterior (PCG) and anterior (ACG) cingulate gyrus, and parietal white matter (PWM). A cumulative head impact index (CHII) estimated RHI. In former NFL players, a higher CHII correlated with lower PWM creatine (r = −0.23, p = 0.02). Multivariate mixed-effect models examined neurochemical differences between the former NFL players and asymptomatic individuals without a history of head trauma. PWM N-acetyl aspartate was lower among the former NFL players (mean diff. = 1.02, p = 0.03). Between-group analyses are preliminary as groups were recruited based on symptomatic status. The ACG was the only region associated with clinical function, including positive correlations between glutamate (r = 0.32, p = 0.004), glutathione (r = 0.29, p = 0.02), and myo-inositol (r = 0.26, p = 0.01) with behavioral/mood symptoms. Other positive correlations between ACG neurochemistry and clinical function emerged (i.e., behavioral/mood symptoms, cognition), but the positive directionality was unexpected. All analyses controlled for age, body mass index, and education (for analyses examining clinical function). In this sample of symptomatic former NFL players, there was a direct effect between RHI and reduced cellular energy metabolism (i.e., lower creatine). MRS neurochemicals associated with neuroinflammation also correlated with behavioral/mood symptoms. Keywords Chronic traumatic encephalopathy . Repetitive head impacts . Magnetic resonance spectroscopy . Magnetic resonance imaging . Tackle football
Introduction Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease found in individuals exposed to repetitive head impacts (RHI), particularly American football players (McKee et al. 2013; Mez et al. 2017). The neuropathology Robert A. Stern and Alexander P. Lin shared role as senior authors * Alexander Lin [email protected] Extended author information availa
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