Expert Looks at Cumulative Concussive and Sub-Concussive Events in Sport

By Michael J. Perrotti, Ph.D., Inc.

Recently, the NFL settled over 4,000 lawsuits by the players. It was reported that the NFL would make enough profits in the first week of the regular season to pay for the settlement! It was also reported that an initial lump sum was to be paid over three years and the balance paid in 17 years. It is doubtful that this can ever address the diminished quality of life of the players secondary to effects of brain injury. In fact, as this article was going to press, the court rejected the NFL settlement as not providing enough money to pay the players. In response,the NFL elected to remove the cap on the settlement amount.

As noted by Henry & De Beaumont (2011), the prevailing attitude in sport culture minimizes concussions. The recovery process is elongated with athletes with multiple concussions. Collins et.al. (2002) found that 9.4% of players with no history of TBI were found to have prolonged post-injury mental status. Chargers as opposed to 31.6% (3.36 odds ratio) of players with multiple concussions. Mounting evidence suggest that within the acute phase, athletes who sustained multiple concussions demonstrate increased symptomology. Junior Sean was reported to have told a friend who played soccer that he experienced headaches for years.

Animal studies demonstrate the existence of a temporal window of metabolic brain vulnerability to second in TBI that had unsubstantial adverse effects in mitochondrial related metabolism, Vagnozzi et.al. (2007).

Measurement

Moser & Schatz (2002) and Moser, Schatz, & Jordan (2005) found that high school athletes who had had two or more concussions had performance decrements on neuropsychological testing similar to athletes in the post-concussion phase. Neuropsychological deficits were found to increase concurrently with the number of concussions in soccer players Wall et.al. (2006) reported have significant neuropsychological deficits on younger athletes with Jockeys. High School football players who sustained a previous concussion resulting in loss of consciousness were four times more likely to sustain a grade 3 injury according to American Academy of neurology (AHN) Guidelines (Gerberich et al., 1983)

Imaging and Repeated Concussions

A large scale study looked at over 300 active amateur boxers. CT scans revealed the presence of a cavum septum pallucidum as a potential marker of Brain atrophy and also revealed that it is progressive in nature.

Long Term Effects

DeBeaumuat et.al (2009) found that former hockey and football players, 30 years post-concussion found decreased performance in neurocognitive measures compared to an age matched control group of former athletes. Guskiewicz et.al. (2005) identified that mild cognitive impairment (MCI) rates (converts to a 10 – 20% annual rate into dementia of Alzheimer’s Type) increased as a function of a number of concussions in former NFL players. Players who had three or more concussions had five times the probability of being diagnosed with MCI and three times more likely to manifest marked memory impairments than retired players with no history of concussion. This same study found an earlier onset of Alzheimer’s in concussed retirees than in the general U.S. population. Moreover, former NFL players with a history of multiple concussions were three times more likely to be diagnosed with depression.

Signs of Traumatic Brain Injury (TBI) can involve deficits in the areas of attention, memory, and executive function. Freeman, et.al. (2005) relate substantial preparations of subjects with Traumatic Brain Injury manifest agitation and anger 15 years post-injury. This writer has observed many patients in his practice with substantial clinical problems post TBI.

For his conclusions and his recommendations, visit the latest issue of Concussion Litigation Reporter.

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