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More than 40 percent of retired National Football League (NFL) players in a recent study had signs of traumatic brain injury based on sensitive MRI scans called diffusion tensor imaging, according to a study released today that will be presented at the American Academy of Neurology’s 68th Annual Meeting in Vancouver, Canada, April 15 to 21, 2016.
“This is one of the largest studies to date in living retired NFL players and one of the first to demonstrate significant objective evidence for traumatic brain injury in these former players,” said study author Francis X. Conidi, MD, DO, of the Florida Center for Headache and Sports Neurology and Florida State University College of Medicine in Tallahassee, FL. Conidi is also a member of the American Academy of Neurology. “The rate of traumatic brain injury was significantly higher in the players than that found in the general population.”
For the study, researchers conducted thinking and memory tests in 40 retired NFL players, along with the brain scans. The players were an average age of 36, ranging from 27 to 56. A majority of the players had been out of the NFL for less than five years. They played an average of seven years in the NFL, with a range of two to 17 years. They reported an average of 8.1 concussions. Twelve players, or 31 percent, said they had several sub-concussive hits, or hits considered below the threshold of a diagnosed concussion.
The MRIs measured the amount of damage to the brain’s white matter, which connects different brain regions, based on the movement of water molecules in the brain tissue. Seventeen players, or 43 percent, had levels of movement 2.5 standard deviations below those of healthy people of the same age, which is considered evidence of traumatic brain injury with a less than one percent error rate.
Twelve of the former athletes, or 30 percent, showed evidence on traditional MRI of injury to the brain due to disruption of the nerve axons, those parts of nerve cells that allow brain cells to transmit messages to each other. On the tests of thinking skills, about 50 percent had significant problems on executive function, 45 percent on learning or memory, 42 percent on attention and concentration, and 24 percent on spatial and perceptual function.
The more years a player spent in the NFL, the more likely he was to have the signs of traumatic brain injury on the advanced MRI. However, there was no relationship between the number of concussions a player had and whether he had traumatic brain injury based on the advanced MRI. There was also no relationship between the number of years a player spent in the NFL and whether he had signs of brain damage on the traditional MRI.
“We found that longer careers placed the athletes at a higher risk of TBI,” said Conidi. “This research in living players sheds light on the possible pathological changes consistent with chronic traumatic encephalopathy that may be taking place.”
Abbott, Hennepin County Medical Center and University of Minnesota Collaborate to Launch the Nation’s Largest, Single-Center Prospective Study on Concussion and Traumatic Brain Injury
Researchers at Hennepin County Medical Center (Minneapolis, Minn.) and the University of Minnesota are launching a study in collaboration with Abbott (NYSE: ABT) “to better identify the range of brain injuries among patients. Using multiple evaluation tools, including eye tracking, blood-based biomarkers, imaging and cognitive measures, scientists hope to develop a new standard approach to help classify brain injuries, including concussions, and provide the information needed to guide doctors’ treatment decisions.”
“We know that there are different types of brain damage that can occur after trauma, whether it’s a mild concussion or a severe injury,” said neurosurgeon Uzma Samadani, M.D., Ph.D., Rockswold Kaplan Endowed Chair for TBI Research at Hennepin County Medical Center (HCMC), associate professor at the University of Minnesotaand one of the lead investigators of the study. “Our goal with this study is to combine multiple assessment techniques to quickly assess the severity of brain injuries and enable clinicians to provide appropriate treatments.”
USING VARIOUS TOOLS TO ASSESS HEAD INJURY
Dr. Samadani’s prior work suggests that eye tracking may detect injury in the brain, which is not always visible in imaging such as a CT scan. In the study, researchers will use eye tracking, which involves a high-frequency camera to map the positions of the pupils as a person watches a video or TV.
“Data have shown a connection between brain injury and abnormal eye movements,” said Dr. Samadani. “With new high-resolution cameras, we can detect subtle differences in movement much more easily and objectively than in the past.”
The study will also employ blood-based biomarker evaluations, as research suggests that certain biomarkers could indicate brain injury. Beth McQuiston, M.D., medical director, Diagnostics, Abbott and co-sponsor of the study says, “When someone experiences a head injury like a concussion, specific protein biomarkers will be found in the blood. If the protein levels are higher than normal, that may show a brain injury has occurred and serve as a warning bell that further evaluation is needed.”
Abbott researchers are working on a test designed to detect the specific proteins in the blood associated with brain injury and help evaluate potential concussions. The test, which is currently in development, would be analyzed on Abbott’s i-STAT – a handheld, portable device that is used to perform a broad range of blood tests right at a person’s side.
Lastly, the Minnesota Spinal Cord Injury and Traumatic Brain Injury Research Grant Program will fund MRI imaging to be used in the study to look for finer structural issues that may not be visible in CT scans. Imaging studies will include MRI scans not typically performed on trauma patients and may help identify tiny areas of bleeding or other damage to the brain.
“Imaging tells us what the brain looks like, eye tracking tells us how well it’s working and blood-based biomarkers can tell us the nature of the damage,” said Thomas Bergman, M.D., study co-investigator and Chief of Neurosurgery at HCMC. “When we put all of this information together, we will have a better understanding about brain injury that will help us treat patients now and in the future.”
ADDITIONAL STUDY DETAILS
Researchers plan to screen 9,000 trauma patients and enroll at least 1,000 of them as part of the study. Patients could range from children to elderly adults, as well as people who are conscious to those in coma. Enrolled patients will be followed for up to one year, making the research the largest single-center, prospective study of TBI in the country.
Additional co-investigators on the study include: Dr. James Miner, Chief of Emergency Department at HCMC; Dr.Fred Apple, HCMC Laboratory Director; Dr. Chad Richardson, Chief of Trauma Surgery at HCMC; HCMC neurosurgeons Dr. Gaylan Rockswold and Dr. Walter Galicich; Dr. Dave Gilbertson, Co-Director of the Chronic Disease Research Group at the Minneapolis Medical Research Foundation and Dr. Sarah Rockswold, Director of the Brain Injury Center at HCMC.
By Brian Burnsed, of the NCAA
Nine schools have been added to the largest-ever study of concussion in sport.
The NCAA-Department of Defense Concussion Assessment, Research and Education Consortium study enters its third year this summer and now includes 30 institutions across the country. The nine new schools will begin baseline screening for all their student-athletes this summer.
More than 170 schools have inquired about taking part in the study.
All student-athletes at each of the participating institutions receive a comprehensive preseason evaluation for concussion and will be monitored in the event of an injury. Data collected at each school are evaluated by a team of researchers led by Steven Broglio, director of the University of Michigan’s NeuroTrauma Research Laboratory; Michael McCrea, director of brain injury research at the Medical College of Wisconsin; and Tom McAllister, chair of the Indiana University School of Medicine Department of Psychiatry.
The researchers have collected more than 25 million data points from 16,000 student-athletes at the 21 institutions already participating. After adding nine new testing sites, researchers estimate that more than 25,000 student-athletes will take part over the course of the three-year study.
“The important expansion of the CARE Consortium to include a diversity of Division I, Division II, Division III and historically black college and university participants further solidifies this study as a groundbreaking initiative,” said Brian Hainline, NCAA chief medical officer. “It is a remarkable collaborative and inclusive effort.”
The NCAA and DOD have dedicated $30 million to the concussion study and an initiative to spur culture change regarding concussion. Participating schools receive a portion of that funding to cover the cost of carrying out the research.
New participants in the CARE Consortium study
Bloomsburg University of Pennsylvania – Division II
University of Chicago – Division III
University of Miami (Florida) – Division I
University of North Georgia – Division II
University of Pennsylvania – Division I
Temple University – Division I
Wake Forest University – Division I
Wilmington College (Ohio) – Division III
Winston-Salem State University – Division II