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Research papers on Head injuries and long-term brain effects in contact sports

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  1. Role of subconcussion in repetitive mild traumatic brain injury

    Julian E. Bailes, Anthony L. Petraglia, Bennet I. Omalu, et al. · 2013 · Journal of neurosurgery · 557 citations

    Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as mea

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  2. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

    Philip H. Montenigro, Christine M. Baugh, Daniel Hamed Daneshvar, et al. · 2014 · Alzheimer s Research & Therapy · 380 citations

    The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 20

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  3. Persistent, Long-term Cerebral White Matter Changes after Sports-Related Repetitive Head Impacts

    Jeffrey J. Bazarian, Tong Zhu, Jianhui Zhong, et al. · 2014 · PLoS ONE · 300 citations

    INTRODUCTION: Repetitive head impacts (RHI) sustained in contact sports are thought to be necessary for the long-term development of chronic traumatic encephalopathy (CTE). Our objectives were to: 1) characterize the magnitude and persistence of RHI-induced white matter (WM) changes; 2) determine their relationship to kinematic measures of RHI; and 3) explore their clinical relevance. METHODS: Prospective, observational study of 10 Division III college football players and 5 non-athlete controls during the 2011-12 season. All subjects underwent diffusion tensor imaging (DTI), physiologic, cognitive, and balance testing at pre-season (Time 1), post-season (Time 2), and after 6-months of no-co

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  4. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts

    Ann Carolyn McKee, Thor D. Stein, Bertrand R. Huber, et al. · 2023 · Acta Neuropathologica · 250 citations

    Over the last 17 years, there has been a remarkable increase in scientific research concerning chronic traumatic encephalopathy (CTE). Since the publication of NINDS-NIBIB criteria for the neuropathological diagnosis of CTE in 2016, and diagnostic refinements in 2021, hundreds of contact sport athletes and others have been diagnosed at postmortem examination with CTE. CTE has been reported in amateur and professional athletes, including a bull rider, boxers, wrestlers, and American, Canadian, and Australian rules football, rugby union, rugby league, soccer, and ice hockey players. The pathology of CTE is unique, characterized by a pathognomonic lesion consisting of a perivascular accumulatio

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  5. Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

    Christopher J. Nowinski, Samantha C. Bureau, Michael Edward Buckland, et al. · 2022 · Frontiers in Neurology · 188 citations

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with a history of repetitive head impacts (RHI). CTE was described in boxers as early as the 1920s and by the 1950s it was widely accepted that hits to the head caused some boxers to become "punch drunk." However, the recent discovery of CTE in American and Australian-rules football, soccer, rugby, ice hockey, and other sports has resulted in renewed debate on whether the relationship between RHI and CTE is causal. Identifying the strength of the evidential relationship between CTE and RHI has implications for public health and medico-legal issues. From a public health perspective, environmentally caused disease

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  6. Chronic Traumatic Encephalopathy in Contact Sports: A Systematic Review of All Reported Pathological Cases

    Joseph C. Maroon, Robert Winkelman, Jeffrey W. Bost, et al. · 2015 · PLoS ONE · 176 citations

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with head trauma. Although initially believed to affect only boxers, the at-risk population has expanded to encompass a much wider demographic, including American football players, hockey players, wrestlers, and military veterans. This expansion has garnered considerable media attention and public concern for the potential neurodegenerative effects of head trauma. The main aim of this systematic review is to give a complete overview of the common findings and risk factors for CTE as well as the status quo regarding the incidence and prevalence of CTE. This systematic review was performed using PubMed and MEDLINE

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  7. Repetitive Head Impacts and Chronic Traumatic Encephalopathy

    A. Mckee, M. Alosco, B. Huber · 2016 · Neurosurgery clinics of North America · 170 citations

    There are growing concerns that cumulative repetitive head impact exposure through routine participation in contact and collision sports is associated with increased risk of long-term problems in memory and cognition, including the development of chronic traumatic encephalopathy (CTE). CTE is a distinctive neurodegenerative disease that occurs as a result of repetitive head impacts (RHI) including concussion and subconcussion. Like most neurodegenerative diseases, CTE can only be diagnosed by postmortem neuropathologic examination of brain tissue. Recently a panel of exerts concluded that CTE is a unique disorder with a pathognomonic lesion that can be reliably distinguished from other neuro

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  8. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males

    Daniel Hamed Daneshvar, Evan S. Nair, Zachary Baucom, et al. · 2023 · Nature Communications · 167 citations

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI), but the components of RHI exposure underlying this relationship are unclear. We create a position exposure matrix (PEM), composed of American football helmet sensor data, summarized from literature review by player position and level of play. Using this PEM, we estimate measures of lifetime RHI exposure for a separate cohort of 631 football playing brain donors. Separate models examine the relationship between CTE pathology and players' concussion count, athletic positions, years of football, and PEM-derived measures, including estimated cumulative head impacts, linear accel

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  10. Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports

    Jason W. Adams, Victor E. Alvarez, Jesse Mez, et al. · 2018 · Journal of Neuropathology & Experimental Neurology · 113 citations

    Traumatic brain injury has been associated with increased risk of Parkinson disease and parkinsonism, and parkinsonism and Lewy body disease (LBD) can occur with chronic traumatic encephalopathy (CTE). To test whether contact sports and CTE are associated with LBD, we compared deceased contact sports athletes (n = 269) to cohorts from the community (n = 164) and the Boston University Alzheimer disease (AD) Center (n = 261). Participants with CTE and LBD were more likely to have β-amyloid deposition, dementia, and parkinsonism than CTE alone (p < 0.05). Traditional and hierarchical clustering showed a similar pattern of LBD distribution in CTE compared to LBD alone that was most frequently ne

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  11. A common neural signature of brain injury in concussion and subconcussion

    Adnan A. Hirad, J. Bazarian, Kian Merchant-Borna, et al. · 2019 · Science Advances · 101 citations

    Clinically silent brain injury in contact sports athletes can be detected by noninvasive MRI. The midbrain is biomechanically susceptible to force loading from repetitive subconcussive head impacts (RSHI), is a site of tauopathy in chronic traumatic encephalopathy (CTE), and regulates functions (e.g., eye movements) often disrupted in concussion. In a prospective longitudinal design, we demonstrate there are reductions in midbrain white matter integrity due to a single season of collegiate football, and that the amount of reduction in midbrain white matter integrity is related to the amount of rotational acceleration to which players’ brains are exposed. We then replicate the observation of

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  12. The Neuropathology of Chronic Traumatic Encephalopathy: The Status of the Literature

    A. Mckee · 2020 · Seminars in Neurology · 65 citations

    Abstract Chronic traumatic encephalopathy (CTE) is a tauopathy associated with repetitive mild head trauma, including concussion and asymptomatic subconcussive impacts. CTE was first recognized in boxers almost a century ago and has been identified more recently in contact sports athletes, military veterans exposed to blast, and victims of domestic violence. Like most neurodegenerative diseases, CTE is diagnosed conclusively by a neuropathological examination of brain tissue. CTE is characterized by the buildup of hyperphosphorylated tau (p-tau) in neurofibrillary tangles (NFTs), neurites, and, sometimes, astrocytes, surrounding small blood vessels in a patchy distribution at the sulcal dept

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  13. Chronic traumatic encephalopathy and athletes

    William P. Meehan, Rebekah Mannix, ROSS D. ZAFONTE, et al. · 2015 · Neurology · 61 citations

    Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athle

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  14. A Proposed Mechanism for Development of CTE Following Concussive Events: Head Impact, Water Hammer Injury, Neurofilament Release, and Autoimmune Processes

    S. Kornguth, N. Rutledge, Gabe Perlaza, et al. · 2017 · Brain Sciences · 33 citations

    During the past decade, there has been an increasing interest in early diagnosis and treatment of traumatic brain injuries (TBI) that lead to chronic traumatic encephalopathy (CTE). The subjects involved range from soldiers exposed to concussive injuries from improvised explosive devices (IEDs) to a significant number of athletes involved in repetitive high force impacts. Although the forces from IEDs are much greater by a magnitude than those from contact sports, the higher frequency associated with contact sports allows for more controlled assessment of the mechanism of action. In our study, we report findings in university-level women soccer athletes followed over a period of four and a h

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  15. Sports Concussion and Chronic Traumatic Encephalopathy: Finding a Path Forward

    James Pepper Kelly, David S. Priemer, Daniel P. Perl, et al. · 2022 · Annals of Neurology · 30 citations

    Sports concussion has recently assumed special importance because of the widely publicized entity of chronic traumatic encephalopathy (CTE). Identified primarily in former contact sports athletes with repeated mild traumatic brain injury (mTBI), CTE is a distinct tauopathy that can only be diagnosed postmortem and for which no specific treatment is available. Although the hazards of repeated mTBI are generally acknowledged, a spirited controversy has developed because a firm link between sports concussion and CTE has been questioned. We briefly review the history of CTE, discuss areas of uncertainty, and offer suggestions to assist neurologists confronting these issues and advance understand

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  16. Animal models of chronic traumatic encephalopathy

    Kelly M McAteer, Renee J Turner, Frances Corrigan · 2017 · Concussion · 21 citations

    Repeated head impacts have been suggested to be associated with the development of the neurodegenerative disorder, chronic traumatic encephalopathy (CTE). CTE is characterized by the accumulation of hyperphosphorylated tau within the brain, with accompanying cognitive and behavioral deficits. How a history of repeated head impacts can lead to the later development of CTE is not yet known, and as such appropriate animal models are required. Over the last decade a number of rodent models of repeated mild traumatic brain injury have been developed that are broadly based on traditional traumatic brain injury models, in controlled cortical impact, fluid percussion and weight drop models, with ada

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  17. Epidemiological Principles in Claims of Causality: An Enquiry into Repetitive Head Impacts (RHI) and Chronic Traumatic Encephalopathy (CTE)

    L. Fortington, J. Cassidy, Rudolph J. Castellani, et al. · 2024 · Sports Medicine (Auckland, N.z.) · 18 citations

    Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude t

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  19. Repetitive subconcussion results in disrupted neural activity independent of concussion history

    K. Solar, M. Ventresca, Rouzbeh Zamyadi, et al. · 2024 · Brain Communications · 14 citations

    Concussion is a public health crisis which results in a complex cascade of neurochemical changes in the brain that can have life changing consequences. Subconcussions are considered less serious and were overlooked until recently, but we now realise repetitive subconcussions, such as repetitive head impacts, can lead to serious neurological deficits. Subconcussions are common in contact sports, and the military where certain personnel are exposed to repetitive occupational blast overpressure. Postmortem studies in athletes reveal that cumulative duration of play and force from collisions are better predictors than concussion history for the presence and severity of chronic traumatic encephal

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  20. Prevalence of Chronic Traumatic Encephalopathy in Athletes With Repetitive Head Impacts: A Systematic Review and Meta‐Analysis

    Bote Qi, Jingwang Tan, Dushuo Feng, et al. · 2025 · Scandinavian Journal of Medicine &amp; Science in Sports · 13 citations

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impacts (RHI), which is commonly observed in athletes participating in contact sports. This systematic review and meta‐analysis aimed to provide a clearer elucidation of the prevalence, risk factors, and potential outcomes of CTE in athletes. Through a comprehensive search of PubMed, EMBASE, Web of Science, and Google Scholar (January 2015 to July 2024), we ultimately included eight eligible studies with a low risk of bias involving 1000 former contact sports athletes diagnosed by neuropathological methods. Data were analyzed in a random‐effects meta‐analysis. The results indicated that the

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  21. Neurodegeneration in the cortical sulcus is a feature of chronic traumatic encephalopathy and associated with repetitive head impacts

    Raymond Nicks, Arsal Shah, Spiro Anthony Stathas, et al. · 2024 · Acta Neuropathologica · 13 citations

    Neurodegeneration is a seminal feature of many neurological disorders. Chronic traumatic encephalopathy (CTE) is caused by repetitive head impacts (RHI) and is characterized by sulcal tau pathology. However, quantitative assessments of regional neurodegeneration in CTE have not been described. In this study, we quantified three key neurodegenerative measures, including cortical thickness, neuronal density, and synaptic proteins, in contact sport athletes (n = 185) and non-athlete controls (n = 52) within the sulcal depth, middle, and gyral crest of the dorsolateral frontal cortex. Cortical thickness and neuronal density were decreased within the sulcus in CTE compared to controls (p’s < 0.05

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  22. Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware)

    M. Turner, D. Maddocks, Majidi Hassan, et al. · 2020 · British Journal of Sports Medicine · 12 citations

    While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a

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  23. Traumatic brain injury or head impacts from contact sports are associated with tau astrogliopathy

    John D. Arena, William Stewart, Gabor G. Kovacs, et al. · 2025 · Brain : a journal of neurology · 7 citations

    Exposure to traumatic brain injury (TBI) and/or repetitive head impacts (RHI) increase the risk of a range of neurodegenerative pathologies, including chronic traumatic encephalopathy neuropathologic change (CTE-NC). Astrocytic tau pathology reminiscent of ageing-related tau astrogliopathy is a component feature of CTE-NC in many cases. Yet the relationship between TBI/RHI exposure and wider tau astrogliopathy, beyond that of CTE-NC, remains poorly characterized. Autopsy-derived material from 556 individuals was selected to include cases with a history of moderate or severe traumatic brain injury (survival >6 months, n = 77) or a history of participation in contact sports (n = 45), for compa

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