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Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players.
Acta Neuropathol 2017; 133(3):337-352AN

Abstract

In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer's disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer's disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.

Authors+Show Affiliations

Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK. Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, UK. Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK.Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK.Department of Cellular Pathology, Cardiff University, Cardiff, Wales, UK.Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK. Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, UK.Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK. Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, UK. Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK.Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK. janice.holton@ucl.ac.uk. Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, UK. janice.holton@ucl.ac.uk. Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK. janice.holton@ucl.ac.uk.Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK. t.revesz@ucl.ac.uk. Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, UK. t.revesz@ucl.ac.uk. Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK. t.revesz@ucl.ac.uk.Cefn Coed Hospital, Swansea, Wales, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28205009

Citation

Ling, Helen, et al. "Mixed Pathologies Including Chronic Traumatic Encephalopathy Account for Dementia in Retired Association Football (soccer) Players." Acta Neuropathologica, vol. 133, no. 3, 2017, pp. 337-352.
Ling H, Morris HR, Neal JW, et al. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133(3):337-352.
Ling, H., Morris, H. R., Neal, J. W., Lees, A. J., Hardy, J., Holton, J. L., ... Williams, D. D. (2017). Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathologica, 133(3), pp. 337-352. doi:10.1007/s00401-017-1680-3.
Ling H, et al. Mixed Pathologies Including Chronic Traumatic Encephalopathy Account for Dementia in Retired Association Football (soccer) Players. Acta Neuropathol. 2017;133(3):337-352. PubMed PMID: 28205009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. AU - Ling,Helen, AU - Morris,Huw R, AU - Neal,James W, AU - Lees,Andrew J, AU - Hardy,John, AU - Holton,Janice L, AU - Revesz,Tamas, AU - Williams,David D R, Y1 - 2017/02/15/ PY - 2016/11/30/received PY - 2017/01/20/accepted PY - 2017/01/19/revised PY - 2017/2/17/pubmed PY - 2017/9/21/medline PY - 2017/2/17/entrez KW - Chronic traumatic encephalopathy KW - Concussion KW - Football KW - Heading KW - Soccer KW - Tauopathy KW - Traumatic brain injury SP - 337 EP - 352 JF - Acta neuropathologica JO - Acta Neuropathol. VL - 133 IS - 3 N2 - In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer's disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer's disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies. SN - 1432-0533 UR - https://www.unboundmedicine.com/medline/citation/28205009/Mixed_pathologies_including_chronic_traumatic_encephalopathy_account_for_dementia_in_retired_association_football__soccer__players_ L2 - https://dx.doi.org/10.1007/s00401-017-1680-3 DB - PRIME DP - Unbound Medicine ER -