Brain injury due to soccer heading and opportunities for its mitigation

足球头球造成的脑损伤及其缓解方法

• 批准号: 8483777
• 负责人: Michael Lawrence Lipton
• 金额: $ 69.01万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8483777
• 关键词: Address; Anisotropy; Apolipoprotein E; Brain; Brain Concussion; Brain Injuries; Cognition; Cognitive; Computers; Craniocerebral Trauma; Cross-Sectional Studies; Data; Development; Devices; Diffusion; Enrollment; Etiology; Exposure to; Foundations; Frequencies; Genes; Genotype; Guidelines; Hand; Head; Individual Differences; Injury; Longitudinal Studies; Magnetic Resonance Imaging; Manufactured Baseball; Measurement; Measures; Minor; Multiple Head Injuries; Outcome; Pathologic; Performance; Play; Post-Concussion Syndrome; Predictive Value; Prospective Studies; Public Health; Questionnaires; Recording of previous events; Recovery; Research Design; Risk; Sampling; Soccer; Sports; Structure; Subgroup; Tablets; Time; Trauma; Traumatic Brain Injury; Upper Extremity; Variant; Vulnerable Populations; Work; adverse outcome; apolipoprotein E-4; base; cognitive function; design; follow-up; in vivo; public health relevance; response; white matter

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) in athletes is a major and increasingly recognized public health problem. The presumed pathologic basis of the injury is multifocal microstructural traumatic axonal injury (TAI), which can be detected in vivo using diffusion tensor MRI (DTI). These structural changes have both short-term and long-term cognitive consequences. Our preliminary studies show that amateur soccer players do head the ball frequently, up to > 5,000 per year, and those who head more than 1,000- 1,500 times per year are at increased risk for structural (TAI) and functional (poorer cognitive performance) changes. Heading exposes the brain to repeated low-level ("subconcussive") trauma. It is known that multiple head injuries in close succession are associated with worse outcomes. Additional work is needed to define exposure-response relationships for soccer heading, the time course for the onset and recovery from these structural and functional effects and particularly vulnerable populations. Herein, we use 3 integrated study designs to determine the influence of heading on brain structure and function. In a cross-sectional study (Aim 1), we assess the relationship of heading over the previous year to structural (TAI) and functional (cognition and post-concussion symptoms (PCS)) measures in a large sample (n=400) of amateur soccer players. To assess causality, we propose a longitudinal study to investigate the incremental effects of heading on changes in TAI, cognition and PCS over 2 years of follow-up (Aim 2). To assess the short-term relationship between heading and day-to-day variability in cognitive function and PCS as well as the predictive value of intensive measurement, we will assess heading, cognition and PCS on a daily basis for 14 days every 3 months using a hand-held device in a substudy of 100 players. We will also assess a number of potential modifiers of the association between heading and brain structure and function (e.g., Apolipoprotein E4 genotype). Specific Aims: Aim I (Cross-sectional): Determine the relationship of heading exposure to MRI evidence of traumatic axonal injury (TAI), cognitive function and post concussion symptoms (PCS). Aim II (Longitudinal): Determine the longitudinal relationships between heading and incremental changes in TAI, cognitive function, and PCS in a prospective study. Aim III (Intensive measurement): Determine the short-term effects on and variability in day-to-day cognitive function and PCS using an intensive measurement design.

描述（由申请人提供）：运动员的创伤性脑损伤（TBI）是一个主要且日益被认识的公共健康问题。推测损伤的病理学基础是多灶性微结构创伤性轴突损伤 (TAI)，可以使用弥散张量 MRI (DTI) 在体内检测到。这些结构性变化会产生短期和长期的认知后果。我们的初步研究表明，业余足球运动员确实经常头球，每年头球次数超过 5,000 次，而每年头球次数超过 1,000-1,500 次的人发生结构性 (TAI) 和功能性（认知能力较差）变化的风险增加。头向使大脑遭受反复的低度（“亚脑震荡”）创伤。众所周知，连续多次头部受伤会导致更糟糕的结果。需要开展更多工作来定义足球头球的暴露-反应关系、这些结构和功能影响的发生和恢复的时间过程以及特别脆弱的人群。在此，我们使用 3 种综合研究设计来确定航向对大脑结构和功能的影响。在一项横断面研究（目标 1）中，我们在大样本 (n=400) 中评估了前一年的头向与结构性 (TAI) 和功能性（认知和脑震荡后症状 (PCS)）测量的关系。业余足球运动员。为了评估因果关系，我们提出了一项纵向研究，以调查在 2 年的随访中航向对 TAI、认知和 PCS 变化的增量影响（目标 2）。为了评估航向与认知功能和 PCS 的日常变异之间的短期关系以及强化测量的预测价值，我们将每 3 个月 14 天每天评估航向、认知和 PCS在 100 名玩家的子研究中使用手持设备。我们还将评估标题与大脑结构和功能之间关联的一些潜在修饰因素（例如载脂蛋白 E4 基因型）。具体目标： 目标 I（横断面）：确定头部暴露与创伤性轴突损伤 (TAI)、认知功能和脑震荡后症状 (PCS) 的 MRI 证据之间的关系。目标 II（纵向）：在前瞻性研究中确定航向与 TAI、认知功能和 PCS 增量变化之间的纵向关系。目标 III（强化测量）：使用强化测量设计确定日常认知功能和 PCS 的短期影响和变异性。