Concussion Monthly Select- February 2020

Concussion Monthly Select- February 2020


Doug Van Pelt, PhD


Below are highlighted recently published concussion research articles with a brief summary and takeaway points.

Association of Blood Biomarkers With Acute Sport-Related Concussion in Collegiate Athletes: Findings From the NCAA and Department of Defense CARE Consortium. McCrea M, Broglio SP, McAllister TW, Gill J, Giza CC5 Huber DL, Harezlak J, Cameron KL, Houston MN, McGinty G, Jackson JC, Guskiewicz K, Mihalik J, Brooks MA, Duma S, Rowson S, Nelson LD, Pasquina P, Meier TB; and the CARE Consortium Investigators, Foroud T, Katz BP, Saykin AJ, Campbell DE, Svoboda SJ, Goldman J, DiFiori J

JAMA Netw Open. 2020 Jan 3;3(1):e1919771. doi: 10.1001/jamanetworkopen.2019.19771.

Summary: Blood biomarkers have the potential to help clinicians and researchers understand concussion pathophysiology and facilitate diagnosis. The current study investigated four potential biomarkers in collegiate athletes at baseline, acute post-concussion, asymptomatic,  and seven days after return to play. Concussed athletes' biomarker levels were also compared to matched contact and non-contact athletes at the same time points. Glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), and tau were all significantly elevated acutely after a concussion. Overall, GFAP provided the best classification of concussed athletes, and even did better than using the SCAT-3 symptom score.
Takeaway: Biomarkers, especially GFAP can be detected post-concussion and can help differentiate athletes with concussion from control athletes. While this study demonstrates that biomarkers are elevated acutely post-concussion, more work need to be done to determine their diagnostic utility.

These next two articles look at the risk for lower body injuries after a concussion. Since concussion can cause cognitive, postural control, and oculomotor deficits, athletes may be at increased risk for another injury after a concussion if these deficits persist.

No Clinical Predictors of Postconcussion Musculoskeletal Injury in College Athletes.

Buckley TA, Howard CM, Oldham JR, Lynall RC, Swanik CB, Getchell N

Med Sci Sports Exerc. 2020 Jan 16. doi: 10.1249/MSS.0000000000002269

Summary: To determine if a concussion increased injury risk, researchers compared the risk of lower body injury among concussed and non-concussed athletes. Additionally, researchers also wanted to determine whether particular concussion deficits (symptoms, cognitive, balance) increased lower body injury among concussed athletes. Concussed athletes were more likely to sustain a lower body injury, but no concussion deficit was associated with increased risk for lower body injury.
Takeaway: While a concussion appears to increase the risk for lower body injury within a year post-concussion, the exact reason for the increased risk is unknown.

Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population.

McPherson AL, Shirley MB, Schilaty ND, Larson DR, Hewett TE

Sports Med. 2020 Jan 22. doi: 10.1007/s40279-020-01262-3.

Summary: While increased risk for injury post concussion has been observed in collegiate athletes (👆 see above), it is unknown if the general population experiences the same increased risk. Researchers examined the medical records of patients with and without anterior cruciate ligament (ACL) injuries to see if those with an ACL injury were more likely to have a prior concussion. Those with an ACL injury were 60% more likely to have a history of concussion within the past three years.
Takeaway: This study demonstrates that concussion can also risk for lower body injuries among non-collegiate athletes.

Tau Positron Emission Tomographic Findings in a Former US Football Player With Pathologically Confirmed Chronic Traumatic Encephalopathy.

Mantyh WG, Spina S, Lee A, Iaccarino L, Soleimani-Meigooni D, Tsoy E, Mellinger TJ, Grant H, Vandevrede L, La Joie R, Lesman-Segev O, Gaus S, Possin KL, Grinberg LT, Miller BL, Seeley WW, Rabinovici GD

JAMA Neurol. 2020 Jan 6. doi: 10.1001/jamaneurol.2019.4509.

Summary: Currently chronic traumatic encephalopathy (CTE) can only be diagnosed by examining someone's brain after death. Accumulation of hyperphosphorylated tau in the brain is the hallmark of CTE so researchers wanted to know if they could use brain scans that measure tau in the brain as an indicator of CTE. Researchers scanned the brain of a professional American football football player 4 years before death. The tau levels measured by the brain scans had a limited association with the levels of tau measured in the brain after death.
Takeaway: Current brain imaging techniques that quantify tau need further work before being considered a CTE biomarker.

Interaction between Age, Sex, and Mental Health Status as Precipitating Factors for Symptom Presentation in Concussed Individuals.

Lariviere K, Bureau S, Marshall C, Holahan MR

J Sports Med (Hindawi Publ Corp). 2019 Dec 31;2019:9207903. doi: 10.1155/2019/9207903. eCollection 2019.

Summary: Concussion symptoms are commonly used to make a concussion diagnosis. However, since concussion symptoms can be influenced by other factors, it is important to understand how concussion symptoms can vary across age, gender, and mental health conditions. Researchers examined the concussion symptoms of 4,865 patients over age 12. A subset of these patients reported having a mental health condition (depression, anxiety, behavior, or learning disorder). Among those without any mental health condition, concussion symptom number decreased as individuals got older, and females overall reported more symptoms than males. When looking at symptom severity, females reported more severe symptoms with age at a greater rate than males. Comparatively, those with a mental health condition reported fewer symptoms and to less severity with increasing age. Also, males had more symptoms and more severe symptoms than females, especially after age 40.
Takeaway: The current study highlights how the number of symptoms and severity of symptoms can vary across age, gender, and mental health conditions.

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