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. 2018 Jan 15;35(2):278-285.
doi: 10.1089/neu.2017.5145. Epub 2017 Nov 17.

Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players

Vivian Schultz  1   2 , Robert A Stern  3   4 , Yorghos Tripodis  3   5 , Julie Stamm  1   3   6 , Pawel Wrobel  1   2 , Christian Lepage  1   7 , Isabelle Weir  5 , Jeffrey P Guenette  1   8 , Alicia Chua  5 , Michael L Alosco  3 , Christine M Baugh  3   9 , Nathan G Fritts  3 , Brett M Martin  10 , Christine E Chaisson  3   10 , Michael J Coleman  1 , Alexander P Lin  1   8   11 , Ofer Pasternak  1   8 , Martha E Shenton  1   8   12   13 , Inga K Koerte  1   2   13
Affiliations

Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players

Vivian Schultz et al. J Neurotrauma. .

Abstract

Thalamic atrophy has been associated with exposure to repetitive head impacts (RHI) in professional fighters. The aim of this study is to investigate whether or not age at first exposure (AFE) to RHI is associated with thalamic volume in symptomatic former National Football League (NFL) players at risk for chronic traumatic encephalopathy (CTE). Eighty-six symptomatic former NFL players (mean age = 54.9 ± 7.9 years) were included. T1-weighted data were acquired on a 3T magnetic resonance imager, and thalamic volumes were derived using FreeSurfer. Mood and behavior, psychomotor speed, and visual and verbal memory were assessed. The association between thalamic volume and AFE to playing football and to number of years playing was calculated. Decreased thalamic volume was associated with more years of play (left: p = 0.03; right: p = 0.03). Younger AFE was associated with decreased right thalamic volume (p = 0.014). This association remained significant after adjusting for total years of play. Decreased left thalamic volume was associated with worse visual memory (p = 0.014), whereas increased right thalamic volume was associated with fewer mood and behavior symptoms (p = 0.003). In our sample of symptomatic former NFL players at risk for CTE, total years of play and AFE were associated with decreased thalamic volume. The effect of AFE on right thalamic volume was almost twice as strong as the effect of total years of play. Our findings confirm previous reports of an association between thalamic volume and exposure to RHI. They suggest further that younger AFE may result in smaller thalamic volume later in life.

Keywords: age at first exposure; chronic traumatic encephalopathy; repetitive head impacts; sports-related head injury; thalamus.

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Conflict of interest statement

RAS is a paid consultant to Avanir Pharmaceuticals, Inc. (Aliso Viejo, CA), Biogen (Cambridge, MA), and Eli Lilly (Indianapolis, IN). He receives royalties for published neuropsychological tests (including the NAB and BQSS) from Psychological Assessment Resources, Inc. (Lutz, FL). CMB receives research funding through the Harvard Football Players Health Study, which is funded by the NFL Players' Association. For all other authors, no competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
A three-dimensional reconstruction of the thalamus as region of interest. The model was created from one randomly selected person using the model maker module of Slicer 4.5. Blue = thalamus. The model is shown from four different views on a para-mid axial, sagittal, and coronal slice and is superimposed on the individual T1-weighted image. The label map as basis for the three-dimensional model was not modified for the image creation.
<b>FIG. 2.</b>
FIG. 2.
Displays significant associations between exposure variables and right thalamic volume. (A) Association between age at first exposure (AFE) to football adjusted for total years of play and absolute right thalamic volume. (B) Relation between total years of play and absolute right thalamic volume.
See this image and copyright information in PMC

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