. 2017 Nov 6:10:56-65.

doi: 10.1016/j.dadm.2017.10.003. eCollection 2018.

White matter signal abnormalities in former National Football League players

Michael L Alosco¹, Inga K Koerte^{2

3}, Yorghos Tripodis^{1

4}, Megan Mariani¹, Alicia S Chua⁴, Johnny Jarnagin¹, Yashar Rahimpour⁵, Christian Puzo¹, Rose C Healy¹, Brett Martin^{1

6}, Christine E Chaisson^{1

4

6}, Robert C Cantu^{1

7

8

9}, Rhoda Au^{1

10

11}, Michael McClean¹², Ann C McKee^{1

13

14}, Alexander P Lin¹⁵, Martha E Shenton^{2

16

17}, Ronald J Killiany^{1

5}, Robert A Stern^{1

8

10}

Affiliations

¹ Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
² Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich Germany.
⁴ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
⁵ Center for Biomedical Imaging, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
⁶ Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
⁷ Concussion Legacy Foundation, Boston, MA, USA.
⁸ Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA.
⁹ Department of Neurosurgery, Emerson Hospital.
¹⁰ Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
¹¹ Framingham Heart Study, National Heart, Lung, and Blood Institute, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
¹² Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
¹³ VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
¹⁴ Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Department of Veterans Affairs Medical Center, Bedford, MA.
¹⁵ Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁶ Department of Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ VA Boston Healthcare System, U.S. Department of Veteran Affairs, Brockton, MA, USA.

PMID: 29201991
PMCID: PMC5699890
DOI: 10.1016/j.dadm.2017.10.003

White matter signal abnormalities in former National Football League players

Michael L Alosco et al. Alzheimers Dement (Amst). 2017.

. 2017 Nov 6:10:56-65.

doi: 10.1016/j.dadm.2017.10.003. eCollection 2018.

Authors

Affiliations

¹ Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
² Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich Germany.
⁴ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
⁵ Center for Biomedical Imaging, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
⁶ Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
⁷ Concussion Legacy Foundation, Boston, MA, USA.
⁸ Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA.
⁹ Department of Neurosurgery, Emerson Hospital.
¹⁰ Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
¹¹ Framingham Heart Study, National Heart, Lung, and Blood Institute, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
¹² Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
¹³ VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA.
¹⁴ Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Department of Veterans Affairs Medical Center, Bedford, MA.
¹⁵ Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁶ Department of Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ VA Boston Healthcare System, U.S. Department of Veteran Affairs, Brockton, MA, USA.

PMID: 29201991
PMCID: PMC5699890
DOI: 10.1016/j.dadm.2017.10.003

Abstract

Introduction: Later-life brain alterations in former tackle football players are poorly understood, particularly regarding their relationship with repetitive head impacts (RHIs) and clinical function. We examined white matter signal abnormalities (WMSAs) and their association with RHIs and clinical function in former National Football League (NFL) players.

Methods: Eighty-six clinically symptomatic former NFL players and 23 same-age reportedly asymptomatic controls without head trauma exposure underwent magnetic resonance imaging and neuropsychological testing. FreeSurfer calculated WMSAs. A cumulative head impact index quantified RHIs.

Results: In former NFL players, increased volume of WMSAs was associated with higher cumulative head impact index scores (P = .043) and worse psychomotor speed and executive function (P = .015). Although former NFL players had greater WMSA volume than controls (P = .046), these findings are inconclusive due to recruitment of controls based on lack of clinical symptoms and head trauma exposure.

Discussion: In former NFL players, WMSAs may reflect long-term microvascular and nonmicrovascular pathologies from RHIs that negatively impact cognition.

Keywords: Alzheimer's disease; Chronic traumatic encephalopathy; Cognitive function; Concussion; Repetitive head impacts; Subconcussive; White matter hyperintensities; White matter signal abnormalities.

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Figures

**Fig. 1**
Greater exposure to repetitive head impacts is associated with increased volume of white matter signal abnormalities. Scatter plot shows the relationship between the cumulative head impact index (x-axis) and volume of white matter signal abnormalities (y-axis, log-scale). This relationship was statistically significant after controlling for age, supratentorial volume, and the modified Framingham Stroke Risk Profile score (P = .043).

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White matter signal abnormalities in former National Football League players

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