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Research papers on Head injuries and long-term brain effects in contact sports

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  1. Consensus statement on concussion in sport—the 5 th international conference on concussion in sport held in Berlin, October 2016

    Paul McCrory, Willem Meeuwisse, Jiří Dvořák, et al. · 2017 · British Journal of Sports Medicine · 3,345 citations

    The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. This document is developed for physicians and healthcare providers who are involved in athlete care, whether at a recreational, elite or professional level. While agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of SRC is evolving and therefore individual management and return-to-play decisions remain in the realm of clinical judgement. This consensus document reflects th

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  2. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

    Paul McCrory, Willem Meeuwisse, Mark Aubry, et al. · 2013 · British Journal of Sports Medicine · 2,595 citations

    This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conferences on Concussion in Sport and is based on the deliberations at the 4th International Conference on Concussion in Sport held in Zurich, November 2012.1–3 \n \nThe new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the Background section. This document is developed pri

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  3. The spectrum of disease in chronic traumatic encephalopathy

    Ann C. McKee, Thor D. Stein, Christopher J. Nowinski, et al. · 2012 · Brain · 2,114 citations

    Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic en

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  4. American Medical Society for Sports Medicine position statement: concussion in sport

    Kimberly G. Harmon, Jonathan A. Drezner, Matthew Gammons, et al. · 2012 · British Journal of Sports Medicine · 1,428 citations

    PURPOSE OF THE STATEMENT: ▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, knowledge gaps and areas requiring additional research. IMPORTANCE OF AN AMSSM STATEMENT: ▸ Sports medicine physicians are frequently involved in the care of patients with sports concussion. ▸ Sports medicine physicians are specifically trained to provide care along the continuum of sports concussion from the acute injury to return-to-play (RTP) decisions. ▸ The care of athletes with sports concussion is ideally performed by healthcare professionals with specific training and experience in the asse

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  5. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022

    Jon Patricios, Kathryn Schneider, Jiří Dvořák, et al. · 2023 · British Journal of Sports Medicine · 1,157 citations

    For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical as

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  6. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football

    Jesse Mez, Daniel H. Daneshvar, Patrick T. Kiernan, et al. · 2017 · JAMA · 1,103 citations

    Importance: Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE). Objective: To determine the neuropathological and clinical features of deceased football players with CTE. Design, Setting, and Participants: Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history. Exposures: Participation in American football at any level of play. Main Outcomes and Measures: Neuropatholog

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  8. Clinical presentation of chronic traumatic encephalopathy

    Robert A. Stern, Daniel H. Daneshvar, Christine M. Baugh, et al. · 2013 · Neurology · 567 citations

    OBJECTIVE: The goal of this study was to examine the clinical presentation of chronic traumatic encephalopathy (CTE) in neuropathologically confirmed cases. METHODS: Thirty-six adult male subjects were selected from all cases of neuropathologically confirmed CTE at the Boston University Center for the Study of Traumatic Encephalopathy brain bank. Subjects were all athletes, had no comorbid neurodegenerative or motor neuron disease, and had next-of-kin informants to provide retrospective reports of the subjects' histories and clinical presentations. These interviews were conducted blind to the subjects' neuropathologic findings. RESULTS: A triad of cognitive, behavioral, and mood impairments

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  9. Role of subconcussion in repetitive mild traumatic brain injury

    Julian E. Bailes, Anthony L. Petraglia, Bennet Omalu, et al. · 2013 · Journal of neurosurgery · 554 citations

    Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as mea

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  10. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

    Philip H. Montenigro, Christine M. Baugh, Daniel H. Daneshvar, et al. · 2014 · Alzheimer s Research & Therapy · 379 citations

    The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 20

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  11. Persistent, Long-term Cerebral White Matter Changes after Sports-Related Repetitive Head Impacts

    Jeffrey J. Bazarian, Tong Zhu, Jianhui Zhong, et al. · 2014 · PLoS ONE · 301 citations

    INTRODUCTION: Repetitive head impacts (RHI) sustained in contact sports are thought to be necessary for the long-term development of chronic traumatic encephalopathy (CTE). Our objectives were to: 1) characterize the magnitude and persistence of RHI-induced white matter (WM) changes; 2) determine their relationship to kinematic measures of RHI; and 3) explore their clinical relevance. METHODS: Prospective, observational study of 10 Division III college football players and 5 non-athlete controls during the 2011-12 season. All subjects underwent diffusion tensor imaging (DTI), physiologic, cognitive, and balance testing at pre-season (Time 1), post-season (Time 2), and after 6-months of no-co

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  12. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts

    Ann C. McKee, Thor D. Stein, Bertrand R. Huber, et al. · 2023 · Acta Neuropathologica · 244 citations

    Over the last 17 years, there has been a remarkable increase in scientific research concerning chronic traumatic encephalopathy (CTE). Since the publication of NINDS-NIBIB criteria for the neuropathological diagnosis of CTE in 2016, and diagnostic refinements in 2021, hundreds of contact sport athletes and others have been diagnosed at postmortem examination with CTE. CTE has been reported in amateur and professional athletes, including a bull rider, boxers, wrestlers, and American, Canadian, and Australian rules football, rugby union, rugby league, soccer, and ice hockey players. The pathology of CTE is unique, characterized by a pathognomonic lesion consisting of a perivascular accumulatio

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  13. Repetitive Head Impacts and Chronic Traumatic Encephalopathy

    A. Mckee, M. Alosco, B. Huber · 2016 · Neurosurgery clinics of North America · 169 citations

    There are growing concerns that cumulative repetitive head impact exposure through routine participation in contact and collision sports is associated with increased risk of long-term problems in memory and cognition, including the development of chronic traumatic encephalopathy (CTE). CTE is a distinctive neurodegenerative disease that occurs as a result of repetitive head impacts (RHI) including concussion and subconcussion. Like most neurodegenerative diseases, CTE can only be diagnosed by postmortem neuropathologic examination of brain tissue. Recently a panel of exerts concluded that CTE is a unique disorder with a pathognomonic lesion that can be reliably distinguished from other neuro

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  14. A common neural signature of brain injury in concussion and subconcussion

    Adnan A. Hirad, J. Bazarian, Kian Merchant-Borna, et al. · 2019 · Science Advances · 101 citations

    Clinically silent brain injury in contact sports athletes can be detected by noninvasive MRI. The midbrain is biomechanically susceptible to force loading from repetitive subconcussive head impacts (RSHI), is a site of tauopathy in chronic traumatic encephalopathy (CTE), and regulates functions (e.g., eye movements) often disrupted in concussion. In a prospective longitudinal design, we demonstrate there are reductions in midbrain white matter integrity due to a single season of collegiate football, and that the amount of reduction in midbrain white matter integrity is related to the amount of rotational acceleration to which players’ brains are exposed. We then replicate the observation of

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  15. The Neuropathology of Chronic Traumatic Encephalopathy: The Status of the Literature

    A. Mckee · 2020 · Seminars in Neurology · 65 citations

    Abstract Chronic traumatic encephalopathy (CTE) is a tauopathy associated with repetitive mild head trauma, including concussion and asymptomatic subconcussive impacts. CTE was first recognized in boxers almost a century ago and has been identified more recently in contact sports athletes, military veterans exposed to blast, and victims of domestic violence. Like most neurodegenerative diseases, CTE is diagnosed conclusively by a neuropathological examination of brain tissue. CTE is characterized by the buildup of hyperphosphorylated tau (p-tau) in neurofibrillary tangles (NFTs), neurites, and, sometimes, astrocytes, surrounding small blood vessels in a patchy distribution at the sulcal dept

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  16. A Proposed Mechanism for Development of CTE Following Concussive Events: Head Impact, Water Hammer Injury, Neurofilament Release, and Autoimmune Processes

    S. Kornguth, N. Rutledge, Gabe Perlaza, et al. · 2017 · Brain Sciences · 33 citations

    During the past decade, there has been an increasing interest in early diagnosis and treatment of traumatic brain injuries (TBI) that lead to chronic traumatic encephalopathy (CTE). The subjects involved range from soldiers exposed to concussive injuries from improvised explosive devices (IEDs) to a significant number of athletes involved in repetitive high force impacts. Although the forces from IEDs are much greater by a magnitude than those from contact sports, the higher frequency associated with contact sports allows for more controlled assessment of the mechanism of action. In our study, we report findings in university-level women soccer athletes followed over a period of four and a h

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  17. Animal models of chronic traumatic encephalopathy

    Kelly M McAteer, Renee J Turner, Frances Corrigan · 2017 · Concussion · 21 citations

    Repeated head impacts have been suggested to be associated with the development of the neurodegenerative disorder, chronic traumatic encephalopathy (CTE). CTE is characterized by the accumulation of hyperphosphorylated tau within the brain, with accompanying cognitive and behavioral deficits. How a history of repeated head impacts can lead to the later development of CTE is not yet known, and as such appropriate animal models are required. Over the last decade a number of rodent models of repeated mild traumatic brain injury have been developed that are broadly based on traditional traumatic brain injury models, in controlled cortical impact, fluid percussion and weight drop models, with ada

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  18. Epidemiological Principles in Claims of Causality: An Enquiry into Repetitive Head Impacts (RHI) and Chronic Traumatic Encephalopathy (CTE)

    L. Fortington, D. Cassidy, Rudolph J Castellani, et al. · 2024 · Sports Medicine (Auckland, N.z.) · 17 citations

    Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude t

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  20. Repetitive subconcussion results in disrupted neural activity independent of concussion history

    K. Solar, M. Ventresca, Rouzbeh Zamyadi, et al. · 2024 · Brain Communications · 14 citations

    Concussion is a public health crisis which results in a complex cascade of neurochemical changes in the brain that can have life changing consequences. Subconcussions are considered less serious and were overlooked until recently, but we now realise repetitive subconcussions, such as repetitive head impacts, can lead to serious neurological deficits. Subconcussions are common in contact sports, and the military where certain personnel are exposed to repetitive occupational blast overpressure. Postmortem studies in athletes reveal that cumulative duration of play and force from collisions are better predictors than concussion history for the presence and severity of chronic traumatic encephal

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  21. Prevalence of Chronic Traumatic Encephalopathy in Athletes With Repetitive Head Impacts: A Systematic Review and Meta‐Analysis

    Bote Qi, Jingwang Tan, Dushuo Feng, et al. · 2025 · Scandinavian Journal of Medicine & Science in Sports · 13 citations

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impacts (RHI), which is commonly observed in athletes participating in contact sports. This systematic review and meta‐analysis aimed to provide a clearer elucidation of the prevalence, risk factors, and potential outcomes of CTE in athletes. Through a comprehensive search of PubMed, EMBASE, Web of Science, and Google Scholar (January 2015 to July 2024), we ultimately included eight eligible studies with a low risk of bias involving 1000 former contact sports athletes diagnosed by neuropathological methods. Data were analyzed in a random‐effects meta‐analysis. The results indicated that the

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  22. Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware)

    M. Turner, D. Maddocks, Majidi Hassan, et al. · 2020 · British Journal of Sports Medicine · 12 citations

    While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a

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  23. Neurodegeneration in the cortical sulcus is a feature of chronic traumatic encephalopathy and associated with repetitive head impacts

    Raymond Nicks, Arsal Shah, Spiro Anthony Stathas, et al. · 2024 · Acta Neuropathologica · 12 citations

    Neurodegeneration is a seminal feature of many neurological disorders. Chronic traumatic encephalopathy (CTE) is caused by repetitive head impacts (RHI) and is characterized by sulcal tau pathology. However, quantitative assessments of regional neurodegeneration in CTE have not been described. In this study, we quantified three key neurodegenerative measures, including cortical thickness, neuronal density, and synaptic proteins, in contact sport athletes (n = 185) and non-athlete controls (n = 52) within the sulcal depth, middle, and gyral crest of the dorsolateral frontal cortex. Cortical thickness and neuronal density were decreased within the sulcus in CTE compared to controls (p’s < 0.05

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  24. Traumatic brain injury or head impacts from contact sports are associated with tau astrogliopathy

    John D. Arena, William Stewart, Gabor G. Kovacs, et al. · 2025 · Brain : a journal of neurology · 7 citations

    Exposure to traumatic brain injury (TBI) and/or repetitive head impacts (RHI) increase the risk of a range of neurodegenerative pathologies, including chronic traumatic encephalopathy neuropathologic change (CTE-NC). Astrocytic tau pathology reminiscent of ageing-related tau astrogliopathy is a component feature of CTE-NC in many cases. Yet the relationship between TBI/RHI exposure and wider tau astrogliopathy, beyond that of CTE-NC, remains poorly characterized. Autopsy-derived material from 556 individuals was selected to include cases with a history of moderate or severe traumatic brain injury (survival >6 months, n = 77) or a history of participation in contact sports (n = 45), for compa

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