Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome
Consensus criteria for traumatic encephalopathy syndrome (TES) specify that at least one core clinical feature of cognitive impairment (CI; e.g., difficulties with memory, executive function) or neurobehavioral dysregulation (ND; e.g., explosiveness, rage, and mood lability) be present and not fully...
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Mary Ann Liebert
2024-11-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2024.0008 |
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| author | Rachel Grashow Shawn R. Eagle Douglas P. Terry Heather DiGregorio Aaron L. Baggish Marc G. Weisskopf Anthony Kontos David O. Okonkwo Ross Zafonte |
| author_facet | Rachel Grashow Shawn R. Eagle Douglas P. Terry Heather DiGregorio Aaron L. Baggish Marc G. Weisskopf Anthony Kontos David O. Okonkwo Ross Zafonte |
| author_sort | Rachel Grashow |
| collection | DOAJ |
| description | Consensus criteria for traumatic encephalopathy syndrome (TES) specify that at least one core clinical feature of cognitive impairment (CI; e.g., difficulties with memory, executive function) or neurobehavioral dysregulation (ND; e.g., explosiveness, rage, and mood lability) be present and not fully accounted for by other health disorders. Associations between self-reported symptoms that mirror the core clinical features of TES—and how they may be related to concomitant medical conditions—remain unclear. The purpose of this study was to evaluate the association of medical conditions and football exposures with TES clinical features (CI+/–, ND+/–) in 1741 former professional American-style football (ASF) players (age, 57.7 ± 13.9 years; professional seasons, 6.6 ± 3.9 years). Demographics (age, race/ethnicity, current body mass index, age of first football exposure, use of performance-enhancing drugs, position played, and past concussion symptoms), self-reported medical conditions (anxiety, depression, attention-deficit hyperactivity disorder [ADHD], sleep apnea, headache, stroke, hypertension, heart disease, high cholesterol, erectile dysfunction, and low testosterone) were collected. Of 1741 participants, 7.4% were CI+ and/or ND+ (n = 129). Participants who were CI+ or ND+ were more likely to report one or more coexisting medical conditions than participants who did not report CI or ND (odds ratio [OR] = 2.04; 95% confidence interval: 1.25–3.47; p = 0.003). Separate general linear models for each medical condition that adjusted for demographics and football-related factors identified significant associations between ADHD, diabetes, erectile dysfunction, headaches, sleep apnea, anxiety, and low testosterone and CI+ and/or ND+ (ORs = 1.8–6.0). Chi-square automatic interaction detection (CHAID) multi-variable decision tree models that incorporated medical conditions and football exposures accurately differentiated former players meeting either CI or ND clinical criteria from those meeting none (accuracy = 91.2–96.6%). CHAID identified combinations of depression, headache, sleep apnea, ADHD, and upper quartiles of concussion symptom history as most predictive of CI+ and/or ND+ status. CI+ and/or ND+ players were more likely to report medical conditions known to cause cognitive symptoms. Concussion exposure and medical conditions significantly increased the likelihood that a former ASF player would demonstrate cognitive or neurobehavioral dysfunction. Clinicians engaged with this population should consider whether treatable coexisting condition(s) could account for some portion of the clinical picture associated with TES presentation. |
| format | Article |
| id | doaj-art-7cc84f5975a84b78af570da346d082fd |
| institution | DOAJ |
| issn | 2689-288X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Mary Ann Liebert |
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| series | Neurotrauma Reports |
| spelling | doaj-art-7cc84f5975a84b78af570da346d082fd2025-08-20T02:58:58ZengMary Ann LiebertNeurotrauma Reports2689-288X2024-11-015137638610.1089/neur.2024.0008Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy SyndromeRachel Grashow0Shawn R. Eagle1Douglas P. Terry2Heather DiGregorio3Aaron L. Baggish4Marc G. Weisskopf5Anthony Kontos6David O. Okonkwo7Ross Zafonte8Harvard Medical School, Boston, Massachusetts, USA.Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Harvard Medical School, Boston, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA.Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Harvard Medical School, Boston, Massachusetts, USA.Consensus criteria for traumatic encephalopathy syndrome (TES) specify that at least one core clinical feature of cognitive impairment (CI; e.g., difficulties with memory, executive function) or neurobehavioral dysregulation (ND; e.g., explosiveness, rage, and mood lability) be present and not fully accounted for by other health disorders. Associations between self-reported symptoms that mirror the core clinical features of TES—and how they may be related to concomitant medical conditions—remain unclear. The purpose of this study was to evaluate the association of medical conditions and football exposures with TES clinical features (CI+/–, ND+/–) in 1741 former professional American-style football (ASF) players (age, 57.7 ± 13.9 years; professional seasons, 6.6 ± 3.9 years). Demographics (age, race/ethnicity, current body mass index, age of first football exposure, use of performance-enhancing drugs, position played, and past concussion symptoms), self-reported medical conditions (anxiety, depression, attention-deficit hyperactivity disorder [ADHD], sleep apnea, headache, stroke, hypertension, heart disease, high cholesterol, erectile dysfunction, and low testosterone) were collected. Of 1741 participants, 7.4% were CI+ and/or ND+ (n = 129). Participants who were CI+ or ND+ were more likely to report one or more coexisting medical conditions than participants who did not report CI or ND (odds ratio [OR] = 2.04; 95% confidence interval: 1.25–3.47; p = 0.003). Separate general linear models for each medical condition that adjusted for demographics and football-related factors identified significant associations between ADHD, diabetes, erectile dysfunction, headaches, sleep apnea, anxiety, and low testosterone and CI+ and/or ND+ (ORs = 1.8–6.0). Chi-square automatic interaction detection (CHAID) multi-variable decision tree models that incorporated medical conditions and football exposures accurately differentiated former players meeting either CI or ND clinical criteria from those meeting none (accuracy = 91.2–96.6%). CHAID identified combinations of depression, headache, sleep apnea, ADHD, and upper quartiles of concussion symptom history as most predictive of CI+ and/or ND+ status. CI+ and/or ND+ players were more likely to report medical conditions known to cause cognitive symptoms. Concussion exposure and medical conditions significantly increased the likelihood that a former ASF player would demonstrate cognitive or neurobehavioral dysfunction. Clinicians engaged with this population should consider whether treatable coexisting condition(s) could account for some portion of the clinical picture associated with TES presentation.https://www.liebertpub.com/doi/10.1089/neur.2024.0008chronic traumatic encephalopathycomorbiditiesconcussionencephalopathy syndromefootballtraumatic encephalopathy syndrome |
| spellingShingle | Rachel Grashow Shawn R. Eagle Douglas P. Terry Heather DiGregorio Aaron L. Baggish Marc G. Weisskopf Anthony Kontos David O. Okonkwo Ross Zafonte Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome Neurotrauma Reports chronic traumatic encephalopathy comorbidities concussion encephalopathy syndrome football traumatic encephalopathy syndrome |
| title | Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome |
| title_full | Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome |
| title_fullStr | Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome |
| title_full_unstemmed | Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome |
| title_short | Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome |
| title_sort | medical conditions in former professional american style football players are associated with self reported clinical features of traumatic encephalopathy syndrome |
| topic | chronic traumatic encephalopathy comorbidities concussion encephalopathy syndrome football traumatic encephalopathy syndrome |
| url | https://www.liebertpub.com/doi/10.1089/neur.2024.0008 |
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