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Long-term consequences of recurrent sports concussion

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Abstract

Background

Recurrent concussions are suspected to promote the development of long-term neurological disorders. The study was designed to assess the prevalence of major depressive disorder, mild cognitive disorders and headache in a population of retired high-level sportsmen and rugby players and to study the link between scores evaluating these disorders and the number of reported concussions (RCs).

Methods

A total of 239 retired rugby players (RRPs) and 138 other retired sportsmen (ORSs) who had reached the French national or international championship level between 1985 and 1990 filled in a self-administered questionnaire describing their sociodemographic data, comorbidities and reported history of RC. A phone interview was then conducted using validated questionnaires for the detection of major depressive disorder (PHQ-9), mild cognitive disorders (F-TICS-m) and headache (HIT-6).

Results

RRPs reported a higher number of RCs than ORSs (p < 0.001). A higher rate of major depressive disorder (PHQ-9 score >9) was observed among RRPs compared to ORSs (9% versus 6%) (p = 0.04), and the PHQ-9 score increased with the number of RCs regardless of the type of sport (p = 0.026). A higher rate of mild cognitive disorders (TICS-m score ≤30) was observed in RRPs compared to ORSs (57% versus 40%, p = 0.005), but no association was found with the number of RC. The HIT-6 score increased with the number of RCs (p = 0.019)

Conclusions

More than 20 years after the end of their career, RRPs present higher rates of depression and lower F-TICS-m scores in favor of mild cognitive impairment compared with ORSs. PHQ-9 and HIT-6 scores were significantly associated with the number of RCs.

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References

  1. ACRM: Mild Traumatic Brain Injury Committee (1993) Definition of mild traumatic brain injury. J Head Trauma Rehabil 8(3):86–87

    Article  Google Scholar 

  2. Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Johnston K, Kelly J, Lovell M, McCrory P, Meeuwisse W, Schamasch P, Concussion in Sport Group (2002) Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Clin J Sport Med 12(1):6–11

    Article  PubMed  Google Scholar 

  3. Cantu RC (2007) Chronic traumatic encephalopathy in the National Football League. Neurosurgery 61(2):223–225

    Article  PubMed  Google Scholar 

  4. Carney N, Ghajar J, Jagoda A, Bedrick S, Davis-OʼReilly C, du Coudray H, Hack D, Helfand N, Huddleston A, Nettleton T, Riggio S (2014) Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery 75(Suppl 1):S3–S15

    Article  PubMed  Google Scholar 

  5. Cook SE, Marsiske M, McCoy KJ (2009) The use of the Modified Telephone Interview for Cognitive Status (TICS-M) in the detection of amnestic mild cognitive impairment. J Geriatr Psychiatry Neurol 22(2):103–109

    Article  PubMed  PubMed Central  Google Scholar 

  6. Critchley M (1949) Punch-drunk syndromes: the chronic traumatic encephalopathy of boxers. Hommage à Clovis Vincent. Neurochirurgie, Maloine, Paris

    Google Scholar 

  7. Decq P, Chermann J-F, Loiseau H, Pariente J, Touchon J, Mias L, Vidalin H, Lagarrigue J (2011) Professional rugby and head injury (Concussions): Guidelines for their management in France. J de Traumatologie du Sport 28(4):227–242

    Article  Google Scholar 

  8. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD (2007) Concussions among United States high school and collegiate athletes. J Athl Train 42(4):495–503

    PubMed  PubMed Central  Google Scholar 

  9. Gonzalez HM, Tarraf W, Whitfield KE, Vega WA (2010) The epidemiology of major depression and ethnicity in the United States. J Psychiatr Res 44(15):1043–1051

    Article  PubMed  PubMed Central  Google Scholar 

  10. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C, Jordan BD (2005) Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 57(4):719–726

    Article  PubMed  Google Scholar 

  11. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP Jr, Matthews A, Mihalik JR, Cantu RC (2007) Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc 39(6):903–909

    Article  PubMed  Google Scholar 

  12. Headache Classification Committee of the International Headache (2013) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 33(9):629–808

    Article  Google Scholar 

  13. Hollis SJ, Stevenson MR, McIntosh AS, Shores EA, Finch CF (2012) Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players. Br J Sports Med 46(10):735–740

    Article  PubMed  Google Scholar 

  14. Hootman JM, Dick R, Agel J (2007) Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 42(2):311–319

    PubMed  PubMed Central  Google Scholar 

  15. Kemp SP, Hudson Z, Brooks JH, Fuller CW (2008) The epidemiology of head injuries in English professional rugby union. Clin J Sport Med 18(3):227–234

    Article  PubMed  Google Scholar 

  16. King D, Hume PA, Brughelli M, Gissane C (2015) Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med 43(3):614–624

    Article  PubMed  Google Scholar 

  17. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Lacoste L, Trivalle C (2009) Adaptation française d’un outil d’évaluation par téléphone des troubles mnésiques: le French Telephone Interview for Cognitive Status Modified F-TICS-m). Neurologie-Psychiatrie-Gériatrie 9(49):17–22

    Article  Google Scholar 

  19. Laker SR (2011) Epidemiology of concussion and mild traumatic brain injury. PM R 3(10 Suppl 2):S354–S358

    Article  PubMed  Google Scholar 

  20. Lehman EJ, Hein MJ, Baron SL, Gersic CM (2012) Neurodegenerative causes of death among retired National Football League players. Neurology 79(19):1970–1974

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY (2011) Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med 39(5):958–963

    Article  PubMed  Google Scholar 

  22. Makdissi M, Darby D, Maruff P, Ugoni A, Brukner P, McCrory PR (2010) Natural history of concussion in sport: markers of severity and implications for management. Am J Sports Med 38(3):464–471

    Article  PubMed  Google Scholar 

  23. Martin A, Rief W, Klaiberg A, Braehler E (2006) Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 28(1):71–77

    Article  PubMed  Google Scholar 

  24. Martin M, Blaisdell B, Kwong JW, Bjorner JB (2004) The Short-Form Headache Impact Test (HIT-6) was psychometrically equivalent in nine languages. J Clin Epidemiol 57(12):1271–1278

    Article  PubMed  Google Scholar 

  25. McCrory P, Johnston K, Meeuwisse W, Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Kelly J, Lovell M, Schamasch P (2005) Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague. Br J Sports Med 39(4):196–204

    PubMed  CAS  PubMed Central  Google Scholar 

  26. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R (2009) Consensus statement on concussion in sport—the Third International Conference on Concussion in Sport held in Zurich, November 2008. Phys Sportsmed 37(2):141–159

    Article  PubMed  Google Scholar 

  27. McCrory P, Meeuwisse WH, Kutcher JS, Jordan BD, Gardner A (2013) What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? Br J Sports Med 47(5):327–330

    Article  PubMed  Google Scholar 

  28. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M (2013) Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 47(5):250–258

    Article  PubMed  Google Scholar 

  29. McKee AC, Gavett BE, Stern RA, Nowinski CJ, Cantu RC, Kowall NW, Perl DP, Hedley-Whyte ET, Price B, Sullivan C, Morin P, Lee HS, Kubilus CA, Daneshvar DH, Wulff M, Budson AE (2010) TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 69(9):918–929

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Merritt VC, Rabinowitz AR, Arnett PA (2015) Injury-related predictors of symptom severity following sports-related concussion. J Clin Exp Neuropsychol 37(3):265–275

    Article  PubMed  Google Scholar 

  31. Mortimer JA, van Duijn CM, Chandra V, Fratiglioni L, Graves AB, Heyman A, Jorm AF, Kokmen E, Kondo K, Rocca WA (1991) Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int J Epidemiol 20(Suppl 2):S28–S35

    Article  PubMed  Google Scholar 

  32. Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH (2005) Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 57(1):128–134

    Article  PubMed  Google Scholar 

  33. Omalu BI, DeKosky ST, Hamilton RL, Hamilton RL, Minster RL, Kamboh MI, Shakir AM, Wecht CH (2006) Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery 59(5):1086–1092

    PubMed  Google Scholar 

  34. Rothman KJ, Greenland S, Lash TL (2008) Modern Epidemiology. Wolters Kluwer Health/Lippincott Williams & Wilkins

  35. Schulz MR, Marshall SW, Mueller FO, Yang J, Weaver NL, Kalsbeek WD, Bowling JM (2004) Incidence and risk factors for concussion in high school athletes, North Carolina, 1996–1999. Am J Epidemiol 160(10):937–944

    Article  PubMed  Google Scholar 

  36. Seifert TD (2013) Sports concussion and associated post-traumatic headache. Headache 53(5):726–736

    Article  PubMed  Google Scholar 

  37. Thomas Antérion C, Honoré S, Cougny H, Grosmaitre C, Laurent B (2001) Apport de l'épreuve d'évocation lexicale du Set Test dans le dépistage de la maladie d'Alzheimer. Rev Neurol (Paris) 157(11):1377–1382

    Google Scholar 

  38. Torres DM, Galetta KM, Phillips HW, Dziemianowicz EM, Wilson JA, Dorman ES, Laudano E, Galetta SL, Balcer LJ (2013) Sports-related concussion: Anonymous survey of a collegiate cohort. Neurol Clin Pract 3(4):279–287

    Article  PubMed  PubMed Central  Google Scholar 

  39. Vercambre MN, Cuvelier H, Gayon YA, Hardy-Léger I, Berr C, Trivalle C, Boutron-Ruault MC, Clavel-Chapelon F (2010) Validation study of a French version of the modified telephone interview for cognitive status (F-TICS-m) in elderly women. Int J Geriatr Psychiatry 25(11):1142–1149

    Article  PubMed  Google Scholar 

  40. Yang M, Rendas-Baum R, Varon SF, Kosinski M (2011) Validation of the Headache Impact Test (HIT-6) across episodic and chronic migraine. Cephalalgia 31(3):357–367

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zuithoff NP, Vergouwe Y, King M, Nazareth I, van Wezep MJ, Moons KG, Geerlings MI (2010) The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study. BMC Fam Pract 11:98

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We thank Timothée Six for help with the data acquisition.

This work was supported by a grant from the Fédération Française de Rugby (FFR) and the Ligue Nationale de Rugby (LNR) and performed under the auspices of the Comité National Olympique et du Sport Français (CNOSF). There are no competing interests.

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Correspondence to Philippe Decq.

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Funding

The Fédération Française de Rugby (FFR) and la Ligue Nationale de Rugby (LNR) provided financial support in the form of research technician funding. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Drs. Jean-Claude Peyrin and Bernard Dusfour are respectively president of the medical committee of the FFR and of the LNR.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Decq, P., Gault, N., Blandeau, M. et al. Long-term consequences of recurrent sports concussion. Acta Neurochir 158, 289–300 (2016). https://doi.org/10.1007/s00701-015-2681-4

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