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Abstract
Objective To test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition.
Methods This cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group.
Results A total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36–2.12), TBI without LOC (β, 0.43; 95% CI, 0.31–0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59–0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001–0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002–0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, −0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition.
Conclusions RHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.
Glossary
- AD=
- Alzheimer disease;
- ADRD=
- Alzheimer disease–related dementias;
- BHR=
- Brain Health Registry;
- CBB=
- CogState Brief Battery;
- CI=
- confidence interval;
- DET=
- detection;
- FMS=
- Forward Memory Span;
- GDS-15=
- 15-item Geriatric Depression Scale;
- GNG=
- Go/No-Go;
- IDN=
- identification;
- LOC=
- loss of consciousness;
- NCPT=
- NeuroCognitive Performance Tests;
- OCL=
- one card learning;
- ONB=
- one-back test;
- OSU TBI-ID=
- Ohio State University TBI Identification Method;
- RHI=
- repetitive head impact;
- RMS=
- Reverse Memory Span;
- TBI=
- traumatic brain injury;
- TMTB=
- Trail-Making Test Part B;
- UCSF=
- University of California, San Francisco
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally as first authors.
↵† These authors contributed equally as senior authors.
CME Course: NPub.org/cmelist
- Received October 11, 2019.
- Accepted in final form February 13, 2020.
- © 2020 American Academy of Neurology
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