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Neuroimage Clin 2018 Dec 3. Epub 2018 Dec 3.

Medical Biophysics, Western University, London, ON, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, London, ON, Canada. Electronic address:

Acute brain changes are expected after concussion, yet there is growing evidence of persistent abnormalities well beyond clinical recovery and clearance to return to play. Multiparametric MRI is a powerful approach to non-invasively study structure-function relationships in the brain, however it remains challenging to interpret the complex and heterogeneous cascade of brain changes that manifest after concussion. Emerging conjunctive, data-driven analysis approaches like linked independent component analysis can integrate structural and functional imaging data to produce linked components that describe the shared inter-subject variance across images. Read More

Clin Neurophysiol 2018 Nov 26;130(1):111-121. Epub 2018 Nov 26.

Department of Linguistics and Languages, McMaster University, Togo Salmon Hall 513, 1280 Main Street, West Hamilton, ON L8S 4M2, Canada; ARiEAL Research Centre, McMaster University, L.R. Wilson Hall, 1280 Main Street, West Hamilton, ON L8S 4M2, Canada; School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West Hamilton, ON L8S 4K1, Canada; MaRS Centre, Vector Institute, Canada; McMaster University, Department of Psychology, Neuroscience and Behaviour, Canada. Electronic address:

Objective: Recent studies demonstrate that sports-related concussions can have negative consequences on long-term brain health. The goal of the present study was to determine whether retired Canadian Football League (CFL) athletes with a history of concussions exhibit alterations in neurocognitive functioning, along with changes in physical, social, and psychological health.

Methods: Our study compared nineteen retired CFL athletes' concussion histories to eighteen healthy age-matched controls with no history of concussion. Read More

Arch Clin Neuropsychol 2018 Dec 6. Epub 2018 Dec 6.

VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.

Objective: We evaluated the influence of the APOE-ε4 allele on post-concussive symptoms in military Veterans with a remote history of mild traumatic brain injury (mTBI).

Method: Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their ε4 status (n = 14 ε4+, n = 63 ε4-). Read More

J Neurotrauma 2018 Dec 6. Epub 2018 Dec 6.

University of Pittsburgh, Neurosurgery , 3434 Fifth Ave , Pittsburgh, Pennsylvania, United States , PA ;

New neuroprotective therapies for severe traumatic brain injury (TBI) have not translated from pre-clinical to clinical success. Numerous explanations have been suggested in both the pre-clinical and clinical arenas. Coverage of TBI in the lay press has reinvigorated interest creating a golden age of TBI research with innovative strategies to circumvent roadblocks. Read More

Open Access J Sports Med 2018 13;9:253-260. Epub 2018 Nov 13.

Beaumont Health System, Detroit, MI, USA.

Background: Major League Baseball (MLB) players are throwing the ball faster and hitting harder than ever before. Although some safety measures have been implemented, by decreasing the 15 days on the disabled list (DL) to the 7 days on the DL, concussion rates remain high across positions and may impact player performance. Our hypothesis was, there would be an increase in concussion incidence following implementation of the 7 day DL, but this would not have a negative impact on player's postconcussion performance. Read More

Brain Inj 2018 Dec 3:1-6. Epub 2018 Dec 3.

e Department of Neurology, and Health Science Research , Mayo Clinic , Rochester , MN , USA.

The aim of this prospective cohort study was to determine the effect of an 'event,' defined as a knock-out (KO), technical knock-out (TKO), choke, or submission, on King-Devick (K-D) test times in mixed martial arts (MMA) athletes. MMA athletes (28.3 ± 6. Read More

Brain Inj 2018 Dec 3:1-11. Epub 2018 Dec 3.

a Cognitive Neurosciences Unit , McGill University , Montreal , Canada.

The diagnosis of a mild traumatic brain injury (mTBI) places large emphasis on patient-reported symptoms which has restricted our ability to evaluate patients. Task-based functional magnetic resonance imaging has the potential to act as an objective measurement of abnormal brain activity and inform clinical decision-making; however, there is little research evaluating pediatric subjects as a function of mTBI-related symptoms. The objective of this study was to evaluate the extent to which brain activity during a spatial navigation task is different between children with mTBI and a group of healthy controls (HCs) based on symptom reporting. Read More

Headache 2018 Dec 1. Epub 2018 Dec 1.

NYU College of Nursing, New York, NY, USA.

Background: There are no clear guidelines on how to treat posttraumatic headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS?

Methods: We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Read More

Psychol Res 2018 Dec 1. Epub 2018 Dec 1.

School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Canada.

Dual tasking is an integral part of everyday activities for children. Therefore, as with the other aspects of child development-motor, cognitive, perceptual, psychological, and behavioral-it is important to understand the maturation process of dual-tasking skills in children. Characterizing age-related changes in children's dual-task performance has been problematic, because differences in dual-tasking ability are confounded by age differences in abilities in the relevant single-task performances. Read More

Br J Sports Med 2018 Dec 1. Epub 2018 Dec 1.

Am J Sports Med 2018 Dec 3:363546518812820. Epub 2018 Dec 3.

Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.

Background:: Concussion is one of the most common sports-related injuries, with little understood about the modifiable and nonmodifiable risk factors. Researchers have yet to evaluate the association between modifiable sensorimotor function variables and concussive injury.

Purpose:: To investigate the association between dynamic balance performance, a discrete measure of sensorimotor function, and concussive injuries. Read More

Brain Inj 2018 Dec 2:1-6. Epub 2018 Dec 2.

a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA.

Objectives: The Balance Error Scoring System (BESS) is commonly used to measure postural stability; however, it has demonstrated inconsistent reliability values when administered by humans. The Tekscan MobileMat™ was developed to automate the assessment of BESS errors and eliminate rater subjectivity. The objective of this study was to report reference values for the BESS, as measured by the MobileMat™, and examine the effect of sex, concussion history, and competitive sport level on BESS performance. Read More

J Athl Train 2018 Dec 5. Epub 2018 Dec 5.

Barrow Neurological Institute, Phoenix, AZ.

Context: Schools that sponsor athletic programs have an obligation to provide a safe environment with appropriate policies for addressing emergencies.

Objective: To describe the emergency preparedness of secondary schools in Arizona specific to emergency action plans (EAPs), cardiac arrest, concussion, and heat illness.

Design: Cross-sectional study. Read More

Curr Opin Neurol 2018 Nov 30. Epub 2018 Nov 30.

Department of Neurology.

Purpose Of Review: To review emerging vision-based assessments in the evaluation of concussion.

Recent Findings: Involvement of the visual pathways is common following concussion, the mildest form of traumatic brain injury. The visual system contains widely distributed networks that are prone to neurophysiologic changes after a concussion, resulting in visual symptoms and ocular motor dysfunction. Read More

Clin Neuropsychol 2018 Dec 5:1-12. Epub 2018 Dec 5.

a Department of Psychological Sciences , Kent State University , Kent , OH , USA.

Objective: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses neurocognitive functioning in sports-related concussion. Previous work demonstrates ImPACT's validity indices detect poor effort at disproportionately higher rates in athletes with histories of attention deficit hyperactivity disorder (ADHD) or academic difficulties. The present study examines whether previously suggested 'dormant' validity indices, Word Memory Correct Distractors (WMCD), and Design Memory Correct Distractors (DMCD), reduce disproportionate invalidity in collegiate athletes with such histories. Read More

J Clin Exp Neuropsychol 2018 Dec 5:1-8. Epub 2018 Dec 5.

c Department of Psychology , Penn State University , University Park , PA , USA.

Introduction: Interpreting change in cognitive performance across baseline and post-concussion evaluations is complicated by poor understanding of how incentives, such as return-to-play, may impact performance. This study examines the influence of an anticipated financial incentive on two sets of outcomes from the ImPACT computerized battery: (a) cognitive composites, meant to serve as measures of cognitive function, and (b) validity indices, proposed as indicators of invalid performance.

Method: 81 uninjured college students, randomized into two groups, completed a concussion assessment battery including ImPACT. Read More

Phys Ther Sport 2018 Nov 28;35:99-105. Epub 2018 Nov 28.

University of Bath, Department for Health, Claverton Down, Bath, BA2 7AY, United Kingdom. Electronic address:

Objectives: To determine incidence rates, severity and the nature of concussion in professional rugby union in Ireland.

Design: Retrospective observational study of time-loss concussion.

Setting: Professional rugby union in Ireland. Read More

J Sci Med Sport 2018 Nov 22. Epub 2018 Nov 22.

The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA; Departments of Pediatrics and Orthopaedic Surgery, Harvard Medical School, USA.

Objectives: To prospectively evaluate single/dual-task timed-up-and-go (TUG) and tandem gait performance among children and adolescents with concussion and healthy controls.

Design: Repeated measures.

Methods: Participants with concussion (n=23; age=14. Read More

Can J Neurol Sci 2018 Dec 4:1-9. Epub 2018 Dec 4.

Ophtalmology Department,Centre Hospitalier de l'Université de Montréal,Montreal, Quebec,Canada.

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. Read More

R I Med J (2013) 2018 Dec 3;101(10):56-57. Epub 2018 Dec 3.

Brown University, Department of Emergency Medicine.

Brain Inj 2018 Nov 30:1-16. Epub 2018 Nov 30.

c Centre for Rehabilitation of Brain Injury , Copenhagen , Denmark.

Objective: To compare the effectiveness of a specialized, interdisciplinary rehabilitation (S-REHAB) with standard care (STAND) for people with persistent post-concussive symptoms (PPCS > 6 month).

Design: Randomized controlled trial.

Participants: Eighty-nine adults. Read More

Brain Inj 2018 Nov 30:1-11. Epub 2018 Nov 30.

h Occupational Therapy Program, School of Rehabilitation , Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada.

Purpose: To capture the scope of literature exploring interventions for caregivers of aging persons with TBI.

Methods: A scoping review of peer reviewed literature was conducted in two phases. Phase I: Searching seven databases, two independent raters screened articles using a set of predetermined criteria. Read More

J Head Trauma Rehabil 2018 Nov 28. Epub 2018 Nov 28.

Department of Psychology, University of Windsor, Windsor, Ontario, Canada (Drs Abeare, Casey, and Erdodi and Mss Messa and Whitfield, and Mr Zuccato); and Michigan State University College of Human Medicine, East Lansing (Mr Rykulski).

Objective: To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores.

Setting: Sport-related concussion management program at a regionally accredited university.

Participants: A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students. Read More

J Head Trauma Rehabil 2018 Nov 28. Epub 2018 Nov 28.

The Center on Brain Injury Research and Training, University of Oregon, Eugene.

Objective: To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention, In the Classroom After Concussion: Best Practices for Student Success.

Design: A randomized controlled trial with a sample of 100 general educators, who were randomly assigned to the In the Classroom Web site (treatment group) or the LEARNet Web site (control group). Participants completed the pretest, accessed the In the Classroom or LEARNet site and the posttest and completed follow-up assessments 60 days after posttest. Read More

BMJ Open Sport Exerc Med 2018 5;4(1):e000455. Epub 2018 Nov 5.

The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.

Introduction: Sports-related concussion (SRC) can be challenging to diagnose, assess and manage. Much of the SRC research is conducted on adults. The assessment of SRC should aim to identify deficits using a detailed multimodal assessment; however, most studies investigating the effects of SRC use diagnostic tools in isolation. Read More

BMJ Open Sport Exerc Med 2018 25;4(1):e000361. Epub 2018 Oct 25.

Institute of Motion Analysis Research (IMAR), Department of Orthopaedic and Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland.

Aim: To compare the available brands of rugby headguards and evaluate their impact attenuation properties at various locations on the cranium, with regard to concussion prevention.

Methods: Seven different branded headguards were fitted onto a rigid headform and drop-tested in three different positions. An accelerometer measured the linear acceleration the headform experienced on impact with the ground. Read More

Front Neurol 2018 15;9:964. Epub 2018 Nov 15.

Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States.

Microglial activation is a pathological hallmark of traumatic brain injury (TBI). Following brain injury, activated microglia/macrophages adopt different phenotypes, generally categorized as M-1, or classically activated, and M-2, or alternatively activated. While the M-1, or pro-inflammatory phenotype is detrimental to recovery, M-2, or the anti-inflammatory phenotype, aids in brain repair. Read More

BMC Public Health 2018 Nov 29;18(1):1324. Epub 2018 Nov 29.

School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.

Background: Concussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM's main purpose is to require each school board in the province to create and implement a concussion policy. Read More

J Neurosurg 2018 Nov 1:1-8. Epub 2018 Nov 1.

OBJECTIVEArtificial neural networks (ANNs) have shown considerable promise as decision support tools in medicine, including neurosurgery. However, their use in concussion and postconcussion syndrome (PCS) has been limited. The authors explore the value of using an ANN to identify patients with concussion/PCS based on their antisaccade performance. Read More

J Surg Orthop Adv Fall 2018;27(3):187-197

Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

This study aimed to determine if gameplay performance in the National Football League (NFL) is adversely affected after returning to play from a sport-related concussion (SRC). Players who sustained a SRC between the 2007-2008 and 2013-2014 seasons were identified. Concussed players were matched to nonconcussed control players in a 2:1 (control-case) fashion by position, season, experience, age, body mass index, and time missed. Read More

J Neurotrauma 2018 Nov 29. Epub 2018 Nov 29.

Wake Forest University School of Medicine, 12279, Biomedical Engineering, Winston-Salem, North Carolina, United States ;

During normal participation in the sport, football players are exposed to repetitive subconcussive head impacts, or impacts that do not result in signs and symptoms of concussion. To better understand the effects of repetitive subconcussive impacts, the biomechanics of on-field head impacts and resulting brain deformation needs to be well-characterized. The current study evaluates local brain response to typical youth football head impacts using the atlas-based brain model (ABM), an anatomically-accurate brain finite element (FE) model. Read More

J Clin Neurosci 2018 Nov 26. Epub 2018 Nov 26.

Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging within 6 months of SRC, and sample size >5. Read More

J Athl Train 2018 Oct;53(10):926-937

Injury Prevention Research Center, University of North Carolina at Chapel Hill.

Context: : The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided in the acquisition of girls' and women's volleyball injury data.

Objective: : To describe the epidemiology of injuries sustained in high school girls' volleyball in the 2005-2006 through 2013-2014 academic years and collegiate women's volleyball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance.

Design: : Descriptive epidemiology study. Read More

Res Sports Med 2018 Nov 28:1-19. Epub 2018 Nov 28.

a Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport , University of Stirling , Stirling , UK.

Omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation has recently been proposed as an ergogenic aid for athletes. This claim is primarily based on mechanistic evidence that n-3PUFA's exert anti-inflammatory properties and act to change the functional capacity of the muscle cell by modifying the membrane fluidity of proteins and lipids within the cell membrane. In this review, we critically evaluate the scientific literature that examines the efficacy of n-3PUFA supplementation to improve athlete performance within the context of promoting muscle adaptation, energy metabolism, muscle recovery and injury prevention (e. Read More

J Neurotrauma 2018 Nov 28. Epub 2018 Nov 28.

University of Michigan, NeuroTrauma Research Laboratory , 1402 Washington Heights , Ann Arbor, Michigan, United States , 48109 ;

Kutcher and Giza suggested incorporating levels of certainty in concussion diagnosis decisions. These guidelines were based on clinical experience rather than objective data. Therefore, we combined data-driven optimization with predictive modeling to identify which athletes are Unlikely to have concussion and classify remaining athletes as Possible, Probable, or Definite concussion by diagnostic certainty. Read More

Front Neurol 2018 13;9:948. Epub 2018 Nov 13.

Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States.

With the advent of susceptibility-weighted imaging (SWI), the ability to identify cerebral microbleeds (CMBs) associated with mild traumatic brain injury (mTBI) has become increasingly commonplace. Nevertheless, the clinical significance of post-traumatic CMBs remains controversial partly because it is unclear whether mTBI-related CMBs entail brain circuitry disruptions which, although structurally subtle, are functionally significant. This study combines magnetic resonance and diffusion tensor imaging (MRI and DTI) to map white matter (WM) circuitry differences across 6 months in 26 healthy control volunteers and in 26 older mTBI victims with acute CMBs of traumatic etiology. Read More

J Integr Med 2018 Nov 17. Epub 2018 Nov 17.

Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta T6E4H4, Canada; Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta T6E4H4, Canada. Electronic address:

Objective: The prevalence of sport-related concussion (SRC) is high and results in a number of serious health consequences. One area that has received minimal research is the relationship between SRC and sleep. The literature shows that sleep deficiency is a frequent negative consequence of SRC. Read More

Handb Clin Neurol 2018 ;158:91-105

UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.

Concussion is a major public health concern, with an estimated 1.6-3.8 million sport-related concussions occurring annually in the United States. Read More

Handb Clin Neurol 2018 ;158:81-90

Department of Emergency Medicine, University of Rochester School of Medicine, Rochester, NY, United States.

The concussion evaluation commonly takes place in the emergency department (ED), but most clinicians have not received formal training in concussion diagnosis and management. Proper diagnosis and management of concussion in the ED diminish postconcussion complications and improve the likelihood of successful concussion recovery. The ED assessment begins with early recognition of the signs and symptoms of concussion, a directed history, appropriate documentation, and identification of conditions ("red flags") that need immediate intervention such as traumatic intracranial hemorrhage, followed by a systematic assessment for risk factors that can predict prolonged recovery, and a concussion-focused physical exam. Read More

Handb Clin Neurol 2018 ;158:75-80

Athletic Medicine, University Health Services, Princeton University, Princeton, NJ, United States.

The recognition and sideline evaluation of possible sport-related concussion are difficult tasks for a physician and other clinicians. Sideline assessment tools have continued to evolve over the years, but objective biomarkers of concussion do not currently exist. Sideline video review programs may aid in the recognition of possible concussion as additional information for the sideline athletic medicine staff. Read More

Handb Clin Neurol 2018 ;158:63-74

Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States.

Sports and recreation-related (SRR) activities are common in the United States. Beyond the benefits to health, SRR activities can create new friendships, give people a sense of belonging, foster teamwork and other leadership skills, and develop sportsmanship and a respect for rules that govern play. Public awareness about the risk of concussion has grown as the long-term consequences of traumatic brain injury (TBI) have become better known, and likely explains the increasing concussion incidence rates. Read More

Handb Clin Neurol 2018 ;158:51-61

Department of Neurosurgery, University of California, Los Angeles, CA, United States. Electronic address:

The majority of the 3.8 million estimated annual traumatic brain injuries (TBI) in the United States are mild TBIs, or concussions, and they occur primarily in adolescents and young adults. A concussion is a brain injury associated with rapid brain movement and characteristic clinical symptoms, with no associated objective biomarkers or overt pathologic brain changes, thereby making it difficult to diagnose by neuroimaging or other objective diagnostic tests. Read More

Handb Clin Neurol 2018 ;158:463-471

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.

Traumatic brain injury (TBI) is associated with several pathophysiologic changes, including: neurostructural alterations; molecular changes with shifts in circulating neurotrophins; impaired neural metabolism; changes in cerebrovascular autoregulation, vasoreactivity, and neurovascular coupling; and alterations in functional brain connectivity. In animal models of TBI, aerobic exercise reduces neuronal injury, promotes neuronal survival, and enhances the production of neuroprotective trophic factors. However, the timing of exercise initiation is an important consideration as early exercise in the acute postinjury period may impede recovery mechanisms, although evidence for this in humans is lacking. Read More

Handb Clin Neurol 2018 ;158:39-49

Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada. Electronic address:

Head impacts that transfer mechanical energy to the skull and create brain injuries have unique dynamic responses and brain tissue trauma characteristics. The magnitude of the impact energy and how it is transmitted creates three-dimensional linear and rotational accelerations of the head, resulting in unique strains on brain tissue. Biomechanical investigations of head injuries in contact sports have historically focused on attenuating energy transfer to the skull and brain. Read More

Handb Clin Neurol 2018 ;158:323-333

Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.

Chronic traumatic encephalopathy (CTE) is a neuropathologic condition that has been described in individuals who have been exposed to repetitive head impacts, including concussions and subconcussive trauma. CTE cannot currently be diagnosed during life. Clinical symptoms of CTE (including changes in mood, behavior, and cognition) are nonspecific and may develop after a latency phase following the injuries. Read More

Handb Clin Neurol 2018 ;158:309-322

Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany. Electronic address:

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Read More

Handb Clin Neurol 2018 ;158:3-10

Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States.

An evolutionary perspective helps explain a conundrum faced by sports neurologists: why is the human brain dependent on physical activity to function optimally, yet simultaneously susceptible to harm from particular types of athletics? For millions of years, human bodies and brains co-evolved to meet the physical and cognitive demands of the uniquely human subsistence strategy of hunting and gathering. Natural selection favored bodies with adaptations for endurance-based physical activity patterns, whereas brains were selected to be big and powerful to navigate the complex cultural and ecologic landscapes of hunter-gatherers. Human brains require physical activity to function optimally because their physiology evolved among individuals who were rarely able to avoid regular physical activity. Read More

Handb Clin Neurol 2018 ;158:297-307

VA Boston Healthcare System, Boston, MA, United States; Departments of Neurology and Pathology, Boston University School of Medicine, and Boston University CTE Center, Boston, MA, United States.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head trauma, including concussion and subconcussion. CTE was first recognized in boxers nearly a century ago as "dementia pugilistica" or "punch drunk," but has been recently identified in contact sports athletes (including American football, ice hockey, soccer, baseball, rugby, boxing, and wrestling) and military veterans exposed to blast. Similar to many other neurodegenerative diseases, CTE is diagnosed conclusively only by neuropathologic examination of brain tissue. Read More