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Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI), but the components of RHI exposure underlying this relationship are unclear. We create a position exposure matrix (PEM), composed of American football helmet sensor data, summarized from literature review by player position and level of play. Using this PEM, we estimate measures of lifetime RHI exposure for a separate cohort of 631 football playing brain donors. Separate models examine the relationship between CTE pathology and players’ concussion count, athletic positions, years of football, and PEM-derived measures, including estimated cumulative head impacts, linear accelerations, and rotational accelerations. Only duration of play and PEM-derived measures are significantly associated with CTE pathology. Models incorporating cumulative linear or rotational acceleration have better model fit and are better predictors of CTE pathology than duration of play or cumulative head impacts alone. These findings implicate cumulative head impact intensity in CTE pathogenesis.
The relationship between the components of repetitive head impacts and chronic traumatic encephalopathy (CTE) remains unclear. Here, the authors use American football helmet sensor data to show that duration of play, cumulative head impacts and linear and rotational accelerations are significantly associated with CTE pathology.
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1 Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Massachusetts General Hospital, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924); Mass General Brigham-Spaulding Rehabilitation, Department of Physical Medicine and Rehabilitation, Charlestown, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924)
2 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
3 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University School of Public Health, Department of Biostatistics, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
4 Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X)
5 University of Colorado Denver Anschutz Medical Campus, Center for Bioethics and Humanities, Aurora, USA (GRID:grid.430503.1) (ISNI:0000 0001 0703 675X); University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, USA (GRID:grid.430503.1) (ISNI:0000 0001 0703 675X)
6 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, USA (GRID:grid.410370.1) (ISNI:0000 0004 4657 1992); Department of Veterans Affairs Medical Center, Bedford, USA (GRID:grid.414326.6) (ISNI:0000 0001 0626 1381); Boston University Chobanian & Avedisian School of Medicine, Department of Pathology and Laboratory Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
7 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Department of Veterans Affairs Medical Center, Bedford, USA (GRID:grid.414326.6) (ISNI:0000 0001 0626 1381)
8 Boston University School of Public Health, Department of Epidemiology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
9 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Concussion Legacy Foundation, Boston, USA (GRID:grid.189504.1)
10 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Concussion Legacy Foundation, Boston, USA (GRID:grid.189504.1); Boston University Chobanian & Avedisian School of Medicine, Department of Neurosurgery, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Emerson Hospital, Department of Neurosurgery, Concord, USA (GRID:grid.414500.4) (ISNI:0000 0004 0426 3713)
11 Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Massachusetts General Hospital, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924); Mass General Brigham-Spaulding Rehabilitation, Department of Physical Medicine and Rehabilitation, Charlestown, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924); Brigham and Women’s Hospital, Department of Physical Medicine and Rehabilitation, Boston, USA (GRID:grid.62560.37) (ISNI:0000 0004 0378 8294)
12 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Neurology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
13 Icahn School of Medicine at Mount Sinai, Neuropathology Brain Bank & Research Core, Department of Pathology, Nash Family Department of Neuroscience, Ronald M. Loeb Center for Alzheimer’s Disease, Friedman Brain Institute, New York, USA (GRID:grid.59734.3c) (ISNI:0000 0001 0670 2351)
14 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Neurosurgery, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Neurology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Anatomy & Neurobiology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
15 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, USA (GRID:grid.410370.1) (ISNI:0000 0004 4657 1992); Department of Veterans Affairs Medical Center, Bedford, USA (GRID:grid.414326.6) (ISNI:0000 0001 0626 1381); Boston University Chobanian & Avedisian School of Medicine, Department of Pathology and Laboratory Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Neurology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
16 Boston University Alzheimer’s Disease Research and CTE Centers, Boston University Chobanian & Avedisian School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Department of Neurology, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558); Boston University Chobanian & Avedisian School of Medicine, Framingham Heart Study, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)