Abstract
Concussion or mild traumatic brain injury (mTBI) in athletes can cause persistent symptoms, known as post-concussion syndrome (PCS), and repeated injuries may increase the long-term risk for an athlete to develop neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), and Alzheimer’s disease (AD). The Center for Disease Control estimates that up to 3.8 million sport-related mTBI are reported each year in the United States. Despite the magnitude of the phenomenon, there is a current lack of comprehensive prognostic indicators and research has shown that available monitoring tools are moderately sensitive to short-term concussion effects but less sensitive to long-term consequences. The overall aim of this review is to discuss novel, quantitative, and objective measurements that can predict long-term outcomes following repeated sports-related mTBIs. The specific objectives were (1) to provide an overview of the current clinical and biomechanical tools available to health practitioners to ensure recovery after mTBIs, (2) to synthesize potential biological mechanisms in animal models underlying the long-term adverse consequences of mTBIs, (3) to discuss the possible link between repeated mTBI and neurodegenerative diseases, and (4) to discuss the current knowledge about fluid biomarkers for mTBIs with a focus on novel exosomal biomarkers. The conclusions from this review are that current post-concussion clinical tests are not sufficiently sensitive to injury and do not accurately quantify post-concussion alterations associated with repeated mTBIs. In the current review, it is proposed that current practices should be amended to include a repeated symptom inventory, a cognitive assessment of executive function and impulse control, an instrumented assessment of balance, vestibulo-ocular assessments, and an improved panel of blood or exosome biomarkers.
Highlights
IntroductionUp to 3.8 million sports-related concussions (mild traumatic brain injury; hereafter referred to as mTBI) are diagnosed annually in the United States; it is estimated that only 50% of mTBIs are reported (Broglio et al, 2017; Iverson et al, 2017)
Up to 3.8 million sports-related concussions are diagnosed annually in the United States; it is estimated that only 50% of mild traumatic brain injury (mTBI) are reported (Broglio et al, 2017; Iverson et al, 2017)
While other potential biomarkers exist such as Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI) modalities, and computerized electroencephalogram (EEG), this review focuses solely on fluid biomarkers including exosomes
Summary
Up to 3.8 million sports-related concussions (mild traumatic brain injury; hereafter referred to as mTBI) are diagnosed annually in the United States; it is estimated that only 50% of mTBIs are reported (Broglio et al, 2017; Iverson et al, 2017). Psychological symptoms including depression, irritability, and anxiety are common Cognitive problems such as memory loss, poor concentration, and reduced problem-solving skills can persist over time (McIinnes et al, 2017; Howell et al, 2018a). Studies have identified a number of risk factors including age, sex, learning issues, history of migraine that could influence development of PCS (Iverson et al, 2017) Both acute and chronic PCS have been identified in the literature, each presenting with unique health concerns (Tagge et al, 2018; Yin et al, 2019; Scott et al, 2020). Development of novel assessment tools is needed to better quantify injury in the short-term and to fully understand the long-term consequences of mTBIs for brain health
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