Abstract

BackgroundFactors of increased prevalence among individuals with Black racial identity (e.g., cardiovascular disease, CVD) may influence the association between exposure to repetitive head impacts (RHI) from American football and later-life neurological outcomes. Here, we tested the interaction between racial identity and RHI on neurobehavioral outcomes, brain volumetric measures, and cerebrospinal fluid (CSF) total tau (t-tau), phosphorylated tau (p-tau181), and Aβ1–42 in symptomatic former National Football League (NFL) players.Methods68 symptomatic male former NFL players (ages 40–69; n = 27 Black, n = 41 White) underwent neuropsychological testing, structural MRI, and lumbar puncture. FreeSurfer derived estimated intracranial volume (eICV), gray matter volume (GMV), white matter volume (WMV), subcortical GMV, hippocampal volume, and white matter (WM) hypointensities. Multivariate generalized linear models examined the main effects of racial identity and its interaction with a cumulative head impact index (CHII) on all outcomes. Age, years of education, Wide Range Achievement Test, Fourth Edition (WRAT-4) scores, CVD risk factors, and APOEε4 were included as covariates; eICV was included for MRI models. P-values were false discovery rate adjusted.ResultsCompared to White former NFL players, Black participants were 4 years younger (p = 0.04), had lower WRAT-4 scores (mean difference = 8.03, p = 0.002), and a higher BMI (mean difference = 3.09, p = 0.01) and systolic blood pressure (mean difference = 8.15, p = 0.03). With regards to group differences on the basis of racial identity, compared to White former NFL players, Black participants had lower GMV (mean adjusted difference = 45649.00, p = 0.001), lower right hippocampal volume (mean adjusted difference = 271.96, p = 0.02), and higher p-tau181/t-tau ratio (mean adjusted difference = −0.25, p = 0.01). There was not a statistically significant association between the CHII with GMV, right hippocampal volume, or p-tau181/t-tau ratio. However, there was a statistically significant Race x CHII interaction for GMV (b = 2206.29, p = 0.001), right hippocampal volume (b = 12.07, p = 0.04), and p-tau181/t-tau ratio concentrations (b = −0.01, p = 0.004).ConclusionContinued research on racial neurological disparities could provide insight into risk factors for long-term neurological disorders associated with American football play.

Highlights

  • Continued research on racial neurological disparities could provide insight into risk factors for long-term neurological disorders associated with American football play

  • Exposure to repetitive head impacts (RHI) from contact sports has been associated with later-life neurological disorders, including chronic traumatic encephalopathy (CTE) and other neurodegenerative diseases (McKee et al, 2013, 2016; Bieniek et al, 2015; Ling et al, 2017; Mez et al, 2017b; Adams et al, 2018; Tagge et al, 2018; Alosco et al, 2019a; Stern et al, 2019)

  • In this sample of symptomatic former National Football League (NFL) players, higher levels of exposure to RHI and Black racial identity had an interactive effect on gray matter volume (GMV), right hippocampal volume, and cerebrospinal fluid (CSF) p-tau181/t-tau ratio concentrations

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Summary

Introduction

Exposure to repetitive head impacts (RHI) from contact sports has been associated with later-life neurological disorders, including chronic traumatic encephalopathy (CTE) and other neurodegenerative diseases (McKee et al, 2013, 2016; Bieniek et al, 2015; Ling et al, 2017; Mez et al, 2017b; Adams et al, 2018; Tagge et al, 2018; Alosco et al, 2019a; Stern et al, 2019). Not all individuals exposed to RHI develop neurological disorders (Casson et al, 2014; Solomon et al, 2016; Deshpande et al, 2017; Baker et al, 2018; Willer et al, 2018; Zivadinov et al, 2018) Among those that do, there is heterogeneity in disease presentation, suggesting other risk factors are at play (McKee et al, 2013; Stern et al, 2013; Alosco et al, 2017c, 2018b; Mez et al, 2017b). We tested the interaction between racial identity and RHI on neurobehavioral outcomes, brain volumetric measures, and cerebrospinal fluid (CSF) total tau (t-tau), phosphorylated tau (p-tau181), and Aβ1−42 in symptomatic former National Football League (NFL) players

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