By Michael J. Perrotti, Ph.D., Inc.
Recently, the NFL settled over 4,000 lawsuits by the players. It was reported that the NFL would make enough profits in the first week of the regular season to pay for the settlement! It was reported that an initial lump sum was to be paid over three years and the balance paid in 17 years. It is doubtful that this can ever address the diminished quality of life of the players secondary to effects of brain injury.
As noted by Henry & De Beaumont (2011), the prevailing attitude in sport culture minimizes concussions. The recovery process is elongated with athletes with multiple concussions. Collins et.al. (2002) found that 9.4% of players with no history of TBI were found to have prolonged post-injury mental status. Chargers as opposed to 31.6% (3.36 odds ratio) of players with multiple concussions. Mounting evidence suggests that within the acute phase, athletes who sustained multiple concussions demonstrate increased symptomology. Junior Sean was reported to have told a friend who played soccer that he experienced headaches for years.
Animal studies demonstrate the existence of a temporal window of metabolic brain vulnerability to second in TBI that had unsubstantial adverse effects in mitochondrial related metabolism, Vagnozzi et.al. (2007).
Measurement
Moser & Schatz (2002) and Moser, Schatz, & Jordan (2005) found that high school athletes who had had two or more concussions had performance decrements on neuropsychological testing similar to athletes in the post-concussion phase. Neuropsychological deficits were found to increase concurrently with the number of concussions in soccer players. Wall et.al. (2006) reported significant neuropsychological deficits in younger athletes with Jockeys. High School football players who sustained a previous concussion resulting in loss of consciousness were four times more likely to sustain a grade three injury according to American Academy of neurology (AHN) Guidelines (Gerberich et al., 1983).
Imaging and Repeated Concussions
A large scale study looked at over 300 active amateur boxers. CT scans revealed the presence of a cavum septum pallucidum as a potential marker of brain atrophy and also revealed that it is progressive in nature.
Long Term Effects
DeBeaumuat et.al (2009) found that former hockey and football players, 30 years post-concussion found decreased performance in neurocognitive measures compared to an age matched control group of former athletes. Guskiewicz et.al. (2005) identified that mild cognitive impairment (MCI) rates (converts to a 10 — 20% annual rate into dementia of Alzheimer’s Type) increased as a function of a number of concussions in former NFL players. Players who had three or more concussions had five times the probability of being diagnosed with MCI and three times more likely to manifest marked memory impairments than retired players with no history of concussion. This same study found an earlier onset of Alzheimer’s in concussed retirees than in the general U.S. population. Moreover, former NFL players with a history of multiple concussions were three times more likely to be diagnosed with depression.
Signs of Traumatic Brain Injury (TBI) can involve deficits in the areas of attention, memory, and executive function. Freeman, et.al. (2005) related substantial preparations of subjects with Traumatic Brain Injury manifest agitation and anger 15 years post-injury. This writer has observed many patients in his practice with substantial clinical problems post TBI.
Conclusions
A substantial aggregate of research on repeated blows to the head (sub-concussive or concussive) indicates a stepwise progression of adverse neurological and neuropsychological events involving motor and cognitive symptoms. Corsellis et.al. (1973) and McKee et.al. (2009) have demonstrated histopathological correlates to neurological and neuropsychological symptom complexes.
Recommendations
Unfortunately, in competitive sports, e.g. NFL, concussions are managed as isolated “at the moment” events. Profit and in other cases the players own denial contributes to a trend of continuing and tragic neurological and neuropsychological impairment in the lives of the players. The profound impairment in activities of daily living in the case of Jim McMahon of the Chicago Bears is a great example. He needs to have his girlfriend make his daily appointments. In other cases, such as Alex Smith, players who suffer a concussion and go on to other teams are apparently not offered neurocognitive mediation programming. Alex went on for the 49ers to the Kansas City Chiefs to lead them to an 8 — 0 record.
Previous articles by this author noted the necessity to develop baselines for players that should be implemented at the time of the concussive events. Return to play protocols such as the SLAM protocol developed in 2001 need to be utilized.
Four thousand NFL players filed lawsuits related to the TBI issue. Isn’t this enough? When are we going to learn and apply the science for safer play and longevity for the players? As concussion experts have noted, time, money, and energy on developing helmets to prevent concussion is an illusory and misleading remedy.
Michael J. Perrotti, Ph.D. can be reached at (714) 528-0100 or by visiting his Website at http://www.drmichaelperrotti.com/
References
Collins, M. W., Lovell, M. R., Iverson, G. L., Cantu, R. C., Maroon, J.C., & Field, M. (2002). Cumulative effects of concussion in high school athletes. Neurosurgery, 51, 1175-1179; discussion, 1180-1171.
Corsellis, J. A., Bruton, C. J., & Freeman,-Browne, D. (1973). The aftermath of boxing. Psychological Medicine, 3, 270-303.
De Beaumont, L., Theoret, H., Mongeon, D., Messier, J., Leclerc, S., Tremblay, S., et al. (2009). Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain, 132, 695-708.
Freeman, J.R., Barth, J.T., Broshek, D.K., & Plehn, K. (2005) Sports injuries. In Silver, J.M., McAllister, T.W., & Yudofsky, S.C. (Eds.) Textbook of traumatic brain injury (453-476). Arlington, VA: American Psychiatric Publishing.
Gerberich, S. G., Priest, J. D., Boden, J. R., Straub, C. P., & Maxwell, R. E. (1983). Concussion incidences and severity in secondary school varsity football players. American Journal of Public Health, 73, 1370-1375.
Guskiewicz, K. M., Marshall, S. W., Bailes, J., McCrea, M., Cantu, R. C., Randolph, C., et al. (2005). Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery, 57, 719-726; discussion, 719-726.
Henry, L. C., & De Beaumont, L. (2011). Effects of repeated concussive and subconcussive impacts in sport. In F. M. Webbe (Ed.). The handbook of sport neuropsychology (155-171) New York, NY: Springer Publishing Company.
McKee, A. C., Cantu, R. C., Nowinski, C. J., Heldey-Whyte, E. T., Gavett, B. E., Buddson, A. E., et al. (2009). Chronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neurology, 68, 709-735.
Moser, R. S. & Schatz, P. (2002). Enduring effects of conscussion in youth athletes. Archives of Clinical Neuropsychology, 17, 91-100.
Moser, R. S., Schatz, P., & Jordan, B. D. (2005). Prolonged effects of concussion in high school athletes. Neurosurgery, 57, 300-306; discussion, 300-306.
Vagnozzi, R., Tavazzi, B., Signoretti, S., Amorini, A. M., Belli, A., Cimatti, M., et al. (2007). Temporal window of metabolic brain vulnerability to concussions: Mitochondrial-related impairment — part I. Neurosurgery, 61, 379-388.
Wall, S. E., Williams, W. H., Cartwright-Hatton, S. Kelly, T. P., Murray, J., Murray, M. et al. (2006). Neuropsychological dysfunction following repeat concussions in jockeys. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 518-520.
