. Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery. 2006 Nov 1;59(5):1086-92; discussion 1092-3. PubMed.

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  1. A major contribution of this report is that it sharply focuses attention on the potentially deleterious effects of repeated head trauma in contact sports. The neuropathological findings are consistent with previous reports of what was termed "dementia pugilistica." It is certainly possible that the erratic fluctuations in mood and the severe depression with multiple suicide attempts relate to the widespread cortical and subcortical neuritic pathology. It also is possible that the abnormal behaviors in life resulted from unrelated psychopathology that may or may not have been exacerbated by steroid use. The authors correctly consider these alternatives, and make a much-needed call to systematically conduct clinico-pathological studies of individuals involved in these contact sports. The clear demonstration that neuropathological lesions can be associated with such sports underscores the paucity of data regarding the possible neuropsychiatric consequences. Full understanding of these consequences is needed to implement appropriate measures to ensure the safety of the participants.

  2. Repeated traumatic brain injury (TBI) in tau transgenic mice variably induces accelerated tangle formation. Moreover, the evidence that TBI is a robust risk factor for AD is very strong; see Yoshiyama et al., 2005.

    References:

    . Enhanced neurofibrillary tangle formation, cerebral atrophy, and cognitive deficits induced by repetitive mild brain injury in a transgenic tauopathy mouse model. J Neurotrauma. 2005 Oct;22(10):1134-41. PubMed.

  3. Given the similarities between Alzheimer disease and dementia pugilistica, we studied retired boxers in the late 1990s. We found that when we standardized for technical knockouts, boxers who were becoming demented were the ones who carried ApoE4 alleles, just as one might predict (Jordan et al., 1997). This raises the question of whether boxers and footballers should be genotyped before committing to a career in these sports. Neither the boxing nor football associations welcome this prospect.

    We also published a case report of a famous boxer, whose name we are not at liberty to disclose, who died of amyloid angiopathy (Jordan et al., 1995). From the perspective of the field of neurodegeneration research, the link between repeated mild brain trauma and degenerative changes in subsequent years is beyond dispute.

    References:

    . Apolipoprotein E epsilon4 associated with chronic traumatic brain injury in boxing. JAMA. 1997 Jul 9;278(2):136-40. PubMed.

    . Apolipoprotein E epsilon 4 and fatal cerebral amyloid angiopathy associated with dementia pugilistica. Ann Neurol. 1995 Oct;38(4):698-9. PubMed.