Examination of parkinsonism in former elite American football players
Authors
Michael L. Alosco, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Charles H. Adler, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA. Electronic address: cadler@mayo.edu.
David W. Dodick, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Yorghos Tripodis, Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Laura J. Balcer, Departments of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.
Charles Bernick, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
Sarah J. Banks, Departments of Neuroscience and Psychiatry, University of California, San Diego, CA, USA.
William B. Barr, Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.
Jennifer V. Wethe, Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Joseph N. Palmisano, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Brett Martin, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Kaitlin Hartlage, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Robert C. Cantu, Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Yonas E. Geda, Barrow Neurological Institute, Phoenix, AZ, USA.
Douglas I. Katz, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Jesse Mez, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Framingham Heart Study, Framingham, MA, USA.
Jeffery L. Cummings, Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
Martha E. Shenton, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, And Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Eric M. Reiman, Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA.
Robert A. Stern, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian, Boston, MA, USA.
Abstract
BACKGROUND: Former American football players are at risk for chronic traumatic encephalopathy (CTE) which may have parkinsonism as a clinical feature. OBJECTIVE: Former football players were prospectively assessed for parkinsonism. METHODS: 120 former professional football players, 58 former college football players, and 60 same-age asymptomatic men without repetitive head impacts, 45-74 years, were studied using the MDS-UPDRS to assess for parkinsonism, and the Timed Up and Go (TUG). Traumatic encephalopathy syndrome (TES), the clinical syndrome of CTE, was adjudicated and includes parkinsonism diagnosis. Fisher's Exact Test compared groups on parkinsonism due to small cell sizes; analysis of covariance or linear regressions controlling for age and body mass index were used otherwise. RESULTS: Twenty-two (12.4%) football players (13.3% professional, 10.3% college) met parkinsonism criteria compared with two (3.3%) in the unexposed group. Parkinsonism was higher in professional (p = 0.037) but not college players (p = 0.16). There were no differences on the MDS-UPDRS Part III total scores. Scores on the individual MDS-UPDRS items were low. TUG times were longer in former professional but not college players compared with unexposed men (13.09 versus 11.35 s, p < 0.01). There were no associations between years of football, age of first exposure, position or level of play on motor outcomes. TES status was not associated with motor outcomes. CONCLUSIONS: Parkinsonism rates in this sample of football players was low and highest in the professional football players. The association between football and parkinsonism is inconclusive and depends on factors related to sample selection, comparison groups, and exposure characteristics.
Publication Date
11-14-2023
Publication Title
Parkinsonism & related disorders
Digital Object Identifier (DOI)
10.1016/j.parkreldis.2023.105903
Recommended Citation
Alosco, Michael L.; Adler, Charles H.; Dodick, David W.; Tripodis, Yorghos; Balcer, Laura J.; Bernick, Charles; Banks, Sarah J.; Barr, William B.; Wethe, Jennifer V.; Palmisano, Joseph N.; Martin, Brett; Hartlage, Kaitlin; Cantu, Robert C.; Geda, Yonas E.; Katz, Douglas I.; Mez, Jesse; Cummings, Jeffery L.; Shenton, Martha E.; Reiman, Eric M.; and Stern, Robert A., "Examination of parkinsonism in former elite American football players" (2023). Neurology. 1704.
https://scholar.barrowneuro.org/neurology/1704
