Sulcal morphology in former American football players

Repetitive head impacts are associated with structural brain changes and an increased risk for chronic traumatic encephalopathy, a progressive neurodegenerative disease that can only be diagnosed after death. Chronic traumatic encephalopathy is defined by the abnormal accumulation of phosphorylated tau protein, particularly at the depths of the superior frontal sulci, suggesting that sulcal morphology may serve as a relevant structural biomarker. Contact sport athletes, such as former football players, are at elevated risk due to their prolonged exposure to repetitive head impacts. Cortical atrophy linked to underlying tau accumulation may result in shallower and wider sulci, potentially making sulcal morphology an imaging marker for identifying individuals at risk for this disease. This study investigated sulcal morphological differences in former football players and examined associations with age, football-related exposure, clinical diagnosis of traumatic encephalopathy syndrome, levels of certainty for chronic traumatic encephalopathy pathology, neuropsychological performance, and positron emission tomography imaging using flortaucipir. We analysed structural magnetic resonance imaging data from 169 male former football players (mean age 57.2 (8.2) years, range 45-74) and 54 age-matched, unexposed asymptomatic male controls (mean age 59.4 (8.5) years, range 45-74). Sulcal depth and width were quantified using the CalcSulc, focusing on two regions in each hemisphere commonly affected by chronic traumatic encephalopathy pathology: the superior frontal and occipitotemporal sulci. Generalized least squares models were used to assess group differences and interactions with age and football exposure variables, including age of first exposure, total years played, and cumulative head impact exposure. An analysis of covariance evaluated relationships between sulcal morphology, clinical measures, and flortaucipir uptake, adjusting for age, race, body mass index, education, imaging site, apolipoprotein E4 status, and total intracranial volume. Former football players demonstrated significantly shallower sulcal depth in the left superior frontal sulcus compared to unexposed controls. Earlier age of first exposure and longer football careers were associated with greater widening of the left occipitotemporal sulcus. Higher cumulative head impact exposure was linked to reduced sulcal depth in the left superior frontal region. However, sulcal morphology was not associated with clinical diagnosis, levels of certainty, neuropsychological test performance, or flortaucipir imaging. These findings suggest that sulcal morphology may reflect cumulative exposure to repetitive head impacts, particularly in brain regions vulnerable to chronic traumatic encephalopathy pathology. Future ante- and post-mortem validation studies are needed to determine whether sulcal morphology can serve as a reliable <i>in vivo</i> biomarker of risk.

Authors

Institutions

Publication Details

Journal
Brain Communications
Published
2025-01-01
DOI
https://doi.org/10.1093/braincomms/fcaf345
Citations
1
Primary Topic
Traumatic Brain Injury Research
Type
article
Field-Weighted Citation Impact
1.35

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Sulcal morphology in former American football players

Michael J. Coleman, Mary Nanna, Sylvain Bouix, Yi Su et al.
1 citations
Brain Communications
Traumatic Brain Injury Research
1.35
article

Sulcal morphology in former American football players

Michael J. Coleman, Mary Nanna, Sylvain Bouix, Yi Su, Jan Durant, Judith D. Goldberg, Tessa Fagle, Katherine M. Breedlove, Christine E. Chaisson, Laura J. Balcer, Tennyson Hunt, Elaine R. Peskind, Douglas I. Katz, Rhoda Au, Alhassan Al-Kharafi, Marci Howard, Vivian Schultz, Brynn Vessey, Sarah Jane Banks, Joseph Palmisano, Lisena Hasanaj, Neil W. Kowall, Charles R. Marmar, Raelynn de la Cruz, Charles H. Adler, Jennifer Fitzsimmons, Debra Babcock, Hector Arcinieago, Robert C. Cantu, Amy Duffy, Hillary Protas, Michelle Montague, Gustavo Mercier, Inga Katharina Koerte, Alexander Lin, Surya Pulukuri, Tashrif Billah, Madison Sestak, J. W. Stearns, Brian Mayville, Kerrin Gallagher, Zachary Baucom, Liliana Serrano, Lindsay A. Farrer, EO Ojo, Christin Nance, Jennifer V. Wethe, Leonard Jung, William Runge, Ofer Pasternak, Yvonne W. Lui, Jenny Gurney, Charles Bernick, Kathleen McLaughlin, Brittany Pine, Irene Simkin, Megan Mariani, Eric M. Reiman, Morgan Golceker, Taylor Platt, Michael D. McClean, Maria Loy, Elizabeth Rizzoni, Nicolette Harmon, James Otis, Kaitlin Hartlage, Nicholas Kim, David W. Dodick, Yonas E. Geda, Jeffrey L. Cummings, Thomas Wısnıewskı, Michael L. Alosco, Jun Lü, William Barr, Nicole Gullotti, Shannon E. Conneely, Carolyn Finney, Sammie Martin, Leonhard Jung, Fatima Tuz‐Zahra, Connie Boker, Daniel H. Daneshvar, Annelise Silva, Edward P. Riley, Robert A. Stern, Douglas S. Annis, Elena M. Bonke, Michael Coleman, Richard M. Greenwald, Jason Miller, Shae Datta, Ivan I. Kirov, Thomas Osgood, Courtney Diamond, Omar John, Brian Im, Alondra Andino, Janani Ramachandran, Robert Helm, Fiona Rice, Tim L. T. Wiegand, Elizabeth A. Colasurdo, Martha E. Shenton, Andrew Serrano, Kaeson Kaylegian, Carina Heller, Rachelle Long, Patrick S.F. Bellgowan, Hector Arciniega, Brett Martin, Jason Weller, Yorghos Tripodis, Marwan N. Sabbagh, Robert Turner, Eduardo Coello, Aaron Ritter, Priscilla Sandoval, Olivia Haller, Keith A. Johnson, Kenneth Marek, Jesse Mez, Kewei Chen, Allan George, Daniel S. Marcus, Huijun Liao, Alana Wickham, Jeffrey L. Cummings, Diane Dixon, Ofer Pasternak, Bryce W. Falk, Anya S Mirmajlesi
article en
1 citations

Abstract

Repetitive head impacts are associated with structural brain changes and an increased risk for chronic traumatic encephalopathy, a progressive neurodegenerative disease that can only be diagnosed after death. Chronic traumatic encephalopathy is defined by the abnormal accumulation of phosphorylated tau protein, particularly at the depths of the superior frontal sulci, suggesting that sulcal morphology may serve as a relevant structural biomarker. Contact sport athletes, such as former football players, are at elevated risk due to their prolonged exposure to repetitive head impacts. Cortical atrophy linked to underlying tau accumulation may result in shallower and wider sulci, potentially making sulcal morphology an imaging marker for identifying individuals at risk for this disease. This study investigated sulcal morphological differences in former football players and examined associations with age, football-related exposure, clinical diagnosis of traumatic encephalopathy syndrome, levels of certainty for chronic traumatic encephalopathy pathology, neuropsychological performance, and positron emission tomography imaging using flortaucipir. We analysed structural magnetic resonance imaging data from 169 male former football players (mean age 57.2 (8.2) years, range 45-74) and 54 age-matched, unexposed asymptomatic male controls (mean age 59.4 (8.5) years, range 45-74). Sulcal depth and width were quantified using the CalcSulc, focusing on two regions in each hemisphere commonly affected by chronic traumatic encephalopathy pathology: the superior frontal and occipitotemporal sulci. Generalized least squares models were used to assess group differences and interactions with age and football exposure variables, including age of first exposure, total years played, and cumulative head impact exposure. An analysis of covariance evaluated relationships between sulcal morphology, clinical measures, and flortaucipir uptake, adjusting for age, race, body mass index, education, imaging site, apolipoprotein E4 status, and total intracranial volume. Former football players demonstrated significantly shallower sulcal depth in the left superior frontal sulcus compared to unexposed controls. Earlier age of first exposure and longer football careers were associated with greater widening of the left occipitotemporal sulcus. Higher cumulative head impact exposure was linked to reduced sulcal depth in the left superior frontal region. However, sulcal morphology was not associated with clinical diagnosis, levels of certainty, neuropsychological test performance, or flortaucipir imaging. These findings suggest that sulcal morphology may reflect cumulative exposure to repetitive head impacts, particularly in brain regions vulnerable to chronic traumatic encephalopathy pathology. Future ante- and post-mortem validation studies are needed to determine whether sulcal morphology can serve as a reliable <i>in vivo</i> biomarker of risk.

Brain CommunicationsVol. 7(5)
Boston University (US), Alzheimer's Association (US), Brigham and Women's Hospital (US), Translational Genomics Research Institute (US), University of Minnesota (US), University of Nevada, Las Vegas (US), Harvard University (US), University of Arizona (US), University of California, Santa Barbara (US), Université du Québec à Montréal (CA), University of Phoenix (US), University of Washington (US), Spaulding Rehabilitation Hospital (US), Lou Ruvo Brain Institute (US), NYU Langone Health (US), Massachusetts General Hospital (US), German Center for Infection Research (DE), Mayo Clinic in Arizona (US), German Centre for Cardiovascular Research (DE), MNGI Digestive Health (US), Arizona State University (US), New York University (US), Ludwig-Maximilians-Universität München (DE), École de Technologie Supérieure (CA)
Alzheimer's Association, National Institute on Minority Health and Health Disparities
Openalex Percentile: Top 15%
Traumatic Brain Injury Research
1.35
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.