eprintid: 1537258 rev_number: 70 eprint_status: archive userid: 608 dir: disk0/01/53/72/58 datestamp: 2017-01-24 11:38:51 lastmod: 2021-09-30 22:48:56 status_changed: 2017-04-10 16:07:05 type: article metadata_visibility: show creators_name: Ling, H creators_name: Morris, HR creators_name: Neal, JW creators_name: Lees, A creators_name: Hardy, J creators_name: Holton, JL creators_name: Revesz, T creators_name: Williams, DDR title: Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired Association football (soccer) players ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F84 divisions: F86 keywords: chronic traumatic encephalopathy, soccer, football, heading, traumatic brain injury, concussion, tauopathy note: Copyright © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. abstract: In retired professional Association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career and concussion history were prospectively collected. Next-of-kin consented for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N=6), TDP-43 (N=6), cerebral amyloid angiopathy (N=5), hippocampal sclerosis (N=2), corticobasal degeneration (N=1), dementia with Lewy bodies (N=1) and vascular pathology (N=1), all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association Football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation including large scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies. date: 2017-03 date_type: published publisher: Springer Verlag (Germany) official_url: http://dx.doi.org/10.1007/s00401-017-1680-3 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green article_type_text: Article verified: verified_manual elements_id: 1203952 doi: 10.1007/s00401-017-1680-3 lyricists_name: Hardy, John lyricists_name: Holton, Janice lyricists_name: Lees, Andrew lyricists_name: Ling, Helen lyricists_name: Morris, Huw lyricists_name: Revesz, Tamas lyricists_name: Smalley, June lyricists_id: JHARD28 lyricists_id: JHOLT26 lyricists_id: AJLEE60 lyricists_id: HLING02 lyricists_id: HRMOR79 lyricists_id: TREVE26 lyricists_id: JASMA87 actors_name: Ling, Helen actors_id: HLING02 actors_role: owner full_text_status: public publication: Acta Neuropathologica volume: 133 number: 3 pagerange: 337-352 issn: 1432-0533 citation: Ling, H; Morris, HR; Neal, JW; Lees, A; Hardy, J; Holton, JL; Revesz, T; Ling, H; Morris, HR; Neal, JW; Lees, A; Hardy, J; Holton, JL; Revesz, T; Williams, DDR; - view fewer <#> (2017) Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired Association football (soccer) players. Acta Neuropathologica , 133 (3) pp. 337-352. 10.1007/s00401-017-1680-3 <https://doi.org/10.1007/s00401-017-1680-3>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/1537258/1/Ling_Mixed_pathologies_including_chronic_traumatic_encephalopathy.pdf