New study reveals number and strength of head impacts, not concussions, drive CTE risk in football MassGenBrigham NatureComms
. Future work should explore different thresholds for counting hits, to further characterize the nature of head impacts most responsible for CTE pathology.
The position an athlete plays serves as a proxy for the RHI exposure experienced. The fact that position at the highest level was not associated with CTE status, CTE severity, or NFT burden , whereas cumulative measures incorporating position were, suggests that one single position inadequately represents an athlete’s lifetime RHI exposure.
This study has several limitations. The study consists of a convenience sample of football playing brain donors, who tend to have greater exposure to RHI than the general population of football players. Even the athletes with lower years of exposure to football often had exposure to RHI from other sources, including other contact sports or military service, which were not characterized in this study.
There are several sources of potential measurement error related to the cumulative RHI exposure measures: These measures were not observed directly while the donors were alive, but instead extrapolated from helmet accelerometer studies of other recent football players. Additionally, play style has changed over decades, and many of the donors played decades ago, but the extrapolated data do not reflect these changes.
This work utilized a PEM to better characterize which components of RHI exposure from football play may be implicated in CTE pathology. Models incorporating impact intensity, in addition to duration of exposure and number of impacts, improved model fit and prediction of CTE pathology compared with models without impact intensity.
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