Data_Sheet_1_Comprehensive Neuropsychiatric and Cognitive Characterization of Former Professional Football Players: Implications for Neurorehabilitation.docx

Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms.
Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports.
Design: Between-groups analyses.
Main measures:Neuropsychiatric. Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive. Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task).
Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions (x̄=6.1), but not former players with ≤ 3 concussions (x̄=2.0), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task.
Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.

研究目的：本研究旨在为存在远期多发性脑震荡病史的人群识别神经康复的新型靶点，具体通过以下三项内容实现：（1）全面表征前职业足球运动员的神经精神与认知功能，重点关注执行功能；（2）区分脑震荡相关异常表现与职业足球运动员的病前/队列特征；（3）探索执行功能与神经精神症状之间的关联。
研究对象：共纳入61名功能完好的前职业足球运动员，以及31名年龄、性别匹配的对照受试者，后者无脑震荡病史且未参与接触性运动。
研究设计：采用组间分析设计。
主要测量工具：
神经精神评估：人格评估量表（Personality Assessment Inventory, PAI）临床分量表及攻击性治疗考虑分量表；迷你国际神经精神访谈（Mini International Neuropsychiatric Interview, MINI）。
认知评估：采用全面的临床神经心理学成套测验，涵盖言语与视觉空间注意、加工速度与记忆、当前及预估病前智商，以及执行功能，其中包含两项针对该人群的新型实验任务指标：即去/不去任务（go/no-go task）中的反应抑制与反应不一致性。
研究结果：（1）与对照受试者相比，前职业足球运动员在PAI抑郁、躁狂及攻击分量表上的得分显著更高，而在反应抑制任务中的表现显著更差。（2）相较于对照组，脑震荡次数＞3次（平均次数x̄=6.1）的前球员，而非脑震荡次数≤3次（平均次数x̄=2.0）的前球员，表现出以下特征：①PAI抑郁分量表得分显著更高；②整体迷你国际神经精神访谈临床诊断率显著更高，且躁狂/轻躁狂发作的比例显著升高；③执行功能表现显著更差。（3）中介分析显示，脑震荡暴露量通过去/不去任务中的反应不一致性，对PAI抑郁、躁狂及攻击分量表得分产生显著的间接效应。
研究结论：本研究观察到前职业足球运动员存在显著的神经精神功能损害，且在一项敏感性较高的执行功能实验任务中表现更差；上述异常既与脑震荡病史相关，也与病前（队列）特征有关。因此，对于存在远期多发性脑震荡病史的人群，应仔细评估其神经精神与执行功能状况。此外，前球员的神经精神症状与反应不一致性存在关联，这提示针对反应不一致性的治疗手段或许可缓解其神经精神功能障碍。