Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L
Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article
In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting
@article{Silverberg2016,
title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},
author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},
doi = {10.1097/JSM.0000000000000241},
year = {2016},
date = {2016-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {26},
number = {3},
pages = {226--231},
abstract = {Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting},
pubstate = {published},
tppubtype = {article}
}
Phillips, S; Woessner, D
Sports-Related Traumatic Brain Injury Journal Article
In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.
Abstract | Links | BibTeX | Tags: Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed
@article{Phillips2015b,
title = {Sports-Related Traumatic Brain Injury},
author = {Phillips, S and Woessner, D},
doi = {10.1016/j.pop.2015.01.010},
year = {2015},
date = {2015-01-01},
journal = {Primary Care - Clinics in Office Practice},
volume = {42},
number = {2},
pages = {243--248},
abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},
keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Stone Jr., M E; Safadjou, S; Farber, B; Velazco, N; Man, J; Reddy, S H; Todor, R; Teperman, S
Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 147–151, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult
@article{StoneJr.2015,
title = {Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population},
author = {{Stone Jr.}, M E and Safadjou, S and Farber, B and Velazco, N and Man, J and Reddy, S H and Todor, R and Teperman, S},
doi = {10.1097/TA.0000000000000679},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {1},
pages = {147--151},
abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population. METHODS: From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion. RESULTS: There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65. CONCLUSION: The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population. LEVEL OF EVIDENCE: Diagnostic study, level II. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Stein, T D; Alvarez, V E; McKee, A C
Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel Journal Article
In: Alzheimer's Research and Therapy, vol. 6, no. 1, 2014.
Abstract | Links | BibTeX | Tags: Aggression, Alzheimer disease, amnesia, army, astrocyte, athlete, behavior change, brain atrophy, brain stem, brain weight, central sulcus, chronic disease, Chronic Traumatic Encephalopathy TAR DNA binding p, cognitive defect, comorbidity, Dementia, depression, diencephalon, diffuse Lewy body disease, exposure, frontotemporal dementia, human, impulsiveness, irritability, Motor neuron disease, nerve fiber, neurite, neurofibrillary tangle, neuropathology, nonhuman, personality disorder, priority journal, Review, short term memory, soldier, staging, suicidal ideation, tau protein, tauopathy, temporal lobe, traumatic brain injury, veteran
@article{Stein2014,
title = {Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel},
author = {Stein, T D and Alvarez, V E and McKee, A C},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84892718392\&partnerID=40\&md5=c39a0e58ad33cee7a570b4681131d6ea},
doi = {10.1186/alzrt234},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {1},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive traumatic brain injury experienced in sport and military service. In most instances, the clinical symptoms of the disease begin after a long period of latency ranging from several years to several decades. The initial symptoms are typically insidious, consisting of irritability, impulsivity, aggression, depression, short-term memory loss and heightened suicidality. The symptoms progress slowly over decades to include cognitive deficits and dementia. The pathology of CTE is characterized by the accumulation of phosphorylated tau protein in neurons and astrocytes in a pattern that is unique from other tauopathies, including Alzheimer's disease. The hyperphosphorylated tau abnormalities begin focally, as perivascular neurofibrillary tangles and neurites at the depths of the cerebral sulci, and then spread to involve superficial layers of adjacent cortex before becoming a widespread degeneration affecting medial temporal lobe structures, diencephalon and brainstem. Most instances of CTE (\>85% of cases) show abnormal accumulations of phosphorylated 43 kDa TAR DNA binding protein that are partially colocalized with phosphorylated tau protein. As CTE is characterized pathologically by frontal and temporal lobe atrophy, by abnormal deposits of phosphorylated tau and by 43 kDa TAR DNA binding protein and is associated clinically with behavioral and personality changes, as well as cognitive impairments, CTE is increasingly categorized as an acquired frontotemporal lobar degeneration. Currently, some of the greatest challenges are that CTE cannot be diagnosed during life and the incidence and prevalence of the disorder remain uncertain. Furthermore, the contribution of age, gender, genetics, stress, alcohol and substance abuse to the development of CTE remains to be determined. © 2014 BioMed Central Ltd.},
keywords = {Aggression, Alzheimer disease, amnesia, army, astrocyte, athlete, behavior change, brain atrophy, brain stem, brain weight, central sulcus, chronic disease, Chronic Traumatic Encephalopathy TAR DNA binding p, cognitive defect, comorbidity, Dementia, depression, diencephalon, diffuse Lewy body disease, exposure, frontotemporal dementia, human, impulsiveness, irritability, Motor neuron disease, nerve fiber, neurite, neurofibrillary tangle, neuropathology, nonhuman, personality disorder, priority journal, Review, short term memory, soldier, staging, suicidal ideation, tau protein, tauopathy, temporal lobe, traumatic brain injury, veteran},
pubstate = {published},
tppubtype = {article}
}
Montenigro, P H; Baugh, C M; Daneshvar, D H; Mez, J; Budson, A E; Au, R; Katz, D I; Cantu, R C; Stern, R A
In: Alzheimer's Research and Therapy, vol. 6, no. 5-8, 2014.
Abstract | Links | BibTeX | Tags: Anxiety, apathy, ataxia, ataxic gait, attention, attention disturbance, behavior disorder, blunted affect, Boxing, chronic brain disease, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy aggression, clinical feature, clonus, cognitive defect, contact sport, delusion, Dementia, depression, depth perception, differential diagnosis, disease classification, dysarthria, dysgraphia, euphoria, executive function, fatigue, football, hopelessness, human, ice hockey, impulsiveness, insomnia, intelligence, irritability, language disability, mania, medical literature, memory disorder, mental concentration, mental instability, mood disorder, muscle weakness, neurologic gait disorder, paranoia, Parkinsonism, personality disorder, physical violence, preventive medicine, psychosis, Research Diagnostic Criteria, Review, risk factor, shuffling gait, social disability, social isolation, spastic gait, spasticity, speech disorder, sport injury, suicidal ideation, traumatic brain injury, traumatic encephalopathy syndrome, tremor, unsteady gait, violence, wrestling
@article{Montenigro2014,
title = {Clinical subtypes of chronic traumatic encephalopathy: Literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome},
author = {Montenigro, P H and Baugh, C M and Daneshvar, D H and Mez, J and Budson, A E and Au, R and Katz, D I and Cantu, R C and Stern, R A},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84908410645\&partnerID=40\&md5=bab59baeecd5adb22d0f84a4ce99bd5c},
doi = {10.1186/s13195-014-0068-z},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {5-8},
abstract = {The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders. © 2014 Montenigro et al.; licensee BioMed Central Ltd.},
keywords = {Anxiety, apathy, ataxia, ataxic gait, attention, attention disturbance, behavior disorder, blunted affect, Boxing, chronic brain disease, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy aggression, clinical feature, clonus, cognitive defect, contact sport, delusion, Dementia, depression, depth perception, differential diagnosis, disease classification, dysarthria, dysgraphia, euphoria, executive function, fatigue, football, hopelessness, human, ice hockey, impulsiveness, insomnia, intelligence, irritability, language disability, mania, medical literature, memory disorder, mental concentration, mental instability, mood disorder, muscle weakness, neurologic gait disorder, paranoia, Parkinsonism, personality disorder, physical violence, preventive medicine, psychosis, Research Diagnostic Criteria, Review, risk factor, shuffling gait, social disability, social isolation, spastic gait, spasticity, speech disorder, sport injury, suicidal ideation, traumatic brain injury, traumatic encephalopathy syndrome, tremor, unsteady gait, violence, wrestling},
pubstate = {published},
tppubtype = {article}
}
Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L
Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article
In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.
@article{Silverberg2016,
title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},
author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},
doi = {10.1097/JSM.0000000000000241},
year = {2016},
date = {2016-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {26},
number = {3},
pages = {226--231},
abstract = {Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Phillips, S; Woessner, D
Sports-Related Traumatic Brain Injury Journal Article
In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.
@article{Phillips2015b,
title = {Sports-Related Traumatic Brain Injury},
author = {Phillips, S and Woessner, D},
doi = {10.1016/j.pop.2015.01.010},
year = {2015},
date = {2015-01-01},
journal = {Primary Care - Clinics in Office Practice},
volume = {42},
number = {2},
pages = {243--248},
abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Stone Jr., M E; Safadjou, S; Farber, B; Velazco, N; Man, J; Reddy, S H; Todor, R; Teperman, S
Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 147–151, 2015.
@article{StoneJr.2015,
title = {Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population},
author = {{Stone Jr.}, M E and Safadjou, S and Farber, B and Velazco, N and Man, J and Reddy, S H and Todor, R and Teperman, S},
doi = {10.1097/TA.0000000000000679},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {1},
pages = {147--151},
abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population. METHODS: From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion. RESULTS: There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65. CONCLUSION: The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population. LEVEL OF EVIDENCE: Diagnostic study, level II. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Stein, T D; Alvarez, V E; McKee, A C
Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel Journal Article
In: Alzheimer's Research and Therapy, vol. 6, no. 1, 2014.
@article{Stein2014,
title = {Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel},
author = {Stein, T D and Alvarez, V E and McKee, A C},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84892718392\&partnerID=40\&md5=c39a0e58ad33cee7a570b4681131d6ea},
doi = {10.1186/alzrt234},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {1},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive traumatic brain injury experienced in sport and military service. In most instances, the clinical symptoms of the disease begin after a long period of latency ranging from several years to several decades. The initial symptoms are typically insidious, consisting of irritability, impulsivity, aggression, depression, short-term memory loss and heightened suicidality. The symptoms progress slowly over decades to include cognitive deficits and dementia. The pathology of CTE is characterized by the accumulation of phosphorylated tau protein in neurons and astrocytes in a pattern that is unique from other tauopathies, including Alzheimer's disease. The hyperphosphorylated tau abnormalities begin focally, as perivascular neurofibrillary tangles and neurites at the depths of the cerebral sulci, and then spread to involve superficial layers of adjacent cortex before becoming a widespread degeneration affecting medial temporal lobe structures, diencephalon and brainstem. Most instances of CTE (\>85% of cases) show abnormal accumulations of phosphorylated 43 kDa TAR DNA binding protein that are partially colocalized with phosphorylated tau protein. As CTE is characterized pathologically by frontal and temporal lobe atrophy, by abnormal deposits of phosphorylated tau and by 43 kDa TAR DNA binding protein and is associated clinically with behavioral and personality changes, as well as cognitive impairments, CTE is increasingly categorized as an acquired frontotemporal lobar degeneration. Currently, some of the greatest challenges are that CTE cannot be diagnosed during life and the incidence and prevalence of the disorder remain uncertain. Furthermore, the contribution of age, gender, genetics, stress, alcohol and substance abuse to the development of CTE remains to be determined. © 2014 BioMed Central Ltd.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Montenigro, P H; Baugh, C M; Daneshvar, D H; Mez, J; Budson, A E; Au, R; Katz, D I; Cantu, R C; Stern, R A
In: Alzheimer's Research and Therapy, vol. 6, no. 5-8, 2014.
@article{Montenigro2014,
title = {Clinical subtypes of chronic traumatic encephalopathy: Literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome},
author = {Montenigro, P H and Baugh, C M and Daneshvar, D H and Mez, J and Budson, A E and Au, R and Katz, D I and Cantu, R C and Stern, R A},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84908410645\&partnerID=40\&md5=bab59baeecd5adb22d0f84a4ce99bd5c},
doi = {10.1186/s13195-014-0068-z},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {5-8},
abstract = {The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders. © 2014 Montenigro et al.; licensee BioMed Central Ltd.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Silverberg, N D; Berkner, P D; Atkins, J E; Zafonte, R; Iverson, G L
Relationship between Short Sleep Duration and Preseason Concussion Testing Journal Article
In: Clinical Journal of Sport Medicine, vol. 26, no. 3, pp. 226–231, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting
@article{Silverberg2016,
title = {Relationship between Short Sleep Duration and Preseason Concussion Testing},
author = {Silverberg, N D and Berkner, P D and Atkins, J E and Zafonte, R and Iverson, G L},
doi = {10.1097/JSM.0000000000000241},
year = {2016},
date = {2016-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {26},
number = {3},
pages = {226--231},
abstract = {Objective: Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Design: Cross-sectional observation study. Setting: Preseason concussion testing for high school athletes. Participants: A large sample (n 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Assessment of Risk Factors: Athletes were divided into 4 groups based on their sleep duration the night before testing. Main Outcome Measures: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Results: Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Conclusions: Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinical Relevance: Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, Article, Athletes, balance disorder, brain concussion, cognition, cognition assessment, cohort analysis, cross-sectional study, descriptive research, Dizziness, drowsiness, emotionality, fatigue, Female, headache, high school, human, human experiment, Immediate Post Concussion Assessment and Cognitive, irritability, Male, memory disorder, mental concentration, nausea, nervousness, neuropsychological test, night sleep, normal human, observational study, paresthesia, Post Concussion Symptom Scale, postconcussion syndrome, priority journal, response time, sadness, sex difference, sleep deprivation, sleep disorder, sleep initiation and maintenance disorders, sleep time, UNITED States, verbal memory, visual disorder, visual memory, vomiting},
pubstate = {published},
tppubtype = {article}
}
Phillips, S; Woessner, D
Sports-Related Traumatic Brain Injury Journal Article
In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.
Abstract | Links | BibTeX | Tags: Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed
@article{Phillips2015b,
title = {Sports-Related Traumatic Brain Injury},
author = {Phillips, S and Woessner, D},
doi = {10.1016/j.pop.2015.01.010},
year = {2015},
date = {2015-01-01},
journal = {Primary Care - Clinics in Office Practice},
volume = {42},
number = {2},
pages = {243--248},
abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},
keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Stone Jr., M E; Safadjou, S; Farber, B; Velazco, N; Man, J; Reddy, S H; Todor, R; Teperman, S
Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population Journal Article
In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 147–151, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult
@article{StoneJr.2015,
title = {Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population},
author = {{Stone Jr.}, M E and Safadjou, S and Farber, B and Velazco, N and Man, J and Reddy, S H and Todor, R and Teperman, S},
doi = {10.1097/TA.0000000000000679},
year = {2015},
date = {2015-01-01},
journal = {Journal of Trauma and Acute Care Surgery},
volume = {79},
number = {1},
pages = {147--151},
abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population. METHODS: From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion. RESULTS: There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65. CONCLUSION: The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population. LEVEL OF EVIDENCE: Diagnostic study, level II. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Stein, T D; Alvarez, V E; McKee, A C
Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel Journal Article
In: Alzheimer's Research and Therapy, vol. 6, no. 1, 2014.
Abstract | Links | BibTeX | Tags: Aggression, Alzheimer disease, amnesia, army, astrocyte, athlete, behavior change, brain atrophy, brain stem, brain weight, central sulcus, chronic disease, Chronic Traumatic Encephalopathy TAR DNA binding p, cognitive defect, comorbidity, Dementia, depression, diencephalon, diffuse Lewy body disease, exposure, frontotemporal dementia, human, impulsiveness, irritability, Motor neuron disease, nerve fiber, neurite, neurofibrillary tangle, neuropathology, nonhuman, personality disorder, priority journal, Review, short term memory, soldier, staging, suicidal ideation, tau protein, tauopathy, temporal lobe, traumatic brain injury, veteran
@article{Stein2014,
title = {Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel},
author = {Stein, T D and Alvarez, V E and McKee, A C},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84892718392\&partnerID=40\&md5=c39a0e58ad33cee7a570b4681131d6ea},
doi = {10.1186/alzrt234},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {1},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive traumatic brain injury experienced in sport and military service. In most instances, the clinical symptoms of the disease begin after a long period of latency ranging from several years to several decades. The initial symptoms are typically insidious, consisting of irritability, impulsivity, aggression, depression, short-term memory loss and heightened suicidality. The symptoms progress slowly over decades to include cognitive deficits and dementia. The pathology of CTE is characterized by the accumulation of phosphorylated tau protein in neurons and astrocytes in a pattern that is unique from other tauopathies, including Alzheimer's disease. The hyperphosphorylated tau abnormalities begin focally, as perivascular neurofibrillary tangles and neurites at the depths of the cerebral sulci, and then spread to involve superficial layers of adjacent cortex before becoming a widespread degeneration affecting medial temporal lobe structures, diencephalon and brainstem. Most instances of CTE (\>85% of cases) show abnormal accumulations of phosphorylated 43 kDa TAR DNA binding protein that are partially colocalized with phosphorylated tau protein. As CTE is characterized pathologically by frontal and temporal lobe atrophy, by abnormal deposits of phosphorylated tau and by 43 kDa TAR DNA binding protein and is associated clinically with behavioral and personality changes, as well as cognitive impairments, CTE is increasingly categorized as an acquired frontotemporal lobar degeneration. Currently, some of the greatest challenges are that CTE cannot be diagnosed during life and the incidence and prevalence of the disorder remain uncertain. Furthermore, the contribution of age, gender, genetics, stress, alcohol and substance abuse to the development of CTE remains to be determined. © 2014 BioMed Central Ltd.},
keywords = {Aggression, Alzheimer disease, amnesia, army, astrocyte, athlete, behavior change, brain atrophy, brain stem, brain weight, central sulcus, chronic disease, Chronic Traumatic Encephalopathy TAR DNA binding p, cognitive defect, comorbidity, Dementia, depression, diencephalon, diffuse Lewy body disease, exposure, frontotemporal dementia, human, impulsiveness, irritability, Motor neuron disease, nerve fiber, neurite, neurofibrillary tangle, neuropathology, nonhuman, personality disorder, priority journal, Review, short term memory, soldier, staging, suicidal ideation, tau protein, tauopathy, temporal lobe, traumatic brain injury, veteran},
pubstate = {published},
tppubtype = {article}
}
Montenigro, P H; Baugh, C M; Daneshvar, D H; Mez, J; Budson, A E; Au, R; Katz, D I; Cantu, R C; Stern, R A
In: Alzheimer's Research and Therapy, vol. 6, no. 5-8, 2014.
Abstract | Links | BibTeX | Tags: Anxiety, apathy, ataxia, ataxic gait, attention, attention disturbance, behavior disorder, blunted affect, Boxing, chronic brain disease, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy aggression, clinical feature, clonus, cognitive defect, contact sport, delusion, Dementia, depression, depth perception, differential diagnosis, disease classification, dysarthria, dysgraphia, euphoria, executive function, fatigue, football, hopelessness, human, ice hockey, impulsiveness, insomnia, intelligence, irritability, language disability, mania, medical literature, memory disorder, mental concentration, mental instability, mood disorder, muscle weakness, neurologic gait disorder, paranoia, Parkinsonism, personality disorder, physical violence, preventive medicine, psychosis, Research Diagnostic Criteria, Review, risk factor, shuffling gait, social disability, social isolation, spastic gait, spasticity, speech disorder, sport injury, suicidal ideation, traumatic brain injury, traumatic encephalopathy syndrome, tremor, unsteady gait, violence, wrestling
@article{Montenigro2014,
title = {Clinical subtypes of chronic traumatic encephalopathy: Literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome},
author = {Montenigro, P H and Baugh, C M and Daneshvar, D H and Mez, J and Budson, A E and Au, R and Katz, D I and Cantu, R C and Stern, R A},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84908410645\&partnerID=40\&md5=bab59baeecd5adb22d0f84a4ce99bd5c},
doi = {10.1186/s13195-014-0068-z},
year = {2014},
date = {2014-01-01},
journal = {Alzheimer's Research and Therapy},
volume = {6},
number = {5-8},
abstract = {The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders. © 2014 Montenigro et al.; licensee BioMed Central Ltd.},
keywords = {Anxiety, apathy, ataxia, ataxic gait, attention, attention disturbance, behavior disorder, blunted affect, Boxing, chronic brain disease, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy aggression, clinical feature, clonus, cognitive defect, contact sport, delusion, Dementia, depression, depth perception, differential diagnosis, disease classification, dysarthria, dysgraphia, euphoria, executive function, fatigue, football, hopelessness, human, ice hockey, impulsiveness, insomnia, intelligence, irritability, language disability, mania, medical literature, memory disorder, mental concentration, mental instability, mood disorder, muscle weakness, neurologic gait disorder, paranoia, Parkinsonism, personality disorder, physical violence, preventive medicine, psychosis, Research Diagnostic Criteria, Review, risk factor, shuffling gait, social disability, social isolation, spastic gait, spasticity, speech disorder, sport injury, suicidal ideation, traumatic brain injury, traumatic encephalopathy syndrome, tremor, unsteady gait, violence, wrestling},
pubstate = {published},
tppubtype = {article}
}