Altered Neurochemistry in Former Professional Soccer Players without a History of Concussion

Abstract

Soccer is played by more than 250 million people worldwide. Repeatedly heading the ball may place soccer players at high risk for repetitive subconcussive head impacts (RSHI). This study evaluates the long-term effects of RSHI on neurochemistry in athletes without a history of clinically diagnosed concussion, but with a high exposure to RSHI. Eleven former professional soccer players (mean age 52.0±6.8 years) and a comparison cohort of 14 age- and gender-matched, former non-contact sport athletes (mean age 46.9±7.9 years) underwent 3T magnetic resonance spectroscopy (MRS) and neurocognitive evaluation. In the soccer players a significant increase was observed in both choline (Cho), a membrane marker, and myo-inositol (ml), a marker of glial activation, compared with control athletes. Additionally, ml and glutathione (GSH) were significantly correlated with lifetime estimate of RSHI within the soccer group. There was no significant difference in neurocognitive tests between groups. Results of this study suggest an association between RSHI in soccer players and MRS markers of neuroinflammation, suggesting that even subconcussive head impacts affect the neurochemistry of the brain and may precede neurocognitive changes. Future studies will need to determine the role of neuroinflammation in RSHI and the effect on neurocognitive function.

Keywords: MR spectroscopy; brain metabolism; repetitive subconcussive brain trauma; soccer.

Figures

FIG. 1.

(A) Location of the MRS voxel in the posterior cingulate gyrus, axial plane. (B) coronal plane. (C) Sagittal plane. (D) Representative spectra of a senior soccer player using LCModel for analysis and reconstruction. Cho, choline; CR, creatinine; Glx, glutamate/glutamine; MRS, magnetic resonance spectroscopy; NAA, N-acetyl aspartate. Color image is available online at www.liebertpub.com/neu

FIG. 2.

Stackplot of magnetic resonance spectroscopy (MRS) spectra. All control spectra were averaged together, Fourier transformed, and displayed in a thick blue line. Each individual senior soccer player spectra is shown in red. The average of all of the soccer players is shown in a thick red line. Major peaks of N-acetylaspartate (NAA), glutamate/glutamine (Glx), creatine (Cr), choline (Cho), and myo-inositol (mI) are labeled. Note the increase in Cho and mI when spectra are scaled to Cr.

FIG. 3.

Correlation between myo-inositol (mI) and glutathione (GSH) and estimated exposure to subconcussive head impact. Cr, creatine; PCr, total creatine (phosphocreatine+creatine).

FIG. 4.

Correlation between glutathione (GSH) and TrailmakingTest (TMT) B. Cr, creatine; PCr, total creatine (phosphocreatine+creatine).