The average viewership during NFL Sunday's is around 23.5 million viewers. These viewers watch over 2,000 different professional football players, and amongst this large number is a brain disease that is seemingly hidden to everyone. Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease associated with a large number of repeated head impacts (e.g. a tackle in the NFL); a disease consisting of varying degrees of cognitive impairment, behavioral changes, and later on motor issues and dementia. With there being no current way to diagnose CTE antemortem, we constantly work on taking steps closer towards that goal. Dr. Krizman and other research studies have focused on new techniques and steps we can take to help achieve the diagnosis of CTE before death.
I was fortunate enough to listen and learn about Dr. Krizman's study about the important research in the "Auditory biological marker of concussion in children." This paper talks about how auditory processing, in which can be disrupted by concussions, can also be used to identify concussion occurrence and severity. The study was then followed by concussed and non-concussed athletes measuring their auditory processing using a technique known as frequency following response (FFR). FFR acts as a biological marker by measuring how accurately and quickly the brain encodes sound, specifically fundamental frequency (F0) (acoustic cue responsible for perception of pitch, allowing to identify speakers in noisy environments). After an experiment conducted comparing FFR results between 20 children who have been diagnosed with a concussion and 20 healthy children, results showed that concussed children had approximately 35% neural responses to F0 compared to the healthy control group. Although the subjects of this experiment were children, the uniformity of the procedure across any age makes it likely to produce similar results with adults. With these consistent results, it can be concluded that concussions affect the brain's ability to encode information at the subcortical level which can potentially be a guide to identifying injury, injury prevention, and injury recovery.
While Dr. Krizman's study highlights the immediate neural slowness following a concussion using FFR, broader research into repetitive head impacts suggested that subconcussive hits (e.g. an NFL tackle) can lead to a higher accumulation of phosphorylated tau proteins. These proteins are triggered by constant trauma on the head, forming aggregates (also found in neurodegenerative diseases Alzheimer's and Parkinson's) that destroy neurons causing cognitive, mood, and behavioral issues. This protein is the hallmark of CTE and is known to be in affect within the subcortical regions and sulci of the cerebral cortex, areas that are functionally linked to the very auditory midbrain pathways measured by the FFR. Because the FFR provides a high-fidelity readout of axonal integrity and timing, it may serve as a critical "functional biopsy" of the brain. If tau pathology disrupts the microsecond-level precision required for the brain to encode the F0, the FFR could detect these degenerative changes years before behavioral symptoms of dementia or motor impairment appear.
The objectivity of FFR is very valuable for keeping athletes safe. FFR cannot be faked or influenced by an athlete's desire to return to play, unlike very subjective symptom checklists that are very prone to "sandbagging." By establishing baseline FFR for all athletes during the beginning of their careers, doctors and researchers could monitor the neural results after every game and/or injury giving them greater precaution for CTE and other neurodegenerative problems. The leap from identifying acute concussions to tracking chronic degenerative represents a significant advancement toward a definitive, living diagnosis of CTE, which is currently seen as impossible.
References
Relationship Between Level of American Football Playing and Diagnosis of Chronic Traumatic Encephalopathy in a Selection Bias Analysis
Jessica LeClair, Jennifer Weuve, Matthew P Fox, Jesse Mez, Michael L Alosco, Chris Nowinski, Ann McKee, Yorghos Tripodis
https://pmc.ncbi.nlm.nih.gov/articles/PMC9989358/
Auditory biological marker of
concussion in children
Nina Kraus1,2,3,4, ElaineC.Thompson1,2, Jennifer Krizman1,2, KatherineCook5,6, TravisWhiteSchwoch1,2 & Cynthia R. LaBella5,6
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