Using data from the Professional Fighters Brain Health Study, a new composite outcome measure has been developed that can distinguish between individual exposed to repetitive head impacts (RHI) vs nonRHI-exposed individuals. The composite measure is the Traumatic Encephalopathy Assessment Measure (TEAM) and includes measures of memory (word list), processing speed (measured with the Digit Symbols Test [DST]), attention (Trail Making A and B tests), and impulsivity (components of the Barrett Impulsivity Scale).
In developing this test, 15 retired fighters, 54 active fighters, and 15 non RHI-exposed individuals were administered the above tests, and a composite TEAM score generated. When comparing active fighters or retired fighters to nonRHI-exposed people, a statistically significant difference was seen (adjusted P = .057 for active fighters v. controls; adjusted P = 0.003 retired fighters v. controls). In the PFBH cohort, the number of professional fights a person has completed can be used as a surrogate measure for how much RHI they experienced. The TEAM score is adjusted for number of professional fights completed, suggesting that TEAM score could be used for clinical assessment of potential traumatic encephalopathy over time.
“We will continue validating the TEAM composite measure in prospective studies and with other cohorts. We hope it will provide another tool for clinicians to evaluate, care for, and follow up on individuals exposed to RHI or others suspected of having traumatic encephalopathy,” said Charles Bernick, MD, MPH of the Cleveland Clinic Lou Ruvo Center for Brain Health. “Additionally, consensus measures for chronic traumatic encephalopathy (CTE) are being developed and clinical trials aimed at reducing CTE pathology are being planned. The composite TEAM measure may serve as a useful outcome measure in such trials.”
The PFBH study is a longitudinal study of active and retired professional fighters and controls in whom annual assessments include measurements from computerized cognitive testing, behavioral inventories, and neurological examination. Participants who had a minimum of 3 assessments over a minimum of 2 years were included in the analyses to develop the TEAM score in this study. Logistic regression modeling was used to identify potential measures for the composite score with forward model selection using a p-value threshold of 0.2. The reported p-values are corrected after the Tukey multiple comparison adjustment.
This study was presented at the 12th Clinical Trials in Alzheimer’s Disease conference taking place in San Diego, CA December 4-7, 2019.
Adil Javed, MD, PhD, and James Stankiewicz MD, FAAN
Robert Shavelle, PhD, FAACPDM; Jordan Brooks, PhD, MPH; David Strauss, PhD, FASA; and Amytis Towfighi, MD
James Geyer, MD, and Jenna Cooper, CRNP