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The Journal of Sports Medicine and Physical Fitness 2017 January-February;57(1-2):77-89

DOI: 10.23736/S0022-4707.16.05092-1


language: English

Multicenter cohort study on association of genotypes with prospective sports concussion: methods, lessons learned, and recommendations

Thomas R. TERRELL 1, Roberd BOSTICK 2, Jeffrey BARTH 3, Richard SLOANE 4, Robert C. CANTU 5, 6, Ellen BENNETT 7, Leslie GALLOWAY 8, Daniel LASKOWITZ 9, Dave ERLANGER 10, Doug MCKEAG 11, Verle VALENTINE 12, Gregory NICHOLS 13

1 University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, TN, USA; 2 Emory University, School of Public Health, Department of Epidemiology, Atlanta, GA, USA; 3 Department of Psychiatry and Neuroscience, Center for Study of Sports TBI, Director, Neuropsychology Service, University of Virginia School of Medicine, Charlottesville, VA, USA; 4 Duke University Center for the Study of Aging and Human Development, Duke University Medical Center Durham, Durham, NC, USA; 5 Boston University School of Medicine, Boston, MA, USA; 6 Center for the Study of Chronic Traumatic Encephalopathy, Boston, MA, USA; 7 Department of Medicine, Neurology, Duke University School of Medicine, Durham, NC, USA; 8 Oak Ridge National Laboratory, Oak Ridge, TN, USA; 9 Department of Medicine, Neurology and Anesthesiology, Duke University School of Medicine, Durham, NC, USA; 10 Mount Sinai School of Medicine, New York, NY, USA; 11 Department of Family Medicine, University of Indiana School of Medicine, Indianapolis, IN, USA; 12 Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD, USA; Sanford Orthopedics and Sports Medicine, Sioux Falls, SD, USA; 13 University of Tennessee Graduate School of Medicine, Knoxville, TN, USA


BACKGROUND: Approximately 3.8 million sports related TBIs occur per year. Genetic variation may affect both TBI risk and post-TBI clinical outcome. Limited research has focused on genetic risk for concussion among athletes. We describe the design, methods, and baseline characteristics of this prospective cohort study designed to investigate a potential association between genetic polymorphisms of apolipoprotein E gene, APOE promoter G-219T, and Tau gene exon 6 polymorphisms (Ser53 Pro and Hist47Tyr) with: 1) the risk of prospective concussion; 2) concussion severity; and 3) postconcussion neurocognitive recovery.
METHODS: The prospective cohort study included a final population of 2947 college, high school, and professional athletes. Baseline data collection included a concussion/medical history questionnaire, neuropsychological (NP) testing, and genetic sampling for the genetic polymorphisms. Data collection on new concussions experienced utilized post-concussion history/mental status form, Lovell post-concussion symptom score, Standardized Assessment of Concussion (SAC) and/or the Sports Concussion Assessment Tool (SCAT)-1/SCAT-2, and post-concussion NP testing.
RESULTS: This paper is focused on discussing the important methodological considerations, organizational challenges and lessons learned in the completion of a multi-center prospective cohort study. A total of 3740 subjects enrolled, with a total of 335 concussions experienced.
CONCLUSIONS: Of critical importance to the success of a study of this type is to successfully recruit committed institutions with qualified local study personnel, obtain “buy-in” from study sites, and cultivate strong working relationships with study sites. The use of approved incentives may improve study site recruitment, enhance retention, and enhance compliance with study protocols. Future publications will detail the specific findings of this study. Collaborative research is very likely needed given the nature of this study population.

KEY WORDS: Apolipoprotein E - Brain concussion - Football - Polymorphism, genetic - Neuropsychological tests - Brain injuries

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