Repetitive Head Trauma in Early Cognitive and Behavioral Decline and Frontolimbic Dysfunction.
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Clark, Michael. Repetitive Head Trauma In Early Cognitive and Behavioral Decline and Frontolimbic Dysfunction. 2017. https://doi.org/10.17615/v77j-e908APA
Clark, M. (2017). Repetitive Head Trauma in Early Cognitive and Behavioral Decline and Frontolimbic Dysfunction. https://doi.org/10.17615/v77j-e908Chicago
Clark, Michael. 2017. Repetitive Head Trauma In Early Cognitive and Behavioral Decline and Frontolimbic Dysfunction. https://doi.org/10.17615/v77j-e908- Last Modified
- March 21, 2019
- Creator
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Clark, Michael
- Affiliation: School of Medicine, Department of Allied Health Sciences, Curriculum in Human Movement Science
- Abstract
- Converging evidence suggests an association between exposure to recurrent concussion and detriments to cognitive and behavioral health later in life. Many believe the clinical symptoms present in those with a history of recurrent trauma may be related to underlying onset or progression of neurodegeneration, though the relationship remains incompletely understood. Chronic traumatic encephalopathy (CTE), a neurodegenerative disease characterized by an accumulation of hyperphosphorylated tau deposits, has been posited as the disease most likely in individuals with clinical symptoms who have been exposed to repetitive head trauma. This thesis focuses on the phenotype of early cognitive and behavioral decline in former professional football players with a history of recurrent concussions and high-volume exposure to subconcussive impacts. This population is believed to be at an especially high risk of developing CTE. We identify 18 cases of mild cognitive and behavioral impairments in this highly exposed group and compare them to 15 healthy controls – former professional football players with a similar playing background. Using a battery of neuropsychological tests and psychiatric symptom surveys, the impairments in this group are characterized. The neural underpinnings of such impairments are examined through diffusion-weighted and functional magnetic resonance imaging (MRI) with a focus on the frontolimbic system. This network, composed of both prefrontal and limbic system regions is thought to be involved in CTE-related pathology, giving rise to the posited clinical syndrome associated with neurodegeneration in exposed individuals. Our results corroborate similar studies in this area by showing marked behavioral dysfunction in the cognitively impaired group coinciding with a loss of white matter integrity in the bilateral uncinate fasciculi. The functional consequences of such neuroanatomical changes are evidenced by enhanced interference of emotionally valent distractors on working memory task performance and corresponding over-activation of the bilateral temporal poles when such distractors are present. This work furthers our understanding of the neural correlates to mild clinical impairments in a group at high-risk for developing neurodegeneration. Such information provides critical insight into pathophysiology and may contribute to early diagnosis, provide targets for pharmacological or psychotherapy, and improve prognosis of future decline.
- Date of publication
- December 2017
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- DOI
- Resource type
- Rights statement
- In Copyright
- Advisor
- Belger, Aysenil
- Zhu, Hongtu
- Kaufer, Daniel
- Mihalik, Jason
- Guskiewicz, Kevin M.
- Giovanello, Kelly
- Degree
- Doctor of Philosophy
- Degree granting institution
- University of North Carolina at Chapel Hill Graduate School
- Graduation year
- 2017
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