PT  - JOURNAL ARTICLE
AU  - Kawas, Mohammad I.
AU  - Atcheson, Kyle M.
AU  - Flood, William C.
AU  - Sheridan, Christopher A.
AU  - Barcus, Richard A.
AU  - Flashman, Laura A.
AU  - McAllister, Thomas W.
AU  - Lipford, Megan E.
AU  - Kim, Jeongchul
AU  - Urban, Jillian E.
AU  - Davenport, Elizabeth M.
AU  - Vaughan, Christopher G.
AU  - Sai, Kiran K. Solingapuram
AU  - Stitzel, Joel D.
AU  - Maldjian, Joseph A.
AU  - Whitlow, Christopher T.
TI  - Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football
AID  - 10.3174/ajnr.A8294
DP  - 2024 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1116--1123
VI  - 45
IP  - 8
4099  - http://www.ajnr.org/content/45/8/1116.short
4100  - http://www.ajnr.org/content/45/8/1116.full
SO  - Am. J. Neuroradiol.2024 Aug 01; 45
AB  - BACKGROUND AND PURPOSE: During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex.MATERIALS AND METHODS: Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study.RESULTS: Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04).CONCLUSIONS: Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.ACCanterior cingulate cortexBOLDblood oxygenation level–dependentdACCdorsal anterior cingulate cortexDMNdefault mode networkHIEhead impact exposureIHCinterhemispheric connectivityRPFCrostral prefrontal cortexRWEcprisk-weighted exposure combined probabilitySNsalience network