Column: Sports Health By Brian Pickering
A colleague of mine recently shared an article that discussed the links between the Apolipoprotein E Epsilon 4 (APOE e4) gene, already known as the most significant factor for late-onset Alzheimer’s disease, and worsened outcomes after a traumatic brain injury. While the link between these may be understandable, it brings many questions to my mind. As a parent, this information would be helpful in determining how many concussions I would allow my child to sustain before removing them from contact/collision sports. It would be difficult to go through life knowing your child would be at a higher risk of suffering from Alzheimer’s later in life — especially knowing you would probably not be around to help care for them.
A number of studies dating as far back as 1997 have linked the APOE e 4 gene variant and poor recovery after concussion or brain injury. These include extended recovery, twice as likely to still have problems 6 months after the concussion, and decreased scores on cognitive tests even months after injury. Studies show a worsened outcome between 3.5 and 14 times more likely for carriers of the APOE e4 gene variant. In fairness, carrying the genetic APOE e4 variant — even carrying two copies — does not mean a definitive diagnosis of late-onset Alzheimer’s disease. Furthermore, those that are non-carriers may develop late-onset Alzheimer’s disease as well.
As medical professionals, there are many ethical questions we are presented with throughout our careers. Institutions of all sizes offer counseling, and support for patients and families when they are faced with making tough medical decisions. I don’t want this article to turn into a debate about what should and shouldn’t be done in regards to genetic testing, because that is not the point of the article. My concerns and questions are shared above, and my thoughts and opinions shift with the day and the circumstance when I am confronted with issues like these. However, I think it is important to look at what genotyping could possibly provide for parents and potential professional athletes when it comes to the long-term effects of head injury in sports. To use a non-concussion example, someone that I consider a close friend and colleague for many years, was told they should not play professional football because their spinal openings in the neck were “too narrow” to safely protect them from permanent paralysis should they sustain an injury to the neck. The NCAA already requires testing to determine if athletes are carriers for sickle cell as well. This information is given to allow an informed decision. Genotyping could offer the same type of information.
Studies show between 10-20percent of all athletes that sustain a concussion may experience symptoms that last months or even years. The author of the article that I mentioned above completed a study with others that showed almost 75 percent of college athletes surveyed, were “possibly” or “very” interested in genetic testing that would show an increased risk for delayed recovery after a concussion. Also, when told that this testing may indicate a susceptibility to Alzheimer’s, it increased their interest in having the testing done.
I always come back to the same thoughts when it comes to concussions — every week there is something new we are learning that helps improve our understanding and potential “treatment” of those that have sustained a concussion. We are only beginning to see some of the benefits of what we have learned over the past five years or so since concussion has been at the forefront of the conversation in sports medicine. I fully support the idea that participation in sports of all kinds is beneficial for students and adolescents, and the fear of injury should not deter parents or athletes away from participating. While it’s important to arm ourselves with helpful knowledge to mitigate risks, it’s also important to remember that the health and social benefits of athletics outweigh the risks for the majority of athletes.
Do you have a question regarding sports medicine that you would like to see addressed in this space in the future? Send your questions to SportsMed@lrhc.org and it may be featured in an upcoming article.
Brian Pickering is a MSE, ATC, NASM-PES at Lake Region Healthcare Sports Medicine.