{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:04:17Z","timestamp":1789718657078,"version":"4.0.1"},"reference-count":60,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec id=\"ab-noi240041-4\"><jats:title>Importance<\/jats:title><jats:p>Parkinsonism is associated with traumatic brain injury and chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repetitive head impact (RHI) exposure, but the neuropathologic substrates that underlie parkinsonism in individuals with CTE are yet to be defined.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the frequency of parkinsonism in individuals with CTE and the association of RHI and neuropathologic substrates with parkinsonism in these individuals.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study included brain donors with neuropathologically diagnosed CTE without other significant neurodegenerative disease and with information on parkinsonism from the Understanding Neurologic Injury and Traumatic Encephalopathy brain bank between July 2015 and May 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-7\"><jats:title>Exposure<\/jats:title><jats:p>Years of contact sports participation as a proxy for RHI.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcomes were frequency of parkinsonism in individuals with CTE and associations between (1) RHI with substantia nigra (SN) Lewy bodies (LBs) and neurofibrillary tangles (NFTs); (2) LBs, NFTs, and arteriolosclerosis with SN neuronal loss; and (3) SN neuronal loss, LBs, NFTs, and arteriolosclerosis with parkinsonism, tested by age-adjusted logistic regressions.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-9\"><jats:title>Results<\/jats:title><jats:p>Of 481 male brain donors with neuropathologically diagnosed CTE, parkinsonism occurred frequently in individuals with CTE (119 [24.7%]; 362 [75.3%] did not have parkinsonism). Participants with parkinsonism had a higher mean (SD) age at death (71.5 [13.0] years) than participants without parkinsonism (54.1 [19.3] years) (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and higher rates of dementia (104 [87.4%] vs 105 [29.0%]), visual hallucinations (45 [37.8%] vs 51 [14.1%]), and probable rapid eye movement sleep behavior disorder (52 [43.7%] vs 58 [16.0%]) (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001 for all). Participants with parkinsonism had a more severe CTE stage (eg, stage IV: 35 [29.4%] vs 39 [10.8%]) and nigral pathology than those without parkinsonism (NFTs: 50 of 117 [42.7%] vs 103 of 344 [29.9%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01; neuronal loss: 61 of 117 [52.1%] vs 59 of 344 [17.1%]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001; and LBs: 28 of 116 [24.1%] vs 20 of 342 [5.8%]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Years of contact sports participation were associated with SN NFTs (adjusted odds ratio [AOR], 1.04; 95% CI, 1.00-1.07; <jats:italic>P<\/jats:italic>\u2009=\u2009.03) and neuronal loss (AOR, 1.05; 95% CI, 1.01-1.08; <jats:italic>P<\/jats:italic>\u2009=\u2009.02). Nigral neuronal loss (AOR, 2.61; 95% CI, 1.52-4.47; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and LBs (AOR, 2.29; 95% CI, 1.15-4.57; <jats:italic>P<\/jats:italic>\u2009=\u2009.02) were associated with parkinsonism. However, SN neuronal loss was associated with SN LBs (AOR, 4.48; 95% CI, 2.25-8.92; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), SN NFTs (AOR, 2.51; 95% CI, 1.52-4.15; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), and arteriolosclerosis (AOR, 2.27; 95% CI, 1.33-3.85; <jats:italic>P<\/jats:italic>\u2009=\u2009.002). In American football players, regression analysis demonstrated that SN NFTs and neuronal loss mediated the association between years of play and parkinsonism in the context of CTE (\u03b2, 0.012; 95% CI, 0.001-0.038).<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi240041-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cross-sectional study of contact sports athletes with CTE, years of contact sports participation were associated with SN tau pathology and neuronal loss, and these pathologies were associated with parkinsonism. Repetitive head impacts may incite neuropathologic processes that lead to symptoms of parkinsonism in individuals with CTE.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2024.2166","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T15:33:27Z","timestamp":1721057607000},"page":"916","source":"Crossref","is-referenced-by-count":14,"title":["Substantia Nigra Pathology, Contact Sports Play, and Parkinsonism in Chronic Traumatic Encephalopathy"],"prefix":"10.1001","volume":"81","author":[{"given":"Jason W.","family":"Adams","sequence":"first","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurosciences, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kirsch","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha M.","family":"Calderazzo","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Tuz-Zahra","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yorghos","family":"Tripodis","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Mez","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Alosco","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor E.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand R.","family":"Huber","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Boston Healthcare System, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kubilus","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry A.","family":"Cormier","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Nicks","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Uretsky","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Nair","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Kuzyk","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurgul","family":"Aytan","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Cherry","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Crary","sequence":"additional","affiliation":[{"name":"Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Daneshvar","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Physical Medicine and Rehabilitation, Mass General Brigham-Spaulding Rehabilitation, Charlestown, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Nowinski","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Concussion Legacy Foundation, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid","family":"Dwyer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas I.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Cantu","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Stern","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann C.","family":"McKee","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"Department of Neurology, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thor D.","family":"Stein","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"noi240041r1","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1007\/s00401-015-1502-4","article-title":"Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank.","volume":"130","author":"Bieniek","year":"2015","journal-title":"Acta Neuropathol"},{"issue":"1","key":"noi240041r2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1111\/bpa.12757","article-title":"Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study.","volume":"0","author":"Bieniek","year":"2020","journal-title":"Brain Pathol"},{"key":"noi240041r3","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25611","article-title":"Duration of American football play and chronic traumatic encephalopathy.","author":"Mez","year":"2020","journal-title":"Ann Neurol"},{"issue":"4","key":"noi240041r4","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1001\/jama.2017.8334","article-title":"Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football.","volume":"318","author":"Mez","year":"2017","journal-title":"JAMA"},{"issue":"7","key":"noi240041r5","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1097\/NEN.0b013e3181a9d503","article-title":"Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury.","volume":"68","author":"McKee","year":"2009","journal-title":"J Neuropathol Exp Neurol"},{"issue":"1","key":"noi240041r6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00401-013-1230-6","article-title":"The neuropathology of sport.","volume":"127","author":"McKee","year":"2014","journal-title":"Acta Neuropathol"},{"issue":"pt 1","key":"noi240041r7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1093\/brain\/aws307","article-title":"The spectrum of disease in chronic traumatic encephalopathy.","volume":"136","author":"McKee","year":"2013","journal-title":"Brain"},{"issue":"4","key":"noi240041r8","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s00401-020-02197-9","article-title":"Characterizing tau deposition in chronic traumatic encephalopathy (CTE): utility of the McKee CTE staging scheme.","volume":"140","author":"Alosco","year":"2020","journal-title":"Acta Neuropathol"},{"issue":"5","key":"noi240041r9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s13195-014-0068-z","article-title":"Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome.","volume":"6","author":"Montenigro","year":"2014","journal-title":"Alzheimers Res Ther"},{"issue":"13","key":"noi240041r10","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1212\/WNL.0b013e3182a55f7f","article-title":"Clinical presentation of chronic traumatic encephalopathy.","volume":"81","author":"Stern","year":"2013","journal-title":"Neurology"},{"issue":"18","key":"noi240041r11","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1212\/WNL.0000000000011850","article-title":"National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome.","volume":"96","author":"Katz","year":"2021","journal-title":"Neurology"},{"issue":"9","key":"noi240041r12","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1093\/jnen\/nly065","article-title":"Lewy body pathology and chronic traumatic encephalopathy associated with contact sports.","volume":"77","author":"Adams","year":"2018","journal-title":"J Neuropathol Exp Neurol"},{"issue":"12","key":"noi240041r13","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson\u2019s disease.","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov Disord"},{"issue":"4","key":"noi240041r14","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1055\/s-0036-1585097","article-title":"Parkinsonism.","volume":"36","author":"Keener","year":"2016","journal-title":"Semin Neurol"},{"issue":"2","key":"noi240041r15","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1002\/ana.22588","article-title":"Nigral pathology and parkinsonian signs in elders without Parkinson disease.","volume":"71","author":"Buchman","year":"2012","journal-title":"Ann Neurol"},{"issue":"4","key":"noi240041r16","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1002\/ana.20226","article-title":"Parkinsonian signs and substantia nigra neuron density in decendents elders without PD.","volume":"56","author":"Ross","year":"2004","journal-title":"Ann Neurol"},{"issue":"7","key":"noi240041r17","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1016\/j.clinph.2008.03.017","article-title":"Pathophysiology of parkinsonism.","volume":"119","author":"Galvan","year":"2008","journal-title":"Clin Neurophysiol"},{"issue":"4","key":"noi240041r18","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1001\/archneur.63.4.584","article-title":"Motor score of the Unified Parkinson Disease Rating Scale as a good predictor of Lewy body\u2013associated neuronal loss in the substantia nigra.","volume":"63","author":"Greffard","year":"2006","journal-title":"Arch Neurol"},{"issue":"7","key":"noi240041r19","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1001\/jamaneurol.2013.114","article-title":"Incidence and pathology of synucleinopathies and tauopathies related to parkinsonism.","volume":"70","author":"Savica","year":"2013","journal-title":"JAMA Neurol"},{"issue":"120011","key":"noi240041r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2021.120011","article-title":"Parkinsonism and cerebrovascular disease.","volume":"433","author":"Narasimhan","year":"2022","journal-title":"J Neurol Sci"},{"issue":"8","key":"noi240041r21","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1212\/WNL.0b013e3182825116","article-title":"Microvascular brain pathology and late-life motor impairment.","volume":"80","author":"Buchman","year":"2013","journal-title":"Neurology"},{"issue":"7","key":"noi240041r22","doi-asserted-by":"publisher","first-page":"e754","DOI":"10.1212\/WNL.0000000000207497","article-title":"Effects of cerebrovascular and Lewy body pathology on parkinsonian signs in community-dwelling older adults.","volume":"101","author":"Agrawal","year":"2023","journal-title":"Neurology"},{"issue":"11","key":"noi240041r23","doi-asserted-by":"publisher","first-page":"3183","DOI":"10.1161\/STROKEAHA.111.623462","article-title":"Cerebrovascular disease pathology and parkinsonian signs in old age.","volume":"42","author":"Buchman","year":"2011","journal-title":"Stroke"},{"issue":"6","key":"noi240041r24","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1002\/mds.20083","article-title":"Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis.","volume":"19","author":"Zijlmans","year":"2004","journal-title":"Mov Disord"},{"issue":"9","key":"noi240041r25","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1002\/mds.25458","article-title":"Head injury and risk of Parkinson disease: a systematic review and meta-analysis.","volume":"28","author":"Jafari","year":"2013","journal-title":"Mov Disord"},{"issue":"6","key":"noi240041r26","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1002\/ana.24396","article-title":"Traumatic brain injury in later life increases risk for Parkinson disease.","volume":"77","author":"Gardner","year":"2015","journal-title":"Ann Neurol"},{"issue":"20","key":"noi240041r27","doi-asserted-by":"publisher","first-page":"e1771","DOI":"10.1212\/WNL.0000000000005522","article-title":"Mild TBI and risk of Parkinson disease: a Chronic Effects of Neurotrauma Consortium Study.","volume":"90","author":"Gardner","year":"2018","journal-title":"Neurology"},{"issue":"1","key":"noi240041r28","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1038\/s41531-023-00603-z","article-title":"Population fraction of Parkinson\u2019s disease attributable to preventable risk factors.","volume":"9","author":"Payami","year":"2023","journal-title":"NPJ Parkinsons Dis"},{"issue":"9","key":"noi240041r29","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1001\/jamaneurol.2016.1948","article-title":"Association of traumatic brain injury with late-life neurodegenerative conditions and neuropathologic findings.","volume":"73","author":"Crane","year":"2016","journal-title":"JAMA Neurol"},{"issue":"8","key":"noi240041r30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.28644","article-title":"American football play and Parkinson disease among men.","volume":"6","author":"Bruce","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"6","key":"noi240041r31","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00401-020-02206-x","article-title":"Association of probable REM sleep behavior disorder with pathology and years of contact sports play in chronic traumatic encephalopathy.","volume":"140","author":"Adams","year":"2020","journal-title":"Acta Neuropathol"},{"issue":"4","key":"noi240041r32","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/S0197-4580(97)00057-2","article-title":"Consensus recommendations for the postmortem diagnosis of Alzheimer\u2019s Disease.","volume":"18","author":"The National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer\u2019s disease","year":"1997","journal-title":"Neurobiol Aging"},{"issue":"10","key":"noi240041r33","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1097\/00005072-199710000-00002","article-title":"Consensus recommendations for the postmortem diagnosis of Alzheimer disease from the National Institute on Aging and the Reagan Institute Working Group on diagnostic criteria for the neuropathological assessment of Alzheimer disease.","volume":"56","author":"Hyman","year":"1997","journal-title":"J Neuropathol Exp Neurol"},{"issue":"1","key":"noi240041r34","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00401-007-0237-2","article-title":"Neuropathologic diagnostic and nosologic criteria for frontotemporal lobar degeneration: consensus of the Consortium for Frontotemporal Lobar Degeneration.","volume":"114","author":"Cairns","year":"2007","journal-title":"Acta Neuropathol"},{"issue":"1","key":"noi240041r35","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s00401-008-0460-5","article-title":"Nomenclature for neuropathologic subtypes of frontotemporal lobar degeneration: consensus recommendations.","volume":"117","author":"Mackenzie","year":"2009","journal-title":"Acta Neuropathol"},{"issue":"1","key":"noi240041r36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00401-009-0612-2","article-title":"Nomenclature and nosology for neuropathologic subtypes of frontotemporal lobar degeneration: an update.","volume":"119","author":"Mackenzie","year":"2010","journal-title":"Acta Neuropathol"},{"issue":"4","key":"noi240041r37","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s00401-022-02479-4","article-title":"Rainwater Charitable Foundation criteria for the neuropathologic diagnosis of progressive supranuclear palsy.","volume":"144","author":"Roemer","year":"2022","journal-title":"Acta Neuropathol"},{"issue":"1","key":"noi240041r38","first-page":"1","article-title":"Neuropathology of non-Alzheimer degenerative disorders.","volume":"3","author":"Dickson","year":"2009","journal-title":"Int J Clin Exp Pathol"},{"issue":"1","key":"noi240041r39","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/00005072-199601000-00010","article-title":"Validity and reliability of the preliminary NINDS neuropathologic criteria for progressive supranuclear palsy and related disorders.","volume":"55","author":"Litvan","year":"1996","journal-title":"J Neuropathol Exp Neurol"},{"issue":"9","key":"noi240041r40","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1097\/NEN.0b013e3181ee7d85","article-title":"TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy.","volume":"69","author":"Mckee","year":"2010","journal-title":"J Neuropathol Exp Neurol"},{"issue":"3","key":"noi240041r41","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1136\/jnnp.33.3.338","article-title":"The central nervous system in motor neurone disease.","volume":"33","author":"Brownell","year":"1970","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"8","key":"noi240041r42","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"11","key":"noi240041r43","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1001\/jamaneurol.2019.2244","article-title":"Association of white matter rarefaction, arteriolosclerosis, and tau with dementia in chronic traumatic encephalopathy.","volume":"76","author":"Alosco","year":"2019","journal-title":"JAMA Neurol"},{"issue":"1","key":"noi240041r44","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s13195-015-0148-8","article-title":"Assessing clinicopathological correlation in chronic traumatic encephalopathy: rationale and methods for the UNITE study.","volume":"7","author":"Mez","year":"2015","journal-title":"Alzheimers Res Ther"},{"issue":"15","key":"noi240041r46","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement Disorder Society\u2013sponsored revision of the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov Disord"},{"issue":"5","key":"noi240041r47","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/s00401-007-0311-9","article-title":"Twenty-first century brain banking: processing brains for research: the Columbia University methods.","volume":"115","author":"Vonsattel","year":"2008","journal-title":"Acta Neuropathol"},{"issue":"2","key":"noi240041r48","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s00401-020-02255-2","article-title":"Neuropathological consensus criteria for the evaluation of Lewy pathology in post-mortem brains: a multi-centre study.","volume":"141","author":"Attems","year":"2021","journal-title":"Acta Neuropathol"},{"issue":"12","key":"noi240041r49","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1212\/01.wnl.0000187889.17253.b1","article-title":"Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.","volume":"65","author":"McKeith","year":"2005","journal-title":"Neurology"},{"issue":"6","key":"noi240041r51","first-page":"390","article-title":"Introduction to mediation analysis with structural equation modeling.","volume":"25","author":"Gunzler","year":"2013","journal-title":"Shanghai Arch Psychiatry"},{"issue":"1","key":"noi240041r52","doi-asserted-by":"publisher","first-page":"3470","DOI":"10.1038\/s41467-023-39183-0","article-title":"Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males.","volume":"14","author":"Daneshvar","year":"2023","journal-title":"Nat Commun"},{"issue":"4","key":"noi240041r53","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.9311","article-title":"Association of traumatic brain injury with and without loss of consciousness with neuropathologic outcomes in community-dwelling older persons.","volume":"5","author":"Agrawal","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"16","key":"noi240041r54","doi-asserted-by":"publisher","first-page":"e1821","DOI":"10.1212\/WNL.0000000000007315","article-title":"Progressive parkinsonism in older adults is related to the burden of mixed brain pathologies.","volume":"92","author":"Buchman","year":"2019","journal-title":"Neurology"},{"issue":"12","key":"noi240041r55","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1002\/mds.21433","article-title":"Mild parkinsonian signs: an overview of an emerging concept.","volume":"22","author":"Louis","year":"2007","journal-title":"Mov Disord"},{"issue":"2","key":"noi240041r56","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1093\/brain\/awad388","article-title":"Nigrostriatal tau pathology in parkinsonism and Parkinson\u2019s disease.","volume":"147","author":"Chu","year":"2024","journal-title":"Brain"},{"issue":"1","key":"noi240041r57","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1002\/ana.20723","article-title":"Substantia nigra tangles are related to gait impairment in older persons.","volume":"59","author":"Schneider","year":"2006","journal-title":"Ann Neurol"},{"issue":"3","key":"noi240041r58","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1002\/ana.410410312","article-title":"Pathological correlates of extrapyramidal signs in Alzheimer\u2019s disease.","volume":"41","author":"Liu","year":"1997","journal-title":"Ann Neurol"},{"issue":"1","key":"noi240041r59","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s40478-022-01475-9","article-title":"Repetitive mild TBI causes pTau aggregation in nigra without altering preexisting fibril induced Parkinson\u2019s-like pathology burden.","volume":"10","author":"Delic","year":"2022","journal-title":"Acta Neuropathol Commun"},{"issue":"8","key":"noi240041r60","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1093\/aje\/kwac075","article-title":"Relationship between level of American football playing and diagnosis of chronic traumatic encephalopathy in a selection bias analysis.","volume":"191","author":"LeClair","year":"2022","journal-title":"Am J Epidemiol"},{"key":"noi240041r45","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2000","edition":"4th ed, text re"},{"key":"noi240041r50","unstructured":"R Core Team. R: a language and environment for statistical computing. 2020. Accessed January 27, 2023. https:\/\/www.r-project.org\/"}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2820667\/jamaneurology_adams_2024_oi_240041_1725483567.45967.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T15:07:56Z","timestamp":1725894476000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2820667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":60,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2024.2166","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}