{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:15:16Z","timestamp":1792653316437,"version":"4.5.0"},"reference-count":114,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:p>\n                    The term \u201crepetitive head impacts\u201d (RHI) refers to the cumulative exposure to concussive and subconcussive events. Although RHI are believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined because of the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, which we term the \u201ccumulative head impact index\u201d (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and 3) to evaluate its predictive properties relative to other exposure metrics (i.e., duration of play, age of first exposure, concussion history). Participants included 93 former high school and collegiate football players who completed objective cognitive and self-reported behavioral\/mood tests as part of a larger ongoing longitudinal study. Using established cutoff scores, we transformed continuous outcomes into dichotomous variables (normal vs. impaired). The CHII was computed for each participant and derived from a combination of self-reported athletic history (i.e., number of seasons, position[s], levels played), and impact frequencies reported in helmet accelerometer studies. A bivariate probit, instrumental variable model revealed a threshold dose-response relationship between the CHII and risk for later-life cognitive impairment (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), self-reported executive dysfunction (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), depression (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), apathy (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.0161), and behavioral dysregulation (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Ultimately, the CHII demonstrated greater predictive validity than other individual exposure metrics.\n                  <\/jats:p>","DOI":"10.1089\/neu.2016.4413","type":"journal-article","created":{"date-parts":[[2016,3,30]],"date-time":"2016-03-30T22:12:15Z","timestamp":1459375935000},"page":"328-340","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":505,"title":["Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players"],"prefix":"10.1177","volume":"34","author":[{"given":"Philip H.","family":"Montenigro","sequence":"first","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Alosco","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett M.","family":"Martin","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Daneshvar","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Mez","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine E.","family":"Chaisson","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Public Health"},{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Nowinski","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Concussion Legacy Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhoda","family":"Au","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann C.","family":"McKee","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"},{"name":"VA Boston Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Cantu","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Concussion Legacy Foundation"},{"name":"Boston University School of Medicine"},{"name":"Emerson Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"McClean","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Stern","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"},{"name":"Boston University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yorghos","family":"Tripodis","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine"},{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,1,15]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2014.965211"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.10.FOCUS12284"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/2013.7.JNS121822"},{"key":"e_1_3_3_5_2","article-title":"Subconcussive blows to the head: a formative review of short-term clinical outcomes","author":"Belanger H.G.","year":"2015","unstructured":"Belanger H.G., , Vanderploeg R.D., , and McAllister T. 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