{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:28:19Z","timestamp":1789507699417,"version":"build-2803163510"},"reference-count":66,"publisher":"SAGE Publications","issue":"3-4","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"crossref","award":["U01NS093334"],"award-info":[{"award-number":["U01NS093334"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:p>\n                    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). In CTE, hyperphosphorylated tau (p-tau) aggregates are found in neurons at the depth of cortical sulci close to the gray matter\/white matter (GM\/WM) boundary. To date, CTE can only be diagnosed postmortem by neuropathological examination. Traumatic encephalopathy syndrome (TES) is the clinical syndrome purported to be associated with CTE pathology. The aim of this study is to investigate microstructural properties at the GM\/WM boundary in individuals with a history of exposure to RHI and clinical features of CTE (i.e., TES). Diffusion magnetic resonance imaging (dMRI), TES diagnoses, and cerebrospinal fluid (CSF) biomarkers were acquired from 165 male former American football players (age: 57.29 \u00b1 8.23 years) from the DIAGNOSE CTE Research Project, a multicenter, observational cohort study. Fractional anisotropy (FA) was measured at the GM\/WM boundary of the whole brain. In addition, a widely used method (tract-based spatial statistics [TBSS]) was applied to measure FA of central WM. We used analyses of covariance to test associations between FA and TES. Furthermore, we used linear regressions to test associations between FA and nine CSF biomarkers (i.e., p-tau-181, -217, -231, total tau, amyloid \u03b2 [A\u03b2]\n                    <jats:sub>1\u201340<\/jats:sub>\n                    , A\u03b2\n                    <jats:sub>1\u201342<\/jats:sub>\n                    , glial fibrillary acidic protein [GFAP], neurofilament light [NfL], and soluble triggering receptor expressed on myeloid cells-2 [sTREM2]). We report an association between higher FA at the GM\/WM boundary and higher levels of certainty for CTE pathology (\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (1, 147) = 5.781, 95% confidence interval (CI) = 0.0003\u20130.003,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.035) as well as neurobehavioral dysregulation (\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (1, 148) = 7.559, 95% CI = 0.001\u20130.009,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.020), and functional dependence\/dementia (\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (1, 148) = 5.046, 95% CI = 0.0004\u20130.006,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.039). In addition, we report an association between higher FA at the GM\/WM boundary and higher CSF p-tau-181 (\u03b2 = 0.272, 95% CI = 0.078\u20130.466,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.029) and p-tau-217 (\u03b2 = 0.295, 95% CI = 0.102\u20130.488,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.027). FA of the central WM was not associated with TES diagnoses. Taken together, these findings suggest that dMRI at the GM\/WM boundary could be used to investigate microstructural alterations suggestive of tau pathology-associated neurodegeneration in individuals with TES, the clinical presentation of CTE. Future studies are needed to validate this approach and to identify clinically useful cutoff values for dMRI metrics.\n                  <\/jats:p>","DOI":"10.1177\/08977151251393966","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:33:11Z","timestamp":1762907591000},"page":"224-235","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Diffusion Alterations at the Gray Matter\/White Matter Boundary in Traumatic Encephalopathy Syndrome"],"prefix":"10.1177","volume":"43","author":[{"given":"Tim L.T.","family":"Wiegand","sequence":"first","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Pankatz","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Arciniega","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York, USA."},{"name":"NYU Concussion Center, NYU Langone Health, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard B.","family":"Jung","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Tuz-Zahra","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Bouix","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Software Engineering and Information Technology, \u00c9cole de technologie sup\u00e9rieure, Universit\u00e9 du Qu\u00e9bec, Montr\u00e9al, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Lubeck","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philine","family":"Rojczyk","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa S.","family":"Schuhmacher","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna","family":"Buring","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas I.","family":"Katz","sequence":"additional","affiliation":[{"name":"Alzheimer\u2019s Disease Research Center and CTE Center, Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."},{"name":"Braintree Rehabilitation Hospital, Braintree, Massachusetts, USA."},{"name":"Department of Neurology, Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yorghos","family":"Tripodis","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA."},{"name":"Alzheimer\u2019s Disease Research Center and CTE Center, Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofer","family":"Pasternak","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suheyla","family":"Cetin-Karayumak","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh","family":"Rathi","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Adler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann C.","family":"McKee","sequence":"additional","affiliation":[{"name":"Department of Pathology, Alzheimer\u2019s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA."},{"name":"Department of Veterans Affairs Medical Center, Bedford, Massachusetts, USA."},{"name":"VA Boston Healthcare System, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Balcer","sequence":"additional","affiliation":[{"name":"Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA."},{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA."},{"name":"Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Bernick","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA."},{"name":"Department of Neurology, University of Washington, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Colasurdo","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P.","family":"Lin","sequence":"additional","affiliation":[{"name":"Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine R.","family":"Peskind","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA."},{"name":"VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Ashton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, M\u00f6lndal, Sweden."},{"name":"Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King\u2019s College London, London, UK."},{"name":"NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK."},{"name":"Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaj","family":"Blennow","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, M\u00f6lndal, Sweden."},{"name":"Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, M\u00f6lndal, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Zetterberg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, M\u00f6lndal, Sweden."},{"name":"Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, M\u00f6lndal, Sweden."},{"name":"Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK."},{"name":"UK Dementia Research Institute at UCL, London, UK."},{"name":"Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China."},{"name":"Wisconsin Alzheimer\u2019s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Alosco","sequence":"additional","affiliation":[{"name":"Alzheimer\u2019s Disease Research Center and CTE Center, Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."},{"name":"Department of Neurology, Boston University Chobanian &amp; Avedisian School of Medicine, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Cummings","sequence":"additional","affiliation":[{"name":"Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Reiman","sequence":"additional","affiliation":[{"name":"Banner Alzheimer\u2019s Institute, Phoenix, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert 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