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In 2020, two retired NFL players sued the league for “explicitly and deliberately” discriminating against Black players who filed claims for damages in the league’s billion-dollar concussion settlement. The league had, their suit revealed, directed clinicians to implement a practice known as race norming, which built into the evaluation process an assumption that Black retired players had lower preexposure cognitive functioning than their white peers – and increased the likelihood that their claims would be denied. The epilogue contextualizes the scandal in relation to the career of one of the plaintiffs, the former defensive lineman Kevin Henry, to reveal how norming – of race, gender, compensation – had pervaded his athletic life long before the NFL denied his claim.
This study examines the relationship of serum total tau, neurofilament light (NFL), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) with neurocognitive performance in service members and veterans with a history of traumatic brain injury (TBI).
Method:
Service members (n = 488) with a history of uncomplicated mild (n = 172), complicated mild, moderate, severe, or penetrating TBI (sTBI; n = 126), injured controls (n = 116), and non-injured controls (n = 74) prospectively enrolled from Military Treatment Facilities. Participants completed a blood draw and neuropsychological assessment a year or more post-injury. Six neuropsychological composite scores and presence/absence of mild neurocognitive disorder (MNCD) were evaluated. Within each group, stepwise hierarchical regression models were conducted.
Results:
Within the sTBI group, increased serum UCH-L1 was related to worse immediate memory and delayed memory (R2Δ = .065–.084, ps < .05) performance, while increased GFAP was related to worse perceptual reasoning (R2Δ = .030, p = .036). Unexpectedly, within injured controls, UCH-L1 and GFAP were inversely related to working memory (R2Δ = .052–.071, ps < .05), and NFL was related to executive functioning (R2Δ = .039, p = .021) and MNCD (Exp(B) = 1.119, p = .029).
Conclusions:
Results suggest GFAP and UCH-L1 could play a role in predicting poor cognitive outcome following complicated mild and more severe TBI. Further investigation of blood biomarkers and cognition is warranted.
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