title: Depressive symptoms and white matter dysfunction in retired NFL players with concussion history.
abstract: OBJECTIVE
  To determine whether correlates of white matter integrity can provide general as well as specific insight into the chronic effects of head injury coupled with depression symptom expression in professional football players.
  
  
  METHODS
  We studied 26 retired National Football League (NFL) athletes who underwent diffusion tensor imaging (DTI) scanning. Depressive symptom severity was measured using the Beck Depression Inventory II (BDI-II) including affective, cognitive, and somatic subfactor scores (Buckley 3-factor model). Fractional anisotropy (FA) maps were processed using tract-based spatial statistics from FSL. Correlations between FA and BDI-II scores were assessed using both voxel-wise and region of interest (ROI) techniques, with ROIs that corresponded to white matter tracts. Tracts demonstrating significant correlations were further evaluated using a receiver operating characteristic curve that utilized the mean FA to distinguish depressed from nondepressed subjects.
  
  
  RESULTS
  Voxel-wise analysis identified widely distributed voxels that negatively correlated with total BDI-II and cognitive and somatic subfactors, with voxels correlating with the affective component (p < 0.05 corrected) localized to frontal regions. Four tract ROIs negatively correlated (p < 0.01) with total BDI-II: forceps minor, right frontal aslant tract, right uncinate fasciculus, and left superior longitudinal fasciculus. FA of the forceps minor differentiated depressed from nondepressed athletes with 100% sensitivity and 95% specificity.
  
  
  CONCLUSIONS
  Depressive symptoms in retired NFL athletes correlate negatively with FA using either an unbiased voxel-wise or an ROI-based, tract-wise approach. DTI is a promising biomarker for depression in this population.
authors.affiliation: Berman Laboratory for Learning and Memory, Center for Brain Health, Dallas, TX, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Strain
authors.forename: Nyaz
authors.initials: N
authors.lastname: Didehbani
authors.forename: C Munro
authors.initials: CM
authors.lastname: Cullum
authors.forename: Sethesh
authors.initials: S
authors.lastname: Mansinghani
authors.forename: Heather
authors.initials: H
authors.lastname: Conover
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kraut
authors.forename: John
authors.initials: J
authors.lastname: Hart
authors.forename: Kyle B
authors.initials: KB
authors.lastname: Womack
mesh_terms: D001924:Brain Concussion; D001927:Brain Diseases / Q000473:pathology*; D003072:Cognition Disorders; D003863:Depression / Q000175:diagnosis / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods; D005538:Football; D006801:Humans; D008279:Magnetic Resonance Imaging; D012179:Retirement