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TOPLINE:

First-degree family history of mental illness is significantly associated with increased aggression in individuals exposed to repetitive head impact and with chronic traumatic encephalopathy (CTE), new retrospective research shows.

METHODOLOGY:

• Researchers assessed 2014-2021 data from the Understanding Neurologic Injury and Traumatic Encephalopathy Brain Bank at Boston University, Boston, for 845 deceased adult male brain donors (mean age at death, 60.3 years) with exposure to repetitive head impact from 2014 to 2021.
• Clinical data were obtained through retrospective assessments, including structured and semistructured telephone interviews and online questionnaires, with family members and spouses of the participants.
• The Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) was also administered to these informants to assess aggressive behaviors across three life stages of the donors: Childhood (birth to age 12 years), adolescence (13-17 years), and adulthood (age 18 years to end of life).
• Neuropathologists diagnosed CTE using the established National Institute of Neurological Disorders and Stroke criteria and assigned stages on the basis of regional involvement.

TAKEAWAY:

• 70% of donors were diagnosed with CTE. A significant positive association was found between first-degree family history of mental illness and adult scores on the BGLHA in those with CTE (P = .02) but not in those without CTE.
• After adjusting for covariates, the strongest association between these factors was in those with CTE who died between the ages of 40 and 59 years (P < .001).
• In the total group with CTE, emotional dysregulation and impulsivity (P < .05) and antisocial behavior (P < .05) showed a significant association with family history of mental illness.
• In those with CTE and in the age group of 40-59 years, emotional dysregulation and impulsivity showed the strongest effect (P < .001), followed by antisocial behavior (P < .001).

IN PRACTICE:

The significant link between first-degree family history of mental illness and aggression “was only observed when CTE pathology was present,” the investigators wrote. “This appears to be a case where together these risk factors add up to a greater risk for aggression than they each do on their own,” corresponding author Jesse Mez, MD, Boston University Chobanian & Avedisian School of Medicine, Boston, said in a press release.

Authors of an accompanying editorial noted that “identifying individuals who are more likely to show symptoms of aggression based on family history of mental illness provides a precision medicine approach to predicting the consequences of CTE. There are treatment protocols that could help mitigate these consequences.”

SOURCE:

The study had three co–first authors listed: Madeline Uretsky, MS; Evan Nair; and Rebecca Burton, MS, all from Boston University Chobanian & Avedisian School of Medicine. The editorial was written by Melissa Shuman Paretsky, PhD, from MSP Psychology PLLC, Farmington Hills, Michigan, and David Q. Beversdorf, MD, from the University of Missouri, Columbia, Missouri. Both papers were published online on November 27 in Neurology.

LIMITATIONS:

The study relied on retrospective informant reports, which may have introduced information and recall biases. Different primary informants provided information for different age groups, potentially affecting consistency. The sample was also relatively homogeneous, which may have limited the generalizability of the study findings. The cross-sectional design restricted causal inferences, and selection bias may have existed as families of symptomatic individuals were more likely to donate brains. Additionally, most donors were elite athletes, leading to CTE rates higher than those in the general population of people exposed to repetitive head impact.

DISCLOSURES:

The study was funded by the National Institutes of Health, Department of Veterans Affairs, Nick and Lynn Buoniconti Foundation, and the Clinical and Translational Science Institute at Boston University. Several investigators reported receiving consulting fees, grants, and royalties from various organizations and being involved with associations or companies related to brain injury, CTE research, and neuropsychology. Full details are listed in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.