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Original Investigation
September 9, 2019

Association of Cavum Septum Pellucidum and Cavum Vergae With Cognition, Mood, and Brain Volumes in Professional Fighters

Author Affiliations
  • 1Imaging Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Department of Psychology, University of California San Diego Health–La Jolla, San Diego
  • 3Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
  • 4Department of Radiology, Vanderbilt University, Medical Center North, South Nashville, Tennessee
JAMA Neurol. Published online September 9, 2019. doi:10.1001/jamaneurol.2019.2861
Key Points

Question  Given the increased frequency of cavum septum pellucidum and cavum vergae in fighters who experience repetitive head trauma, is the presence of these imaging findings associated with lower cognitive and mood testing scores and reduced volumes of various brain structures?

Findings  This population-based cohort study demonstrated that fighters with cavum vergae or increased cavum septum pellucidum and cavum vergae length had decreased volumes in various brain structures and lower cognitive scores vs fighters without these imaging findings.

Meaning  The presence of cavum septum pellucidum and cavum vergae was associated with lower regional brain volumes and cognitive performance in a cohort exposed to repetitive head trauma.


Importance  Many studies have investigated the imaging findings showing sequelae of repetitive head trauma, with mixed results.

Objective  To determine whether fighters (boxers and mixed martial arts fighters) with cavum septum pellucidum (CSP) and cavum vergae (CV) have reduced volumes in various brain structures or worse clinical outcomes on cognitive and mood testing.

Design, Setting, and Participants  This cohort study assessed participants from the Professional Fighters Brain Health Study. Data were collected from April 14, 2011, to January 17, 2018, and were analyzed from September 1, 2018, to May 23, 2019. This study involved a referred sample of 476 active and retired professional fighters. Eligible participants were at least 18 years of age and had at least a fourth-grade reading level. Healthy age-matched controls with no history of trauma were also enrolled.

Exposures  Presence of CSP, CV, and their total (additive) length (CSPV length).

Main Outcomes and Measures  Information regarding depression, impulsivity, and sleepiness among study participants was obtained using the Patient Health Questionnaire depression scale, Barrett Impulsiveness Scale, and the Epworth Sleepiness Scale. Cognition was assessed using raw scores from CNS Vital Signs. Volumes of various brain structures were measured via magnetic resonance imaging.

Results  A total of 476 fighters (440 men, 36 women; mean [SD] age, 30.0 [8.2] years [range, 18-72 years]) and 63 control participants (57 men, 6 women; mean [SD] age, 30.8 [9.6] years [range, 18-58 years]) were enrolled in the study. Compared with fighters without CV, fighters with CV had significantly lower mean psychomotor speed (estimated difference, –11.3; 95% CI, –17.4 to –5.2; P = .004) and lower mean volumes in the supratentorium (estimated difference, –31 191 mm3; 95% CI, –61 903 to –479 mm3; P = .05) and other structures. Longer CSPV length was associated with lower processing speed (slope, –0.39; 95% CI, –0.49 to –0.28; P < .001), psychomotor speed (slope, –0.43; 95% CI, –0.53 to –0.32; P < .001), and lower brain volumes in the supratentorium (slope, –1072 mm3 for every 1-mm increase in CSPV length; 95% CI, –1655 to –489 mm3; P < .001) and other structures.

Conclusions and Relevance  This study suggests that the presence of CSP and CV is associated with lower regional brain volumes and cognitive performance in a cohort exposed to repetitive head trauma.

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