Hostname: page-component-797576ffbb-pxgks Total loading time: 0 Render date: 2023-12-04T07:50:21.858Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Apolipoprotein E (APOE) ϵ4 Allele Is Associated with Increased Symptom Reporting Following Sports Concussion

Published online by Cambridge University Press:  20 October 2015

Victoria C. Merritt*
Penn State University, University Park, Pennsylvania
Peter A. Arnett
Penn State University, University Park, Pennsylvania
Correspondence and reprint requests to: Victoria C. Merritt; 372 Moore Building, Department of Psychology, Penn State University, University Park, PA 16802. E-mail:


Exploring the relationship between genetic factors and outcome following brain injury has received increased attention in recent years. However, few studies have evaluated the influence of genes on specific sequelae of concussion. The purpose of this study was to determine how the ϵ4 allele of the apolipoprotein E (APOE) gene influences symptom expression following sports-related concussion. Participants included 42 collegiate athletes who underwent neuropsychological testing, including completion of the Post-Concussion Symptom Scale (PCSS), within 3 months after sustaining a concussion (73.8% were evaluated within 1 week). Athletes provided buccal samples that were analyzed to determine the make-up of their APOE genotype. Dependent variables included a total symptom score and four symptom clusters derived from the PCSS. Mann-Whitney U tests showed higher scores reported by athletes with the ϵ4 allele compared to those without it on the total symptom score and the physical and cognitive symptom clusters. Furthermore, logistic regression showed that the ϵ4 allele independently predicted those athletes who reported physical and cognitive symptoms following concussion. These findings illustrate that ϵ4+ athletes report greater symptomatology post-concussion than ϵ4- athletes, suggesting that the ϵ4 genotype may confer risk for poorer post-concussion outcome. (JINS, 2016, 22, 89–94)

Brief Communication
Copyright © The International Neuropsychological Society 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Ariza, M., Pueyo, R., del M Matarín, M., Junqué, C., Mataró, M., Clemente, I., & Sahuquillo, J. (2006). Influence of APOE polymorphism on cognitive and behavioral outcome in moderate and severe traumatic brain injury. Journal of Neurology, Neurosurgery, & Psychiatry, 77(10), 11911193.Google Scholar
Bazarian, J.J., Zemlan, F.P., Mookerjee, S., & Stigbrand, T. (2006). Serum S-100B and cleaved-tau are poor predictors of long-term outcome after mild traumatic brain injury. Brain Injury, 20(7), 759765.Google Scholar
Blennow, K., Hardy, J., & Zetterberg, H. (2012). The neuropathology and neurobiology of traumatic brain injury. Neuron, 76(5), 886899.Google Scholar
Chamelian, L., Reis, M., & Feinstein, A. (2004). Six-month recovery from mild to moderate traumatic brain injury: The role of APOE-epsilon4 allele. Brain, 127(12), 26212628.Google Scholar
Chiang, M.-F., Chang, J.-G., & Hu, C.-J. (2003). Association between apolipoprotein E genotype and outcome of traumatic brain injury. Acta Neurochirurgica, 145(8), 649654.Google Scholar
Christensen, H., Batterham, P.J., Mackinnon, A.J., Jorm, A.F., Mack, H.A., Mather, K.A., & Easteal, S. (2008). The association of APOE genotype and cognitive decline in interaction with risk factors in a 65–69 year old community sample. BMC Geriatrics, 8(1), 1424.Google Scholar
Dardiotis, E., Fountas, K.N., Dardioti, M., Xiromerisiou, G., Kapsalaki, E., Tasiou, A. &Hadjigeorgiou, G.M. (2010). Genetic association studies in patients with traumatic brain injury. Neurosurgical Focus, 28(1), E9:112.Google Scholar
Eisenberg, D.T.A., Kuzawa, C.W., & Hayes, M.G. (2010). Worldwide allele frequencies of the human apolipoprotein E gene: Climate, local adaptations, and evolutionary history. American Journal of Physical Anthropology, 143(1), 100111.Google Scholar
Freeman, B., Smith, N., Curtis, C., Huckett, L., Mill, J., & Craig, I.W. (2003). DNA from buccal swabs recruited by mail: Evaluation of storage effects on long-term stability and suitability for multiplex polymerase chain reaction genotyping. Behavior Genetics, 33(1), 6772.Google Scholar
Ingelsson, M., Shin, Y., Irizarry, M.C., Hyman, B.T., Lilius, L., Forsell, C. & Graff, C. (2003). Genotyping of apolipoprotein E: Comparative evaluation of different protocols. Current Protocols in Human Genetics, Chapter 9, Unit 9.14.Google Scholar
Jordan, B.D. (2007). Genetic influences on outcome following traumatic brain injury. Neurochemical Research, 32(4-5), 905915.Google Scholar
Lange, R.T., Brickell, T., French, L.M., Ivins, B., Bhagwat, A., Pancholi, S. & Iverson, G.L. (2013). Risk factors for postconcussion symptom reporting after traumatic brain injury in U.S. military service members. Journal of Neurotrauma, 30(4), 237246.Google Scholar
Liaquat, I., Dunn, L.T., Nicoll, J.A.R., Teasdale, G.M., & Norrie, J.D. (2002). Effect of apolipoprotein E genotype on hematoma volume after trauma. Journal of Neurosurgery, 96(1), 9096.Google Scholar
Lovell, M.R., Iverson, G.L., Collins, M.W., Podell, K., Johnston, K.M., Pardini, D., & Maroon, J.C. (2006). Measurement of symptoms following sports-related concussion: Reliability and normative data for the post-concussion scale. Applied Neuropsychology, 13(3), 166174.Google Scholar
Merritt, V.C., & Arnett, P.A. (2014). Premorbid predictors of postconcussion symptoms in collegiate athletes. Journal of Clinical and Experimental Neuropsychology, 36(10), 10981111.Google Scholar
Moran, L.M., Taylor, H.G., Ganesalingam, K., Gastier-Foster, J.M., Frick, J., Bangert, B., & Wright, M. (2009). Apolipoprotein E4 as a predictor of outcomes in pediatric mild traumatic brain injury. Journal of Neurotrauma, 26(9), 14891495.Google Scholar
Ruff, R.M., Iverson, G.L., Barth, J.T., Bush, S.S., & Broshek, D.K. (2009). Recommendations for diagnosing a mild traumatic brain injury: A National Academy of Neuropsychology education paper. Archives of Clinical Neuropsychology, 24(1), 310.Google Scholar
Silver, J.M., McAllister, T.W., & Arciniegas, D. (2009). Depression and cognitive complaints following mild traumatic brain injury. American Journal of Psychiatry, 166(6), 653661.Google Scholar
Sundström, A., Marklund, P., Nilsson, L.G., Cruts, M., Adolfsson, R., Van Broeckhoven, C. & Nyberg, L. (2004). APOE influences on neuropsychological function after mild head injury: Within-person comparisons. Neurology, 62(11), 19631966.Google Scholar
Teasdale, G.M., Murray, G.D., & Nicoll, J.A.R. (2005). The association between APOE ε4, age and outcome after head injury: A prospective cohort study. Brain, 128(11), 25562561.Google Scholar