Association of Nonconcussive Repetitive Head Impacts and Intense Physical Activity With Levels of Phosphorylated Tau(181) and Total Tau in Plasma of Young Elite Soccer Players

IMPORTANCE: Head impacts resulting in traumatic brain injury (TBI) lead to the elevation of phosphorylated tau protein (p-tau(181)) in plasma. To our knowledge, this study is the first to investigate dynamics of p-tau(181) levels and the ratio of p-tau(181) to total tau in individuals after nonconcussive head impacts. OBJECTIVE: To determine the association of repetitive low-intensity head impacts on p-tau(181) and total tau protein levels in the plasma of young adult elite soccer players and assess the possible association of head impacts with focused attention and cognitive flexibility. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, young elite soccer players performed intense physical activity with and without heading the ball. The study was conducted at a university facility in Slovakia from October 1, 2021, to May 31, 2022. Eligible participants were selected based on similarities in demographic variables, excluding those with a history of TBI. MAIN OUTCOMES AND MEASURES: The primary study outcomes were the levels of total tau protein and p-tau(181) in plasma samples and the cognitive status of the study participants. RESULTS: A total of 37 male athletes participated in the study (mean [SD] age: exercise group, 21.6 [1.6] years; heading group, 21.2 [1.5] years). We found significantly elevated levels of total tau and p-tau(181) in the plasma of soccer players 1 hour after physical exercise (tau, 1.4-fold; 95% CI, 1.2-1.5; P < .001; p-tau(181), 1.4-fold; 95% CI, 1.3-1.5, P < .001) and repetitive head impacts (tau, 1.3-fold; 95% CI, 1.2-1.4; P < .001; p-tau(181), 1.5-fold; 95% CI, 1.4-1.7 P < .001). The ratio of p-tau(181) to tau was significantly higher 1 hour after exercise and heading training, and remained elevated specifically in the heading group even after 24 hours (1.2-fold; 95% CI, 1.1-1.3; P = .002). Performance in cognitive tests revealed a significant decline in focused attention and cognitive flexibility after physical exercise and heading training; physical exercise of higher intensity without heading training was associated with a greater negative cognitive performance than heading only. CONCLUSIONS AND RELEVANCE: In this cohort study of young elite soccer players, the elevation of p-tau(181) and tau was observed after acute intense physical activity and nonconcussive repetitive head impacts. The increase of p-tau(181) levels relative to tau after 24 hours indicated an acute enrichment of phosphorylated tau fraction in the periphery when compared with preimpact levels; an imbalance of tau proteins may have long-lasting consequences in the brain of head-impacted individuals.