Age of First Exposure to Football Is Not Associated With Later-in-Life Cognitive or Mental Health Problems

Caccese, Jaclyn B.; Merz, Zachary C.; Büttner, Fionn; Terry, Douglas P.

doi:10.3389/fneur.2021.647314

Cited by 18 publications

(20 citation statements)

References 36 publications

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“…This same research team, however, also using subjects from the LEGEND study and a different methodology, did not find an association between AFE and these same self-reported symptom outcomes ( N = 93) ( 93 ). Four additional independent studies, one large survey of former NFL players ( N = 3,506) ( 71 ), one clinical study of former NFL players ( N = 45) ( 91 ), and two surveys of men who played high school football ( N = 123, N = 186) ( 85 , 86 ), have not found a statistically significant association between earlier AFE to football and self-reported cognitive, neurobehavioral, or psychological functioning later in life. In one large-scale study of active and retired professional fighters, earlier AFE to combat sport was associated with worse measured cognitive functioning and greater self-reported symptoms of depression and impulsiveness ( 122 ).…”

Section: Discussionmentioning

confidence: 99%

“…It will be important to observe whether the findings of prior studies are replicated by future research investigating this association. The best available evidence to date suggests that earlier AFE to contact or collision sports is not associated with worse cognitive functioning or mental health in (i) current high school athletes, (ii) current collegiate athletes ( 84 , 87 , 88 , 90 , 111 , 123 , 124 ), or (iii) middle-aged men who played high school football ( 85 , 86 ).…”

Section: Discussionmentioning

confidence: 99%

“…Four follow-up studies, using different samples and methodologies, have not replicated findings from the DETECT and LEGEND studies regarding AFE ( 71 , 85 , 86 , 91 ). Solomon et al ( 91 ) aimed to replicate the study findings of Stamm et al with data from former NFL players ( 120 ), focusing particularly on neuropsychological test results.…”

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 92%

“…Former NFL players are not ideal for examining associations between youth sports participation and later in life brain health. Iverson et al ( 85 , 86 ) recruited two independent samples of men in the United States: (i) ages 35–55 years ( M = 44.8, SD = 6.2 years; N = 123) and (ii) ages 35 and older ( M = 51.8, SD = 10.9 years; N = 186), who played high school football. Participants completed the Patient Health Questionnaire-8 to assess symptoms of depression over the preceding 2 weeks, the British Columbia Post-Concussion Symptom Inventory to assess frequency and severity of persistent concussion symptoms, and a survey of medical history.…”

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

“…Although men who played football before age 12 reported a greater number of lifetime concussions and a younger age at first concussion than those who started at or after age 12, younger AFE to football was not associated with symptoms of, or treatment for, mental health problems, memory loss, chronic pain, or headaches. Specifically, younger AFE to football was not associated with (1) ever having seen a psychologist, counselor, or therapist for mental health care; (2) ever being prescribed medications for depression; (3) feeling depressed in the preceding week or year; (4) current symptoms of depression; (5) ever having been prescribed medications for anxiety; (6) having had problems with anxiety in the preceding week or year; (7) current symptoms of anxiety; (8) current post-concussion-like symptoms; or (9) current perceived difficulties with cognitive functioning ( 85 , 86 ).…”

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

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Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review

Büttner

Caccese

2021

Front. Neurol.

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A controversial theory proposes that playing tackle football before the age of 12 causes later in life brain health problems. This theory arose from a small study of 42 retired National Football League (NFL) players, which reported that those who started playing tackle football at a younger age performed worse on selected neuropsychological tests and a word reading test. The authors concluded that these differences were likely due to greater exposure to repetitive neurotrauma during a developmentally sensitive maturational period in their lives. Several subsequent studies of current high school and collegiate contact/collision sports athletes, and former high school, collegiate, and professional tackle football players have not replicated these findings. This narrative review aims to (i) discuss the fundamental concepts, issues, and controversies surrounding existing research on age of first exposure (AFE) to contact/collision sport, and (ii) provide a balanced interpretation, including risk of bias assessment findings, of this body of evidence. Among 21 studies, 11 studies examined former athletes, 8 studies examined current athletes, and 2 studies examined both former and current athletes. Although the literature on whether younger AFE to tackle football is associated with later in life cognitive, neurobehavioral, or mental health problems in former NFL players is mixed, the largest study of retired NFL players (N = 3,506) suggested there was not a significant association between earlier AFE to organized tackle football and worse subjectively experienced cognitive functioning, depression, or anxiety. Furthermore, no published studies of current athletes show a significant association between playing tackle football (or other contact/collision sports) before the age of 12 and cognitive, neurobehavioral, or mental health problems. It is important to note that all studies were judged to be at high overall risk of bias, indicating that more methodologically rigorous research is needed to understand whether there is an association between AFE to contact/collision sports and later in life brain health. The accumulated research to date suggests that earlier AFE to contact/collision sports is not associated with worse cognitive functioning or mental health in (i) current high school athletes, (ii) current collegiate athletes, or (iii) middle-aged men who played high school football. The literature on former NFL players is mixed and does not, at present, clearly support the theory that exposure to tackle football before age 12 is associated with later in life cognitive impairment or mental health problems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 92%

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

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Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review

Büttner

Caccese

2021

Front. Neurol.

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Exposure to Head Impacts and Cognitive and Behavioral Outcomes in Youth Tackle Football Players Across 4 Seasons

Rose

Yeates

Nguyen³

et al. 2021

JAMA Netw Open

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IMPORTANCERepetitive head impacts have been posited to contribute to neurocognitive and behavioral difficulties in contact sport athletes. OBJECTIVE To identify associations between cognitive and behavioral outcomes and head impacts measured in youth tackle football players over 4 seasons of play. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from July 2016 through January 2020, spanning 4 football seasons. The setting was a youth tackle football program and outpatient medical clinic. Players were recruited from 4 football teams composed of fifth and sixth graders, and all interested players who volunteered to participate were enrolled. Data analysis was performed from March 2020 to June 2021. EXPOSURES Impacts were measured using helmet-based sensors during practices and games throughout 4 consecutive seasons of play. Impacts were summed to yield cumulative head impact gravitational force equivalents per season. MAIN OUTCOMES AND MEASURES Ten cognitive and behavioral measures were completed before and after each football season. RESULTS There were 70 male participants aged 9 to 12 years (mean [SD] age, 10.6 [0.64] years),with 18 completing all 4 years of the study. At the post-season 1 time point, higher cumulative impacts were associated with lower self-reported symptom burden (β = −0.6; 95% CI, −1.0 to −0.2; P = .004). After correcting for multiple comparisons, no other associations were found between impacts and outcome measures. At multiple times throughout the study, premorbid attentiondeficit/hyperactivity disorder, anxiety, and depression were associated with worse cognitive or behavioral scores, whereas a premorbid headache disorder or history of concussion was less often associated with outcomes. CONCLUSIONS AND RELEVANCEIn this cohort of youth tackle football players, premorbid conditions, including attention-deficit/hyperactivity disorder, anxiety, and depression, were associated with cognitive and behavioral outcomes more often than cumulative impact.

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American Football Play and Parkinson Disease Among Men

et al. 2023

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ImportanceParkinsonism and Parkinson disease (PD) are known to result from repetitive head impacts from boxing. Repetitive head impacts from American football may also be associated with increased risk of neurodegenerative pathologies that cause parkinsonism, yet in vivo research on the association between football play and PD is scarce and limited by small samples and equivocal findings.ObjectiveTo evaluate the association between football participation and self-reported parkinsonism or PD diagnosis.Design, Setting, and ParticipantsThis cross-sectional study leveraged data from the online Fox Insight study. Participants completed online questionnaires and self-reported whether they currently had a diagnosis of Parkinson disease or parkinsonism by a physician or other health care professional. In November 2020, the Boston University Head Impact Exposure Assessment was launched for data collection on repetitive head impacts. Data used for this manuscript were obtained from the Fox Insight database on June 9, 2022. A total of 1875 men who endorsed playing any organized sport were included. Former athletes were divided into those who participated in football (n = 729 [38.9%]) and those who participated in other sports (reference group).ExposuresSelf-reported participation in football, duration and level of football play, age at first exposure.Main Outcomes and MeasuresLogistic regression tested associations between PD status and history of football play, duration of football play, highest level played, and age at first exposure, controlling for age, education, history of diabetes or heart disease, body mass index, history of traumatic brain injury with loss of consciousness, and family history of PD.ResultsIn this sample of 1875 men (mean [SD] age, 67.69 [9.84] years) enriched for parkinsonism or PD (n = 1602 [85.4%]), 729 (38.9%) played football (mean [SD] duration, 4.35 [2.91] years). History of playing football was associated with higher odds of having a parkinsonism or PD diagnosis (odds ratio [OR], 1.61; 95% CI, 1.19-2.17). Among the entire sample, longer duration of play was associated with higher odds of having a parkinsonism or PD diagnosis (OR, 1.12; 95% CI, 1.06-1.19). Among football players, longer duration of football play (OR, 1.12; 95% CI, 1.02-1.23) and higher level of play (OR, 2.93; 95% CI, 1.28-6.73) were associated with higher odds of having parkinsonism or PD.Conclusions and RelevanceIn this cross-sectional study of participants enriched for PD, participation in football was associated with higher odds of having a reported parkinsonism or PD diagnosis.

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Age of First Exposure to Football Is Not Associated With Later-in-Life Cognitive or Mental Health Problems

Cited by 18 publications

References 36 publications

Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review

Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review

Exposure to Head Impacts and Cognitive and Behavioral Outcomes in Youth Tackle Football Players Across 4 Seasons

American Football Play and Parkinson Disease Among Men

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