Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study

Roberts, Andrea L.; Pascual‐Leone, Álvaro; Speizer, Frank E.; Zafonte, Ross; Baggish, Aaron L.; Taylor, Herman A.; Nadler, Lee M.; Courtney, Theodore K.; Connor, Ann; Grashow, Rachel; Stillman, Alexandra; Marengi, Dean A.

doi:10.1177/0363546519868989

Cited by 64 publications

(76 citation statements)

References 54 publications

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“…26,27 Recently, years of professional play, concussion history, and position were significantly associated with neuropsychiatric symptoms in the largest study of living ASF football players to date. 28 These results align with prior work in nonprofessional football cohorts suggesting a link between cumulative head impacts and neurobehavioral symptoms. 29 Using either exposure to football as a proxy for repetitive head injury, or using mood and behavioral changes as a phenotypic marker of brain degeneration, clinicians familiar with this literature may be inclined to suggest CTE before considering other contributors to cognitive symptoms.…”

Section: Discussionsupporting

confidence: 87%

Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football

Grashow

Baggish

Speizer

et al. 2020

Annals of Neurology

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Objective American‐style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. Methods A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. Results Despite being a postmortem diagnosis, 108 players (2.8%) self‐reported clinician‐diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self‐reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non‐CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self‐reporting CTE. Interpretation Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE‐linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106–112

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Section: Discussionsupporting

confidence: 87%

Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football

Grashow

Baggish

Speizer

et al. 2020

Annals of Neurology

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“…H ead trauma, including both concussive events and repeated subconcussive events, have been associated with cognitive impairment in former professional American-style football players, combat veterans, and the general public. [1][2][3] These findings are derived mostly from retrospective clinical assessments. To the degree that animal models can simulate neurocognitive decline, however, controlled experiments are suggestive.…”

Section: Introductionmentioning

confidence: 99%

Modifiable Risk Factors for Poor Cognitive Function in Former American-Style Football Players: Findings from the Harvard Football Players Health Study

Roberts

Zafonte

Speizer

et al. 2020

Journal of Neurotrauma

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Recent attention to consequences of head trauma among former professional American-style football players has increased the likelihood that former players and their healthcare providers attribute neurocognitive effects to these exposures. In addition to head trauma, however, many potentially modifiable risk factors are associated with cognitive impairment. We examined the association of self-reported risk factors for cognitive impairment (e.g., cardiovascular health, sleep, pain, depression, anxiety, smoking, physical impairment, and physical activity) with cognition-related quality of life, measured by the Quality of Life in Neurological Disorders, Applied Cognition-General Concerns (Neuro-QOL) among 3803 former National Football League (NFL) players. We examined the prevalence of risk factors among men who had experienced a high number of concussion symptoms during playing years, comparing men with good current cognition-related QOL, the ''healthy concussed,'' to men with poor cognition-related QOL, the ''unhealthy concussed.'' Physical functioning, pain, depression, and anxiety were very strongly associated with poor cognitive-related QOL (risk ratio range, 2.21-2.70, p < 0.0001 for all). Short sleep duration and low physical activity were also strongly associated (RR = 1.69 and 1.57, respectively, p < 0.0001 for both). The largest differences between healthy and unhealthy concussed were in chronic pain (72.0% vs. 21.2%), depressive symptoms (50.3% vs. 6.3%), anxiety symptoms (53.4% vs. 11.6%), and physical impairment (52.4% vs. 12.5%). Substantial differences also existed in prevalence of sleep apnea, short sleep duration, highintensity exercise, weight training, high blood pressure, and body mass index ‡35 kg/m 2 (all differences >10 percentage points). We identified cognitive risk factors, including chronic pain, mood problems, sleep problems, obesity, and lack of exercise, that were commonly present in former football players with cognition-related impairment. Better treatment for these factors may reduce cognitive problems in this population.

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“…Although the clinical features of former boxers have been described for almost a century, 47 and there is increasing evidence of long-term cognitive and neuropsychiatric impairments in living former American football players (with greater exposure to RHI associated with worse later-life symptoms), 43,63 the specific clinical presentation associated with underlying CTE neuropathology remains unclear. Our knowledge of the clinical presentation of CTE is based primarily on retrospective histories obtained from the next of kin of deceased individuals whose brains have been donated for neuropathological examination.…”

Section: Clinical Features Reported In Neuropathologically Confirmedmentioning

confidence: 99%

Clinical Presentation of Chronic Traumatic Encephalopathy

et al. 2020

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Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts (RHI), such as those received in contact/collision sports, blast injury in military veterans, and domestic violence. Currently, CTE can only be diagnosed following death. Although the clinical features of former boxers have been described for almost a century, and there is increasing evidence of long-term cognitive and neuropsychiatric impairments in living former American football players, the specific clinical presentation associated with underlying CTE neuropathology remains unclear. These features include diverse and nonspecific changes in cognition, mood, behavior, and motor functioning. Currently, there are no validated and widely accepted clinical diagnostic criteria. Proposed criteria are primarily based on retrospective telephonic interviews with the next of kin of individuals who were diagnosed with CTE postmortem. Prospective studies involving individuals presumably at high risk for CTE are underway; these will hopefully clarify the clinical features and course of CTE, allow the diagnostic criteria to be refined, and lead to the development and validation of in vivo biomarkers. This article reviews what is currently known about the clinical presentation of CTE and describes the evolution of this knowledge from early case reports of “punch drunk” boxers through larger case series of neuropathologically confirmed CTE. This article concludes with a discussion of gaps in research and future directions to address these areas.

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Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study

Cited by 64 publications

References 54 publications

Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football

Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football

Modifiable Risk Factors for Poor Cognitive Function in Former American-Style Football Players: Findings from the Harvard Football Players Health Study

Clinical Presentation of Chronic Traumatic Encephalopathy

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