Neuropsychological functioning in ageing retired NFL players: a critical review

Schaffert, Jeff; LoBue, Christian; Fields, Lindy M.; Wilmoth, Kristin; Didehbani, Nyaz; Hart, John; Cullum, C. Munro

doi:10.1080/09540261.2019.1658572

Cited by 15 publications

(20 citation statements)

References 49 publications

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“…Although football players may experience, on average, more than 1000 subconcussive events per playing season, olfactory performance remains to be a subtle factor in describing brain injury. Similar results were obtained in analyses measuring visuospatial scanning speed, visuomotor processing speed, visuospatial construction, and verbal memory of NFL players compared to healthy controls [29]. Subtle olfactory differences may be di cult to detect with the current behavioral assessments used on human mTBI patients, and thus warrants further attention.…”

Section: Discussionsupporting

confidence: 72%

Increases of phospho-Tau (Ser202/Thr205) in the olfactory regions are associated with impaired EEG and olfactory behavior in traumatic brain injury mice

Yoon¹,

Seol²,

Kim³

et al. 2021

Preprint

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Traumatic brain injury (TBI) leads to long-term cognitive impairments with an increased risk for neurodegenerative and psychiatric disorders. Among these various impairments, olfactory dysfunction is one of the most common symptoms in TBI patients. However, there are very few studies that show the association between olfactory dysfunction and repetitive TBI, which accounts for the majority of all head injuries. In this present study, we investigated the effects of repetitive TBI on olfactory functioning and the related pathological neuronal injuries in mice. Through pathological examination, we found a significant increase in p-Tau (S202/T205) in olfactory bulb-associated areas such as the Anterior Olfactory Nucleus (AON), Pyriform Cortex (PC), Tenia Tecta (TT), and Olfactory Tubercle (OT). Neuronal atrophy in the Lateral Anterior Olfactory Nucleus (AOL), Granule Layer Olfactory Bulb (GrO), and Dorsal Tenia Tecta (DTT) was also found to be correlated with p-Tau levels. Furthermore, electroencephalography (EEG) of repetitive TBI mouse models showed impaired spontaneous delta oscillation, as well as altered cross-frequency coupling between delta phase and amplitudes of the fast oscillations in the resting-state olfactory bulb. Also, abnormal alterations in EEG band powers were observed during the olfactory oddball paradigm test. This study provides evidence of pathological and physiological alterations in the mouse olfactory system caused by repetitive TBI. Together, p-Tau alterations and EEG impairments may serve as important biomarkers of olfactory track-associated dysfunctions and behavioral impairments commonly observed in repetitive TBI patients.

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Section: Discussionsupporting

confidence: 72%

Increases of phospho-Tau (Ser202/Thr205) in the olfactory regions are associated with impaired EEG and olfactory behavior in traumatic brain injury mice

Yoon¹,

Seol²,

Kim³

et al. 2021

Preprint

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“…Researchers using diverse experimental neuroimaging techniques have reported that some former NFL players have measurable macrostructural (53-55) and microstructural (56,57) differences in their brains, and differences in neurochemistry, measured by magnetic resonance spectroscopy (58), and neurophysiology, measured using several technologies (e.g., positron emission tomography and functional magnetic resonance imaging) (59)(60)(61)(62)(63)(64). Some clinical studies have reported that some former NFL players perform worse on neuropsychological tests than control participants (54,57,65). In large survey studies, most participants report that they have broadly normal health, but a subgroup of former NFL players reports poor mental health and cognitive functioning (66)(67)(68)(69)(70)(71).…”

Section: Professional American Football and Later In Life Brain Diseasesmentioning

confidence: 99%

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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“…We also did not find an association between neuropsychological functioning and likelihood of TES diagnosis in our multivariate model. Research investigating the link between head-injury exposure and cognitive functioning has been equivocal at best (28). A well-cited study by Stamm et al in 2015 suggested worse executive functioning deficits in those who began playing football earlier than 12 years of age (29), though this study has limitations in the form of inequity between groups in regards to learning disabilities, substance use, and steroid use, as well as the lack of a control group (30).…”

Section: Discussionmentioning

confidence: 73%

Frequency and Predictors of Traumatic Encephalopathy Syndrome in a Prospective Cohort of Retired Professional Athletes

et al. 2021

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Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, p = 0.087), number of concussions (OR = 1.020, p = 0.532), number of concussions with loss of consciousness (OR = 1.141 p = 0.188), and years playing professionally (OR = 0.976, p = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, p < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.

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Neuropsychological functioning in ageing retired NFL players: a critical review

Cited by 15 publications

References 49 publications

Increases of phospho-Tau (Ser202/Thr205) in the olfactory regions are associated with impaired EEG and olfactory behavior in traumatic brain injury mice

Increases of phospho-Tau (Ser202/Thr205) in the olfactory regions are associated with impaired EEG and olfactory behavior in traumatic brain injury mice

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

Frequency and Predictors of Traumatic Encephalopathy Syndrome in a Prospective Cohort of Retired Professional Athletes

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