The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume

Bryant, Barry R.; Narapareddy, Bharat R.; Bray, Michael J.C.; Richey, Lisa N.; Krieg, Akshay; Shan, Guogen; Peters, Matthew E.; Bernick, Charles

doi:10.1080/09540261.2019.1665501

Cited by 18 publications

(27 citation statements)

References 24 publications

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“…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%

“…Finally, there has been one large-scale study of active ( n = 442) and retired ( n = 64) professional fighters (i.e., boxers, mixed martial artists, and martial artists), and this study examined numerous neuroimaging variables, neuropsychological test scores, and self-report symptom measures. Earlier AFE to combat sports was associated with several differences in brain macrostructure, worse measured cognitive functioning, and greater self-reported symptoms of depression and impulsiveness ( 122 ). Although the authors state, “AFE to competitive fighting was defined as the study participant's self-reported age (in years) when competitive fighting began…This age was the earlier of either amateur or professional competitive fighting experience,” the descriptive statistics for AFE were not presented.…”

Section: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

“…Without an available pre-registered protocol detailing study outcomes and statistical analysis plans prior to data collection, it was/is not possible to determine selective outcome reporting and selective analytical reporting. One study (5%) was judged to be at high risk of bias due to a perceived limitation in the statistical analysis ( 89 ), and one study (5%) was considered high risk of bias due to clear evidence that data for only a subset of analyses was fully reported, and that the fully reported results were selected based on the (statistically significant) nature of the results ( 122 ).…”

Section: Risk Of Bias Assessment Findingsmentioning

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: Studies With Retired Amateur and Professional Athletesmentioning

confidence: 99%

Section: Risk Of Bias Assessment Findingsmentioning

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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“…4,5 In the context of contact sports, multiple authors have noted neurodegenerative changes due to TBI with accompanying neuropsychiatric deficits, such as those observed in chronic traumatic encephalopathy (CTE). [6][7][8] Although some of the earliest evidence of this was observed in combat sports such as boxing, 9,10 similar neurological effects of repetitive head impacts (RHIs) have been observed in military personnel and athletes playing football, soccer, and hockey. 11,12 Boxers and mixed martial arts (MMA) fighters, who regularly receive strikes to the head during practice and competitions, represent important populations at risk for developing neuropsychiatric complications from RHI.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 Boxers and mixed martial arts (MMA) fighters, who regularly receive strikes to the head during practice and competitions, represent important populations at risk for developing neuropsychiatric complications from RHI. 6,8,13 Boxing and MMA matches have traditionally utilized weight classes to separate competitors into different divisions, such that neither competitor has an unfair physical advantage during a fight. Although fighters need not fight at the exact same weight class in each professional bout, it is uncommon for their fighting weight to deviate substantially throughout their career.…”

Section: Introductionmentioning

confidence: 99%

Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters

Bray

Tsai

Bryant

et al. 2021

Neurotrauma Reports

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Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (£139.9 lb), middleweight (140.0-178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weightcutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

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White matter hyperintensities in former American football players

Alosco

Tripodis

Baucom

et al. 2022

Alzheimer's & Dementia

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Introduction:The presentation, risk factors, and etiologies of white matter hyperintensities (WMH) in people exposed to repetitive head impacts are unknown. We examined the burden and distribution of WMH, and their association with years of play, age of first exposure, and clinical function in former American football players.Methods: A total of 149 former football players and 53 asymptomatic unexposed participants (all men, 45-74 years) completed fluid-attenuated inversion recovery magnetic resonance imaging, neuropsychological testing, and self-report neuropsychiatric measures. Lesion Segmentation Toolbox estimated WMH. Analyses were performed in the total sample and stratified by age 60. Results:In older but not younger participants, former football players had greater total, frontal, temporal, and parietal log-WMH compared to asymptomatic unexposed men. In older but not younger former football players, greater log-WMH was associated with younger age of first exposure to football and worse executive function.Discussion: In older former football players, WMH may have unique presentations, risk factors, and etiologies.

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The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume

Cited by 18 publications

References 24 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

Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters

White matter hyperintensities in former American football players

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