By Susan E. Matthews
A new study suggests that football may not be as dangerous for brain health as past research suggests, but experts are not convinced by the findings.
Researchers from Loyola University Medical Center studied retired NFL players, both through surveys and through in-person assessments, and found no evidence showing that the players had chronic traumatic encephalopathy (CTE), a neurodegenerative disease found in the brains of former players who committed suicide. It's still possible that participating in the sport increases the players' risk of late-life cognitive impairment, study author Christopher Randolph, PhD, professor of psychiatry at Loyola's Chicago Stritch School of Medicine, noted, though the risk is probably not very large.
The researchers conducted telephone interviews with 531 retired NFL players over the age of 50 in the first part of the study. The retirees had played professionally for an average of 7.5 years, and 35 percent of the sample set had possible cognitive impairment, based on a screening interview. The researchers then recruited 41 of the retired players based on evidence of their probable mild cognitive impairment. These players were studied in person by researchers. The retired football players showed identical levels of impairment when compared to non-athletes who also had mild cognitive impairments, but both groups were worse off than the control group.
"The retired NFL players basically look like regular patients who have mild cognitive impairment and have never played football," Randolph said in a statement.
The study did not compare the survey's results showing that 35 percent of the total group had possible cognitive impairment to a control group, but Jeffrey Kutcher, MD, a neurologist at the University of Michigan and member of the American Academy of Neurology, said he thought this was a "relatively high percentage" -- likely higher than that of the general population. Randolph warned against over-interpreting that number, which relied on participants to respond to a survey.
The study, published in the Journal of the International Neuropsychological Society, brings up the issue that currently, CTE does not have any clearly defined diagnostic criteria, clinically, said to John Hart, Jr., MD, of the University of Texas at Dallas, who has studied cognitive deficits in football players. The condition, which is thought to be characterized by irritability, impulsiveness, depression, aggression, short-term memory loss, and heightened suicidal behavior, has only been identified pathologically through autopsies of football players, Dr. Hart said.
"CTE as it stands now is a diagnosis based on autopsy -- you have to be dead before you find that diagnosis," said Daniel Amen, PhD, medical director of Amen Clinics in Newport Beach, Calif., and the study participants were not.
Randolph, however, defended the research. "There may be a higher rate of late-life cognitive impairment, though that still remains to be established, but it's probably not due to anything unique," about football, he said. The higher risk of late-life cognitive impairment is likely due to the brain cell damage they incur during repetitive head trauma, and is similar to the risk found in people who have sustained brain injuries or had strokes at a young age, he said.
Further research is needed on both CTE and concussions, according to Hart.
Getting a Proper Diagnosis
All current research on the connection between football and brain health, including this study's data, leads Amen to caution players to take exceptional care of their brains, he said, and to encourage past players to immediately figure out if their brains are damaged. Kutcher agreed.
For former players, the takeaway is to "get yourself to a neurologist who is experienced in cognitive disorders," Kutcher said.
Not a week goes by when Kutcher doesn't meet a patient who played a contact sport, such as football or hockey, in college or professionally, coming in complaining of cognitive issues, he said.
Hall of Famer Harry Carson, a former linebacker for the Giants, said that at a recent Hall of Fame luncheon, a microphone was being passed between tables for the players to talk about what it meant to be there. At every table, at least one player declined to talk. This is because they're "very hesitant to speak in public for fear of losing their train of thought," he said. "I can see the cognitive decline in some of those Hall of Famers."
As professional athletes, players are trained to be in touch with their physical and even mental health, Carson said, but "from a neurological standpoint, you sometimes have no clue in what's going on." Carson, who declined to comment on the recent study, encouraged all players who feel a shift in their emotional or mental well being to consult a neurologist to find out what the issue is.
Kutcher agreed that it's important to see a specialist. Often, the patients he sees are coming from a regular care doctor who told them that because they played the sport, they have CTE. "While a lot of good has come from increasing awareness, a lot of bad is going on," Kutcher said of incorrect diagnoses he thinks result from increased media coverage of the connection between football and CTE. This can have devastating effects on patients' lives: "I've seen people who have tried to commit suicide," because they are devastated by an incorrect diagnosis, he said. Diagnoses of neurological conditions, and the exact reason for their cause varies based on the individual, he said.
"The media attention to this issue continues to far outweigh any meaningful results from sound experimental science, and a definitive epidemiological study still has yet to be done," the researchers wrote in the study.
Improving the Game
Hart emphasized that the new knowledge we have on the risks that come with contact sports and concussions may reduce the risk that future generations experience similar health problems.
Carson emphasized that though he played in the NFL, he still receives letters and emails from people who played contact sports at a high school or collegiate level but still are experiencing cognitive problems. "I think everyone has to be more vigilant in terms of sustaining some kind of trauma to the head -- it doesn't necessarily just go away," he said.
Even if changes are made to the rules, "the game will continue to be the game it is," Carson said, adding that he doesn't think it's possible for concussions to be completely eliminated from the sport. "I know my grandson is not going to play football," he said.
"Despite New Study, Experts Still Warn of Link Between Football and Cognitive Disease" originally appeared on Everyday Health.