Association of Playing High School Football With Cognition and Mental Health Later in Life

Abstract

IMPORTANCE American football is the largest participation sport in US high schools and is a leading cause of concussion among adolescents. Little is known about the long-term cognitive and mental health consequences of exposure to football-related head trauma at the high school level.OBJECTIVE To estimate the association of playing high school football with cognitive impairment and depression at 65 years of age. DESIGN, SETTING, AND PARTICIPANTSA representative sample of male high school students who graduated from high school in Wisconsin in 1957 was studied. In this cohort study using data from the Wisconsin Longitudinal Study, football players were matched between March 1 and July 1, 2017, with controls along several baseline covariates such as adolescent IQ, family background, and educational level. For robustness, 3 versions of the control condition were considered: all controls, those who played a noncollision sport, and those who did not play any sport.EXPOSURES Athletic participation in high school football. MAIN OUTCOMES AND MEASURESA composite cognition measure of verbal fluency and memory and attention constructed from results of cognitive assessments administered at 65 years of age. A modified Center for Epidemiological Studies' Depression Scale score was used to measure depression. Secondary outcomes include results of individual cognitive tests, anger, anxiety, hostility, and heavy use of alcohol. RESULTS Among the 3904 men (mean [SD] age, 64.4 [0.8] years at time of primary outcome measurement) in the study, after matching and model-based covariate adjustment, compared with each control condition, there was no statistically significant harmful association of playing football with a reduced composite cognition score (-0.04 reduction in cognition vs all controls; 97.5% CI, -0.14 to 0.05) or an increased modified Center for Epidemiological Studies' Depression Scale depression score (-1.75 reduction vs all controls; 97.5% CI, -3.24 to -0.26). After adjustment for multiple testing, playing football did not have a significant adverse association with any of the secondary outcomes, such as the likelihood of heavy alcohol use at 65 years of age (odds ratio, 0.68; 95% CI, 0.32-1.43). CONCLUSIONS AND RELEVANCECognitive and depression outcomes later in life were found to be similar for high school football players and their nonplaying counterparts from mid-1950s in Wisconsin. The risks of playing football today might be different than in the 1950s, but for current athletes, this study provides information on the risk of playing sports today that have a similar risk of head trauma as high school football played in the 1950s.

American Medical Society for Sports Medicine position statement on concussion in sport

“…Several studies have reported that NFL and college football athletes with a history of concussion are more likely to experience depression, although the risk of mental health issues, including suicide, among former NFL players is lower than age-matched controls 101–103. Former high school football players show no difference in cognitive function testing and have lower depression scores when compared with non-contact sport controls 104. Mental health issues are common, multifactorial and often present independent of participation in contact or collision sport.…”

Nutrition as Medicine to Improve Outcomes in Adolescents Sustaining a Sports-related Concussion

“…Brain injury, of any severity, in the developing brain is complicated by ongoing cerebral maturation. 26 Of crucial importance in prognosis is the rapid increase in reactive stressors that heighten the metabolic demand on the brain. 27 Concussion induces inflammatory sensory stimulus that is preferentially transmitted to brainstem and specific hypothalamic nuclei which have direct connection to the hypothalamic paraventricular nucleus.…”

Reassuring News About Football and Cognitive Decline?

“…However, the results of the study by Deshpande et al 9 offer some reassurance against CTE being a widespread epidemic among former football players, at least when considering high school football players as a group and examining long-term outcomes among this group on average.…”

“…Additional strengths of the study by Deshpande et al 9 include their careful consideration of some potential confounding factors, comparison of football players with different control groups, and analysis examining potential attrition bias. Future longitudinal, population-based studies should continue to use such thoughtfulness in data analysis.…”

“…Furthermore, an ideal study to investigate the potential for long-term risks associated with football and concussion would evaluate longitudinal trajectories in cognition and emotional well-being across the life span from youth through older adulthood. The study by Deshpande et al 9 had some repeated measures of cognition and mood measured in later life, although the analysis strategy was focused primarily on outcomes measured at single time points. If future studies do find group differences, a trajectory-based approach would be more informative in differentiating the possibility of chronic, stable differences from a downward trajectory suggestive of neurodegenerative disease.…”