Comprehensive Neuropsychiatric and Cognitive Characterization of Former Professional Football Players: Implications for Neurorehabilitation

Abstract

Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms. Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports. Design: Between-groups analyses. Main measures: Neuropsychiatric . Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive . Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task). Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions ( 6 1 ), but not former players with ≤ 3 concussions ( 2 0 ), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task. Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.

Predictors and Correlates of Depression in Retired Elite Level Rugby League Players

“…In the present study, a greater lifetime history of concussions and a greater history of exposure to elite-level collision sports were not associated with current symptoms of depression. This study is inconsistent with survey studies of former elite and professional athletes that have shown an association between a greater number of prior concussions and current symptoms of depression ( 17 – 22 ). Those studies were conducted prior to the greatly increased awareness of, and sensitivity to, concussions.…”

“…Researchers have reported that correlates of depression and psychological distress in retired elite and professional athletes include retirement due to injury ( 8 ), greater athletic identity ( 8 ), a higher level of career dissatisfaction ( 11 , 119 ), current adverse life events ( 11 , 12 , 119 ), chronic pain ( 2 , 3 , 66 , 75 ), osteoarthritis ( 116 ), and lifetime history of prior concussions ( 17 – 22 ). In the present study, neither lifetime history of concussions nor contact sport exposure were meaningfully related to depression in retired elite level rugby league players.…”

“…There is considerable interest in whether repetitive neurotrauma, either in the form of concussions, or so-called subconcussive impacts , is associated with later in life mental health problems in former amateur and professional contact, collision, and combat sport athletes ( 13 – 16 ). Researchers have reported an association between a greater number of self-reported concussions and greater symptoms of later-in-life depression ( 17 – 22 ). The duration of a professional career is sometimes used as a proxy for exposure to low-level repetitive mild neurotrauma ( 23 ).…”

A Systematic Review of the Effects of Football Playing on Changes in Serum Brain-Derived Neurotrophic Factor Level

“…In addition, in competitive sports, it is necessary to consider other factors, such as the stressful effects of competition and injury potential, among other factors that could influence the behaviour of serum BDNF level. Some cognitive (e.g., anger expression and mental fatigue) and behavioural (e.g., coping skills, competitive anxiety, and mental toughness) characteristics of football players [22,23] could also influence changes in serum BDNF level [24]. The available evidence indicates that exercise is an effective strategy for enhancing BDNF activity, with promising preliminary evidence in high-intensity exercise [1]; however, there is a lack of data available regarding football playing.…”

High cognitive demand tasks may detect mild alterations in executive functions in American football players: A pilot study

“…In the study of cognitive alterations in RHT, emphasis has been placed on the processes that have shown sensitivity to indicate alterations in athletes, such is the case of working memory, decision-making, planning, inhibition, and reaction times 14,15 . In this sense, the use of computerized tests represents an advantage in the study of repeated blows to the head, since it allows the randomized presentation of the stimuli to avoid the learning effect of a pencil and paper test and the measurement of times reaction rate as a measure of processing speed 16 .…”