Julie M Stamm1, Alexandra P Bourlas1, Christine M Baugh1, Nathan G Fritts1, Daniel H Daneshvar1, Brett M Martin1, Michael D McClean1, Yorghos Tripodis1, Robert A Stern2. 1. From the CTE Center (J.M.S., A.P.B., C.M.B., N.G.F., D.H.D., Y.T., R.A.S.), Department of Anatomy and Neurobiology (J.M.S., R.A.S.), BU Alzheimer's Disease Center (A.P.B., Y.T., R.A.S.), Department of Neurology (C.M.B., R.A.S.), and Department of Neurosurgery (R.A.S.), Boston University School of Medicine; and Data Coordinating Center (B.M.M.), Department of Environmental Health (M.D.M.), and Department of Biostatistics (Y.T.), Boston University School of Public Health, Boston, MA. 2. From the CTE Center (J.M.S., A.P.B., C.M.B., N.G.F., D.H.D., Y.T., R.A.S.), Department of Anatomy and Neurobiology (J.M.S., R.A.S.), BU Alzheimer's Disease Center (A.P.B., Y.T., R.A.S.), Department of Neurology (C.M.B., R.A.S.), and Department of Neurosurgery (R.A.S.), Boston University School of Medicine; and Data Coordinating Center (B.M.M.), Department of Environmental Health (M.D.M.), and Department of Biostatistics (Y.T.), Boston University School of Public Health, Boston, MA. bobstern@bu.edu.
Abstract
OBJECTIVE: To determine the relationship between exposure to repeated head impacts through tackle football prior to age 12, during a key period of brain development, and later-life executive function, memory, and estimated verbal IQ. METHODS: Forty-two former National Football League (NFL) players ages 40-69 from the Diagnosing and Evaluating Traumatic Encephalopathy using Clinical Tests (DETECT) study were matched by age and divided into 2 groups based on their age of first exposure (AFE) to tackle football: AFE <12 and AFE ≥12. Participants completed the Wisconsin Card Sort Test (WCST), Neuropsychological Assessment Battery List Learning test (NAB-LL), and Wide Range Achievement Test, 4th edition (WRAT-4) Reading subtest as part of a larger neuropsychological testing battery. RESULTS: Former NFL players in the AFE <12 group performed significantly worse than the AFE ≥12 group on all measures of the WCST, NAB-LL, and WRAT-4 Reading tests after controlling for total number of years of football played and age at the time of evaluation, indicating executive dysfunction, memory impairment, and lower estimated verbal IQ. CONCLUSIONS: There is an association between participation in tackle football prior to age 12 and greater later-life cognitive impairment measured using objective neuropsychological tests. These findings suggest that incurring repeated head impacts during a critical neurodevelopmental period may increase the risk of later-life cognitive impairment. If replicated with larger samples and longitudinal designs, these findings may have implications for safety recommendations for youth sports.
OBJECTIVE: To determine the relationship between exposure to repeated head impacts through tackle football prior to age 12, during a key period of brain development, and later-life executive function, memory, and estimated verbal IQ. METHODS: Forty-two former National Football League (NFL) players ages 40-69 from the Diagnosing and Evaluating Traumatic Encephalopathy using Clinical Tests (DETECT) study were matched by age and divided into 2 groups based on their age of first exposure (AFE) to tackle football: AFE <12 and AFE ≥12. Participants completed the Wisconsin Card Sort Test (WCST), Neuropsychological Assessment Battery List Learning test (NAB-LL), and Wide Range Achievement Test, 4th edition (WRAT-4) Reading subtest as part of a larger neuropsychological testing battery. RESULTS: Former NFL players in the AFE <12 group performed significantly worse than the AFE ≥12 group on all measures of the WCST, NAB-LL, and WRAT-4 Reading tests after controlling for total number of years of football played and age at the time of evaluation, indicating executive dysfunction, memory impairment, and lower estimated verbal IQ. CONCLUSIONS: There is an association between participation in tackle football prior to age 12 and greater later-life cognitive impairment measured using objective neuropsychological tests. These findings suggest that incurring repeated head impacts during a critical neurodevelopmental period may increase the risk of later-life cognitive impairment. If replicated with larger samples and longitudinal designs, these findings may have implications for safety recommendations for youth sports.
Authors: J N Giedd; J Blumenthal; N O Jeffries; F X Castellanos; H Liu; A Zijdenbos; T Paus; A C Evans; J L Rapoport Journal: Nat Neurosci Date: 1999-10 Impact factor: 24.884
Authors: Rachel M Brouwer; Inge L C van Soelen; Suzanne C Swagerman; Hugo G Schnack; Erik A Ehli; René S Kahn; Hilleke E Hulshoff Pol; Dorret I Boomsma Journal: Hum Brain Mapp Date: 2013-12-31 Impact factor: 5.038
Authors: Justin J F O'Rourke; William H Adams; Kevin Duff; Joanne Byars; Peg Nopoulos; Jane S Paulsen; Leigh J Beglinger Journal: Arch Clin Neuropsychol Date: 2010-12-08 Impact factor: 2.813
Authors: Kevin M Guskiewicz; Stephen W Marshall; Julian Bailes; Michael McCrea; Herndon P Harding; Amy Matthews; Johna Register Mihalik; Robert C Cantu Journal: Med Sci Sports Exerc Date: 2007-06 Impact factor: 5.411
Authors: Bryan R Cobb; Jillian E Urban; Elizabeth M Davenport; Steven Rowson; Stefan M Duma; Joseph A Maldjian; Christopher T Whitlow; Alexander K Powers; Joel D Stitzel Journal: Ann Biomed Eng Date: 2013-07-24 Impact factor: 3.934
Authors: Robert A Stern; Daniel H Daneshvar; Christine M Baugh; Daniel R Seichepine; Philip H Montenigro; David O Riley; Nathan G Fritts; Julie M Stamm; Clifford A Robbins; Lisa McHale; Irene Simkin; Thor D Stein; Victor E Alvarez; Lee E Goldstein; Andrew E Budson; Neil W Kowall; Christopher J Nowinski; Robert C Cantu; Ann C McKee Journal: Neurology Date: 2013-08-21 Impact factor: 9.910
Authors: Inga K Koerte; Jakob Hufschmidt; Marc Muehlmann; Yorghos Tripodis; Julie M Stamm; Ofer Pasternak; Michelle Y Giwerc; Michael J Coleman; Christine M Baugh; Nathan G Fritts; Florian Heinen; Alexander Lin; Robert A Stern; Martha E Shenton Journal: J Neurotrauma Date: 2015-12-15 Impact factor: 5.269
Authors: Andrea L C Schneider; Elizabeth Selvin; Menglu Liang; Lawrence Latour; L Christine Turtzo; Silvia Koton; Josef Coresh; Thomas Mosley; Christopher T Whitlow; Yun Zhou; Dean F Wong; Geoffrey Ling; Rebecca F Gottesman Journal: J Neurotrauma Date: 2019-05-23 Impact factor: 5.269
Authors: Joel Castellanos; Cheng Perng Phoo; James T Eckner; Lea Franco; Steven P Broglio; Mike McCrea; Thomas McAllister; Jenna Wiens Journal: Sports Med Date: 2021-03 Impact factor: 11.136
Authors: Inga K Koerte; Alexander P Lin; Anna Willems; Marc Muehlmann; Jakob Hufschmidt; Michael J Coleman; Isobel Green; Huijun Liao; David F Tate; Elisabeth A Wilde; Ofer Pasternak; Sylvain Bouix; Yogesh Rathi; Erin D Bigler; Robert A Stern; Martha E Shenton Journal: Brain Pathol Date: 2015-05 Impact factor: 6.508
Authors: Julie M Stamm; Inga K Koerte; Marc Muehlmann; Ofer Pasternak; Alexandra P Bourlas; Christine M Baugh; Michelle Y Giwerc; Anni Zhu; Michael J Coleman; Sylvain Bouix; Nathan G Fritts; Brett M Martin; Christine Chaisson; Michael D McClean; Alexander P Lin; Robert C Cantu; Yorghos Tripodis; Robert A Stern; Martha E Shenton Journal: J Neurotrauma Date: 2015-09-23 Impact factor: 5.269
Authors: Jaclyn B Caccese; Grant L Iverson; Kenneth L Cameron; Megan N Houston; Gerald T McGinty; Jonathan C Jackson; Patrick O'Donnell; Paul F Pasquina; Steven P Broglio; Michael McCrea; Thomas McAllister; Thomas A Buckley Journal: J Neurotrauma Date: 2019-09-20 Impact factor: 5.269
Authors: Jaclyn B Caccese; Ryan M DeWolf; Thomas W Kaminski; Steven P Broglio; Thomas W McAllister; Michael McCrea; Thomas A Buckley Journal: Sports Med Date: 2019-03 Impact factor: 11.136
Authors: Breton M Asken; Molly J Sullan; Aliyah R Snyder; Zachary M Houck; Vaughn E Bryant; Loren P Hizel; Molly E McLaren; Duane E Dede; Michael S Jaffee; Steven T DeKosky; Russell M Bauer Journal: Neuropsychol Rev Date: 2016-08-25 Impact factor: 7.444