Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes

Background Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women.Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB.Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders.Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB.Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health

Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

Background: Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries. Objective: The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football. Methods: Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary. Results: The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men’s football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players. Conclusion: Future research should focus on concussion in women’s contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided

Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes

Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women. Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB. Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=-7.038, 95% CI -12.98 to -0.08, p=0.038) and verbal fluency tests (MD=-7.534, 95% CI -13.75 to -0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=-10.36, 95% CI -18.48 to -2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=-9.166, 95% CI -17.59 to -0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB. Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health

Neurocognitive performance of 425 top-level football players: Sport-specific norm values and implications

Objective Concussion diagnosis and management in sports largely relies on neurocognitive testing. In the absence of baseline assessment, only norm values of the general population are available for comparison with scores of concussed athletes. To evaluate whether (elite) sport specific norm values are needed, cognitive performance was compared between top-level football players and the general population. Methods Cognitive performance of 425 top-level football players was evaluated using the computerized test battery CNS Vital Signs. Players were split into two age groups (15-19 and 20-29 years) and test results were compared with a norm sample (n = 268) by means of age-standardized scores using Cohen's d effect size statistics. Results The younger age group outperformed the norm sample in all domains, with small to moderate effects on tests of processing speed (d = 0.58, 95% CI = 0.31,0.85), cognitive flexibility (d = 0.27, 95% CI = 0.01,0.53) and psychomotor speed (d = 0.97, 95% CI = 0.69,1.24). In the older age group, no differences were found on four out of six domains; a moderate positive effect was found for psychomotor speed (d = 0.74, 95% CI = 0.54,0.93), a small negative effect for reaction time (d = -0.47, 95% CI = -0.66,-0.28). Relative to the norm, older football players scored lower than younger football players on all test domains. Conclusion Cognitive performance of elite football players may be different from the general population. It is recommended to use football-specific norm scores for comparison with test results of concussed players, and to choose an adequate control group when investigating effects of contact sport on cognition. Studies with older/retired football players are needed to further analyze potential sport-specific age effects

Cortical thickness and neurocognitive performance in former high-level female soccer and non-contact sport athletes

Background: Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). Methods: 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. Results: SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. Perspective: In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case–control study design require a cautious interpretation

Every second retired elite female football player has MRI evidence of knee osteoarthritis before age 50 years: a cross-sectional study of clinical and MRI outcomes

Purpose: To assess knee health in retired female football players, using magnetic resonance imaging (MRI) and self-report. The focus of analysis were degenerative changes of the tibiofemoral joint, and their relationship to osteoarthritis symptoms and previous knee injury. Methods: Forty-nine retired elite, female football players (98 knees) aged 37 years on average participated. Tibiofemoral cartilage and meniscus status of both knees were evaluated using MRI and graded according to modified Outerbridge and Stoller classifications, respectively. Symptoms were assessed through a standardised questionnaire (Knee Osteoarthritis Outcome Score: KOOS). Knee injury history was recorded via a semi-structured interview. To investigate how injury variables relate to outcomes, binary logistic regression models were used and reported with odds ratios (OR). Results: Fifty-one per cent of players (n = 25) fulfilled the MRI criterion for knee osteoarthritis, 69.4% (n = 34) had substantial meniscal loss and 59.6% (n = 28) reported substantial clinical symptoms. Chondral- and meniscal loss were associated with significantly lower scores on three of five KOOS subscales (p <.05). Both chondral and meniscal loss were significantly predicted by previous traumatic knee injury (OR = 4.6, OR = 2.6), the injury affecting the non-striking leg (OR = 8.6, OR = 10.6) and type of injury; participants with combined ACL/meniscus injuries had the highest risk for substantial chondral and meniscal loss (OR = 14.8, OR = 9.5). Chondral loss was significantly predicted by isolated meniscus injury treated with partial meniscectomy (OR = 5.4), but not by isolated reconstructed ACL injury. Clinical symptoms were only significantly predicted by previous traumatic knee injury (OR = 5.1). Conclusions: Serious degenerative changes were found in a high number of retired female football players’ knees 10 years after their career. Meniscal integrity is key for knee osteoarthritis outcomes in young adults, and thus, its preservation should be a priority