Association of Playing High School Football With Cognition and Mental Health Later in Life
Deshpande SK, Hasegawa RB, Rabinowitz AR, Whyte J, Roan CL, Tabatabaei A, Baiocchi M, Karlawish JH, Master CL, Small DS. JAMA Neurol. 2017; ahead of print.
Take-Home Message
High school football players followed since the 1950’s had no differences in cognitive or depressive symptoms at ~65 years of age compared with other men who did not participate in football.
Many have questioned the long-term safety of football due to previous reports stating there is an increased risk for cognitive impairments and depression later in life among those who played football. Though concerning and informative, many of these studies contain biases or lack a control group. Therefore, these authors followed 2,692 men (~65 years of age) who graduated
from high school in 1957 to identify the long-term association of playing high school football with cognitive impairment using a composite cognitive score (letter fluency, delayed word recall tests), and depression using the modified Center for Epidemiological Studies’ Depression Scale score. These items were assessed at 54, 65, and 72 years of age. The authors matched high school football players (834 players; 31%) to 3 versions of controls: all controls (858 men), non-collision sport participants, and those that did not participate in any sports. Participants were matched based on several factors such as IQ, family background, and education level. The authors found that football players did not have different cognitive composite scores than all controls or when compared to non-sports participants. There was a small effect found between football players and non-collision sport players. Football players were less likely to report depressive symptoms compared with all controls.
The authors found that men who participated in high school football in Wisconsin from 1957 were not adversely associated with cognitive impairment or depression later in life. Though, this is one of the first large longitudinal study to follow people since high school with a well-defined control group it should be noted that they were unable to assess for concussion history or athletic
exposure (how many times they participated in a game or practice). This may be relevant because these specific factors are likely associated with cognitive and mental decline. Therefore, future longitudinal studies looking to investigate football participation and its association to cognitive and mental status will need to include factors such as concussion history, position, or continued play on higher levels (such as college). It’s also unclear if we can apply these results to our current football players because much has changed in football since the late 1950s (e.g., management of concussions, size of players). Despite these limitations, these findings are reassuring. Unlike other recent studies that have garnered a lot of media attention this study is a nice example of a well-done study that offers new insights into the long-term health of our patients compared with the rest of the population. Medical professionals need to be aware of the strengths and weaknesses in these studies to be able to convey this information to parents and athletes to enable them to make decisions based on evidence and not hype.
Question for Discussion
Are athletes playing football today at greater risk for poor long-term outcomes than those who played in the 1950s?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban