No Overall Link of Concussions to Cognitive Decline in Older Ex-rugby Players

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Elite ex-rugby players aged 50+ who suffered three or more rugby-related concussions in their career have similar cognitive function to those who had experienced fewer concussions, according to a new study in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

The BRAIN study worked with nearly 150 retired elite male players now aged 50+ who played for either England, Oxford University or Cambridge University in the pre-professional era.

While no worsening of cognitive function was seen in the group overall and in the under 75s, the study did find that over 75s with three or more rugby-related concussions during their career (14/48) had significantly worse cognitive function on average than those who had experienced fewer concussions, and may be at risk of future cognitive problems.

The findings have implications for the clinical management of older ex-rugby players, and possibly ex-players of other contact sports who may be at risk of impaired cognition, the team noted.

Given the age of the 75+ participants, these findings therefore primarily relate to the pre-professional era in rugby. Additional work is needed for younger players, particularly when reaching older ages when more cognitive problems manifest.

This study marks the first to attempt to measure cognitive function in a large number of former players and to link this to their concussion and playing history. Previous studies which have focussed on younger players have found little or no association between concussions and reduced cognitive function.

The study’s last author, Professor Neil Pearce from the London School of Hygiene & Tropical Medicine, said: “Evidence is accumulating on the possible long-term health risks in former contact sport athletes. However, each sport is different and there is currently little evidence from rugby players. This study adds to this knowledge gap, and shows that playing elite rugby may affect cognitive function in older age. It’s important more research is conducted to confirm this, and on those who played in the early years of professional rugby.”

One partial explanation for the reduced cognition in the 75+ groups could be that the former elite rugby players in this study were mostly highly educated, therefore having a higher average cognitive function at the start of their playing careers.

Dr Valentina Gallo, from the University of Groningen in the Netherlands (formerly at Queen Mary University of London), another of the Principal Investigators of the BRAIN study, and study first author, said: “Our findings are in line with those of previous studies, and perhaps highlight that the high cognitive reserve in this study group may have masked the initial phases of any cognitive problems they experience. We’ll be following up on this group of players to shed further light on our findings.”

Participants took part in an extensive set of tests capturing physical and cognitive capabilities. with cognitive function measured using the Pre-clinical Alzheimer Cognitive Composite (PACC) score, which combines tests that assess episodic memory, timed executive function, and global cognition.

After adjusting for possible confounding factors including age, smoking and player playing position, participants over 75 with three or more concussions scored about two points lower on the PACC score. This indicates a difference in cognitive function that can only be detectable with this sort of detailed testing, but which may indicate an increased risk of developing neuro-degenerative conditions.

A total of 116 (80%) respondents reported at least one rugby-related concussion. Among the concussed, the number of rugby-related concussion ranged between one and 25, with a median of two. The number of rugby-related concussions was not associated with the position they played or with length of rugby career.

Dr Simon Kemp, RFU Medical Services Director, said: “This study, that started in 2017, adds to our developing understanding of the potential long term consequences of head impacts and concussions.  The agreed group of participants were aged 50+ principally because of the greater likelihood that we might detect any neurocognitive decline if present.  It is important to also conduct research with younger retired players.

Source: London School of Hygiene & Tropical Medicine

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