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Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players

Guskiewicz, Kevin M. Ph.D., A.T.C.; Marshall, Stephen W. Ph.D.; Bailes, Julian M.D.; McCrea, Michael Ph.D.; Cantu, Robert C. M.D.; Randolph, Christopher Ph.D.; Jordan, Barry D. M.D., M.P.H.

doi: 10.1227/01.NEU.0000175725.75780.DD
Clinical Studies: Special Article: Sports: Trauma

OBJECTIVE: Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate the association between previous head injury and the likelihood of developing mild cognitive impairment (MCI) and Alzheimer's disease in a unique group of retired professional football players with previous head injury exposure.

METHODS: A general health questionnaire was completed by 2552 retired professional football players with an average age of 53.8 (±13.4) years and an average professional football playing career of 6.6 (± 3.6) years. A second questionnaire focusing on memory and issues related to MCI was then completed by a subset of 758 retired professional football players (≥50 yr of age). Results on MCI were then cross-tabulated with results from the original health questionnaire for this subset of older retirees.

RESULTS: Of the former players, 61% sustained at least one concussion during their professional football career, and 24% sustained three or more concussions. Statistical analysis of the data identified an association between recurrent concussion and clinically diagnosed MCI (χ2 = 7.82, df = 2, P = 0.02) and self-reported significant memory impairments (χ2 = 19.75, df = 2, P = 0.001). Retired players with three or more reported concussions had a fivefold prevalence of MCI diagnosis and a threefold prevalence of reported significant memory problems compared with retirees without a history of concussion. Although there was not an association between recurrent concussion and Alzheimer's disease, we observed an earlier onset of Alzheimer's disease in the retirees than in the general American male population

CONCLUSION: Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.

Departments of Exercise and Sport Scienceand Orthopedics,University of North Carolina at Chapel Hill,Chapel Hill, North Carolina,(Guskiewicz, Marshall

Department of Neurosurgery,West Virginia UniversitySchool of Medicine,Morgantown, West Virginia(Bailes)

Neuroscience Center, Waukesha Memorial Hospital,Waukesha, Wisconsin, andDepartment of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin(McCrea)

Neurosurgery Service, Emerson Hospital,Concord, Massachusetts, andNeurological Sports Injury Center,Brigham and Women's Hospital,Boston, Massachusetts(Cantu)

Chicago Neurological Institute,Chicago, Illinois, and Department of Neurology, Loyola University Medical School,Maywood, Illinois,(Randolph)

Memory Evaluation and Treatment Service, Burke Rehabilitation Hospital, White Plains, New York(Jordan)

Reprint requests: Kevin M. Guskiewicz, Ph.D., A.T.C., Sports Medicine Research Laboratory, Department of Exercise and Sport Science, 211 Fetzer CB #8700, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700. Email:

Received, November 5, 2004.

Accepted, May 3, 2005.

Copyright © by the Congress of Neurological Surgeons