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2014 ; 6
(5
): 384-95
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Is There Chronic Brain Damage in Retired NFL Players? Neuroradiology,
Neuropsychology, and Neurology Examinations of 45 Retired Players
#MMPMID25177413
Casson IR
; Viano DC
; Haacke EM
; Kou Z
; LeStrange DG
Sports Health
2014[Sep]; 6
(5
): 384-95
PMID25177413
show ga
BACKGROUND: Neuropathology and surveys of retired National Football League (NFL)
players suggest that chronic brain damage is a frequent result of a career in
football. There is limited information on the neurological statuses of living
retired players. This study aimed to fill the gap in knowledge by conducting
in-depth neurological examinations of 30- to 60-year-old retired NFL players.
HYPOTHESIS: In-depth neurological examinations of 30- to 60-year-old retired
players are unlikely to detect objective clinical abnormalities in the majority
of subjects. STUDY DESIGN: A day-long medical examination was conducted on 45
retired NFL players, including state-of-the-art magnetic resonance imaging (MRI;
susceptibility weighted imaging [SWI], diffusion tensor imaging [DTI]),
comprehensive neuropsychological and neurological examinations, interviews, blood
tests, and APOE (apolipoprotein E) genotyping. LEVEL OF EVIDENCE: Level 3.
METHODS: Participants' histories focused on neurological and depression symptoms,
exposure to football, and other factors that could affect brain function. The
neurological examination included Mini-Mental State Examination (MMSE) evaluation
of cognitive function and a comprehensive search for signs of dysarthria,
pyramidal system dysfunction, extrapyramidal system dysfunction, and cerebellar
dysfunction. The Beck Depression Inventory (BDI) and Patient Health Questionnaire
(PHQ) measured depression. Neuropsychological tests included pen-and-paper and
ImPACT evaluation of cognitive function. Anatomical examination SWI and DTI MRI
searched for brain injuries. The results were statistically analyzed for
associations with markers of exposure to football and related factors, such as
body mass index (BMI), ethanol use, and APOE4 status. RESULTS: The retired
players' ages averaged 45.6 ± 8.9 years (range, 30-60 years), and they had 6.8 ±
3.2 years (maximum, 14 years) of NFL play. They reported 6.9 ± 6.2 concussions
(maximum, 25) in the NFL. The majority of retired players had normal clinical
mental status and central nervous system (CNS) neurological examinations. Four
players (9%) had microbleeds in brain parenchyma identified in SWI, and 3 (7%)
had a large cavum septum pellucidum with brain atrophy. The number of
concussions/dings was associated with abnormal results in SWI and DTI.
Neuropsychological testing revealed isolated impairments in 11 players (24%), but
none had dementia. Nine players (20%) endorsed symptoms of moderate or severe
depression on the BDI and/or met criteria for depression on PHQ; however, none
had dementia, dysarthria, parkinsonism, or cerebellar dysfunction. The number of
football-related concussions was associated with isolated abnormalities on the
clinical neurological examination, suggesting CNS dysfunction. The APOE4 allele
was present in 38% of the players, a larger number than would be expected in the
general male population (23%-26%). CONCLUSION: MRI lesions and neuropsychological
impairments were found in some players; however, the majority of retired NFL
players had no clinical signs of chronic brain damage. CLINICAL RELEVANCE: These
results need to be reconciled with the prevailing view that a career in football
frequently results in chronic brain damage.
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