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Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies

Grant L Iverson Orcid Logo, Rudolph J Castellani, J David Cassidy, Geoff M Schneider, Kathryn J Schneider Orcid Logo, Ruben J Echemendia Orcid Logo, Julian E Bailes, K Alix Hayden, Inga K Koerte Orcid Logo, Geoffrey T Manley Orcid Logo, Michael McNamee Orcid Logo, Jon S Patricios Orcid Logo, Charles H Tator Orcid Logo, Robert C Cantu, Jiri Dvorak Orcid Logo

British Journal of Sports Medicine, Volume: 57, Issue: 12, Pages: 810 - 821

Swansea University Author: Michael McNamee Orcid Logo

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DOI (Published version): 10.1136/bjsports-2023-106890

Abstract

Objective Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repeti...

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Published in: British Journal of Sports Medicine
ISSN: 0306-3674 1473-0480
Published: BMJ 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63688
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We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes.Design Systematic review.Data sources Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022.Eligibility criteria Studies measuring future risk (cohort studies) or approximating that risk (case-control studies).Results Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias.Conclusion Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors.</abstract><type>Journal Article</type><journal>British Journal of Sports Medicine</journal><volume>57</volume><journalNumber>12</journalNumber><paginationStart>810</paginationStart><paginationEnd>821</paginationEnd><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0306-3674</issnPrint><issnElectronic>1473-0480</issnElectronic><keywords/><publishedDay>14</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-06-14</publishedDate><doi>10.1136/bjsports-2023-106890</doi><url>http://dx.doi.org/10.1136/bjsports-2023-106890</url><notes>Systematic review</notes><college>COLLEGE NANME</college><department>Sport and Exercise Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>STSC</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>Funding for some of the administrative aspects of the numerous systematic reviews prepared for the 6th International Consensus Conference on Concussion in Sport was provided through an educational grant from the Concussion in Sport International Consensus Conference Organising Committee through Public Creations for partial administrative and operational costs associated with the writing of the systematic reviews. 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spelling v2 63688 2023-06-22 Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies 85b0b1623e55d977378622a6aab7ee6e 0000-0002-5857-909X Michael McNamee Michael McNamee true false 2023-06-22 STSC Objective Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes.Design Systematic review.Data sources Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022.Eligibility criteria Studies measuring future risk (cohort studies) or approximating that risk (case-control studies).Results Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias.Conclusion Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. Journal Article British Journal of Sports Medicine 57 12 810 821 BMJ 0306-3674 1473-0480 14 6 2023 2023-06-14 10.1136/bjsports-2023-106890 http://dx.doi.org/10.1136/bjsports-2023-106890 Systematic review COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University Funding for some of the administrative aspects of the numerous systematic reviews prepared for the 6th International Consensus Conference on Concussion in Sport was provided through an educational grant from the Concussion in Sport International Consensus Conference Organising Committee through Public Creations for partial administrative and operational costs associated with the writing of the systematic reviews. Partial support for travel to the Consensus Conference, for some of the authors, also was provided by the International Olympic Committee. 2023-11-14T16:20:39.5853468 2023-06-22T12:11:57.7591297 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Grant L Iverson 0000-0001-7348-9570 1 Rudolph J Castellani 2 J David Cassidy 3 Geoff M Schneider 4 Kathryn J Schneider 0000-0002-5951-5899 5 Ruben J Echemendia 0000-0001-6116-8462 6 Julian E Bailes 7 K Alix Hayden 8 Inga K Koerte 0000-0003-1281-9286 9 Geoffrey T Manley 0000-0002-0926-3128 10 Michael McNamee 0000-0002-5857-909X 11 Jon S Patricios 0000-0002-6829-4098 12 Charles H Tator 0000-0001-7335-4246 13 Robert C Cantu 14 Jiri Dvorak 0000-0002-2178-2326 15 63688__28350__35ec4b9e696741ef8d95244d9adb0e23.pdf 63688Supp.pdf 2023-08-23T10:49:52.2750203 Output 591189 application/pdf Proof true false eng
title Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
spellingShingle Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
Michael McNamee
title_short Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
title_full Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
title_fullStr Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
title_full_unstemmed Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
title_sort Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies
author_id_str_mv 85b0b1623e55d977378622a6aab7ee6e
author_id_fullname_str_mv 85b0b1623e55d977378622a6aab7ee6e_***_Michael McNamee
author Michael McNamee
author2 Grant L Iverson
Rudolph J Castellani
J David Cassidy
Geoff M Schneider
Kathryn J Schneider
Ruben J Echemendia
Julian E Bailes
K Alix Hayden
Inga K Koerte
Geoffrey T Manley
Michael McNamee
Jon S Patricios
Charles H Tator
Robert C Cantu
Jiri Dvorak
format Journal article
container_title British Journal of Sports Medicine
container_volume 57
container_issue 12
container_start_page 810
publishDate 2023
institution Swansea University
issn 0306-3674
1473-0480
doi_str_mv 10.1136/bjsports-2023-106890
publisher BMJ
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
url http://dx.doi.org/10.1136/bjsports-2023-106890
document_store_str 1
active_str 0
description Objective Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes.Design Systematic review.Data sources Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022.Eligibility criteria Studies measuring future risk (cohort studies) or approximating that risk (case-control studies).Results Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias.Conclusion Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors.
published_date 2023-06-14T16:20:43Z
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