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Estimated Age of First Exposure to Contact Sports and Neurocognitive, Psychological, and Physical Outcomes in Healthy NCAA Collegiate Athletes: A Cohort Study

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Abstract

Background

Collegiate football players who started playing tackle football before age 12 years did not show worse neuropsychological test performance than those who started playing tackle football after age 12 years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performance, greater psychological distress, or worse postural stability in collegiate student athletes.

Objective

The purpose of this study was to examine the association between estimated age of first exposure (eAFE) to repetitive head impacts (RHI) and these outcome measures in collegiate student athletes.

Methods

1891 female and 4448 male collision/contact (i.e., football, ice hockey, lacrosse, wrestling, soccer) and non-contact (i.e., golf, rifle, rowing/crew, swimming, tennis) sport athletes completed baseline testing, including the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory 18 (BSI-18), and Balance Error Scoring System (BESS).

Results

For women, the eAFE-by-sport interaction was associated with ImPACT Verbal Memory and Visual Memory, whereby earlier eAFE to contact sports was associated with higher composite scores (B = − 0.397, B = − 0.485, respectively). For men, the eAFE-by-sport interaction was associated with BSI-18 Depression and Global Severity Index and symptom severity scores, whereby earlier eAFE to football was associated with lower psychological distress and symptom severity [Depression, Exp(B) = 1.057; Global Severity Index, Exp(B) = 1.047; Symptom Severity, Exp(B) = 1.046]. Parameter estimates were small suggesting these results may have minimal practical relevance.

Conclusion

Findings suggest that RHI during early adolescence is unrelated to brain health as measured by these specific outcome measures in collegiate student athletes.

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Data availability statement

The CARE Consortium datasets generated and analyzed during the current study are available in the FITBIR repository (https://fitbir.nih.gov/).

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Acknowledgements

This publication was made possible, in part, with support from the Grand Alliance CARE Consortium, funded by the NCAA and the DoD. The USAMRAA, Ford Detrick, MD, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the DoD (DHP funds).

Contributing CARE Consortium investigators include: Justus D. Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Joshua T. Goldman, MD, MBA and Christopher C. Giza, MD (University of California, Los Angeles); Holly J. Benjamin MD (University of Chicago); James R. Clugston, MD, MS (University of Florida); Luis A. Feigenbaum, DPT, ATC (University of Miami); James T. Eckner, MD, MS (University of Michigan); Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Christina L. Master, MD (University of Pennsylvania); Anthony P. Kontos, PhD (University of Pittsburgh Medical Center); Jonathan Jackson, MD (United States Air Force Academy); Adam Susmarski, DO (United States Naval Academy); Stefan Duma, PhD (Virginia Tech); Christopher M. Miles, MD (Wake Forest University); Laura Lintner DO (Winston-Salem University).

Author information

Authors and Affiliations

  1. School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, 43210, USA

    Jaclyn B. Caccese

  2. College of Health Sciences, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA

    Barry A. Bodt

  3. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA

    Grant L. Iverson

  4. Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown, MA, 20129, USA

    Grant L. Iverson

  5. Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 541 S. College Ave, Newark, DE, 19716, USA

    Thomas W. Kaminski

  6. Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 100 Discovery Blvd, Newark, DE, 19713, USA

    Kelsey Bryk & Thomas A. Buckley

  7. The Micheli Center for Sports Injury Prevention, Boston Children’s Hospital, 9 Hope Ave, Waltham, MA, 02453, USA

    Jessie Oldham

  8. Michigan Concussion Center, University of Michigan, 401 Washtenaw Ave, Ann Arbor, MI, 48104, USA

    Steven P. Broglio

  9. Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Michael McCrea

  10. Indiana University School of Medicine, Goodman Hall, 355 W. 16th St., Suite 4800, Indianapolis, IN, 46202, USA

    Thomas McAllister

Authors
  1. Jaclyn B. Caccese
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  2. Barry A. Bodt
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  3. Grant L. Iverson
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  4. Thomas W. Kaminski
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  5. Kelsey Bryk
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  6. Jessie Oldham
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  7. Steven P. Broglio
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  8. Michael McCrea
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  10. Thomas A. Buckley
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Consortia

CARE Consortium Investigators

  • Justus D. Ortega
  • , Nicholas Port
  • , Joshua T. Goldman
  • , Christopher C. Giza
  • , Holly J. Benjamin
  • , James R. Clugston
  • , Luis A. Feigenbaum
  • , James T. Eckner
  • , Jason P. Mihalik
  • , Christina L. Master
  • , Anthony P. Kontos
  • , Jonathan Jackson
  • , Adam Susmarski
  • , Stefan Duma
  • , Christopher M. Miles
  •  & Laura Lintner

Corresponding author

Correspondence to Thomas A. Buckley.

Ethics declarations

Funding

This publication was made possible, in part, with support from the Grand Alliance CARE Consortium, funded by the NCAA and the DoD. The USAMRAA, Ford Detrick, MD, USA, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the DoD (DHP funds).

Conflict of interest

Grant L. Iverson serves as a scientific advisor for BioDirection, Inc., Sway Operations, LLC, and Highmark, Inc. He has a consulting practice in forensic neuropsychology, including expert testimony. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and salary support as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Heinz Family Foundation, the Boston Bolts, the Mooney-Reed Charitable Foundation, and the Spaulding Research Institute. Jaclyn B. Caccese, Barry Bodt, Thomas W. Kaminski, Kelsey Bryk, Jessie Oldhamn, Steven P. Broglio, Thomas W. McAllister, Michael McCrea, and Thomas A. Buckley declare that they have no additional conflicts of interest to disclose.

Research involving human participants

The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki.

Informed consent

All study procedures were reviewed and approved by the University of Michigan IRB, the US Army Medical Research and Materiel Command Human Research Protection Office (HRPO), as well the local IRB at each of the performance sites. Participants provided written informed consent prior to participation.

Additional information

The members of CARE Consortium Investigators are listed in Acknowledgements section.

This article is part of a Topical Collection on The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium.

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Caccese, J.B., Bodt, B.A., Iverson, G.L. et al. Estimated Age of First Exposure to Contact Sports and Neurocognitive, Psychological, and Physical Outcomes in Healthy NCAA Collegiate Athletes: A Cohort Study. Sports Med 50, 1377–1392 (2020). https://doi.org/10.1007/s40279-020-01261-4

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