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Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study

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Abstract

Background

Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing.

Objectives

We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns.

Methods

In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1–2 (n = 309); 3–5 (n = 413); 6–9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx.

Results

More than one-third of participants reported being currently “extremely concerned” about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being “not at all concerned” regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being “not at all” or “slightly” concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently “moderately” or “extremely” concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns.

Conclusions

Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player’s functioning and well-being.

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Acknowledgements

The authors are grateful to Candice Goerger, Caprice Hunt, Hope Campbell, Greggory Kobelski, Danielle Hunt, Becky Parmeter, and Alexa Wild for their invaluable efforts in the administration, coordination, and execution of the NFL-LONG study. Special thanks are in order for members of the NFL Alumni Association and Legends community for their assistance in recruitment of study participants. Further, we thank each of the clinicians, researchers, educators, and former players who helped us adapt and develop the current general health survey.

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Correspondence to Ruben J. Echemendia.

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Funding

Funding for this study came from the National Football League. No funding was received for the expressed purpose of writing this paper, and the funding source had no direct involvement or oversight of the preparation of this paper.

Conflicts of Interest/Competing Interests

ZYK reports grants from the National Football League (NFL) during the conduct of this study as well as grants from the Centers for Disease Control and Prevention (CDC), U.S. Department of Defense (DoD), and National Institutes of Health. BLB acknowledges support from the National Institute of Neurological Disorders and Stroke under the NIH under the award NO L30NS113158-01. AC receives funding from the National Collegiate Athletics Association (NCAA) as Director of the NCAA Injury Surveillance Program. MM reports a grant from NFL during the conduct of the study as well as grants from NIH, CDC, DoD, and NCAA outside the submitted work. WPM receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete; and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the NFL. RJE is a paid consultant for the National Hockey League (NHL) and co-chair of the NHL/NHL Players’ Association Concussion Subcommittee. He is also a paid consultant for Major League Soccer, the US Soccer Federation, and Princeton University Athletic Medicine and he occasionally provides expert testimony in matters related to mild traumatic brain injury and sports concussion. The other authors have no conflicts of interest to declare.

Ethics Approval

This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill.

Consent to Participate

All participants provided informed consent prior to completing the study procedures.

Consent for Publication

The authors affirm that human research participants provided informed consent for publication of the data presented in this study.

Code availability

Data are not publicly available. Code used for study analyses may be made available upon reasonable request to the corresponding author.

Availability of Data and Material

Data are not publicly available.

Authors’ Contributions

Dr. Samuel R. Walton: creation and distribution of the study questionnaire, management of study database, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Zachary Y. Kerr: creation and distribution of the study questionnaire, management of study database, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Rebekah Mannix: established research hypotheses, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Benjamin L. Brett: creation and distribution of the study questionnaire, management of study database, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Avinash Chandran: creation and distribution of the study questionnaire, management of study database, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. J. D. DeFreese: creation and distribution of the study questionnaire, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Michael McCrea: creation and distribution of the study questionnaire, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Kevin M. Guskiewicz: creation and distribution of the study questionnaire, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. William P. Meehan III: creation and distribution of the study questionnaire, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Dr. Ruben J. Echemendia: creation and distribution of the study questionnaire, established research hypotheses, planned analyses of the data, interpretation of study findings, manuscript preparation and revision, final approval of the submitted manuscript. Other contributors to the project are as follows (included in Acknowledgements): Hope Campbell: assisted in the creation and distribution of the study questionnaire and in the collection and management of the questionnaire responses. Assisted with oversight of the project administration and execution. Candice Goerger, Project Administrator: assisted in the creation and distribution of the questionnaire instrument as well as collection and management of the questionnaire responses. Additionally, she was responsible for overseeing the project administration and execution. Caprice Hunt, Project Coordinator (University of North Carolina at Chapel Hill): assisted in the creation and distribution of the questionnaire, oversight of the project administration, and execution of the study. Greggory Kobelski: assisted in oversight of the project administration, and execution of the study. Danielle Hunt: assisted in oversight of the project administration, and execution of the study. Becky Parmeter: assisted in oversight of the project administration, and execution of the study. Alexa Wild: assisted in oversight of the project administration, and execution of the study.

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Walton, S.R., Kerr, Z.Y., Mannix, R. et al. Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study. Sports Med 52, 1189–1203 (2022). https://doi.org/10.1007/s40279-021-01589-5

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