In the Journals

High school football may not reduce cognition, mental health later in life

High school students who played football in the 1950s experienced cognitive and depression outcomes later in life at similar rates to those who did not play football, according to recent data. These findings may provide current athletes with information on the long-term risks of playing contact sports. Other clinicians noted that further research was needed to draw broader conclusions.

“There has been limited work examining the association of playing high school football with cognitive impairment and depression later in life,” Sameer K. Deshpande, BS, from the department of statistics at the University of Pennsylvania’s Wharton School, and colleagues wrote in JAMA Neurology. “Without population-level samples, it is difficult to estimate the base rate of long-term dysfunction among professional football players, much less among high school players.”

To determine the link between playing high school football and cognitive impairment/depression at age 65 years, researchers examined a cohort of 3,904 male high school students who graduated from high school in Wisconsin in 1957. Using data from the population-based Wisconsin Longitudinal Study, they matched the players with controls based on several covariates, including adolescent IQ, family background and educational level, at baseline. Controls included those who played a noncollision sport and those who did not play any sport. Secondary measures included results from individual cognitive tests, anger, anxiety, hostility and heavy drinking.

Analysis revealed no evidence that playing football had a negative long-term connection with cognitive functioning and mental health. There was no statistical significant harmful link between playing football and a reduced composite cognition score compared with each control condition after matching and adjusting for covariates (–0.04 reduction in cognition vs. all controls; 97.5% CI, –0.14 to 0.05). Using a modified Center for Epidemiological Studies’ Depression Scale, the researchers did not observe a significantly harmful connection between playing football and an increased depression score compared with control condition (–1.75 decrease vs. all controls; 97.5% CI, –3.24 to –0.26). Additionally, there was no significant adverse link between playing football and any of the secondary outcomes at age 65 years.

“Although our findings may not generalize to current high school football players, they may be relevant to current athletes playing contact sports with similar mean levels of head trauma as among the [Wisconsin Longitudinal Study] football players,” Deshpande and colleagues wrote. “Repeating our analysis with a younger cohort as they reach 65 years of age may improve our understanding of how the risks of playing football have evolved over time.”

In a related editorial, Allison R. Kaup, PhD, and Kristine Yaffee, MD, from San Francisco Veterans Affairs Healthcare System and the department of psychiatry at University of California, San Francisco, wrote that although this study was a good first step, further population-based, prospective study remains necessary to better investigate these risks.

“Future studies should be designed to include a more comprehensive neuropsychological battery to enable identification of whether there is a specific profile of cognitive decline,” they wrote. “The public health significance of a potential link between concussion and neurodegenerative disease, and the many gaps that remain in our understanding of this link, necessitate additional population-based prospective studies.” – by Savannah Demko

Disclosure: Deshpande and colleagues report no relevant financial disclosures. Kaup reports receiving access to cognitive software and tablet devices by Akili Interactive Labs. Yaffee reports serving on monitor boards for Takeda Inc and an NIH-funded study, and serving as a member of Alzheimer’s Association Medical and Scientific Advisory Council and the Counsel of the German Center for Neurodegenerative Diseases.

High school students who played football in the 1950s experienced cognitive and depression outcomes later in life at similar rates to those who did not play football, according to recent data. These findings may provide current athletes with information on the long-term risks of playing contact sports. Other clinicians noted that further research was needed to draw broader conclusions.

“There has been limited work examining the association of playing high school football with cognitive impairment and depression later in life,” Sameer K. Deshpande, BS, from the department of statistics at the University of Pennsylvania’s Wharton School, and colleagues wrote in JAMA Neurology. “Without population-level samples, it is difficult to estimate the base rate of long-term dysfunction among professional football players, much less among high school players.”

To determine the link between playing high school football and cognitive impairment/depression at age 65 years, researchers examined a cohort of 3,904 male high school students who graduated from high school in Wisconsin in 1957. Using data from the population-based Wisconsin Longitudinal Study, they matched the players with controls based on several covariates, including adolescent IQ, family background and educational level, at baseline. Controls included those who played a noncollision sport and those who did not play any sport. Secondary measures included results from individual cognitive tests, anger, anxiety, hostility and heavy drinking.

Analysis revealed no evidence that playing football had a negative long-term connection with cognitive functioning and mental health. There was no statistical significant harmful link between playing football and a reduced composite cognition score compared with each control condition after matching and adjusting for covariates (–0.04 reduction in cognition vs. all controls; 97.5% CI, –0.14 to 0.05). Using a modified Center for Epidemiological Studies’ Depression Scale, the researchers did not observe a significantly harmful connection between playing football and an increased depression score compared with control condition (–1.75 decrease vs. all controls; 97.5% CI, –3.24 to –0.26). Additionally, there was no significant adverse link between playing football and any of the secondary outcomes at age 65 years.

“Although our findings may not generalize to current high school football players, they may be relevant to current athletes playing contact sports with similar mean levels of head trauma as among the [Wisconsin Longitudinal Study] football players,” Deshpande and colleagues wrote. “Repeating our analysis with a younger cohort as they reach 65 years of age may improve our understanding of how the risks of playing football have evolved over time.”

In a related editorial, Allison R. Kaup, PhD, and Kristine Yaffee, MD, from San Francisco Veterans Affairs Healthcare System and the department of psychiatry at University of California, San Francisco, wrote that although this study was a good first step, further population-based, prospective study remains necessary to better investigate these risks.

“Future studies should be designed to include a more comprehensive neuropsychological battery to enable identification of whether there is a specific profile of cognitive decline,” they wrote. “The public health significance of a potential link between concussion and neurodegenerative disease, and the many gaps that remain in our understanding of this link, necessitate additional population-based prospective studies.” – by Savannah Demko

Disclosure: Deshpande and colleagues report no relevant financial disclosures. Kaup reports receiving access to cognitive software and tablet devices by Akili Interactive Labs. Yaffee reports serving on monitor boards for Takeda Inc and an NIH-funded study, and serving as a member of Alzheimer’s Association Medical and Scientific Advisory Council and the Counsel of the German Center for Neurodegenerative Diseases.