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. 2017 Sep 19;7(9):e1236.
doi: 10.1038/tp.2017.197.

Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

M L Alosco  1   2 , A B Kasimis  1 , J M Stamm  1   3 , A S Chua  4 , C M Baugh  1   2   5 , D H Daneshvar  1 , C A Robbins  1   6 , M Mariani  1 , J Hayden  1 , S Conneely  1 , R Au  2   7   8   9 , A Torres  10   11 , M D McClean  12 , A C McKee  1   2   13   14   15 , R C Cantu  1   2   6   16   17 , J Mez  1   2 , C J Nowinski  1   6 , B M Martin  1   18 , C E Chaisson  1   18 , Y Tripodis  1   4 , R A Stern  1   2   9   16
Affiliations

Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

M L Alosco et al. Transl Psychiatry. .

Abstract

Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.

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Conflict of interest statement

CB has received research funding from the National Collegiate Athletic Association and the Harvard Football Players Health Study, which is funded by the National Football League Players’ Association. CJN is an unpaid member of the Mackey-White Committee of the NFL Players Association and a member of the advisory board of Oxeia Biopharmaceuticals (San Diego, CA, USA) with stock options. ACM has received funding from the NFL and WWE, and is a member of the Mackey-White Committee of the NFL Players Association. RCC is a paid consultant to the NFL Head Neck and Spine Committee and NOCSAE. He is a member of the Mackey-White Committee of the NFL Players Association and is a paid member of the Medical Science Committee for the NCAA Student-Athlete Concussion Injury Litigation. He receives royalties from book publications, and compensation from expert legal opinion. RAS is a member of the Mackey-White Committee of the NFL Players Association. He is a paid consultant to Avanir Pharmaceuticals (Aliso Viejo, CA, USA), Eli Lilly (Indianapolis, IN, USA) and Biogen (Cambridge, MA, USA). He is a member of the Board of Directors of King-Devick Test (Chicago, IL, USA), and he receives royalties for published neuropsychological tests from Psychological Assessment Resources (Lutz, FL, USA). The remaining authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Age of first exposure to American football and reported symptoms of behavioral dysregulation and executive dysfunction in 214 former American football players. Figure presents the results of the linear mixed-effect analyses that showed that those who began playing American football before age 12 exhibited worse (on average) scores on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) Behavioral Regulation Index (BRI; P=0.001) and BRIEF-A Metacognition Index (MI; P=0.016). Higher scores represent worse reported clinical function. The circle represents the mean and the horizontal line is the median. The mean group differences were significant after controlling for age, education and total seasons of football play.
Figure 2
Figure 2
Age of first exposure to American football and reported symptoms of apathy in 214 former American football players. Figure presents the results of the linear mixed-effect analyses that showed that those who began playing American football before age 12 exhibited worse (on average) scores on the Apathy Evaluation Scale (AES), P=0.002. Higher scores represent greater reported symptoms of apathy. The circle represents the mean and the horizontal line is the median. The mean group differences were significant after controlling for age, education and total seasons of football play.
Figure 3
Figure 3
Age of first exposure to American football and reported symptoms of depression in 214 former American football players. Figure presents the results of the linear mixed-effect analyses that showed that those who began playing American football before age 12 exhibited worse (on average) scores on the Center for Epidemiologic Studies Depression Scale (CES-D), P=0.001. Higher scores represent greater reported symptoms of depression. The circle represents the mean and the horizontal line is the median. The mean group differences were significant after controlling for age, education and total seasons of football play.
See this image and copyright information in PMC

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