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. 2023 Jul 3;6(7):e2323822.
doi: 10.1001/jamanetworkopen.2023.23822.

Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players

Shima Espahbodi  1   2   3 , Eef Hogervorst  4 , Tara-Mei Povall Macnab  1   3 , Ahmed Thanoon  1   2   3 , Gwen Sacha Fernandes  1   5 , Bonnie Millar  1   3   6 , Ashley Duncan  7 , Maria Goodwin  4 , Mark Batt  2 , Colin W Fuller  8 , Gordon Fuller  9 , Eamonn Ferguson  3   6   10   11 , Tobias Bast  3   6   10   12 , Michael Doherty  1   2   3   6 , Weiya Zhang  1   2   3   6
Affiliations

Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players

Shima Espahbodi et al. JAMA Netw Open. .

Erratum in

  • Errors in the Byline.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Aug 1;6(8):e2330818. doi: 10.1001/jamanetworkopen.2023.30818. JAMA Netw Open. 2023. PMID: 37566423 Free PMC article. No abstract available.

Abstract

Importance: Although professional soccer players appear to be at higher risk of neurodegenerative disease, the reason remains unknown.

Objective: To examine whether heading frequency is associated with risk of cognitive impairment in retired professional soccer players.

Design, setting, and participants: A UK nationwide cross-sectional study was conducted between August 15, 2020, and December 31, 2021, in 459 retired male professional soccer players older than 45 years and registered with the Professional Footballers' Association or a League Club Players' Association.

Exposure: Data on heading frequency in 3 bands-0 to 5, 6 to 15, and more than 15 times per match or training session and other soccer-specific risk factors, such as player position and concussion-were collected through a self-reported questionnaire.

Main outcomes and measures: Cognitive impairment was defined using the Telephone Interview for Cognitive Status-modified as scores of less than or equal to 21. Hopkins Verbal Learning Test, verbal fluency, and independent activities of daily living were also assessed. Test Your Memory and physician-diagnosed dementia/Alzheimer disease were self-reported via the questionnaire. Adjusted odds ratios (AORs) with 95% CIs were calculated.

Results: Of 468 retired male professional soccer players who completed questionnaires (mean [SD] age, 63.68 [10.48]; body mass index, 27.22 [2.89]), 459 reported heading frequency: 114 headed 0 to 5 times, 185 headed 6 to 15 times, 160 headed more than 15 times per match, and 125 headed 0 to 5 times, 174 headed 6 to 15 times, and 160 headed more than 15 times per training session during their careers. The prevalence of cognitive impairment was 9.78% (0-5 times), 14.78% (6-15 times), and 15.20% (>15 times) per match (P = .51). Compared with players reporting 0 to 5 headers per match, the AORs were 2.71 (95% CI, 0.89-8.25) for players reporting 6 to 15 headers per match and 3.53 (95% CI, 1.13-11.04) for players reporting more than 15 headers per match (P = .03 for trend). Corresponding AORs for heading frequency per training session were 2.38 (95% CI, 0.82-6.95) for those reporting 6 to 15, and 3.40 (95% CI, 1.13-10.23) for those reporting more than 15 in comparison with those who reported 0 to 5 (P = .03 for trend). Concussion involving memory loss was also associated with a greater risk of cognitive impairment (AOR, 3.16; 95% CI, 1.08-9.22). Similar results were observed with other cognitive tests and self-reported physician-diagnosed dementia/Alzheimer disease.

Conclusions and relevance: The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Espahbodi reported receiving grants from the Football Association (FA) and Professional Footballers Association and Versus Arthritis during the conduct of the study. Dr Hogervorst reported receiving grants from the FA and Professional Footballers’ Association (PFA) during the conduct of the study. Dr Macnab reported receiving grants from FA, PFA, and Versus Arthritis during the conduct of the study. Dr Duncan reported receiving grants from Versus Arthritis, the FA, and PFA during the conduct of the study. Dr Batt reported receiving a 5-years grant from Versus Arthritis Centre and nonfinancial support from the FA during the conduct of the study. Dr C. Fuller reported providing consultancy services to Federation 17 Internationale de Football Association, the FA, and English Premier League during the conduct of study. Dr G. Fuller reported receiving travel funding provided by World Rugby to attend academic meetings and membership of Concussion in Sport Expert Panel. Dr Ferguson reported receiving grants from the FA during the conduct of the study. Dr Bast reported receiving grants from the FA, and Neuro-Bio Ltd, Boehringer Ingelheim Pharma, CNS Drug Discovery, and b-neuro, University of Manchester, outside the submitted work. Dr Doherty reported receiving grants from the FA, PFA and partial funding of the costs to undertake this study during the conduct of the study. Dr Zhang reported receiving grants to the institution from the FA, PFA, and Versus Arthritis during the conduct of the study; grants from Versus Arthritis, FOREUM Project, HTA T2T clinical trial for gout, MRC Pain hub grant, and NIHR Biological Research Centre outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Study Population
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