Concussion in sport is an issue that’s hit the headlines with increasing frequency over the last few years, but how much do we really know about the long-term effects of head injuries?
What do we know so far?
In short, the answer is ‘very little’. While we may recognize the short-term symptoms of a concussion, not much is known about the long-term impact of either concussions or sub-concussive head impacts (for example, when heading a football). Recent years have seen this topic brought into the public eye, with growing evidence pointing toward an increased risk of cognitive decline and the development of neurodegenerative disease in people exposed to repeated head impacts.
Much of this research points towards a neurodegenerative disease called CTE (chronic traumatic encephalopathy), which can cause dementia and is associated with repeated blows to the head. Research around this association is gradually building, although all of this work to date has involved small cohorts or single case studies.
For example, a 2017 study observed CTE in the brains of four former football (soccer) players known to have headed the ball frequently, and reported a higher incidence of CTE in these footballers than the general population. This study was very important as it was the first time that CTE had been linked with association football, but of course, further research is required to validate these findings in larger cohorts.
It is likely that there is an association between repeated head impacts and the development of neurodegenerative disease, though the mechanisms behind this and the additional factors that contribute to disease risk remain in question. However, there is no evidence that a single concussion increases the risk of neurodegenerative disease, and not everyone with a history of repetitive head impacts will go on to develop CTE or other neurodegenerative diseases.
The Drake Foundation, a not-for-profit committed to understanding and improving the health and welfare of sports players, is investing in scientific studies to improve our knowledge of the long-term effects of concussion.
The BRAIN and HEADING studies are two such projects investigating the long-term brain health of retired rugby and football (soccer) players, respectively. Both studies are investigating the associations between a history of concussions or heading the ball with cognitive decline and the development of neurodegenerative disease.
In both studies, former elite players over the age of 50 will be asked about their history of head impacts and a range of data will be collected. This will include face-to-face assessments to gather data on their playing and work history; lifestyle factors; physical and cognitive ability; and a clinical neurological examination. The participants will also have the option to provide blood samples for biomarker analysis.
In addition, The Drake Foundation has recently announced the commitment of funding to the Drake Football Study, which will be the most comprehensive study to-date to measure the mental and physical health of professional footballers over time. This study will provide information not only on brain health, but the overall long-term health and wellbeing of football players. It is hoped that this longitudinal study – the first of its kind – will provide new insights into players’ health across their careers and into retirement, giving an overall picture of player health progression. This information could ultimately enable health practitioners to develop preventative and curative measures for future generations of players, as well as wider society. It is hoped that these studies, as well as others investigating player health, brain pathology and cognitive function, will soon provide us with an understanding not only of the long-term effects of head impacts, but also the steps that can be taken to minimise these effects on players.
Find out more: www.drakefoundation.org