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.
Highlights
Exposure to repetitive head impacts (RHI) during American football has become a significant concern to clinicians, researchers and the general community because of their association with long-term neurological consequences.[1]
Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; 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
Summary
Exposure to repetitive head impacts (RHI) during American football has become a significant concern to clinicians, researchers and the general community because of their association with long-term neurological consequences.[1]. Youth football is played between ages of 5 and 14, a period when the brain undergoes substantial maturation in males.[30,31,32,33,34,35,36,37,38,39,40,41,42] Exposure to RHI over a single season of youth football (without diagnosed concussions) has been associated with white matter alterations in 8–13 year olds.[43] RHI exposure during peak neurodevelopment may disrupt normal brain maturation to increase vulnerability to long-term clinical impairments, especially in the context of continued football participation.[44,45] In a study of former National
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