Abstract
Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms.Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports.Design: Between-groups analyses.Main measures: Neuropsychiatric. Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive. Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task).Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions (), but not former players with ≤ 3 concussions (), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task.Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.
Highlights
Repetitive concussions are a growing public health concern due to their cumulative effects and evidence of down-stream neurodegenerative consequences [1,2,3,4,5,6]
While postmortem research has established a link with chronic traumatic encephalopathy (CTE) in this population [3, 5, 6], there remains a gap in our understanding of the long-term neuropsychiatric and cognitive sequelae in retired players measured in vivo
We compared the demographic characteristics of the former professional football players to the control participants and found that the two groups were similar in age, educational attainment, and estimated premorbid IQ
Summary
Repetitive concussions are a growing public health concern due to their cumulative effects and evidence of down-stream neurodegenerative consequences [1,2,3,4,5,6]. Studies examining neuropsychiatric function in former professional football players have focused predominantly on depression, with significantly higher symptom endorsement and rates of clinically elevated depression relative to control participants [8,9,10,11,12,13,14]. In a pilot study of 17 former professional football players without a diagnosis of dementia, we observed significantly higher mania symptoms and aggression on the Personality Assessment Inventory (PAI) [16] as compared to control participants. In the former players, higher aggression scores were negatively associated with orbitofrontal cortex thickness and uncinate fasciculus axial diffusivity [17]. Few other studies to date, have examined neuropsychiatric symptoms other than depression in vivo
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