Retired Rugby Players Research Articles

Pain, impairment, medication use and health-related quality of life of retired professional rugby players.

Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life. This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players. A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions. Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living (p=0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%). Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players.

Concussion-Related Biomarker Variations in Retired Rugby Players and Implications for Neurodegenerative Disease Risk: The UK Rugby Health Study.

The health and well-being of retired rugby union and league players, particularly regarding the long-term effects of concussions, are of major concern. Concussion has been identified as a major risk factor for neurodegenerative diseases, such as Alzheimer's and Amyotrophic Lateral Sclerosis (ALS), in athletes engaged in contact sports. This study aimed to assess differences in specific biomarkers between UK-based retired rugby players with a history of concussion and a non-contact sports group, focusing on biomarkers associated with Alzheimer's, ALS, and CTE. We randomly selected a sample of male retired rugby or non-contact sport athletes (n = 56). The mean age was 41.84 ± 6.44, and the mean years since retirement from the sport was 7.76 ± 6.69 for participants with a history of substantial concussions (>5 concussions in their career) (n = 30). The mean age was 45.75 ± 11.52, and the mean years since retirement was 6.75 ± 4.64 for the healthy controls (n = 26). Serum biomarkers (t-tau, RBP-4, SAA, Nf-L, and retinol), plasma cytokines, and biomarkers associated with serum-derived exosomes (Aβ42, p-tau181, p-tau217, and p-tau231) were analyzed using validated commercial ELISA assays. The results of the selected biomarkers were compared between the two groups. Biomarkers including t-tau and p-tau181 were significantly elevated in the history of the substantial concussion group compared to the non-contact sports group (t-tau: p < 0.01; p-tau181: p < 0.05). Although between-group differences in p-tau217, p-tau231, SAA, Nf-L, retinol, and Aβ42 were not significantly different, there was a trend for higher levels of Aβ42, p-tau217, and p-tau231 in the concussed group. Interestingly, the serum-derived exosome sizes were significantly larger (p < 0.01), and serum RBP-4 levels were significantly reduced (p < 0.05) in the highly concussed group. These findings indicate that retired athletes with a history of multiple concussions during their careers have altered serum measurements of exosome size, t-tau, p-tau181, and RBP-4. These biomarkers should be explored further for the prediction of future neurodegenerative outcomes, including ALS, in those with a history of concussion.

The Impact of Athletic Identity, Psychological Flexibility, and Value Consistent Living on the Mental Health and Well-Being of Retired Elite Rugby Players

Retirement from sport is widely accepted as an important period of change for athletes. Existing studies have focused on investigating the mental health and well-being of current players, while limited research has explored the impact of retirement on elite rugby players. The present study aimed to examine how athletic identity, psychological flexibility, and valued living impact subjective well-being and psychological distress in retired elite rugby players. A cross-sectional, between-subject, factorial design was adopted. Seventy-seven retired elite rugby players were recruited to the Tackling Next Steps project and completed an online survey between March 2021 and December 2021. Suboptimal levels of subjective well-being were reported by 64% of retired players, and 43% reported clinical levels of distress. Valued living and psychological flexibility were shown to significantly predict subjective well-being. The results show that promoting psychological flexibility and valued living may have positive effects on subjective well-being in retired rugby players.

Lower systemic nitric oxide bioactivity, cerebral hypoperfusion and accelerated cognitive decline in formerly concussed retired rugby union players.

What is the central question of this study? What are the molecular, cerebrovascular and cognitive biomarkers of retired rugby union players with concussion history? What is the main finding and its importance? Retired rugby players compared with matched controls exhibited lower systemic nitric oxide bioavailability accompanied by lower middle cerebral artery velocity and mild cognitive impairment. Retired rugby players are more susceptible to accelerated cognitive decline. Following retirement from sport, the chronic consequences of prior-recurrent contact are evident and retired rugby union players may be especially prone to accelerated cognitive decline. The present study sought to integrate molecular, cerebrovascular and cognitive biomarkers in retired rugby players with concussion history. Twenty retired rugby players aged 64±5years with three (interquartile range (IQR), 3) concussions incurred over 22 (IQR, 6) years were compared to 21 sex-, age-, cardiorespiratory fitness- and education-matched controls with no prior concussion history. Concussion symptoms and severity were assessed using the Sport Concussion Assessment Tool. Plasma/serum nitric oxide (NO) metabolites (reductive ozone-based chemiluminescence), neuron specific enolase, glial fibrillary acidic protein and neurofilament light-chain (ELISA and single molecule array) were assessed. Middle cerebral artery blood velocity (MCAv, doppler ultrasound) and reactivity to hyper/hypocapnia ( / ) were assessed. Cognition was determined using the Grooved Pegboard Test and Montreal Cognitive Assessment. Players exhibited persistent neurological symptoms of concussion (U=109(41) , P=0.007), with increased severity compared to controls (U=77(41) , P<0.001). Lower total NO bioactivity (U=135(41) , P=0.049) and lower basal MCAv were apparent in players (F2,39 =9.344, P=0.004). This was accompanied by mild cognitive impairment (P=0.020, 95% CI, -3.95 to -0.34), including impaired fine-motor coordination (U=141(41) , P=0.021). Retired rugby union players with history of multiple concussions may be characterised by impaired molecular, cerebral haemodynamic and cognitive function compared to non-concussed, non-contact controls.

NZ-RugbyHealth Study: Current Postural Control Ability of Former Rugby Union and Non-contact Sport Players.

Players in contact sports frequently experience mild traumatic brain (concussion) injuries (TBI). While there are known disruptions to balance following acute head trauma, it is uncertain if sport-related concussion injuries have a lasting impact on postural control. To assess postural control in retired rugby players in comparison to retired non-contact sport players, and to evaluate any association with self-reported sport-related concussion history. Using a cross-sectional design, 75 players in the NZ-RugbyHealth study from three sports groups (44 ± 8years; 24 elite rugby, 30 community rugby, 21 non-contact sport) took part in this study. The SMART EquiTest® Balance Master was used to assess participant's ability to make effective use of visual, vestibular and proprioceptive information using standardised tests. Postural sway was also quantified using centre of pressure (COP) path length. The relationship among sports group, sport-related concussion history and postural control was evaluated using mixed regression models while controlling for age and body mass index. Limited significant differences in balance metrics were found between the sports groups. A statistically significant (p < 0.001) interaction indicated a relationship between COP path length and sport-related concussion history in the most challenging balance condition, such that path length increased as the number of previous sport-related concussions increased. There was some evidence for a relationship between sport-related concussion recurrence in sports players and postural stability in challenging balance conditions. There was no evidence of impaired balance ability in retired rugby players compared with non-contact sport athletes.

Lean Mass, Muscle Strength, and Muscle Quality in Retired Rugby Players: The UK Rugby Health Project.

Although athletes from sports such as rugby have greater lean mass and strength during their playing careers, little is known about these characteristics post-retirement. Therefore, this study investigated lean mass, strength, and muscle quality in retired elite and amateur rugby players and non-contact athletes. Retired elite male rugby players (n=42, 43.9±10.3 y; 101.1±13.4 kg; 1.82±0.09 m), amateur rugby players (n=46, 48.0±10.5 y; 98.9±16.6 kg; 1.79±0.07 m) and non-contact athletes (n=30, 51.3±12.5 y; 91.3±13.4 kg; 1.79±0.07 m) received one total body dual-energy X-ray absorptiometry assessment of appendicular lean mass (ALM) and ALM index (ALMI). Grip strength was measured, and muscle quality (grip strength/unit of arm lean mass) was calculated. Sarcopenia was identified as ALMI<7.23 kg/m2 and handgrip strength<37.2 kg. Total lean mass, ALM and grip strength were greater in the elite rugby compared to amateur rugby and non-contact groups (p<0.01). There were no significant differences in muscle quality or sarcopenia prevalence. Retired elite rugby players had greater lean mass and grip strength than amateur rugby and non-contact athletes, although muscle quality was similar. The greater lean mass and strength might reflect genetic influences or previous participation in a highly physical sport.

Spinal cord and brain tissue impairments as long-term effects of rugby practice? An exploratory study based on T1 and ihMTsat measures

Rugby players are subject to multiple impacts to their head and neck that could have adverse neurological effects and put them at increased risk of neurodegeneration.Previous studies demonstrated altered default mode network and diffusion metrics on brain, as well as more foraminal stenosis, disc protrusion and neck pain among players of contact sports as compared to healthy controls. However, the long-term effects of practice and repetitive impacts on brain and cervical spinal cord (cSC) of the rugby players have never been systematically investigated.In this study, 15 retired professional and amateur rugby players (R) and 15 age-matched healthy controls (HC) (all males; mean age R: 46.8 ± 7.6; and HC: 48.6 ± 9.5) were recruited both to investigate cord impairments and further characterize brain structure damage. Medical questionnaires including modified Japanese Orthopedic Association scale (mJOA) and Neck Disability Index (NDI) were filled by all participants. A 3 T multi-parametric MR protocol including conventional qualitative techniques such as T1-, T2-, and T2*-weighted sequences, as well as state-of-the art quantitative techniques including MP2RAGE T1 mapping and 3D ihMTRAGE, was used on both brain and cSC. Normalized brain WM and GM volumes, spine Overall Stenosis Score, cord cross-sectional area and regional T1 and ihMT metrics were derived from these acquisitions.Rugby players showed significantly higher NDI scores, as well as a faster decline of normalized brain GM volume with age as compared to HC. Moreover, higher T1 values on cSC suggestive of structural degeneration, together with higher T1 and lower ihMTsat on brain WM suggestive of demyelination, were observed in retired rugby players as compared to age-matched controls, which may suggest cumulative effects of long-term impacts on the tissues. Metrics also suggest early aging and different aging processes on brain tissue in the players.These preliminary observations provide new insights in the domain, which should now be further investigated on larger cohorts and multicentric longitudinal studies, and further correlated to the likelihood of neurodegenerative diseases and risk factors.

Vertebral Anomalies in Retired Rugby Players and the Impact on Bone Density Calculation of the Lumbar Spine

Dual energy X-ray absorptiometry (DXA) lumbar spine bone mineral density (BMD) measurements are subject to artificial elevation in the presence of structural abnormalities that are more common with age and injury, including osteoarthritis, fracture and osteophytes. The aims of this study were to investigate the presence of vertebral abnormalities on DXA scans in retired rugby players and a nonrugby control group, and to explore the effect of vertebral exclusion on the BMD diagnostic outcome. Eigty-seven male retired rugby players and 51 non-rugby controls from the UK Rugby Health Project participated in the study. Lumbar spine, total hip and femoral neck BMD were measured by DXA and scans were analyzed pre and post exclusion of anomalous vertebrae. Data were analyzed by age group to enable application of T-scores (≥50 y) and Z-scores (<50 y). From 138 lumbar spine scans, 66 required adjustment. One hundred twenty-two vertebral exclusions were made, and 12 lumbar spine scans (10 in retired rugby athletes) were un-reportable (<2 evaluable vertebrae). Vertebral exclusion significantly lowered lumbar spine BMD across all groups (p<0.01) and lowered the overall lowest T/Z-score. This effect was more pronounced in rugby groups (age <50 y, p < 0.001; age ≥50 y, p = 0.031) than in the control groups (age <50y, p = 0.125; age ≥50 y, p = 0.250). Vertebral abnormalities detected on lumbar spine scans, were highly prevalent and impacted final the T/Z-score in this cohort of retired rugby players. Current guidelines recommend exclusion of abnormalities from lumbar spine scans in adults aged ≥50 years. Our findings suggest that vertebral exclusions should also be applied to lumbar spine scans performed in those aged <50 years, particularly in former contact sports athletes, given their high risk for vertebral deformity.

Creation of the Argentina- Sports Concussion Assessment &amp; Research Study (Arg-SCARS)

To investigate how and why, over time, rugby union players might vary in their cognitive and behavioral functioning, whilst exploring modifying and contributing factors for the development of clinical symptoms and problems in association with repetitive neurotrauma. There is an urgent need for an improved understanding of the relationship between repetitive sports concussion and cognitive decline risk given that sports concussion prevention may plausibly impact upon neurodegeneration prevention. The Argentina- Sports Concussion Assessment & Research Study (Arg-SCARS) aims to explore the association between sports concussion and cognitive function over time in two cohorts of participants: active and retired rugby players. The Arg-SCARS is a longitudinal, prospective, naturalistic (nontreatment) study of rugby union players. It will be conducted in one Institute for Neurologic Research (FLENI) in Buenos Aires, Argentina. The "active rugby players cohort" will consist of approximately 100 men aged between 18 and 35 years. The 'retired rugby players cohort" will consist of at least 140 men aged between 35 and 65 years. All participants will be evaluated in a uniform manner at entry and longitudinally thereafter with instruments that include a clinical and neuropsychological test battery, biological fluids collection, and structural neuroimaging. In those with and without sports concussion, cognitive and behavioral functioning will be assessed at biannual intervals for 12-year follow-up. Outcome Measures will include: 1) rate of change for each cognitive and behavioral marker; 2) rate of volume change of whole brain, hippocampus, and entorhinal cortex; 3) rates of change for each biological marker; 4) group differences for each cognitive and biological marker measurement; 5) assessing interrelationships among cognitive and biological markers. The findings of this study will provide us with greater insights and therefore better understanding of how repetitive head trauma influence rugby union player's risk of getting cognitive impairment later on in life.

Neurovascular Coupling by Functional Near Infra-Red Spectroscopy and Sport-Related Concussion in Retired Rugby Players: The UK Rugby Health Project.

Aim: This study investigated cerebral hemodynamic responses to a neurovascular coupling (NVC) test in retired contact athletes with a history of repeated mild traumatic brain injury (mTBI) and in controls with no history of mTBI.Methods: Twenty-one retired rugby players (47.7 ± 12.9 year old; age at retirement: 38.5 ± 8.9 year; number of years playing rugby: 12.7 ± 3.7 year) with a history of three or more diagnosed concussions (8.9 ± 7.9 concussions per player) and 23 controls with no history of mTBI (46.5 ± 12.8 year old) performed a NVC test to detect task-orientated cerebral hemodynamic changes using functional near-infrared spectroscopy (fNIRS).Results: The NVC showed a statistically significant reduction in the cerebral hemodynamic response in comparison to the control group which had a greater relative increase of oxyhemoglobin (O2Hb). There were reductions in left middle frontal gyrus (MFG) O2Hb (−0.015 ± 0.258 μM) and relative increases in deoxyhemoglobin (HHb; −0.004 ± 0.159 μM) in the same region for the mTBI group in comparison to the control group (−0.160 ± 0.311 μM; −0.121 ± 0.076 μM for O2Hb and HHb, respectively). The mTBI group induced a greater rate of oxygen extraction compared to the control group.Conclusion: This was the first study to examine cerebral hemodynamic changes in retired rugby players in response to a NVC test, and we found reduced cerebral hemodynamic responses in participants with a history of mTBI compared to controls. These results suggest altered cerebral metabolic demands in participants with a history of multiple head injuries. Further research is needed to ascertain an understanding of the changes in hemodynamics from playing into retirement.

Rugby Player’s Aorta: Alarming Prevalence of Ascending Aortic Dilatation and Effacement in Elite Rugby Players

BackgroundPrompted by a cluster of observations concerning ascending aortic pathology in elite rugby players, we assessed over 150 asymptomatic predominantly retired players with echocardiography, aiming to document the prevalence and severity of ascending aortic dilatation and/or anterior aortic effacement, both ‘risk factors’ for potentially catastrophic aortic complications. MethodsRugby players (at least 5 years of high level competitive rugby) were classified as elite (national, state or first grade representatives) or non-elite. A total of 152 asymptomatic players with a mean age of 45 ± 13 years (range 21–65) underwent transthoracic echocardiography. Z-scores (number of standard deviations from a population mean) were calculated for aortic root and ascending aortic size. ResultsRegarding the aortic root, a Z-score of >2 was seen in 24% (expected prevalence 2.3%, p < 0.001) and a Z-score >3 was seen in 4% (expected prevalence 0..1%, p < 0.001). Sixty-two (62) players (41%) had an aortic root greater than 40 mm diameter. Ascending aortic Z-scores were >2 in 53% of players and >3 in 22% (p < 0.001). Abnormal anterior aortic effacement at the sinotubular junction (STJ) was seen in 88 players (58%). Abnormal aortic dilatation and effacement were associated with a longer duration of competitive rugby participation and elite status, respectively. ConclusionsAscending aortic dilatation with abnormal anterior effacement is exceedingly common in asymptomatic retired elite rugby players. This warrants increased surveillance in retired players until the clinical significance of these findings can be further investigated.

Bone mineral density in retired rugby players: initial findings from the UK Rugby Health project

Introduction Regular exercise that delivers impact forces to the skeleton are positively associated with bone strength. Athletes from high impact sports such as rugby have higher bone density than non-athletes ( Hind et al., 2015 ). Engaging in regular impact exercise is widely suggested as a means for reducing the risk of osteoporosis in later life ( Heinonen et al., 1996 ). However, to date there have been few studies of the bone density of retired athletes and none in retired rugby players. Objective To investigate bone mineral density (BMD) at the hip and spine, and the prevalence of low BMD, in a cohort of retired rugby players. Methods Retired rugby players (77 males; 25.8 years competitive rugby; 10.6 years since retirement; 36 former professional; 41 former amateur level) were separated into two groups: over 50 years of age (n = 27; 57.2 ± 7 years; 175.8 ± 7.6 cm; 94.9 ± 16.9 kg) and under 50 years (n = 50; 40.1 ± 6.2 years; 182.1 ± 6.4 cm; 101.9 ± 13.8 kg). Each participant received dual energy X-ray absorptiometry scans (Lunar iDXATM; GE Healthcare, WI; Encore software version 15.0) of the dual femur and the lumbar spine. BMD for the lumbar spine, femoral neck and total hip were derived. T-scores were evaluated for participants aged over 50 years, and Z-scores for those aged under 50 years ( ISCD, 2015 ). Results Eight (30%) retired players aged over 50 years had osteopenia (T-score Conclusion Our findings suggest that participation in high impact sports during young adulthood might not be sufficient to reduce the risk of osteoporosis in later life. Further research is needed to identify why some former rugby players have low BMD and others don't. This research would have the potential to inform assumptions on the role of exercise for bone health throughout the lifespan. Bone mineral density, T-scores or Z-scores for male retired rugby players, mean, SD (range) Retired rugby players aged Femoral Neck BMD (g.cm−2) n=50 Total Hip BMD (g.cm−2) n=50 Lumbar Spine BMD (g.cm−2) n=48† Hip Z-score n=49* Lumbar Spine Z-score n=47†* Lowest Z-score n=49* 1.135 ± 0.146 1.192 ± 0.151 1.319 ± 0.139 0.3 ± 1.1 0.3 ± 1.2 -0.1 ± 1.0 (0.814 – 1.502) (0.924 – 1.611) (1.040 – 1.677) (-1.7 – 3.5) (-2.1 – 3.3) (-2.1 – 3.5) *no reference score for n=1 participant (non-white) †n=2 lumbar spine scans unreportable due to Retired rugby players aged >50 years Femoral Neck BMD (g.cm−2) n=27 Total Hip BMD (g.cm−2) n=27 Lumbar Spine BMD (g.cm−2) n=20‡ Hip T-score n=27 Lumbar Spine T-score n=20‡ Lowest T-score n=27 1.018 ± 0.180 1.099 ± 0.179 1.226 ± 0.164 -0.4 ± 1.4 0.1 ± 1.4 -0.6 ± 1.2 (0.650 – 1.421) (0.699 – 1.459) (0.822 – 1.512) (-3.2 – 2.7) (-3.2 – 2.4) (-3.2 – 1.5) ‡n=7 lumbar spine scans unreportable due to

Vertebral body anomalies on bone density scans in younger and older retired rugby players: the UK Rugby Health project

Introduction Lumbar spine (LS) bone mineral density measured by dual energy X-ray absorptiometry (DXA) may be abnormally elevated by conditions in or around the spine. The International Society for Clinical Densitometry recommends excluding vertebrae if there is a focal structural abnormality (FSA) affecting some but not all of the scanned vertebrae, or if there is a T-score discrepancy (>1.0 SD difference in bone density between adjacent vertebrae). Anomalies can include osteoarthritis and degenerative changes, and fracture which have previously been reported in retired rugby players ( Hind et al., 2014 ; Davies et al., 2017 ). Objective To quantify vertebral body exclusions in a UK cohort of younger and older retired rugby players. Methods Retired rugby players (77 males; 10.6 yrs post retirement) aged 50 years or over (n = 27, 57.2 ± 7 years; 175.8 ± 7.6 cm; 94.9 ± 16.9 kg) and under 50 years (n = 50;40.1 ± 6.2 years; 182.1 ± 6.4 cm; 101.9 ± 13.8 kg) received one DXA scan of the anteroposterior lumbar spine (L1-L4; Lunar iDXA TM ; GE Healthcare, WI; Encore software v 15.0). A DXA scan of the dual femur was also performed. T-scores were evaluated for those aged over 50 years, and Z-scores for those aged under 50 years ( ISCD, 2015 ). Each LS scan was evaluated in consensus by two experienced densitometrists and vertebrae were excluded where there was evidence of a FSA or a T/Z-score discrepancy. If more than two vertebrae were excluded, the scan was defined un-reportable. Results In retired rugby players aged >50y, 18 (67%) scans required vertebral body exclusion. There were 41 exclusions and seven scans were un-reportable. In younger retired players ( 50 y was 0.1 ± 1.4. The mean LS Z-score for Conclusion In this cohort of UK retired rugby players, a high number of vertebral body anomalies were identified. Therefore, our findings demonstrate the need for care when interpreting lumbar spine bone density DXA scans. We also suggest that vertebral body exclusions apply to Z-scores as well as T-scores where there is evidence of FSA or BMD discrepancy. It is recommended that hip scans are conducted alongside lumbar spine BMD scans in former athletes where the prevalence of degenerative changes can be high.

Influence of playing rugby on long-term brain health following retirement: a systematic review and narrative synthesis

ObjectivesThe aim of this review was to systematically investigate long-term brain health in retired rugby players.MethodsSix databases were systematically searched from inception to January 2018 using Medical Subject Headings and...

BRain health and healthy AgeINg in retired rugby union players, the BRAIN Study: study protocol for an observational study in the UK

IntroductionRelatively little is known about the long-term health of former elite rugby players, or former sportspeople more generally. As well as the potential benefits of being former elite sportspersons, there...

Long-term consequences of recurrent sports concussion

Recurrent concussions are suspected to promote the development of long-term neurological disorders. The study was designed to assess the prevalence of major depressive disorder, mild cognitive disorders and headache in a population of retired high-level sportsmen and rugby players and to study the link between scores evaluating these disorders and the number of reported concussions (RCs). A total of 239 retired rugby players (RRPs) and 138 other retired sportsmen (ORSs) who had reached the French national or international championship level between 1985 and 1990 filled in a self-administered questionnaire describing their sociodemographic data, comorbidities and reported history of RC. A phone interview was then conducted using validated questionnaires for the detection of major depressive disorder (PHQ-9), mild cognitive disorders (F-TICS-m) and headache (HIT-6). RRPs reported a higher number of RCs than ORSs (p < 0.001). A higher rate of major depressive disorder (PHQ-9 score >9) was observed among RRPs compared to ORSs (9% versus 6%) (p = 0.04), and the PHQ-9 score increased with the number of RCs regardless of the type of sport (p = 0.026). A higher rate of mild cognitive disorders (TICS-m score ≤30) was observed in RRPs compared to ORSs (57% versus 40%, p = 0.005), but no association was found with the number of RC. The HIT-6 score increased with the number of RCs (p = 0.019) CONCLUSIONS: More than 20 years after the end of their career, RRPs present higher rates of depression and lower F-TICS-m scores in favor of mild cognitive impairment compared with ORSs. PHQ-9 and HIT-6 scores were significantly associated with the number of RCs.