The mysterious case of the forward who lost his memory
Every day before he went to sleep, he asked him to tell him about when he was a center forward and the top scorer in the Scottish league. But the grandfather will no longer be able to tell the story to his little granddaughter. Those muddy fields of Glasgow that brought him glory have now been hidden in some corner of his brain because of dementia.
… And it is that footballers have a higher risk of mortality due to neurodegenerative disease in the last stages of life
Indeed, a new study shows higher mortality from neurodegenerative disease among former professional soccer players than among the general population. In contrast, mortality from other common diseases is lower among former soccer players.
Neurodegenerative diseases such as Alzheimer’s disease, amyotrophic lateral sclerosis ( ALS ), and chronic traumatic encephalopathy, have been associated with participation in contact sports such as soccer, rugby, or American football.
On the other hand, the health benefits derived from physical activity have long been identified. This includes the prevention of chronic diseases and the reduction of overall mortality.
Studies have also shown that elite athletes derive health benefits from playing sports, including lower mortality and a lower risk of cardiovascular disease than the general population.
A new study on mortality in former professional footballers
This new study, recently published in the New England Journal of Medicine, was conducted to compare neurodegenerative disease mortality among former Scottish professional soccer players and a control group from the general population.
In total there were 7,676 former players and 23,028 controls. The causes of death were determined from the respective death certificates.
During the mean follow-up of the study (18 years), 1,180 deaths of former players (15.4%) and 3,807 deaths were recorded in the control group (16.5%). The mean age (± SD) at death was 67.9 ± 13 years and 64.7 ± 14 years, respectively.
Study results
Mortality from all causes was lower among former soccer players compared to the general population. However, the time-based analysis showed that mortality was lower among ex-players up to the age of 70, and higher thereafter.
Neurodegenerative disease
Neurodegenerative disease as the primary or related cause of mortality was identified in 222 former soccer players (2.9%) and 228 controls (1.0%) (Hazard ratio: 3.53; 95% CI, 2.72 -4.57; P <0.001).
On the other hand, among former players, the estimated risk of mortality from neurodegenerative disease was higher for people with Alzheimer’s than for people with Parkinson’s.
Data corroborated by medication
Since death certificates are subject to errors, the type of drugs used for diseases such as Alzheimer’s and related dementias was also investigated. The results of this analysis showed that dementia-related medications were prescribed more frequently in former soccer players than in the control group.
Influence of player position on mortality
The analysis based on the different playing boundaries did not show significant differences between goalkeepers and field players.
There were differences in medications for the treatment of dementia. These were prescribed less frequently for goalkeepers than for outfield players (Odds ratio: 0.41; 95% CI, 0.19-0.89; P = 0.02).
This difference in the prescription of dementia medications could be attributed to various factors, including the nature of the roles played by goalkeepers versus outfield players. Goalkeepers, while susceptible to high-impact collisions, might have less exposure to repetitive minor head traumas associated with heading the ball, a common occurrence for outfield players.
These findings suggest a nuanced relationship between the position played and long-term cognitive health and wellness, underlining the need for further research in this area to better understand the mechanisms at play and to develop targeted strategies for protecting athletes across all positions.
Neurodegenerative diseases in other sports
The reduced mortality in former professional soccer players up to the age of 70 is comparable to other sports. This may be due to higher levels of physical activity and lower obesity and smoking rates among elite athletes compared to the general population.
On the other hand, there is a certain degree of evidence regarding participation in contact sports and the increased risk of cognitive problems and neuropsychiatric impairment in later life. Also the increased risk of neurodegenerative disease and chronic traumatic encephalopathy due to repetitive brain trauma.
Concussion clinics specialize in diagnosing, treating, and managing concussions—mild traumatic brain injuries common in contact sports. These centers are essential for both immediate and long-term concussion effects, offering care plans that include assessment, recovery, and prevention strategies.
Athletes from sports like American football, boxing, ice hockey, and rugby are particularly at risk and benefit from the targeted interventions provided by these clinics. A multidisciplinary team of professionals, including neurologists, physical therapists, and neuropsychologists, collaborate to meet the complex needs of patients.
Additionally, concussion clinics play a vital role in education and research, aiming to raise awareness about concussion signs, management, and prevention. They are instrumental in advancing our understanding of diagnostics and treatments for concussions and exploring the connection between repetitive head impacts and neurodegenerative diseases. Early intervention and comprehensive management by these clinics are crucial in protecting athletes’ neurological health and reducing the risk of severe outcomes.
Heading the ball: neurodegenerative problem?
It appears that not only the major trauma that leads to symptomatic concussions increases the risk of neurological disorders in the future. Thus, the total duration of exposure to repetitive head impacts has been associated with neuropathology, neurodegeneration, and cognitive and neuropsychiatric symptoms in later stages.
The average player heads the ball 6 to 12 times per game (in addition to heading drills in practice), which adds up to thousands of times during his career.
In small case series studies, head hitting has been associated with altered brain neurochemistry, decreased brain white matter integrity, and decreased cortical mass in professional soccer players (no obvious concussion). There are also case reports of former professional footballers with dementia whose brains were linked to chronic traumatic encephalopathy on post-mortem examinations.
In any case, sport is always beneficial…
If the granddaughter of our center forward wants to emulate the footsteps of her grandfather, there should be no fear of subsequent cognitive decline or the appearance of dementia later on. On the contrary, the health benefits derived from sports practice and the enjoyment of the sport itself should be taken into account.
It is simply necessary to bear in mind the findings of the study and to carry out more research to investigate the possible consequences of hitting the ball with the head.
If it were shown that repeatedly heading the ball has neurocognitive impairment as a consequence, it would not be a trauma to change the rules and make hitting the ball with the head be penalized with a foul (as occurs when it is touched with the hand). Of course, the corner kicks would lose much of their emotion.
