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Concussions from Football Tied to Long-Term Cognitive Problems

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March 10, 2023 — Eric Washington, former linebacker for the University of Kansas’ football team, got involved with sports as a child. “We crashed into each other when we played, and whoever was strongest or most reckless was thought to have the best sports career ahead of them,” he says.

He and his friends boxed and played football on each other’s lawns “with no equipment or protection, just a lot of guys engaging in high collision together.”

In high school, Washington became a successful football player. “You had to show people you weren’t scared, so you took on bigger … guys and ran into them,” he recalls. “I became one of those fearless people who was known as ‘that guy’ — a hard-hitter, relentless, reckless person.”

Washington’s first major brain injury took place in ninth grade. “It was the first head-on-head collision that knocked me out and I missed much of ninth grade because of it,” he says. “I went from being a quiet, reserved, mild-mannered person to being aggressive, having mood swings, and lashing out.”

He developed problems with memory and concentration, which worsened as he got into college football. “I remember two or three times when I got dazed after a head injury and they took me out, but then I got right back in the game,” he says. 

Like Washington, many athletes experience brain injuries during their careers, with between 1.6 and 3 million sports- and recreation-related concussions taking place annually, around 300,000 of which are from football. 

Cognitive changes following concussions are also common. A new study published in the Archives of Clinical Neuropsychology shines light on the problem.

For Washington, the concussions, and their effects, continued into college. While on a football scholarship at Kansas, “I thought everything was OK. Even after my concussions, I could still get back in the game and my body retained ‘muscle memory’ of how to play football and could follow directions, even if my mind wasn’t quite there anymore.”

During senior year, a neck and spinal cord injury ended his sports career. “Everything spiraled downward after that,” he says. “I ended up in terrible relationships, distant from my family, and even homeless for a while. I ended up in mental institutions and in dark places and with cognitive problems.”

Does Concussion Affect Long-Term Cognitive Functioning?

In the new study, investigators examined 353 former NFL players (average age, 54 years old) who had been retired from their playing careers for close to 3 decades. 

Using a laptop or tablet, the former players completed a battery of neuropsychological tests through an online platform called TestMyBrain. An array of cognitive functions were tested, including processing speed, visual-spatial and working memory, short- and long-term memory, and vocabulary.

The players completed a 76-item questionnaire that included 10 questions about signs and symptoms of concussion following a blow to the head while playing football: headaches, nausea, dizziness, loss of consciousness, memory problems, disorientation, confusion, seizure, visual problems, or feeling unsteady on their feet. They were also asked if they had ever been diagnosed with a concussion.

Senior study author Laura Germine, PhD, director of the Laboratory for Brain and Cognitive Health Technology at McLean Hospital in Boston, says we know the impact of concussions on short-term health, but “it’s not as clear how concussion history impacts cognitive functioning in the longer term among former professional football players.” 

She says there “have been lots of mixed findings in former players, so we wanted to address this question using sensitive, state-of-the-art and objective measures of cognitive function in a larger samples of former players than has previously been tested for this kind of study.” 

One reason for the “mixed findings” in earlier research is that some studies have focused on diagnosed concussions and cognitive problems. But many football players’ concussions don’t end up being diagnosed, so the researchers decided to look specifically at concussion symptoms.

Accelerated Cognitive Aging 

Former players who reported more concussion symptoms scored worse on cognitive tests. For example, the differences in visual memory between the players with the highest- and lowest- reported concussion symptoms were equal to differences in cognitive performance between a typical 35-year-old and a typical 60-year-old.

On the other hand, poorer cognitive performance wasn’t connected to the number of diagnosed concussions, the number of years they played professional football, or the age when the first played football. 

The researchers conducted a follow-up study comparing the 353 players to 5,086 men who didn’t play football. They found that cognitive performance was generally worse in the former players

 “While our findings aren’t conclusive in this respect, we did see the biggest differences in cognitive performance (compared with men of similar age) among older players,” Germine says.

Long-Term Cognitive Issues

Washington continues to struggle with cognitive problems.

“My long-term memory seems like it’s intact sometimes, but after a period of time, there are ‘holes.’ Or I look at people and I might recognize a face, but I don’t remember who the people are.”

He also has difficulties with reading and memory. “My eyes have issues with tracking and tracing. And if I read out loud, I’ll be stuttering and sputtering and won’t be able to retain what I’ve just read. Sometimes, I’ll put the remote in the freezer, or I’ll set my phone down outside and won’t know where it is.”

Washington did complete college, graduating with a bachelor’s degree in applied behavioral science that led him to work with adults with developmental disabilities. However, schoolwork was difficult and has become even more difficult of late.

“I’d like to become a social worker to help other people, but trying to get through my classes may not be in the cards,” he says.

He’s currently being treated for cancer and the chemotherapy also affects his cognition. “I was getting A’s in my classwork in one course, but I couldn’t remember anything on the final, so I got an F and failed the course,” he says.

He hopes that as the cancer resolves, he’ll be able to give his studies another try. Although the cognitive challenges resulting from his concussions remain formidable, “not having ‘chemo-brain’ will free up some cognitive abilities and hopefully I’ll do better in my classes and get my social work degree.”

Get Appropriate Support

Germine says the study findings “underscore the need for parents, school systems, and anyone who plays football to understand the importance of reporting any and all concussion symptoms, even if they don’t feel serious at the time.” 

She notes that “appropriate measures to address and reduce the impact of head injury — even in the absence of diagnosed concussions — may be key to maintaining cognitive health long-term.”

Additionally, “we need to be doing everything we can to prevent head injury and concussion from happening in the first place. Measures that reduce the likelihood of head impact are important to make football safer for developing brains,” she says.

Washington urges people to take head injuries seriously and not just “return to the game” and to be evaluated for a concussion; and if a concussion is diagnosed, to receive treatment for the symptoms (such as emotional trauma, attentional or memory problems, or visual problems).

In addition, both encourage people who have sustained a concussion to get emotional support. Washington attends support groups offered by the Brain Injury Association of America.

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