Summary: A new study from researchers at Boston University reports an increase in later life emotional and behavioral problems in people who played youth tackle football before the age of 12.

Source: Boston University School of Medicine.

A new study has found an association between participation in youth tackle football before age 12 and impaired mood and behavior later in life. The study appears in Nature’s Translational Psychiatry.

Researchers from Boston University’s Chronic Traumatic Encephalopathy (CTE) Center studied 214 former American football players, including 43 who played only through high school and 103 who played only through college. The average age of the former players at the time of the study was 51. Participants received telephone-administered cognitive tests and completed online measures of depression, behavioral regulation, apathy and executive functioning (initiating activity, problem-solving, planning and organization). Results from former players who started playing tackle football before the age of 12 were compared against those of participants who started playing at age 12 or later.

The study showed that participation in youth football before age 12 increased the risk of problems with behavioral regulation, apathy and executive functioning by two-fold and increased the risk of clinically elevated depression scores by three-fold. The increased risk was independent of the total number of years the participants played football, the number of concussions they reported, or whether they played through high school, college or professionally. The researchers chose the cutoff of age 12 because the brain undergoes a key period of development and maturation between the years 10-12 in males. They examined other age cutoffs as well, though the age 12 cutoff led to the most robust findings. In addition, even when a specific age cutoff was not used, younger age of first exposure to football was associated with worse clinical function.

The new study follows previous research from the BU CTE Center that examined former professional players. In those studies, the former NFL players who started tackle football prior to age 12 had worse memory and mental flexibility, as well as structural brain changes on MRI scans, compared to former players who began at age 12 or older.

“This study adds to growing research suggesting that incurring repeated head impacts through tackle football before the age of 12 can lead to a greater risk for short- and long-term neurological consequences,” said Michael Alosco, PhD, lead author of the study and a post-doctoral fellow at Boston University School of Medicine (BUSM).

However, more research on this topic is needed before any recommendations on policy or rule changes can be made,” stated corresponding author Robert Stern, PhD, professor of neurology, neurosurgery and anatomy and neurobiology at BUSM.

The researchers point out there are many important health and psychosocial benefits of participating in athletics and team sports during pre-adolescence.

Researchers from the University of Wisconsin-Madison and Harvard University also participated in this study.

Funding: This work was supported by grants from the National Institutes of Health (NIH; R01 NS 078337; R56 9500304025; U01 NS093334; U01NS086659-01; K23AG046377). This publication also was supported by the National Center for Advancing Translational Sciences, NIH, through BUCTSI Grant Number 1UL1TR001430, as well as the Concussion Legacy Foundation. Michael L. Alosco and research reported in this publication are supported by a Pilot Grant from the Boston University Alzheimer’s Disease Center (AG013846), and NIH/NINDS under grant number F32NS096803.

Source: Gina DiGravio – Boston University School of Medicine
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Full open access research for “Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes” by M L Alosco, A B Kasimis, J M Stamm, A S Chua, C M Baugh, D H Daneshvar, C A Robbins, M Mariani, J Hayden, S Conneely, R Au, A Torres, M D McClean, A C McKee, R C Cantu, J Mez, C J Nowinski, B M Martin, C E Chaisson, Y Tripodis & R A Stern in Translational Psychiatry. Published online September 19 2017 doi:10.1038/tp.2017.197

Abstract

Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

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 greater than or equal to12, 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.

“Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes” by M L Alosco, A B Kasimis, J M Stamm, A S Chua, C M Baugh, D H Daneshvar, C A Robbins, M Mariani, J Hayden, S Conneely, R Au, A Torres, M D McClean, A C McKee, R C Cantu, J Mez, C J Nowinski, B M Martin, C E Chaisson, Y Tripodis & R A Stern in Translational Psychiatry. Published online September 19 2017 doi:10.1038/tp.2017.197