Former elite-level rugby players in England who experienced concussions during their career performed no worse on the Preclinical Alzheimer Cognitive Composite (PACC) at the age of 50 or older than did those who had no concussions, a study published in the June issue of Alzheimer's and Dementia found.
The BRAIN study involved 146 retired professional male rugby players whose mean career length was 15.8 years.
The findings “suggest that having suffered rugby-related concussions during their playing career, or the length of the rugby career, are not associated with an overall worse long-term cognitive function," wrote lead author Valentina Gallo, MD, PhD, associate professor of epidemiology and sustainable health at the University of Groningen in the Netherlands, and colleagues.
However, the investigators noted the relationship changed with age: “among older former players (80+ years), having suffered more than three concussions is associated with a decrease in cognitive function of about 1 SD below the mean PACC score compared to former players of the same age who have suffered no concussion."
The effect in the older age group, the investigators noted, “appeared to be driven by a small number of older participants in the high concussion group who were considered cognitively impaired according to their MMSE scores."
The overall lack of a strong effect of concussions on cognition stands in sharp contrast to findings in American football players, particularly in retired NFL players. A 2017 neuropathology study in JAMA, for instance, identified chronic traumatic encephalopathy (CTE) in the brains of 110 out of 111 deceased former NFL players.
In an email to Neurology Today, Dr. Gallo noted that some of the findings from the current study might be attributable in part to the effects of cognitive reserve. British rugby players, Dr. Gallo said, come from a “highly selected group of very highly educated people."
Many of the professional players had previously played during college at Oxford or Cambridge universities, the paper noted. “Our sample included highly educated and professionally engaged people; thus, it is plausible that their cognitive reserve would compensate for cognitive function impairment until a higher-than-normal threshold is reached."
Previous studies of cognition and concussion in ruby players have reached mixed conclusions. A Scottish study found no association between concussion and cognitive function in 52 retired rugby players, although former players, as a group, showed a non-significantly increased risk of cognitive decline compared to the population at large.
Likewise, a French study found no link between concussion and cognitive function in professional rugby players there but did see that rugby players as a group were significantly more likely than other retired athletes to have mild cognitive disorder. Finally, a New Zealand study of former rugby players found that those recalling one or more concussion had worse scores on cognitive flexibility, executive function and complex attention than those without concussion.
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Gallo V, McElvenny DM, Seghezzo G, et al. Concussion and long-term cognitive function among rugby players-The BRAIN Study. Alzheimers Dement 2022;18(6):1164-1176
Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA 2017;318(4):360-370.
Hume PA, Theadom A, Lewis GN, et al. A comparison of cognitive function in former rugby union players compared with former non-contact-sport players and the impact of concussion history. Sports Med 2017;47(6):1209-1220.
McMillan TM, McSkimming P, Wainman-Lefley J, et al. Long-term health outcomes after exposure to repeated concussion in elite level rugby union players. J Neurol Neurosurg Psychiatry 2017; 88(6):505-511.
Decq P, Gault N, Blandeau M, et al. Long-term consequences of recurrent sports concussion. Acta Neurochir Wien 2016;158(2):289-300.
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