No Overall Link Between Concussions and Cognitive Decline in Retired Rugby Players: Study

Pavankumar Kamat

October 21, 2021

A new study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association found that rugby-related concussions and length of rugby career had no significant association with an overall worse cognitive function among retired elite level male players aged 50 years and above. However, older individuals aged over 75 years did show a trend of decrease in cognitive function.

The Brain Health and Healthy Ageing in Retired Rugby Union Players (BRAIN) study recruited 146 former elite-level male rugby union players aged 50 years and above from England. Self-reported information on rugby-related concussions was collected using the BRAIN-Q tool. Changes in cognitive function were assessed using the Preclinical Alzheimer Cognitive Composite (PACC).

79.5% of participants had experienced rugby-related concussion(s) during their mean playing career spanning 15.8 years.

Overall, no association was observed between concussion and cognitive function assessed by the PACC (ß-coefficient for high vs no concussion –0.03; 95% CI, –0.31 to 0.26). In individuals aged 80 years and above, having had ≥3 concussions during their career was associated with a decreased cognitive function of about one standard deviation below the mean PACC score (ß, –1.04; 95% CI, –1.62 to –0.47) compared with having no concussion. `

The length of playing career had no significant association cognitive function measures; however, there was a borderline significant negative association for participants aged 80 years and above.

Accumulating Evidence

Prof Neil Pearce from the London School of Hygiene & Tropical Medicine, one of the study authors, said in a news release: "Evidence is accumulating on the possible long-term health risks in former contact sport athletes. However, each sport is different and there is currently little evidence from rugby players. This study adds to this knowledge gap, and shows that playing elite rugby may affect cognitive function in older age. It’s important more research is conducted to confirm this, and on those who played in the early years of professional rugby."

The study had certain limitations, including cross-sectional design and susceptibility to recall bias. Prof David Curtis from the UCL Genetics Institute stated that deriving any robust conclusions from the study was hard, owing to the small sample size of the study and a lower likelihood of ex-players with dementia participating in the study.

Despite limitations, some experts have lauded the study. Dr Davide Bruno, senior lecturer in psychology at the Liverpool John Moores University, said: "This is a solid piece of research. They had access to a unique population, which is not easy to recruit, and employed a comprehensive cognitive battery to evaluate their intellectual status."

Commenting on the study, Dr Susan Kohlhaas, director of research at Alzheimer’s Research UK, said: "Findings from this study of ex-amateur elite level rugby union players adds to our understanding of the risks involved with professional sports. While we know exercise is good for our brain health, certain sports involving high energy collisions have been linked to risk of long-term neurological problems."

The study was funded by a grant from the Drake Foundation to the London School of Hygiene and Tropical Medicine, with subcontracts to Queen Mary University of London and the Institute of Occupational Medicine.

Gallo V, McElvenny DM, Seghezzo G, Kemp S, Williamson E, Lu K, Mian S, James L, Hobbs C, Davoren D, Arden N, Davies M, Malaspina A, Loosemore M, Stokes K, Cross M, Crutch S, Zetterberg H, Pearce N. Concussion and long-term cognitive function among rugby players-The BRAIN Study. Alzheimers Dement. 2021 Oct 20. doi: 10.1002/alz.12455. [Epub ahead of print]. PMID: 34668650.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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