Tag: concussion

College football players may underestimate their risk of injury and concussion, according to a new study published today in JAMA Network Open.

Christine Baugh, PhD, MPH, assistant professor of medicine at the University of Colorado School of Medicine and member of the CU Center for Bioethics and Humanities, is the corresponding author of the article, “Accuracy of US College Football Players’ Estimates of Their Risk of Concussion or Injury.”

Baugh and co-authors report on survey results of 296 college football players from four teams in the Power 5 Conferences of the National Collegiate Athletic Association. Athletes were surveyed in 2017. The researchers found that between 43 percent and 91 percent of respondents underestimated their risk of injury and between 42 percent and 63 percent underestimated their risk of concussion.

To measure the accuracy of football players’ risk estimations, the researchers modeled individual athletes’ probabilities of sustaining a concussion or injury and compared model estimates to athlete perceptions. While recognizing that many people underestimate health risks, the authors point out that the risks college football athletes face may be more severe or debilitating than those faced by many in the general population. Given this elevated risk profile, they say it is concerning that athletes tend to underestimate the likelihood of these risks. These results raise questions about informed consent and how much risk should be acceptable in the context of a game, Baugh and her co-authors write.

“That athletes underestimated their risk of concussion and injury in this study raises important ethical considerations,” Baugh and her colleagues write. “What is the threshold for college athletes to be sufficiently informed of the risks and benefits of football to make decisions that align with their values and preferences?”

In addition to Baugh, four co-authors are listed. Those authors are affiliated with the University of Washington, the Seattle Children’s Research Institute, Boston Children’s Hospital, and Harvard Medical School, where Baugh completed a Post-Doctoral Fellowship in Mental Health Policy prior to joining the CU School of Medicine.

Media Release:

PULLMAN, Wash. – States with college teams in strong conferences, in particular the Southeastern Conference (SEC), were among the last to take up regulations on youth concussions, according to a recent study. The study, which investigated the association between youth sport participation and passage of concussion legislation, uncovered the importance of SEC affiliation, and found a similar connection in states with high rates of high school football participation.

In contrast, states with higher gender equality, measured by the number of women in the labor force, were early adopters.

Washington State University sociologists Thomas Rotolo and Michael Lengefeld, a recent WSU Ph.D. now at Goucher College, analyzed the wave of youth concussion laws from 2007 to 2014, specifically looking at return-to-play guidelines: a mandated 24-hour wait period before sending a player with a possible concussion back on to the field.

“We explored a lot of different ways of measuring college football presence, and the thing that just kept standing out was SEC membership,” said Rotolo, the lead author on the study published in the journal Social Science & Medicine. “Every college town thinks they have a strong college football presence, but the SEC is a very unique conference.”

Co-author Lengefeld, a former high school football player from Texas, knows first-hand how important the sport is throughout the South, but the data showed a specific correlation between resistance to youth concussion regulations among SEC states in particular.

“This SEC variable was similar to the South effect, but not all southern states have an SEC school–and in SEC states the resistance to concussion laws was a bit stronger,” he said.

Lengefeld added that the SEC also stands out since it has the largest number of viewers and brings in more profits than any other conference.

Scientists have known for more than a century that youth concussions were a serious health issue, but the movement to create concussion health policies for youth sports did not gain any ground until a Washington state middle school player was badly injured. In 2006, Zackery Lystedt was permanently disabled after being sent back onto the field following a concussion. The Seattle Seahawks took up the cause in the state, followed by the NFL which took the issue nationwide.

Even though the NFL advocated for youth concussion policy changes, the states responded differently. Washington state, Oregon and New Mexico were among the first to adopt the new return-to-play guidelines, while states like Georgia and Mississippi were among the last.

“There’s clearly something culturally going on that was different in those states,” said Lengefeld.

The researchers also investigated the role of gender equity in concussion adoption since football is often viewed as hyper-masculine. They used women’s participation in the labor market as a rough indicator of a state’s gender egalitarian views and found a statistically significant difference showing that states with higher levels of women’s labor market participation enacted the concussion legislation more quickly.

Lengefeld said the methodology they used in this study can also be applied to analyze how many other health policies are enacted across different states.

“As we were submitting this research for publication, COVID-19 was just starting, and we noticed all the differences in the way states are behaving,” Lengefeld said. “It’s not new for sociologists to study the diffusion of laws at the state level, but this is another way of doing that that incorporates a set of ideas about culture.”

Press Release:

DALLAS – Nov. 11, 2020 – Even though repeated hits to the head are common in professional sports, the long-term effects of concussions are still poorly understood. While many believe that professional athletes who experience multiple concussions will end up with severe cognitive impairment later in life, a UT Southwestern study suggests that may not necessarily be the case.

The preliminary study, published in Cognitive and Behavioral Neurology, looked at a small cohort of retired professional football players who had a history of concussions and were diagnosed with mild cognitive impairment (MCI), a known risk factor for Alzheimer’s disease. The 10 retired athletes, plus 10 nonathletes, were given a battery of cognitive tests to assess their verbal memory, learning, and language skills. The nonathletes also had MCI but no history of traumatic brain injury.

“For the most part, the athletes had a similar cognitive profile to the nonathletes,” says Nyaz Didehbani, Ph.D., assistant professor in the department of psychiatry and the study’s corresponding first author.” But they did score lower on a couple of items, more specifically on our naming test, which has been showing up in a number of our studies. A consistent complaint from many of our athletes includes word-finding and naming difficulties.”

Name recall, or the ability to see something and name it, diminishes quite frequently with normal aging, says Munro Cullum, Ph.D., vice chair and chief of the division of psychology in the department of psychiatry and the study’s senior author. “It’s not that they have lost the ability, but rather have a reduced ability to quickly retrieve words when they’re shown a picture.”

Despite differences in their ability to name recall, the retired football players scored similarly to the nonathletes on verbal memory and learning. This is in contrast to findings from other studies in which a history of concussions in athletes has been found to also affect these areas.

“Overall, the study is suggestive that just because you’ve had a history of multiple concussions, it doesn’t mean you will develop a neurodegenerative change or problems later in life,” says Cullum.

The retired NFL players range in age from 64 to 77 and played anywhere from six to 14 years in the NFL. The nonathletes were selected from an Alzheimer’s Disease Research Center database at UT Southwestern. The groups were similar in age, sex, race, and education.

One clue as to why multiple concussions appear to have a selective effect on name recall may lie within the brain itself. Imaging from other studies done by the UT Southwestern group on these athletes demonstrated an interesting phenomenon.

“We had an imaging finding of an abnormality in the white matter deep in the part of the brain where word retrieval is thought to occur,” Cullum says. These studies found that changes in white matter in retired athletes with a history of concussions were linked to poorer performance in naming, though it is still unclear why only this area of the brain appears to be affected. The authors are designing experiments to learn more.

Although the degree of the cognitive impairment wasn’t much worse in retired athletes with MCI, this study provides only a small picture of the issue. There is evidence from other studies that exposure to repeated concussions can lead to earlier onset of MCI and that cognitive impairment may be higher in retired athletes.

The team at UT Southwestern is working to resolve these conflicting results from other studies by following a larger cohort of retired athletes over time. They are seeking to investigate the long-term effects of concussion on the brain by assessing how cognition changes over time, the rates at which it changes, and the effects of comorbidities (the presence of other illnesses) and psychological factors in athletes with MCI and a history of head injuries.

Within the context of this study, the authors are also interested in looking at different ways to evaluate cognition to better understand the state of neurodegenerative changes in athletes and to determine if the link between concussion and MCI is direct or correlative.

“Their being professional athletes does not necessitate automatically falling into this doom-and-gloom category that the cognitive impairment will progress and worsen,” says Didehbani. “Those cases are really just a subset, just like with the normal population.”