Former elite rugby players over the age of 75 who had multiple concussions in their playing careers have worse cognitive function, researchers report today.
The BRAIN study worked with nearly 150 retired, male elite players now aged 50 and over who played for England, Oxford University or Cambridge University in the pre-professional era.
Writing in the latest edition of Alzheimer’s & Dementia, the authors found those under 75 who suffered three or more rugby-related concussions during their career have no worse average cognitive function than those who had experienced no, one or two concussions.
However, 14 out of 48 over 75s who had suffered three or more rugby-related concussions during their career had significantly worse cognitive function on average than those who had experienced no, one or two concussions.
These men may be at greater risk of more problems in the future, such as memory loss, warn the authors, who add the findings could have implications for the clinical management of older former rugby players, as well as those from other contact sports.
The research was conducted by the London School of Hygiene & Tropical Medicine, Queen Mary University of London and the Institute of Occupational Medicine with researchers from UCL and the University of Oxford, and with assistance from the Rugby Football Union (RFU).
It was the first to include substantial numbers from the over-75 age-group and the authors suggest that lower cognitive function was only noticeable in those over 75 could be in part due to the fact the former elite rugby players in this study were generally highly educated and likely had higher than average cognitive function at the start of their playing careers.
Dr Valentina Gallo, now of the University of Groningen in the Netherlands (formerly at Queen Mary University of London), a principal investigator and study first author, said: “Our findings are in line with those of previous studies, and perhaps highlight that the high cognitive reserve in this study group may have masked the initial phases of any cognitive problems they experience. We’ll be following up on this group of players to shed further light on our findings.”
Participants took part in a series of tests that measured physical and cognitive capabilities. Their cognitive function was measured using the Pre-clinical Alzheimer Cognitive Composite (PACC) score, which combines tests that assess episodic memory, timed executive function, and global cognition.
They found participants over 75 years with three or more concussions scored about two points lower on the PACC score.
While this does not indicate clinical disease, it indicates a difference in cognitive function and could indicate an increased risk of eventually developing neuro-degenerative conditions such as Alzheimer’s disease.
At least one rugby-related concussion was reported by 116 (80%) of the respondents, ranging from one to 25, but the median was two.
Dr Simon Kemp, RFU medical services director, said: “This study, that started in 2017, adds to our developing understanding of the potential long-term consequences of head impacts and concussions.
“The agreed group of participants were aged 50 plus principally because of the greater likelihood that we might detect any neurocognitive decline if present. It is important to also conduct research with younger retired players.”
He added that a new research programme has been launched with Premiership Rugby and two independent experts alongside the Advanced Brain Health Clinic in London, which will assess and manage retired elite male and female rugby players between the ages of 30-55 who have concerns over their individual brain health.
Lauren Pulling, CEO of The Drake Foundation, which funded the BRAIN study, said: “These are interesting results that provide new insights into the long-term effects of rugby as it was played in the pre-professional era, given that a difference in cognitive function was not seen until players were aged over 75.
“The findings also raise questions about how these effects might differ compared with players from today’s game, particularly given the players coming forward with early-onset neurodegenerative diseases following participation in modern rugby union.”
Gallo V, McElvenny DM, Seghezzo G et al. Concussion and long-term cognitive function among rugby players-The BRAIN Study. Alzheimer’s & Dementia 21 October 2021; doi: 10.1002/alz.12455.
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