Concussions from Football Tied to Long-Term Cognitive Problems

March 10, 2023 — Eric Washington, former linebacker for the University of Kansas’ football team, got involved with sports as a child. “We crashed into each other when we played, and whoever was strongest or most reckless was thought to have the best sports career ahead of them,” he says.

He and his friends boxed and played football on each other’s lawns “with no equipment or protection, just a lot of guys engaging in high collision together.”

In high school, Washington became a successful football player. “You had to show people you weren’t scared, so you took on bigger … guys and ran into them,” he recalls. “I became one of those fearless people who was known as ‘that guy’ — a hard-hitter, relentless, reckless person.”

Washington’s first major brain injury took place in ninth grade. “It was the first head-on-head collision that knocked me out and I missed much of ninth grade because of it,” he says. “I went from being a quiet, reserved, mild-mannered person to being aggressive, having mood swings, and lashing out.”

He developed problems with memory and concentration, which worsened as he got into college football. “I remember two or three times when I got dazed after a head injury and they took me out, but then I got right back in the game,” he says. 

Like Washington, many athletes experience brain injuries during their careers, with between 1.6 and 3 million sports- and recreation-related concussions taking place annually, around 300,000 of which are from football. 

Cognitive changes following concussions are also common. A new study published in the Archives of Clinical Neuropsychology shines light on the problem.

For Washington, the concussions, and their effects, continued into college. While on a football scholarship at Kansas, “I thought everything was OK. Even after my concussions, I could still get back in the game and my body retained ‘muscle memory’ of how to play football and could follow directions, even if my mind wasn’t quite there anymore.”

During senior year, a neck and spinal cord injury ended his sports career. “Everything spiraled downward after that,” he says. “I ended up in terrible relationships, distant from my family, and even homeless for a while. I ended up in mental institutions and in dark places and with cognitive problems.”

Does Concussion Affect Long-Term Cognitive Functioning?

In the new study, investigators examined 353 former NFL players (average age, 54 years old) who had been retired from their playing careers for close to 3 decades. 

Using a laptop or tablet, the former players completed a battery of neuropsychological tests through an online platform called TestMyBrain. An array of cognitive functions were tested, including processing speed, visual-spatial and working memory, short- and long-term memory, and vocabulary.

The players completed a 76-item questionnaire that included 10 questions about signs and symptoms of concussion following a blow to the head while playing football: headaches, nausea, dizziness, loss of consciousness, memory problems, disorientation, confusion, seizure, visual problems, or feeling unsteady on their feet. They were also asked if they had ever been diagnosed with a concussion.

Senior study author Laura Germine, PhD, director of the Laboratory for Brain and Cognitive Health Technology at McLean Hospital in Boston, says we know the impact of concussions on short-term health, but “it’s not as clear how concussion history impacts cognitive functioning in the longer term among former professional football players.” 

She says there “have been lots of mixed findings in former players, so we wanted to address this question using sensitive, state-of-the-art and objective measures of cognitive function in a larger samples of former players than has previously been tested for this kind of study.” 

One reason for the “mixed findings” in earlier research is that some studies have focused on diagnosed concussions and cognitive problems. But many football players’ concussions don’t end up being diagnosed, so the researchers decided to look specifically at concussion symptoms.

Accelerated Cognitive Aging 

Former players who reported more concussion symptoms scored worse on cognitive tests. For example, the differences in visual memory between the players with the highest- and lowest- reported concussion symptoms were equal to differences in cognitive performance between a typical 35-year-old and a typical 60-year-old.

On the other hand, poorer cognitive performance wasn’t connected to the number of diagnosed concussions, the number of years they played professional football, or the age when the first played football. 

The researchers conducted a follow-up study comparing the 353 players to 5,086 men who didn’t play football. They found that cognitive performance was generally worse in the former players

 “While our findings aren’t conclusive in this respect, we did see the biggest differences in cognitive performance (compared with men of similar age) among older players,” Germine says.

Long-Term Cognitive Issues

Washington continues to struggle with cognitive problems.

“My long-term memory seems like it’s intact sometimes, but after a period of time, there are ‘holes.’ Or I look at people and I might recognize a face, but I don’t remember who the people are.”

He also has difficulties with reading and memory. “My eyes have issues with tracking and tracing. And if I read out loud, I’ll be stuttering and sputtering and won’t be able to retain what I’ve just read. Sometimes, I’ll put the remote in the freezer, or I’ll set my phone down outside and won’t know where it is.”

Washington did complete college, graduating with a bachelor’s degree in applied behavioral science that led him to work with adults with developmental disabilities. However, schoolwork was difficult and has become even more difficult of late.

“I’d like to become a social worker to help other people, but trying to get through my classes may not be in the cards,” he says.

He’s currently being treated for cancer and the chemotherapy also affects his cognition. “I was getting A’s in my classwork in one course, but I couldn’t remember anything on the final, so I got an F and failed the course,” he says.

He hopes that as the cancer resolves, he’ll be able to give his studies another try. Although the cognitive challenges resulting from his concussions remain formidable, “not having ‘chemo-brain’ will free up some cognitive abilities and hopefully I’ll do better in my classes and get my social work degree.”

Get Appropriate Support

Germine says the study findings “underscore the need for parents, school systems, and anyone who plays football to understand the importance of reporting any and all concussion symptoms, even if they don’t feel serious at the time.” 

She notes that “appropriate measures to address and reduce the impact of head injury — even in the absence of diagnosed concussions — may be key to maintaining cognitive health long-term.”

Additionally, “we need to be doing everything we can to prevent head injury and concussion from happening in the first place. Measures that reduce the likelihood of head impact are important to make football safer for developing brains,” she says.

Washington urges people to take head injuries seriously and not just “return to the game” and to be evaluated for a concussion; and if a concussion is diagnosed, to receive treatment for the symptoms (such as emotional trauma, attentional or memory problems, or visual problems).

In addition, both encourage people who have sustained a concussion to get emotional support. Washington attends support groups offered by the Brain Injury Association of America.

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Dementia risk rises if you live with chronic pain, study says | CNN



CNN
— 

Chronic pain, such as arthritis, cancer or back pain, lasting for over three months, raises the risk of cognitive decline and dementia, a new study found.

The hippocampus, a brain structure highly associated with learning and memory, aged by about a year in a 60-year-old person who had one site of chronic pain compared with people with no pain.

When pain was felt in two places in the body, the hippocampus shrank even more — the equivalent of just over two years of aging, according to estimates in the study published Monday in the journal Proceedings of the National Academy of Sciences, or PNAS.

“In other words, the hippocampal (grey matter volume) in a 60-y-old individual with (chronic pain) at two body sites was similar to the volume of (pain free) controls aged 62-y-old,” wrote corresponding author Tu Yiheng and his colleagues. Tu is a professor of psychology at the Chinese Academy of Sciences in Beijing.

The risk rose as the number of pain sites in the body increased, the study found. Hippocampal volume was nearly four times smaller in people with pain in five or more body sites compared with those with only two — the equivalent of up to eight years of aging.

“Asking people about any chronic pain conditions, and advocating for their care by a pain specialist, may be a modifiable risk factor against cognitive decline that we can proactively address,” said Alzheimer’s disease researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

The study analyzed data from over 19,000 people who had undergone brain scans as part of the UK Biobank, a long-term government study of over 500,000 UK participants between the ages of 40 and 69.

People with multiple sites of body pain performed worse than people with no pain on seven of 11 cognitive tasks, the study found. In contrast, people with only one pain site performed worse on only one cognitive task — the ability to remember to perform a task in the future.

The study controlled for a variety of contributing conditions — age, alcohol use, body mass, ethnicity, genetics, history of cancer, diabetes, vascular or heart problems, medications, psychiatric symptoms and smoking status, to name a few. However, the study did not control for levels of exercise, Isaacson said.

“Exercise is the #1 most powerful tool in the fight against cognitive decline and dementia,” he said via email. “People affected by multisite chronic pain may be less able to adhere to regular physical activity as one potential mechanism for increased dementia risk.”

Equally important is a link between chronic pain and inflammation, Isaacson said. A 2019 review of studies found pain triggers immune cells called microglia to create neuroinflammation that may lead to changes in brain connectivity and function.

People with higher levels of pain were also more likely to have reduced gray matter in other brain areas that impact cognition, such as the prefrontal cortex and frontal lobe — the same areas attacked by Alzhemier’s disease. In fact, over 45% of Alzheimer’s patients live with chronic pain, according to a 2016 study cited by the review.

The study was also not able to determine sleep deficits — chronic pain often makes getting a good night’s sleep difficult. A 2021 study found sleeping less than six hours a night in midlife raises the risk of dementia by 30%.

Globally, low back pain is a leading cause of years lived with disability, with neck pain coming in at No. 4, according to the 2016 Global Burden of Disease Study. Arthritis, nerve damage, pain from cancer and injuries are other leading causes.

Researchers estimate over 30% of people worldwide suffer with chronic pain: “Pain is the most common reason people seek health care and the leading cause of disability in the world,” according to articles published in the journal The Lancet in 2021.

In the United States alone, at least 1 in 5 people, or some 50 million Americans, live with long-lasting pain, according to the US Centers for Disease Control and Prevention.

Nearly 11 million Americans suffer from high-impact chronic pain, defined as pain lasting over three months that’s “accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores,” according to the National Center for Complementary and Integrative Health.

Chronic pain has been linked to anxiety, depression, restrictions in mobility and daily activities, dependence on opioids, increased health care costs, and poor quality of life. A 2019 study estimated about 5 million to 8 million Americans were using opioids to manage chronic pain.

Pain management programs typically involve a number of specialists to find the best relief for symptoms while providing support for the emotional and mental burden of pain, according to John Hopkins Medicine.

Medical treatment can include over-the-counter and prescription medications to stop the pain cycle and ease inflammation. Injections of steroids may also help. Antidepressants increase the amount of serotonin, which controls part of the pain pathway in the brain. Applying brief bursts of electricity to the muscles and nerve endings is another treatment.

Therapies such as massage and whirlpool immersion and exercises may be suggested by occupational and physical therapists. Hot and cold treatments and acupuncture may help as well.

Psychologists who specialize in rehabilitation may recommend cognitive and relaxation techniques such as meditation, tai chi and yoga that can take the mind off fixating on pain. Cognitive behavioral therapy is a key psychological treatment for pain.

Going on an anti-inflammatory diet may be suggested, such as cutting back on trans fats, sugars and other processed foods. Weight loss may be helpful as well, especially for back and knee pain, according to Johns Hopkins.

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Alcohol and dementia: Study finds benefits in minimal drinking, but it’s complicated | CNN



CNN
— 

Keeping alcohol consumption to one or two drinks a day lessened the odds of developing dementia, according to a study of nearly 4 million South Koreans.

However, drinking more than two drinks a day increased that risk, according to the study published Monday in the journal JAMA Network Open.

“We found that maintaining mild to moderate alcohol consumption as well as reducing alcohol consumption from a heavy to moderate level were associated with a decreased risk of dementia,” said first author Dr. Keun Hye Jeon, an assistant professor at CHA Gumi Medical Center, CHA University in Gumi, South Korea, in an email.

But don’t rush to the liquor store, experts say.

“This study was well done and is extremely robust with 4 million subjects, but we should be cautious not to over interpret the findings,” said Alzheimer’s researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

Alcohol use can be a risk factor for breast and other cancers, and consuming too much can contribute to digestive problems, heart and liver disease, hypertension, stroke, and a weak immune system over time, according to the US Centers for Disease Control and Prevention.

There are red flags for Alzheimer’s as well. For example, if a person has one or two copies of the APOE4 gene variant, which raises your risk of developing the mind-wasting disease, drinking is not a good choice, Isaacson said.

“Alcohol has been shown to be harmful for brain outcomes in people with that risk gene — and about 25% of the US population carries one copy of APOE4,” he said.

The new study examined the medical records of people covered by the Korean National Health Insurance Service (NHIS), which provides a free health exam twice a year to insured South Koreans who are 40 and older. In addition to doing various tests, examiners asked about each person’s drinking, smoking and exercise habits.

The study looked at the data collected in 2009 and 2011 and categorized people by their self-reported drinking levels. If a person said they drank less than 15 grams (approximately 0.5 ounces) of alcohol a day, they were considered “mild” drinkers.

In the United States, a standard drink contains 14 grams of alcohol, which is roughly the same as 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

If study participants told doctors they drank 15 to 29.9 grams a day — the equivalent of two standards drinks in the US — the researchers categorized them as “moderate” drinkers. And if people said they drank over 30 grams, or three or more drinks a day, researchers considered them “heavy” drinkers.

Researchers also looked at whether people sustained or changed the amount they drank between 2009 and 2011, Jeon said.

“By measuring alcohol consumption at two time points, we were able to study the relationship between reducing, ceasing, maintaining and increasing alcohol consumption and incident dementia,” he said.

The team then compared that data to medical records in 2018 — seven or eight years later — to see if anyone studied had been diagnosed with dementia.

After adjusting for age, sex, smoking, exercise level and other demographic factors, researchers found people who said they drank at a mild level over time — about a drink a day — were 21% less likely to develop dementia than people who never drank.

People who said they continued to drink at moderate level, or about two drinks a day, were 17% less likely to develop dementia, the study found.

“One has to be cautious when interpreting studies using medical records. They can be fraught with challenges in how diseases are coded and studied,” Isaacson said. “Any anytime you ask people to recall their behaviors, such as drinking, it leaves room for memory errors.”

The positive pattern did not continue as drinking increased. People who drank heavily — three or more drinks a day — were 8% more likely to be diagnosed with dementia, the study found.

If heavy drinkers reduced their drinking over time to a moderate level, their risk of being diagnosed with Alzheimer’s fell by 12%, and the risk of all-cause dementia fell by 8%.

However, people aren’t very good at judging how much alcohol they are drinking, Isaacson said.

“People don’t really monitor their pours of wine, for example,” Isaacson said. “They may think they are drinking a standard-sized glass of wine, but it’s really a glass and a half every time. Drink two of those pours and they’ve had three glasses of wine. That’s no longer mild or moderate consumption.”

In addition, too many people who think they are moderate drinkers do all of their drinking on weekends. Binge drinking is on the rise worldwide, even among adults, studies show.

“If someone downs five drinks on Saturday and Sunday that’s 10 drinks a week so that would qualify as a moderate alcohol intake,” Isaacson said. “To me, that is not that is not the same as having a glass of wine five days a week with a meal, which slows consumption.”

The new study also found that starting to drink at a mild level was associated with a decreased risk of all-cause dementia and Alzheimer’s, “which, to our knowledge, has never been reported in previous studies,” the authors wrote.

However, “none of the existing health guidelines recommends starting alcohol drinking,” Jeon said, adding that since the study was observational, no cause and effect can be determined.

“Our findings regarding a initiation of mild alcohol consumption cannot be directly translated into clinical recommendations, thereby warranting additional studies to confirm these associations further,” Jeon said.

A study published in March 2022 found that just one pint of beer or glass of wine a day can shrink the overall volume of the brain, with the damage increasing as the number of daily drinks rises.

On average, people between 40 and 69 who drank a pint of beer or 6-ounce glass of wine per day for a month had brains that appeared two years older than those who only drank half of a beer, according to that previous study.

“I’ve never personally suggested someone to start drinking moderate amounts of alcohol if they were abstinent,” Isaacson said. “But there’s really not a one-size-fits-all approach towards counseling a patient on alcohol consumption.”

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1 in 10 Americans over 65 have dementia, study finds | CNN





CNN
— 

One in 10 Americans over 65 had dementia, while 22% experienced mild cognitive impairment, the earliest stage of the slow slide into senility, according to a new study conducted between 2016 and 2017.

The research, which the authors said is the first nationally representative examination of cognitive impairment prevalence in more than 20 years, was able to measure prevalence of dementia and mild cognitive impairment by age, education, ethnicity, gender and race.

The results showed older adults who self-identified as Black or African American were more likely to have dementia, while those who identify as Hispanic were more likely to suffer from mild cognitive impairment. People who had less than a high school education were more likely to have both conditions.

“Dementia research in general has largely focused on college-educated people who are racialized as white,” lead study author Jennifer Manly said in a statement.

“This study is representative of the population of older adults and includes groups that have been historically excluded from dementia research but are at higher risk of developing cognitive impairment because of structural racism and income inequality,” said Manly, professor of neuropsychology at the Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University.

“If we’re interested in increasing brain health equity in later life, we need to know where we stand now and where to direct our resources,” Manly said.

The study, published Monday in the journal JAMA Neurology, analyzed data from in-depth neuropsychological tests and interviews with nearly 3,500 people over age 65 enrolled in the Health and Retirement Study, a long-term research project sponsored by the National Institute on Aging and the Social Security Administration.

The research was based on a randomly selected sample of people from the study that completed the core survey and underwent neurological testing between June 2016 and October 2017.

Fifteen percent of people who identified as Black tested positive for dementia, while 22% had mild cognitive decline, the study found. Ten percent of people who identified as Hispanic had dementia, but the rate of milder issues was higher — 28% tested positive for mild cognitive impairment. Nine percent of White people had dementia, while 21% had mild cognitive impairment.

Educational achievement, which experts consider to be protective against cognitive decline, showed a significant divide: Nine percent of people with a college degree tested positive for dementia, compared with 13% of those who never received a high school diploma. Twenty-one percent of people over 65 with college degrees had mild cognitive decline, compared with 30% of those with less than a high school degree.

The extreme elderly had the highest rates of dementia and mild cognitive impairment. Only 3% of adults between 65 and 69 tested positive for dementia, compared with 35% of those 90 and older.

In fact, every five-year increase in age was associated with higher risk of dementia and mild cognitive impairment, the report said. The study, however, found no differences between men and women in rates of either condition

Symptoms of mild cognitive impairment can include losing items, forgetting to do things or go to appointments, or struggling to come up with words. A loss of smell and taste and movement issues can also be symptoms, according to the National Institute on Aging.

People with mild cognitive impairment are fully capable of taking care of themselves, “but what they have to go through to do so is exhausting,” Laura Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told CNN in an earlier interview. She was not involved in the current study.

People with mild cognitive impairment may not remember where they are supposed to be, Baker said. ” ‘Let me check my calendar. Oh, I forgot to write on this calendar. Let’s check another calendar. Oh, I can’t find that calendar. I’ve lost my phone. Where is the key? I can’t find the key.’ They’re able to regroup in the early stages and accomplish things, but the toll is immense.”

Not everyone with mild cognitive impairment goes on to develop dementia, although many do, experts say. Lifestyle changes may be a key to reversing mental decline. A 2019 study found personalized lifestyle interventions -— such as diet, exercise, stress reduction and sleep hygiene — not only stopped cognitive decline in people at risk for Alzheimer’s, but actually increased their memory and thinking skills over 18 months. Women responded better than men, a follow-up study found.

A February study found about a third of women 75 years or older with mild cognitive impairment reversed their progression to dementia at some point during follow-up. All of the women, however, had high levels of education and academic performance and excellent written language skills, or what experts call “cognitive reserve.”

Signs of dementia can differ from one person to the next, and can include memory loss and confusion, difficulty speaking, understanding and expressing thoughts, or reading and writing, according to the National Institutes of Health.

People with dementia can act impulsively or show poor judgment, and they can have trouble paying bills or handling money responsibly. They may repeat questions, use strange words to refer to familiar objects and take longer than usual to complete daily tasks.

Wandering and getting lost in a familiar neighborhood is another sign of dementia, as is losing interest in daily activities or events or acting as if they don’t care about other people’s feelings. They may lose their balance or have other problems with movement. At times, people with dementia can hallucinate or experience delusions or paranoia.

Alzheimer’s disease is the most well-known cause of dementia, but cognitive issues can be caused by vascular problems that block the flow of blood to the brain or via ministrokes caused by tiny blood clots traveling to the brain. Frontal lobe dementia, a rare form thought to be associated with abnormal amounts of the proteins tau and TDP-43, often begins in people younger than 60. Another type of decline, called Lewy body dementia, is thought to be caused by abnormal deposits of the protein alpha-synuclein, which are called Lewy bodies.

A person with signs of cognitive decline or dementia needs a full workup by a neurologist to determine the underlying cause, the NIH said. Side effects from a number of medications can mimic dementia, as can certain diseases, such as Huntington’s disease.

If you’ve just been diagnosed with dementia, continue to meet with doctors and specialists and consider asking for a referral to a memory clinic, according to the National Institutes of Health. Reach out to your local Alzheimer’s Disease Research Center and consider joining a clinical trial.

The Alzheimer’s Association has detailed information on the differences between dementia and Alzheimer’s, and it offers many levels of support for both patients and caregivers.

Work on staying healthy — exercise helps with mood, balance and thinking, while eating a well-balanced diet and getting quality sleep can improve the brain’s ability to function.



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