BLOG: Head injuries increase dementia risk 

Alzheimer’s Australia NSW believes that the association between concussions and other head injuries sustained in football and the development of dementia is worrying and that steps must be taken to protect players.

We must ensure that the likelihood and impact of risk events is reduced to protect players’ current welfare and future well-being.

Football players may sustain concussive or subconcussive injuries throughout their playing career, with research suggesting this may increase their risk of developing dementia. The relationship between concussions and traumatic brain injuries (TBIs) sustained in football and dementia is complex and further research in Australia is needed.

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In recent years public awareness of the potential long-term effects of concussions and mild traumatic brain injuries sustained in sport, especially different types of football, has increased. There is a growing understanding of the link between blows to the head suffered in football and other contact sports, such as boxing, and the potential for increased risk of dementia in later life.

The association between traumatic brain injury and dementia risk is becoming increasingly evident. An analysis of case control studies found a 58 per cent increased risk of Alzheimer’s disease for those with a history of head injury. Another review found that moderate and severe head injuries increase the risk of developing dementia by two to four times.

Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Concussion may be caused either by a direct blow to the head, face, or neck, or a blow elsewhere on the body with an impulsive force transmitted indirectly to the head. Simply put, concussion is caused by a direct or indirect force to the head which makes the brain move around inside the skull and results in a disturbance to brain function. A person does not have to lose consciousness to suffer a concussion.

This disruption to normal brain function is a traumatic brain injury (TBI). TBIs are classified as mild, moderate or severe, depending on whether the injury causes unconsciousness, how long unconsciousness lasts and the severity of symptoms. Although most TBIs are classified as mild because they are not life-threatening, even a mild TBI can have serious and long-lasting effects.

Severe decline in thinking skills, characteristic of dementia, may develop years after the injury took place and the person seems to have recovered from its immediate effects.

Research is emerging on a progressive neuro-degenerative disease caused by repetitive brain trauma including concussive or subconcussive blows to the head. Known as Chronic Traumatic Encephalopathy (CTE), it involves a build-up of the toxic tau protein and the progressive death of brain cells.

It was first noticed in boxers and described as being ‘‘punch drunk’’ in 1928. Punch drunk was later termed ‘‘dementia pugilistica’’, literally meaning ‘‘dementia of a fighter’’. In the 1960s the condition was renamed CTE when the symptoms were also identified in athletes of other sports.

The onset of CTE is often in midlife, years or decades after recovery from the initial effects of concussive or subconcussive brain trauma.

It has been reported that symptoms initially present as poor concentration, attention and memory loss as well as disorientation, dizziness and headaches. People with CTE typically progress to experience irritability, outbursts of violent or aggressive behaviour, confusion and speech abnormalities.

There is a high frequency of suicide, drug overdose and depressive disorders during this stage. As the disease progresses there is a greater loss of motor functioning.

The relationship between concussions and TBIs sustained in football and dementia is complex and may be complicated by other factors such as drug and alcohol abuse, depression, and diagnostic difficulties.

The existing research does indicate that “for some athletes there may be severe and devastating long-term consequences of repetitive brain trauma that has traditionally been considered only mild”.

However, it is known that TBIs increase the risk of developing dementia and that football players can suffer TBIs throughout their playing career.

Although the research evidence about the association between head injuries sustained in football and dementia is thus far limited, it is sufficiently concerning.

Alzheimer’s Australia NSW believes we need to err on the side of caution and limit the possible risk events in each code to protect the welfare of players at all levels of the game, from junior players through to professionals.

This is an extract from a discussion paper, Football, Head Injuries and the Risk of Dementia, released by Alzheimer’s Australia NSW. The paper can be found at: http://www.fightdementia.org.au/common/files/NSW/AlzNSW_Football_head_injuries__the_risk_of_dementia...