Football and Alzheimer's
As a former collegiate football player, I have had numerous people give me their two cents on the risks of concussions on my health. I was never concerned about their opinions, because the former players that I had heard of who struggled with brain issues had played professionally, not just at the high school and collegiate levels. Now, six months removed from the last time I laced up a pair of cleats, I’m revisiting these thoughts and wondering how valid they were. Did I put myself at risk of developing serious cognitive impairment by playing football for over 10 years?
Our understanding of concussions is relatively new, with the first thorough studies of these injuries being conducted within the last 25 years. Because of this, it seems like concussions are a new problem for the sport of football, but concussions have been a known problem since the infancy of organized football. In fact, the proceedings of the Annual Football Coaches Association meeting in 1937 addressed the dangers of allowing players to continue to play with concussions.
In football, players are hit so often that neurons don’t have time to recover before the next trauma, which can lead to multiple concussions throughout a season of play. Studies show that collegiate football players end a single season of play with less mid-brain white matter (nerve fibers that connect nerve cells) than they'd started with. Former football players are more likely to forget things or have trouble thinking clearly, and former NFL players are 20 times more likely than the general population to be diagnosed with dementia in their thirties or forties. It wasn’t until the early 2000s that doctors looked at the brains of deceased former-players and discovered epicenters of hyperphosphorylated tau proteins, which are also associated with Alzheimer’s Disease. This came to be known as CTE.
Since this discovery, steps have been taken to make the game safer. New rules have been introduced, and safety equipment has been improved to some degree. In my time playing college football, before every season, players were required to take a baseline concussion exam that tests reaction time, memory, and other cognitive functions. If a player was later diagnosed with a concussion, they were not allowed to return to the field before they passed this exam at their baseline performance. Thankfully, no person that I played with ever experienced an especially traumatic brain injury, but when these injuries happened at other schools, the staff used them as an opportunity to teach us how we could prevent ourselves from suffering similar injuries.
Much work still needs to be done to improve helmet designs to reduce the risk of concussions. We know that repeated concussions contribute to early dementia, but to this day, equipment safety standards only require helmets to be tested for their effectiveness in preventing skull fractures, not concussions. Concussions are more likely to occur when the head rotates in the left-right direction whereas skull fractures are often the result of brute force to the head. The brain is one of the softest substances in the body, almost Jell-O like, and forceful rotation of the head causes stretching and deformation of the nervous tissue that impairs the ability of the neurons to fire properly. It is thought that the key to preventing this stretching and deformation is to keep the brain moving in synchronization with the skull throughout impact. To do this, we would need to figure out how to slow the skull down on impact so that the brain does not lag. Currently, the best guess that we have for how to do this is by increasing the size of helmets and filling the helmets with more air to absorb the rotational force.
In the coming years, as we begin to learn more about brain health, Alzheimer’s, and CTE we may finally know the true and lasting effects that football has on the brain. Knowing what I know now, I would play football again if I had the chance to go back, and I will encourage my future children to play football if they want to. Football has taught me invaluable lessons about teamwork, accountability, and commitment, and I am optimistic that the game will continue to get safer as time goes on.